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Research FAQ and the Ski Industry

What is the Frequency of Knee Injuries in the Ski Industry? References (1-4),(10-11),(14) The standard rate of injury in the ski industry is 10.1 injuries / 100 ski area employees (OSHA). Knees are the most frequently injured body part for skiers (35-41%). ALL skiing injuries involve ligament sprains (ACL and/or MCL). Rate of ACL injuries for ski instructors and patrollers is ~4.3 per 100,000 skier days Lifelong skiers / racers are associated with a higher risk of severe knee and hip osteoarthritis (14) Is there any research to support Injury Prevention Programs? References (2)(9)(12)(15) Research studies have concluded that a 4-6 week injury prevention program with neuromuscular training significantly reduces knee, ACL, and lower extremity injuries in a variety of sports, at all levels, and all ages. Recent meta-analyses and systematic reviews of the literature found that Injury Prevention programs reduce the rate of ACL injuries by 53%, and up to 67%. A recent study from 2020 with adolescent alpine ski racers showed a 45% reduction in ACL injuries after implementing an injury prevention program A skilled exercise program (as in ACL Strong) has been proven to slow or stop the progression of osteoarthritis (degenerative joint disease) by improving strength, mobility, balance, joint integrity, and function. What results have you had with ACL Strong? Results after 3 seasons of the ACL Strong Ski Area Program indicate a 58% reduction in ACL injuries compared to the standard ski industry rate. More than 1500 participants have enrolled in ACL Strong and the feedback has been overwhelmingly positive with reports of people feeling better, skiing better, and being able to do daily activities with more ease and less pain. ACL Strong is appropriate for all ages and fitness levels, with clear instructions and modifications to handle even the most experienced joints with a complicated history. A research study, supported by NSAA, is currently planned for the 2021/22 season to measure the impact of the ACL Strong program on reducing ACL (and other lower extremity) injuries among ski area employees. Can you reduce slip and falls on snow and ice? Balance training is proven to reduce falls. Most of the research on fall reduction is with the elderly population, due to high prevalence of falls and the immediate 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. We expect to see a reduction in Slip/Trip/Falls with implementation of the ACL Strong program, based on the fundamental impact of improving strength, balance, and neuromuscular control. What is the Return on Investment? How much can we expect to save? An average ACL injury costs $30,000-60,000 The actual cost to a company can be significantly greater than the medical expenses A ski resort with 500 employees can expect to have 51 injury reports per season (average rate of 10.1 per OSHA). Most likely, 23-40 of those reports would be lower extremity injuries; while 18 of those reports would specifically involve the knee. Ligament sprains (i.e. torn ACL or MCL) will likely be involved in 2-6 of these injuries. The cost of knee injuries alone would be around $234,000. If all 500 employees completed 6 weeks in ACL Strong, you could expect to reduce knee injuries by at least 50%, lowering your knee injury reports to only 9 (and reducing ACL/MCL injuries to 1-3), saving $117,000 on knee reports alone (not accounting for fewer hip, ankle, and lower back reports that will likely occur as a result). In summary, by enrolling 500 employees into ACL Strong, you could expect to see a minimum return of $92,000, saving 1-3 employees from tearing their ACL and losing the season, and saving 9 employees from reporting knee injuries. Imagine saving $460,000 in 5 years, plus having a thriving organization and happy employees that come back every year!

If you pay the medical bills, these numbers speak for themselves.

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.

A 4-6 week neuromuscular training program is the MOST EFFECTIVE way to reduce employee injuries on snow and ice.

References:

  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.
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