Research FAQ relating to the Ski Industry

Documentation regarding the Frequency of Knee Injuries in the Ski Industry. (See references 1-4, 10-11, 14)

  • Knees are the most frequently injured body part for skiers (35-41%)
  • Approximately half of knee injuries in skiing involve a ligament sprain (typically ACL and/or MCL)
  • The rate of injury in the workplace in the ski industry, per OSHA, is 10.5 injuries / 100 ski area employees (increased from 10.1 in 2020, 10.3 in 2021).
  • The most common mechanism of injury for employees is slips/trips/falls, accounting for 60% of employee injuries in the ski industry
  • The most common body part injured for ski industry employees is the knee (nearly 40%)
  • Rate of ACL injuries for ski instructors and patrollers is ~4.3 per 100,000 skier days
  • Lifelong skiers and racers are associated with a higher risk of severe knee and hip osteoarthritis

Documentation to support Injury Prevention Programs. (See references 2,9,12,15)

  • A 4-6 week injury prevention program with neuromuscular training significantly reduces knee, ACL, and lower extremity injuries in a variety of sports, levels, and ages.
  • Meta-analysis and systematic review of the literature found that Injury Prevention Programs reduce the rate of ACL injuries by 53% and up to 67% for female athletes.
  • A 2020 study with adolescent alpine ski races showed a 45% reduction in ACL injuries after implementing an injury prevention program (included neuromuscular training exercises off-snow and on-snow)
  • A skilled exercise program has been proven to slow the progression of osteoarthritis and reduce symptoms by improving strength, mobility, and balance.

Can you really reduce slips/trips/falls on snow and ice?

  • Reactive balance training drills are proven to reduce falls, primarily tested in the elderly population due to the high prevalence of falls and the impact on quality of life.
  • Strength, postural control, balance, reaction time, and proprioception have been identified as contributing factors to slips/falls on snow and ice surfaces.
  • By improving strength, postural control, and reactive balance, we expect to see a reduction in slips/falls on snow and ice with implementation of the ACL Strong training program.

Results from ACL Strong

  • From 2018-2021, which included 3 seasons with ski area employees, participants in ACL Strong had a 58% lower rate of knee injury compared to the OSHA standard for this population
  • During the 2021-2022 season, 968 ski area employees from 48 ski resorts participated in ACL Strong and had 62% fewer knee injuries reported compared to the OSHA standard, and 70% fewer ACL injuries than the rate that has been measured for patrollers and instructors in reference 1. This reduction in knee injuries represents an estimated $270,000 saved.
  • Anecdotally, the feedback from participants has been overwhelmingly positive, with reports of “feeling better”, “skiing better”, and experiencing “less pain”. See what members have said about their experience here.
  • To date, nearly 4000 participants have enrolled in ACL Strong training for reducing the risk of injury and improving performance or quality of life. Many return every year to repeat the 4-6 week course to prepare for their sport.
  • Results from 2022-2023: ACL Strong participants at 6 ski areas were compared to non-ACL Strong participants at the same ski areas. The control group (non-participants) had an average cost per lower extremity injury claim of $12,097; while ACL Strong participants had an average claim of only $874, indicating less severe injuries are more likely to occur with the ACL Strong participants.

What is the Return on Investment (ROI)? How much can you expect to save?

  • Workers compensation data shows that the average cost of a knee injury report is between $11,000-18,000, which includes incidents ranging from report only (no medical) to medical and time-off required. One ACL injury costs an estimated $50,000-80,000 on average.
  • The actual cost to a company can be 2-5 times greater than the medical expenses, with secondary expenses including an increased Mod Factor, replacing and training employees, utilization of other resources, etc.
  • For example: An organization with 500 employees can expect to have 51 injury reports per season (average rate 10.3, per OSHA). Statistically, 23-40 of those reports would be lower extremity injuries; while 18 of those reports would specifically involve the knee. You can expect that 9 will involve sprained ligaments, with 2-3 potentially being torn ACLs.
  • The cost of knee injuries alone can be $198,000-$324,000.
  • If all 500 employees completed 6 weeks in a neuromuscular training program like ACL Strong, you could expect to reduce knee injuries by at least 50%, lowering your knee injury reports to only 9 (and likely saving at least 1 employee from experiencing a torn ACL). You could expect to save ~100-150k on knee injury reports alone, plus additional savings by reducing other lower extremity injuries.
  • With investment in the program AND paying employees to complete the training, the ROI in the above example is still $60,000-$85,000 for 500 employees!
  • In just 3 years, you could have $250,000 more in your budget to support your thriving organization and happy employees that feel valued!
  • If you depend on workers compensation to cover employee injuries, then you will feel the savings through your mod factor for the next few years. Even more immediately than that, you will feel the impact through improved employee morale, reduced stress on HR and department leaders, and an overall more positive guest experience.


  1. Viola RW, Steadman JR, Mair SD, Briggs KK, Sterett WI. Anterior Cruciate Ligament Injury Incidence Among Male and Female Professional Alpine Skiers. The American Journal of Sports Medicine. 1999;27(6):792-795. doi:10.1177/03635465990270061701
  2. Westin M, et al. Prevention of Anterior Cruciate Ligament Injuries in Adolescent Alpine Skiers. Frontiers in Active Sports and Living. 2020 Mar.
  3. Jordan MJ, Aagaard P, Herzog W. Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review. Open Access J Sports Med. 2017;8:71-83. Published 2017 Mar 30. doi:10.2147/OAJSM.S106699
  4. Flørenes TW, Bere T, Nordsletten L, Heir S, Bahr R. Injuries among male and female World Cup alpine skiers. Br J Sports Med. 2009 Dec;43(13):973-8. doi: 10.1136/bjsm.2009.068759. PMID: 19945979.
  5. Roos EM. Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol. 2005 Mar;17(2):195-200. doi: 10.1097/01.bor.0000151406.64393.00. PMID: 15711235.
  6. Lopes TJA, Simic M, Myer GD, Ford KR, Hewett TE, Pappas E. The Effects of Injury Prevention Programs on the Biomechanics of Landing Tasks: A Systematic Review With Meta-analysis. Am J Sports Med. 2018 May;46(6):1492-1499. doi: 10.1177/0363546517716930. Epub 2017 Jul 31. PMID: 28759729; PMCID: PMC6604048.
  7. Hébert-Losier K, Holmberg HC. What are the exercise-based injury prevention recommendations for recreational alpine skiing and snowboarding? A systematic review. Sports Med. 2013 May;43(5):355-66. doi: 10.1007/s40279-013-0032-2. PMID: 23463392.
  8. Huang YL, Jung J, Mulligan CMS, Oh J, Norcross MF. A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster-Randomized Controlled Trials With Meta-analysis. Am J Sports Med. 2020 May;48(6):1505-1515. doi: 10.1177/0363546519870175. Epub 2019 Aug 30. PMID: 31469584.
  9. Davey A, Endres NK, Johnson RJ, Shealy JE. Alpine Skiing Injuries. Sports Health. 2019 Jan/Feb;11(1):18-26. doi: 10.1177/1941738118813051. PMID: 30782106; PMCID: PMC6299353.
  10. Petushek EJ, Sugimoto D, Stoolmiller M, Smith G, Myer GD. Evidence-Based Best-Practice Guidelines for Preventing Anterior Cruciate Ligament Injuries in Young Female Athletes: A Systematic Review and Meta-analysis. Am J Sports Med. 2019 Jun;47(7):1744-1753. doi: 10.1177/0363546518782460. Epub 2018 Jul 12. PMID: 30001501; PMCID: PMC6592422.
  11. Mayr H, Cheze L. The Knee Injuries in Skiing: Mechanisms and Assessment. 33rd International Conference on Biomechanics in Sports. 2015.
  12. Gau C, Abeysekera J. A Systems Perspective of Slip and Fall Accidents on Icy and Snowy Surfaces. Ergonomics. 2004 May.
  13. Michaëlsson K, Byberg L, Ahlbom A, Melhus H, Farahmand BY. Risk of severe knee and hip osteoarthritis in relation to level of physical exercise: a prospective cohort study of long-distance skiers in Sweden. PLoS One. 2011;6(3):e18339. Published 2011 Mar 30. doi:10.1371/journal.pone.0018339
  14. Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. J Orthop Res. 2018 Oct;36(10):2696-2708. doi: 10.1002/jor.24043. Epub 2018 Jun 13. PMID: 29737024.
Scroll to Top