What are the exercise-based injury prevention recommendations for recreational alpine skiing and snowboarding? A systematic review.

BACKGROUND
Skiing and snowboarding are two activities that significantly contribute to the total number of sports-related injuries reported per year. Strength, endurance and cardiovascular fitness are central components in sports injury prevention. Providing exercises and training recommendations specific to recreational skiers and snowboarders is important in both injury prevention and reducing the prevalence and cost associated with alpine winter sports injuries.


OBJECTIVE
The aim of this paper was to systematically review the literature for injury prevention recommendations specific to recreational alpine skiers and snowboarders. The focus was to discern recommendations that targeted physical fitness, exercise and/or training in the prevention of musculoskeletal injuries in these two sports.


DATA SOURCES
Fourteen electronic databases were searched in October 2011 using relevant MeSH terms and key words.


STUDY SELECTION
Articles were included if they addressed injury prevention, recreational alpine skiing or snowboarding and musculoskeletal injuries. Only original research articles published in peer-reviewed journals, and in the English-language, were reviewed. Articles on elite athletes were excluded.


STUDY APPRAISAL AND SYNTHESIS METHODS
Two independent reviewers quality assessed articles meeting inclusion criteria using a modified version of the Downs and Black Quality Assessment Checklist. Data on study population, study design, study location and injury prevention recommendation(s) were extracted from articles using a standard form and subsequently categorized to facilitate data synthesis.


RESULTS
A total of 30 articles met the inclusion criteria and were reviewed, having an average ± standard deviation quality score of 72% ± 17% (range: 23-100 %). Overall, 80 recommendations for the prevention of musculoskeletal injuries in recreational alpine skiers and snowboarders were identified and classified into five main groups: equipment (n = 24), education and knowledge (n = 11), awareness and behaviour (n = 15), experience (n = 10) and third-party involvement (n = 20). No recommendations pertained to physical fitness, exercise and/or training per se, or its role in preventing injury.


LIMITATIONS
A comprehensive meta-analysis was not possible because several articles did not report data in sufficient detail.


CONCLUSIONS
The importance of targeting physical fitness in injury prevention is accepted in sports medicine and rehabilitation; yet, there was a paucity of articles included in this review that explicitly investigated this aspect with regards to recreational alpine skiing and snowboarding. The most frequent recommendations for preventing skiing and snowboarding injuries concerned equipment or the involvement of third parties. The dominance of equipment-related measures in the injury prevention literature may be rationalized from a sports biomechanics viewpoint, as these activities involve high velocities and impact forces. Nonetheless, this also indicates a need for appropriate levels of strength, endurance and conditioning to meet the technical demands of these sports. Bearing this in mind, future research is encouraged to investigate the role of physical fitness, exercise and training in decreasing the incidence and severity of skiing and snowboarding injuries in recreational athletes.