Injuries to the lower extremities are among the greatest health risks in elite alpine and Nordic winter sports. A retrospective analysis of the medical records of 99 athletes from Turkey’s national teams across five winter sports shows how significantly the sheer frequency of individual diagnoses differs from their actual impact.

The analysis makes it clear that the most common injury is not necessarily the most serious, especially when the duration of training and competition absences is considered. The study was published in the Journal of Clinical Medicine.

The cohort included 34 women and 65 men. The athletes averaged 18 years of age, had logged about 3700 hours of training and competition over their careers, and sustained their first injury at a mean age of 15.5 years.

In their analysis, the researchers distinguished between incidence — injuries per 10,000 hours of sport — and the so‑called injury burden. Injury burden denotes weeks of absence per 10,000 hours of sport and therefore allows a more realistic assessment of the consequences of accidents.

Frequent but Mild

Across all disciplines, ankle sprains were the most frequent diagnosis. The overall incidence was 1.7 injuries per 10,000 hours, with snowboarders particularly affected 3.2 and alpine skiers at 2.8 injuries per 10,000 hours.

Despite these comparatively high figures, the consequences remained manageable: Ankle injuries averaged 4.4 weeks of absence per 10,000 hours. While certainly relevant from a sports medicine perspective, they are not the most consequential injury for athletes.

Overuse Burden Revealed

The picture was markedly worse for medial tibial stress syndrome (MTSS). Although it occurred less often than ankle sprains — 0.9 injuries per 10,000 hours — the burden was substantially higher: 9.5 weeks of absence per 10,000 hours, the highest value in the cohort.

This pattern was especially pronounced in cross‑country skiing. There, MTSS reached an incidence of 1.6 and caused 13.4 weeks of absence per 10,000 hours. The data illustrate how overuse injuries can severely impair performance. Insidious complaints do not immediately end training but can accumulate over weeks and months into significant performance losses.

Sex-Specific Differences

Differences between female and male athletes were most notable for cruciate ligament injuries. For women, anterior cruciate ligament (ACL) rupture was the most burdensome injury: incidence was 0.4 per 10,000 hours, and the burden was 16.2 weeks of absence per 10,000 hours. For men, MTSS — at 9.7 weeks of absence per 10,000 hours — produced the greatest sporting consequences.

These figures argue clearly for sex‑specific prevention strategies, particularly intensified neuromuscular training to reduce the risk for ACL injuries in female athletes.

Discipline Risk Profiles

Clear differences also emerged between disciplines. In alpine skiing, ACL rupture was the most consequential injury, with 34.3 weeks of absence per 10,000 hours. Among snowboarders, injuries to the knee collateral ligaments caused the highest burden, at 27.8 weeks of absence per 10,000 hours.

These patterns reflect the specific biomechanical demands of each discipline — from repetitive loading in cross‑country skiing to abrupt rotational and valgus‑stress situations in alpine racing.

Risky Training

Another finding of the analysis was that most injuries occurred in training rather than competition. The longer cumulative training hours are likely the main reason.

The authors therefore recommend prioritizing prevention measures in training, eg, through systematic load management, technique optimization and recovery strategies.

Conclusion: Incidence Vs Impact

The data make clear that incidence alone does not determine the relevance of an injury in winter sports. Although ankle sprains dominate numerically, MTSS and ACL ruptures have far more serious consequences for athletes’ subsequent careers.

The authors wrote that prevention in winter sports must therefore pursue two strategies: reduce the risk for acute trauma and effectively prevent overuse injuries. They also called for sex‑ and discipline‑specific concepts to help safeguard athletes’ careers over the long term.

This story was translated from Medscape's German edition.