II. Epidemiology

  1. Injury Incidence: 0.5 to 5.6 injuries per 1000 ski days
  2. Majority of injuries occur on downhill runs

III. Advantages: Benefits

  1. Lower impact than other aerobic sports (e.g. Running)
    1. Safe after total hip replacement
      1. Gschwend (2000) Acta Orthop Scand 71(3):243-9 [PubMed]
      2. van der Bogert (1999) Med Sci Sports Exerc 31:131 [PubMed]
  2. Higher femoral Bone Mineral Density
    1. Pettersson (2000) Calcif Tissue Int 67(3):199-206 [PubMed]
  3. Moderate to strenuous aerobic Exercise
    1. Energy cost is net VO2 to speed ratio
      1. Study calculated VO2 from Heart Rate
    2. Energy cost equivalent to uphill treadmill walking
      1. Classic skiing: 162 ml/km-kg
      2. Skate Skiing: 148 ml/km-kg
      3. Mognoni (2001) Eur J Appl Physiol 85(1-2):62-7 [PubMed]
  4. Pole Striding effective in Peripheral Vascular Disease
    1. Improves Claudication pain and Exercise tolerance
    2. Langbein (2002) J Vasc Surg 35(5):887-93 [PubMed]

IV. Technique: Cross Country Skiing

  1. Classical skiing (Diagonal Stride)
  2. Skate Skiing (Free style)
    1. Offset (V1)
      1. Double pole plant to one side (e.g. left)
      2. Poling when weight is transferred to one ski
    2. Two skate (V2A)
      1. Symmetrical pole plant
    3. One skate (V2)
      1. Pole planted as weight is transferred to each ski
      2. Highest energy cost (VO2 to speed) and Heart Rate
        1. Millet (2003) J Sports Sci 21(1):3-11 [PubMed]
  3. Pole Striding
    1. Often used for dry land training in off season
    2. Walking with use of poles (especially on uphill)
    3. Body position and leg movement similar to skiing

V. Associated Conditions: Common Cross Country Skiing Injuries

  1. Hip and thigh
    1. Hamstring Strain
  2. Knee
    1. Medial Collateral Ligament Sprain (most common)
    2. Anterior Cruciate Ligament Rupture
    3. Medial or Lateral Meniscal Tear
    4. Patellofemoral Syndrome
  3. Ankle and calf
    1. Acute Lateral Ankle Sprain
    2. Medial Tibial Stress Syndrome
    3. Exertional Compartment Syndrome
  4. Foot
    1. Hallux Rigidus (Skier's Toe)
    2. Sesamoid inflammation of great toe
  5. Shoulder
    1. Acromioclavicular joint separation
    2. Rotator Cuff Tendinitis
  6. Elbow
    1. Triceps Tendinitis
  7. Hand and wrist
    1. Thumb Ulnar Collateral Ligament Rupture (Skier's Thumb)
    2. Wrist extensor Tendinitis
  8. Cold related injury
    1. Frostbite
    2. Hypothermia
  9. Exercise Induced Bronchospasm (EIB)
    1. X-C Skiing has highest EIB rate of all winter sports
      1. EIB in 50% of Olympic skiers (25% in other sports)
      2. Wilber (2000) Med Sci Sports Exerc 32(4):732-7 [PubMed]
    2. Slow warm-up prior to cold Exercise may reduce EIB
      1. Slowly build-up exertion level in a work-out
      2. Warm-up before a ski race

VI. Prognosis: Predictors of Cross Country Skiing performance

  1. Best predictors on Exercise Treadmill Testing
    1. Males: Onset of blood lactate accumulation
    2. Females: Intensity when respiratory exchange ratio 1
    3. Larsson (2002) Scand J Med Sci Sports 12(6):347-53 [PubMed]
  2. Upper body conditioning is critical to performance
    1. Hoff (1999) Med Sci Sports Exerc 31(6):870-7 [PubMed]
    2. Mahood (2001) Med Sci Sports Exerc 33(8):1379-84 [PubMed]
    3. Millet (2003) J Sports Sci 21(1):3-11 [PubMed]

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