Winter sports participation is increasingly popular worldwide, with recent estimates of 9.8% of the U.S. population (~30 million people) participating in winter sports during the 2022-2023 season.
Skiing (~15 million people) and snowboarding (~8 million people) represent the vast majority of winter sports activities. The incidence of injury in skiers is 1.23 per 100,000 participants and the incidence of injury in snowboarders is 1.22 per 100,000 participants. Given the number of ski and snowboard participants each year, it is important to understand how best to prevent and treat musculoskeletal injuries that occur in winter sports.
What are the most common injury patterns seen in winter sports?
Musculoskeletal injuries that occur in skiing or snowboarding are often related to a traumatic event due to a dangerous combination of steep terrain, high speeds, skier/snowboarder ability, variable snow conditions and fatigue. A recent study using data from the National Electronic Injury Surveillance System (NEISS), between 2008 and 2019 demonstrated that there were over 156,000 injuries related to skiing, snowboarding and snowmobiling.3 Several studies have demonstrated upper extremity injuries, especially wrist injuries, to be more common in snowboarding and lower extremity injuries, especially anterior cruciate ligament (ACL) tears, to be more common in skiing.4,6 Overall, fractures are cited as the most common diagnosis related to emergency room visits, although soft tissue injuries, including sprains, contusions, ligament tears and meniscal injuries occur frequently as well.3,8 Given the high-speed nature of skiing and snowboarding, no body location is exempt from injury (Table 1).

An important feature of winter sports is the high proportion of pediatric participants. Prior studies have suggested that pediatric patients may be at higher risk for injury during skiing and snowboarding, possibly due to a higher center of gravity, increased head-to-body ratio, underdeveloped neurocognitive control and poor coordination.5,7,9,10 A recent study demonstrated a similar incidence of injuries among pediatric skiers and pediatric snowboarders, with head trauma (19%) being the most common injury, followed by wrist (16%), forearm (11%) and shoulder (10%). Appropriate awareness of the different injury patterns across adult and pediatric skiers and snowboarders is essential for the physicians caring for these athletes.
Which winter sports carry the highest risk of injury?
According to recent evidence, skiing and snowboarding are associated with similar injury rates, with an estimated injury incidence of 1.23 per 100,000 participants for skiers and 1.22 per 100,000 participants for snowboarders.3 By contrast, injury rates for snowmobiling are significantly lower at 0.22 per 100,000 participants.3 These values are based on emergency room visits and thus do not account for less severe injuries that do not require immediate medical evaluation or those injuries that present in outpatient clinics in a delayed fashion. Encouragingly, injury rates for adult skiers and snowboarders appear to be decreasing, with a greater than 50% decrease in injury incidence for both winter sports between 2009 and 2018. Similarly, rates of injury among pediatric skiers and snowboarders have also decreased over the last decade.10 In fact, the incidence of lower extremity injuries in skiers has consistently decreased over the last several decades, while upper extremity injury rates have largely remained the same.4,6 These trends are likely related to a combination of improvements in ski/snowboard equipment, particularly newer generation bindings, improved grooming, and increased safety awareness.
How are these injuries treated?

Fortunately, most musculoskeletal injuries associated with winter sports can be treated non-operatively and only a small proportion of patients require hospital admission. Hurt et al reported that only 4.5% of winter sports musculoskeletal injuries to emergency rooms required hospital admission, with fractures and periarticular dislocations having the highest likelihood of hospital admission. Similarly, Warren et al. reported a 5% hospital admission rate in pediatric patients with ski and snowboard injuries. Ultimately, the treatment is based on the nature and severity of the injury, with fractures and ligament injuries most frequently requiring surgery.
How can winter sports musculoskeletal injuries be prevented?
Injury prevention is essential to make winter sports participation safe for all ages and ability levels. Many of these injury prevention strategies should begin before hitting the slopes. Strengthening the core, hamstrings, gluteal musculature and quadriceps is critical to improving balance, coordination and preventing falls.6 Additionally, regular aerobic exercise helps improve cardiovascular and pulmonary health, which is especially important when skiing and snowboarding at higher altitudes. Finally, proper nutrition, hydration and warm outerwear are all critical to minimize the effects of ever-changing environmental conditions, as most injuries occur later in the day, likely during periods of physical and/or mental fatigue.
Proper skiing and snowboarding instruction are critical to preventing injuries and are often available to skiers and snowboarders of all ability levels. Instructors can provide key insights into proper equipment fitting, warm-up and cool-down programs, safe skiing practices (including proper fall mechanics to minimize injury risk) and individualized terrain progression programs. The Professional Ski Instructors of America (PSIA) and the American Association of Snowboarding Instructors (AASI) are excellent resources with additional information on proper ski and snowboarding instruction. For more information, visit https://www.thesnowpros.org/.
As mentioned previously, the use of proper equipment is an important component of injury prevention, including appropriately sized boots, bindings, skis/snowboards, and protective gear. Frequent professional servicing of this equipment is also critical, as adjustments may be needed due to changes in weight, height, terrain conditions or other factors. Appropriate helmet use has been a topic of concern for many years in winter sports injury prevention, with previous surveys demonstrating that less than 50% of skiers and snowboarders routinely wore helmets.6 Falls from height and at high speeds may occur during skiing and snowboarding activities and can result in significant, devastating traumatic brain injury (TBI), which has been associated with 88% of fatal skiing and snowboarding accidents. While helmet use is not currently mandated by U.S. ski resorts, recent evidence from the National Ski Areas Association (NSAA) has reported encouraging increases in helmet use over the last 20 years (Figure 1). This has also been associated with significant decreases in the rates of head, neck and face injuries.

Finally, the most important component of injury prevention in winter sports is behavioral, with use of appropriate caution and common sense. After reviewing injury trends from 2008-2018 in Canadian ski resorts, a higher proportion of injuries occur on easier terrain and in participants with day passes.1 This highlights the importance of becoming familiar with runs when visiting a new ski resort, and being cognizant of busier trails that attract participants of varying ability levels. Skiing or riding under control and at speeds consistent with one’s own ability, stopping when fatigue sets in, and getting ‘in shape’ prior to hitting the slopes are important behavioral measures that participants can take to minimize injury risk.2 The NSAA emphasizes the importance of participants’ behavior, which is reflected in their “Your Responsibility Code” and “Park Smart” safety campaigns (Figure 2). These programs place an emphasis on 1) controlled, graduated skiing or riding based on ability, 2) abiding by signs and warnings, and 3) avoiding impairments. Ultimately, each skier and snowboarder is responsible for promoting a safe environment for themselves and those around them. For more information on other NSAA safety initiatives, visit www.nsaa.org.
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Conclusions:
Winter sports participation in skiing and snowboarding has continued to increase over the last decade. There is a risk of injury due to the high rates of speed involved in these sports. Fortunately, the overall injury rates have declined, which is likely a reflection of improvements in protective equipment and increased safety awareness. Through the continued evolution of safe skiing and snowboarding practices, we can help ensure that participants of all ages and abilities may continue to enjoy these winter sports while minimizing injury risk.
References
1. Dickson TJ, Terwiel FA. Injury trends in alpine skiing and a snowboarding over the decade 2008-09 to 2017-18. J Sci Med Sport. 2021;24(10):1055-1060.
2. Hunter RE. Skiing injuries. Am J Sports Med. 1999;27(3):381-389.
3. Hurt J, Graf A, Dawes A, et al. Winter sport musculoskeletal injuries: epidemiology and factors predicting hospital admission. Eur J Orthop Surg Traumatol. 2023;33(5):1735-1743.
4. Kim S, Endres NK, Johnson RJ, Ettlinger CF, Shealy JE. Snowboarding injuries: trends over time and comparisons with alpine skiing injuries. Am J Sports Med. 2012;40(4):770-776.
5. Maier GS, Bischel O, Kusche H, et al. Different injury patterns after snowboard in children and adolescents. J Orthop. 2020;19:229-232.
6. Owens BD, Nacca C, Harris AP, Feller RJ. Comprehensive Review of Skiing and Snowboarding Injuries. J Am Acad Orthop Surg. 2018;26(1):e1-e10.
7. Polites SF, Mao SA, Glasgow AE, Moir CR, Habermann EB. Safety on the slopes: ski versus snowboard injuries in children treated at United States trauma centers. J Pediatr Surg. 2018;53(5):1024-1027.
8. Posch M, Schranz A, Lener M, et al. In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation. Knee Surg Sports Traumatol Arthrosc. 2021;29(6):1790-1796.
9. Summers Z, Teague WJ, Hutson JM, et al. The spectrum of pediatric injuries sustained in snow sports. J Pediatr Surg. 2017;52(12):2038-2041.
10. Warren A, Dea M, Barron IG, Zapata I. Ski and snowboard injury patterns in the United States from 2010 to 2020 in pediatric patients. Injury. 2023;54(8):110899.