LET IT SNOW!

Posted on by Dr.Mike

Let it Snow
Prepare athletes for winter sports.
By Nataliya Schetchikova, PhD
Having treated football and cycling teams and athletes in many championships, including the Olympic Games, Ted Forcum, DC, DACBSP, CSCS, has always focused on summer sports. Recently, however, he says he started “growing in the appreciation of winter sports.” On the practical side, some winter activities, such as snow-shoeing and cross-country skiing, generally involve less impact on the back and the knees. But the beautiful winter scenery can also feed the soul—it’s hard to beat the enjoyment of standing on a mountain top, admiring moonlight reflecting off the glowing snow, he says.
To make winter sports enticing for others, Dr. Forcum, president of ACA’s Sports Council, puts together fun events, such as a full-moon midnight snow-shoeing tour, with champagne and hot chocolate. “Everyone can snow-shoe, so it’s a great way to get started [doing winter sports],” he says. And while champagne is the initial attraction for many, “most end up drinking hot chocolate,” he says, laughing.
While not as popular in the United States as summer sports, winter outdoor activities have their fair share of fans—and injuries. According to the U.S. Consumer Product Safety Commission, skiing and snowboarding each sent approximately 144,000 people to the emergency room in 2004, followed by 74,000 injuries from sledding, snow tubing and tobogganing, 50,000 injuries each from ice hockey and ice skating, and 35,000 injuries from snowmobiling.1
Preventing Injuries
According to the American Academy of Orthopedic Surgeons (AAOS), most injuries happen at the end of the day, when athletes are tired, and the majority of injuries can be prevented through proper preparation, paying attention while doing the sport, and stopping before fatigue or pain sets in.1
While some winter sports, such as snow-shoeing or cross-country skiing, are generally low-impact activities, others can be extremely intense, with high speeds multiplying the potential for injury. Yet, some approach winter sports as activities that don’t require special preparation. For example, says Darren Paul, DC, a skier and hockey player in a sports-oriented practice in Vancouver, weekend warriors usually transition from summer to winter sports by getting back on the couch rather than maintaining their fitness level. As a result, their de-conditioned bodies predispose them to injuries.
“When athletes are unfit, they start developing inappropriate habits, moving in imbalanced ways and compromising certain tissues,” agrees Gordon Lawson, MSc, DC, DACBN, FCCSS©, FACO, a fan of many winter sports who has treated injured hockey players in his clinic in Ontario. He adds that he is often “frustrated” with athletes who neglect to promptly address prior injuries. For example, an elite hockey player sought Dr. Lawson’s care in September for an ankle sprain he sustained in April. By the time the athlete started treatment, he had a chronic problem with the calcaneal-fibular ligament, and, as a result, he couldn’t carry on normal pre-season workouts, says Dr. Lawson.
The rule of thumb says it takes three or four months to prepare for a winter sport—and, depending on the intensity, some sports require at least six months of training, says David Jensen, DC, a skier with 15 years of experience who has worked with Olympic and X Games athletes, including the U.S. ski team. In his Aspen, Colo. practice, which employs four chiropractors, an orthopedic surgeon and a variety of CAM practitioners (www.winhealthinstitute.com), Dr. Jensen helps condition athletes to ski for six to seven hours at a time—or to complete 24-hour endurance skiing marathons, using a combination of plyometric, hand-eye coordination and speed drills. (See sidebar.)
Preseason training should include a good balance of aerobic-style work and core strength training, says Clive Bridgham, DC, DACBSP, an avid Alpine skier and coach who has worked at many winter events—including the X Games, Gravity Games and the 2002 Salt Lake City Winter Olympics—with the World Olympians Association, and who has treated skiers, skaters and snowboarders in his clinic. “Once athletes are in season, it is important to continue core strength and aerobic fitness work,” he says, adding that a study performed on the U.S. ski team determined that ongoing training during the season is needed to maintain a competitive edge.
Muscle Work
Because most winter sports primarily involve lower extremities, Dr. Bridgham emphasizes the importance of hamstring strength, recommending that DCs work with patients on training each hamstring individually, as well as check the pelvis and lumbar spine for proper alignment. “The knee—especially the anterior cruciate ligament (ACL)—seems most vulnerable to injury, and the major protection to the ACL is provided by the hamstrings,” he says.
Climbing, skiing, snowboarding and snowshoeing are all “quad- and glute-laden activities,” so creating and maintaining quadriceps and gluteus balance—through squatting and stair-climbing exercises, for example—is essential, says Dr. Forcum. “If you train one muscle in preference, you’ll set up another body part for failure,” he adds.
Lunges also make for good lower-extremity exercises, says Dr. Paul. “The most important thing is to be sport specific in your training. In hockey and cross-country skiing, you are pushing more sideways with your legs, so tailor your lunges to be more sideways, to help stretch inner thigh muscles. Downhill skiers need more of a straightforward lunge,” he says, adding that endurance takes preference in training for winter sports, followed by strength and flexibility work.
In addition to extremity training, Dr. Lawson reminds athletes to work on the abdominals and their back muscles—and to perform a sport-specific warm-up. “Do a general warm-up for five to 10 minutes, then dynamic stretching for the particular sport. If you are playing hockey, circle around the rink for five minutes, doing specific starts, stops and active stretches, to work the exact muscles you need.”
Taking Precautions
After an athlete is properly trained for a sport, one more step is in order: planning protection from low temperatures and wind exposure. That includes battling the risk of frostbite by not overdressing, to avoid the chill caused by sweating, says Dr. Forcum. “You need light-weight protective gear to keep you warm, and a wind-breaking shell on top,” he recommends.
Wearing layers—and choosing clothes with ventilation—often makes for a good choice, says Dr. Bridgham. Protective gear, such as helmets, gloves and goggles, is also key, he says. “Especially in high altitudes, it is extremely important to wear goggles or sunglasses while outdoors to protect the eyes from the sun, as well as sunscreen for all exposed skin.”
Proper footwear—especially for children, who have a more difficult time adapting to variations in temperature—is another must, says Dr. Forcum. “Make sure you carry hand and toe warmers with you, and make sure that your shoes are big enough to adapt to an extra layer of socks. If you cram [your feet into the shoes], you will reduce the circulation,” he says.
Because the outside temperatures are low, people often forget to drink, and they shouldn’t. “The dry air and low humidity causes loss of hydration with every exhalation,” says Dr. Bridgham, adding that dehydration also affects performance. “In general, by the time the athlete is thirsty, his or her performance has already diminished.”
Treating Winter Athletes
For doctors of chiropractic working with winter athletes, it’s helpful to “enjoy and perform winter sports,” says Dr. Bridgham. “Then you understand the forces involved in the sports and how they may injure the structures.”
Since some winter sports involve great forces due to the speed, “remember to evaluate head injury or concussion, as well as neck involvement in the injury, such as in a skier going 70 miles an hour in a downhill race and crashing,” Dr. Bridgham continues.
Those working with pros should be “current on sports technology and on understanding strength and conditioning,” advises Dr. Jensen. “Many professional athletes understand strength and conditioning better than some chiropractors,” he adds.
Teaming up with a fitness professional is also a good idea, says Dr. Lawson. “After I identify muscle weaknesses in athletes and diagnose the areas of deficiency, I pass my patients over to a kinesiologist who implements my prescription in a focused, supervised fashion, making sure the athletes do the exercise properly.”
And, of course, patient education, especially for beginners, is of prime importance. Remind them to “start early in the off season, begin slowly and capture any pain or discomfort early,” says Dr. Lawson. It’s important to teach patients not to write off their pain and discomfort as a small problem that will go away. “An injury early in the season can terminate play for the rest of the season,” he notes.
With proper preparation and precautions, winter can be an excellent time of the year to encourage outside activities and enjoy Mother Nature, sports experts agree.
“I can’t wait for the winter to get here,” says Dr. Forcum.
Resources
• Safety tips for children playing winter sports: http://kidshealth.org/kid/watch/out/winter_sports.html
• Tips to prevent winter sports injuries: http://orthoinfo.aaos.org/topic.cfm?topic=A00062
• Sport-specific recommendations:
www.ipsm.org/institute_update/january_2003/winter_injuries.asp
Reference
1. http://orthoinfo.aaos.org/topic.cfm?topic=A00062
ACA News Extra…

Outside the Box
In addition to traditional endurance, strength, and aerobic work, chiropractors working with athletes recommend the following training for their patients:
Plyometric training for skiers
• Jumping down from a bench to the ground, and then to a higher platform
Hand-eye coordination
• Juggling
• A combination of juggling and recognizing baseballs, soccer balls or footballs on an eye chart and reading a number on each ball. “At 70 to 80 miles an hour, speed skiers must both read the gates and keep awareness [of their surroundings]—the body and the brain must multitask at different levels,” Dr. Jensen explains.
Flexibility
• Pilates
• Gyrotonics
• Yoga
• Tai chi
• Chi gong
Proprioception work
• Stability balls and pads
• iJoy board
“Skiers and snowboarders work on unstable surfaces, they need to adapt balance rapidly and appropriately,” says Dr. Forcum. He recommends adding balance work, such as squats on a stability ball, to the training or treatment routine.

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