Snowboarding Ankle Injuries

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Snowboarders tend to get more ankle injuries than skiers, and skiers tend to get more knee injuries than snowboarders
  • The “snowboarder’s fracture” is unique to ankle injuries in snowboarding
  • A fracture of the “lateral process of the talus” is sometimes missed on regular x-rays and it’s sometimes necessary to use specialized imaging to make a proper diagnosis
  • When treated early and properly this fracture will typically allow full return of sports participation but a missed diagnosis can result in significant problems

In this post I’m going to discuss a particular type of broken bone seen in snowboarding snowboardoften referred to as “the snowboarder’s fracture.” This particular fracture occurs in one of the ankle bones called “the talus”. A fracture in the lateral process of the talus is called the snowboarder’s fracture.

Patterns of injury are a bit different in snowboarding compared to skiing. Skiers tend to get more knee injuries than ankle injuries, and snowboarders tend to get more ankle injuries than knee injuries. One proposed reason for this difference is due to the less rigid boots used in snowboarding, which provide minimal protection to the ankle joint.

Most ankle injuries in snowboarding affect the lead leg. And about half of all ankle injuries in snowboarding are fractures. The “snowboarder’s fracture” occurs because of sudden upward movement of the foot, combined with the foot turning inwards. This injury typically occurs when landing from a jump. Pain is present on the outer side of the foot and ankle, and is often associated with swelling, bruising and significant tenderness to touch. Unfortunately, this injury is often missed, because regular X-rays don’t always show the fracture very well. If I’m suspicious for a snowboarder’s fracture and the x-rays look normal, I’ll often order a CAT scan as this can be a much more accurate way to diagnose this fracture.

Treatment of the snowboarder’s fracture depends on how big and how displaced the broken fragment is. For a small fracture that is in normal alignment, we can treat these without surgery. This typically means about 4 to 6 weeks of having the foot and ankle in a cast and no weight bearing on the leg. Large and displaced fractures are typically treated with surgery—the fragment is moved back into its normal position and screws are inserted to hold it in place. Recovery after surgery also includes a period of non-weight-bearing, followed by gradual restoration of motion, strength, and function of the ankle joint.

ssd.bannerOutcomes of snowboarder’s fractures are typically good if the injury is diagnosed early and appropriately treated.

Most athletes are able to get back to normal physical activity within 4 to 6 months. However, significant problems can result if this fracture is missed and appropriate treatment is delayed. These include non-healed bony fragments causing pain and poor function, as well as early arthritis of the joint, which can significantly limit movement of the foot. When a snowboarder presents with acute pain on the outer side of the foot or ankle after an injury on the slopes, it’s very important to see a skilled physician for a proper exam and appropriate diagnostic imaging to avoid missing this injury.

ACL Bracing by DonJoy

HELPING WITH PREVENTION, PROTECTION & HEALING

acl-bracing

DonJoy pioneered the concept of functional knee bracing more than 30 years ago. Our first prototypes were simple neoprene sleeves sewn together in the Carlsbad, Calif. garage of our founders, Philadelphia Eagles Offensive Line Captain Mark Nordquist and local lawyer Ken Reed. Those first braces came from a deep understanding of the need for prevention, protection and healing, and DonJoy has led the profession of performance ever since by studying the body, listening to athletes, consulting physicians and pushing the envelope of innovation.

THE PERCEPTION

The overall perception of knee bracing technology available to most patients today is that “everyday” knee braces can be unsightly, bulky, heavy, minimally effective, restrictive and uncomfortable. These misconceptions combine to produce “brace anxiety” among many patients, often preventing mainstream adoption and compliance of braces that can help prevent injuries, allow people to remain active while healing, and protect the knee from future injury.

THE REALITY

Patients are looking for quick, effective and economic options for maintaining or regaining their life activities; most want to delay expensive, invasive surgeries. While some patients are turning to the use of prescription narcotics (which can lead to addiction) and cortisone shots to manage their pain, these treatment options do not provide stability to the knee.

THE FACTS

Young people between the ages of 15-25 account for half of all ACL injuries.

A person who has torn their ACL has a 15 times greater risk of a second ACL injury during the initial 12 months after ACL reconstruction, and risk of ACL injury to the opposite knee is two times that of the restructured knee.

Many athletes don’t return to sport after ACL reconstruction due to fear of re-injury.

BRACING FOR PREVENTION

Given the physicality of football, it’s easy to understand why collegiate and professional linemen wear braces on both knees. The line of scrimmage is an environment prone to knee injuries, so team doctors, athletic trainers and coaches don’t hesitate to equip their players with bilateral (both knees) custom braces.

As with helmets and shoulder pads, knee braces have become standard equipment to assist in preventing season-ending knee injuries. And the same logic holds true with skiing, snowboarding, soccer, basketball, volleyball, professional rodeo, water sports and others. An ounce of prevention is worth a pound of cure.

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BRACING POST INJURY

Why brace after ACL reconstruction? Clinicians will typically prescribe a functional knee brace after the patient has regained full range of motion—that’s usually between three to five months after surgery. Graft strength of the new ACL is considerably weaker than the native (original) ACL during the first 12 months, so a brace during this early period helps protect it from harmful forces that occur in everyday life or in sport.defiance-300x250

Bracing also elevates a patient’s confidence, allowing them to return to their previous or enhanced level of activity. Just look to athletes including Robert Griffin III, Tiger Woods, Adrian Peterson, Tom Brady, Lindsey Vonn, Matt Ryan and Peyton Manning just to name a few. Another important reason? Peace of mind. A functional knee brace provides not only confidence for the patient, but confidence for the surgeon, knowing that their patient’s knee is protected.

5 INJURY PREVENTION MOVEMENTS TO DO BEFORE YOU HIT THE SLOPES

It’s never too early, or too late, to get your body ready for the slopes. Skiing and snowboarding is taxing on your body, and even though you are fit and workout regularly, you still need to prepare your body for mountain-like movements to avoid soreness or injury.

5 Injury Prevention Movements to Do Before You Hit the Slopes

There are five essential body-type movements that prepare the body for the unstable surface and quick reactions when needed on the slopes. A strong and sturdy core is the base to provide strength and power when skiing and snowboarding. To ensure you can move, twist and turn quickly, you need to focus on flexion, extension, rotation, balance and stability. These five essential movements will strengthen the core and prepare you for unexpected bumps, turns and jumps when you hit the mountain.


FLEXION

Bending of a joint between two bones that decreases the angle between two bones. In other words, if the movement decreases the angle between the two body parts, that’s flexion. V-Ups strengthen the core while working on your torso flexion.

Begin lying on the ground, arms extended overhead. Tuck your chin and begin to lift your spine up off the ground. As you do this, lift your legs up. Meet in the middle and pause, then curl back down and repeat: EXAMPLE: V-UPS (15 REPS)

v-up-1 v-up

V-UP MODIFICATION:

For a modified version, instead of keeping your legs straight as you lift your spine and legs off the floor, bring your knees in. Meet in the middle and pause, then curl back down and repeat.

v-up_modification v-up_modification-1


EXTENSION

Extension is opposite of flexion. It’s a movement of increasing the angle between two bones, straightening the muscle that was previously bent. Begin face down on the stability ball. Your torso should be centered, arms extended overhead and legs straight. Your body is in an upside down “V” position. Engage your core and lift your back up maintaining a flat spine. EXAMPLE: BACK EXTENSION ON A STABILITY BALL (15 REPS)

back-extension-exercise back-extension-exercise-1


ROTATIONplank rotation exercise

This is a movement when your body twists, or rotates. Begin in a high plank. Lift your right arm up and rotate your body to the right side. Return your palm to the ground and rotate to the left. Continue to alternate. EXAMPLE: PLANK ROTATION (10 REPS PER SIDE)

 


bosu ball single-leg jump and balance exerciseBALANCE

This is when you’re able to maintain a stable position during movement.EXAMPLE: SINGLE-LEG BOSU BALL BALANCE JUMPS (10 REPS)

On the stability ball side of the BOSU, continue to jump on and off the BOSU with one leg and the other knee bent. Keep your arms extended forward for an additional challenge. Then repeat on the other side. This will help you strengthen your balance needed for when you have to shift weight skiing or snowboarding.


plankSTABILIZATION

This is when one has the ability to hold a static position. Begin in a push-up position and lower down to your forearms. Engage your core, maintaining spine alignment, and hold for 30 to 60 seconds. EXAMPLE: FOREARM PLANK (45 SECONDS)

BY FARA ROSENZWEIG for BetterBraces.com

ACL INJURY: SKIING WITH A TORN ACL

When a skier falls and one of the knee (or both) twists while the foot remains planted on the ski, the skier will most likely suffer an ACL rupture.

skiing-with-a-torn-meniscus

The ACL or anterior cruciate ligament is one of the four important ligaments holding the knee joint together. The ACL can tear when a skier lands on a bent knee then twisting it or landing on an overextended knee. A popping sound can be heard and the skier will have the sensation that the knee gave out. This sensation is caused by the knee joint becoming lax after the ACL quits its job of holding it together and assuring its stability.

An ACL tear is a serious skiing ailment, and one of the most widespread among skiers. Because the feet are bound to long thin boards and are independent from each other, as opposed to skiboarding or snowboarding, the risk of one ski getting caught while the other continues its course is very high. Other ligament sprains often occur as well, but the ACl rupture is the most common and the most severe.

Instability from such an occurrence happens often, and the duration is usually determined by the severity of the tear. It is just about impossible to prevent yourself from falling when on the slopes, and every time you fall you run the risk of injuring your ACL. There is something you can do…to avoid ACL injuries while skiing, wear a knee brace that offers extra support to your ACL. This will ensure you sufficiently protect your knees while skiing and allow you to stabilize them if they do become injured.

By BetterBraces.com

The World’s Leading Custom Knee Brace: Defiance by Donjoy

Defiance Knee BraceThe custom Defiance is DonJoy’s flagship knee brace. With clinically-proven technology including the 4-Points-of-Leverage System™ plus innovative, high-tech materials and design, this lightweight brace provides durable support for moderate-to-severe ACL, PCL, MCL and LCL instabilities. Plus, the low-profile design fits comfortably underneath clothing and sports uniforms, including hockey and football.

As the strongest of DonJoy’s functional braces, the custom, carbon composite Defiance is recommended for high-collision sports, while its featherweight materials and custom fit also make it the brace of choice for activities of daily living. Available with the LoPro FourcePoint Hinge, the only hinge clinically-proven to protect the ACL.

defiance-brace

Defiance technology is on the field, on the court, on the slopes and in the water protecting knees and providing confidence to those who wear it. First introduced in 1992, DonJoy has produced more than a million braces; in college football alone, 22 of the Associated Press Top 25 teams use the Defiance knee brace.

FEATURES & BENEFITS

  • Backed by DonJoy’s Knee Guarantee Program™
  • Custom-made craftsmanship
  • Lifetime warranty on frame and hinges
  • Clinically-proven 4-Points-of-Leverage System™
  • Custom fabricated
  • Swooping Thigh Cuff for inner thigh clearance and bilateral brace use
  • Strong, lightweight carbon composite frame
  • ACL, PCL, or Combined Instability (CI) strap configurations
  • 24-hour turnaround time

Options

  • Patented, clinically  proven FourcePoint™ hinge technology (stop kit not included)
  • Over 40 custom frame colors and graphics
  • Defiance Extra includes reinforced carbon composite frame
  • Metal Caps – PowerCaps, metal strap tab caps (recommended for contact sports)
  • High strength stainless steel gears (recommended for contact sports)
  • Standard Low Profile Hinge
  • DropLock Hinge

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