Special Issue "Mountain Sports Activities: Injuries and Prevention"

Special Issue Editor

Prof. ret. Dr. Martin Burtscher
E-Mail Website
Guest Editor
University of Innsbruck, Innsbruck, Austria
Interests: exercise physiology with emphasis on mountain sports activities; physiological and pathophysiological effects of altitude and hypoxia; epidemiology and prevention of accidents and emergencies in skiing and mountaineering; life-style interventions in health and disease, primarily focussing on exercise, environmental and nutritional aspects

Special Issue Information

Dear Colleagues,

Popularity of mountain sports activities is steeply increasing all over the world and particularly in the Alps. Millions of people are practicing one or more recreational sports like downhill or cross-country skiing, ski mountaineering, mountain hiking, rock or ice climbing, high-altitude mountaineering, mountain biking, paragliding, etc. Although it is indisputable that leisure-time exercise is generally associated with health benefits, especially outdoor activities also bear an inherent risk of injury due to both objective and subjective risk factors. Whereas many epidemiological data are available on the prevalence of injuries during different recreational mountain sports activities, much less is known on risk factors, causes and mechanisms of such injuries and even less on the outcomes of targeted preventive measures.

This Special Issue seeks research papers on injuries occurring during various types of recreational mountain sport activities, focusing on risk factors, underlying causes and mechanisms, outcomes of and/or suggestions for prevention studies. We especially encourage the submission of interdisciplinary work and multi-country collaborative research. We welcome original research papers as well as systematic reviews and meta-analysis.

Prof. Dr. Martin Burtscher
Guest Editor

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Keywords

  • Public health aspects of mountain sports activities
  • Prevalence, risk factors, causes and mechanisms of injuries during various types of mountain sports activities
  • Outcomes of and suggestions for targeted injury prevention

Published Papers (8 papers)

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Research

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Open AccessArticle
External Workload Indicators of Muscle and Kidney Mechanical Injury in Endurance Trail Running
Int. J. Environ. Res. Public Health 2019, 16(20), 3909; https://doi.org/10.3390/ijerph16203909 - 15 Oct 2019
Abstract
Muscle and kidney injury in endurance athletes is worrying for health, and its relationship with physical external workload (eWL) needs to be explored. This study aimed to analyze which eWL indexes have more influence on muscle and kidney injury biomarkers. 20 well-trained trail [...] Read more.
Muscle and kidney injury in endurance athletes is worrying for health, and its relationship with physical external workload (eWL) needs to be explored. This study aimed to analyze which eWL indexes have more influence on muscle and kidney injury biomarkers. 20 well-trained trail runners (age = 38.95 ± 9.99 years) ran ~35.27 km (thermal-index = 23.2 ± 1.8 °C, cumulative-ascend = 1815 m) wearing inertial measurement units (IMU) in six different spots (malleolus peroneus [MPleft/MPright], vastus lateralis [VLleft/VLright], lumbar [L1–L3], thoracic [T2–T4]) for eWL measuring using a special suit. Muscle and kidney injury serum biomarkers (creatin-kinase [sCK], creatinine (sCr), ureic-nitrogen (sBUN), albumin [sALB]) were assessed pre-, -post0h and post24h. A principal component (PC) analysis was performed in each IMU spot to extract the main variables that could explain eWL variance. After extraction, PC factors were inputted in multiple regression analysis to explain biomarkers delta change percentage (Δ%). sCK, sCr, sBUN, sALB presented large differences (p < 0.05) between measurements (pre < post24h < post0h). PC’s explained 77.5–86.5% of total eWL variance. sCK Δ% was predicted in 40 to 47% by L1–L3 and MPleft; sCr Δ% in 27% to 45% by L1–L3 and MPleft; and sBUN Δ% in 38%-40% by MPright and MPleft. These findings could lead to a better comprehension of how eWL (impacts, player load and approximated entropy) could predict acute kidney and muscle injury. These findings support the new hypothesis of mechanical kidney injury during trail running based on L1–L3 external workload data. Full article
(This article belongs to the Special Issue Mountain Sports Activities: Injuries and Prevention)
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Open AccessArticle
Injury-Related Behavioral Variables in Alpine Skiers, Snowboarders, and Ski Tourers—A Matched and Enlarged Re-Analysis
Int. J. Environ. Res. Public Health 2019, 16(20), 3807; https://doi.org/10.3390/ijerph16203807 - 10 Oct 2019
Abstract
Behavioral variables might play an important role in explaining the differences in injury rates across winter sport disciplines and injury prevention programs might be more specifically designed based on this knowledge. On ski slopes, alpine skiing, snowboarding, and ski touring are the predominant [...] Read more.
Behavioral variables might play an important role in explaining the differences in injury rates across winter sport disciplines and injury prevention programs might be more specifically designed based on this knowledge. On ski slopes, alpine skiing, snowboarding, and ski touring are the predominant winter sport disciplines. Therefore, the aim of the present study was to investigate possible differences in injury-related behavioral variables between practitioners of these disciplines. Using a matched re-analysis approach of a cross-sectional survey, 414 winter sport participants (alpine skiers, snowboarders, ski tourers, each n = 138) were analyzed on the differences in sensation seeking, treated injuries, and injury-related behavioral variables. Cochran–Mantel–Haenszel and Friedman tests revealed significantly higher sensation seeking, p < 0.001, and a significantly higher percentage of participants reporting to have consumed alcohol in the past five skiing days, p = 0.006, in snowboarders compared to alpine skiers. The participants with treated injuries showed higher sensation seeking, p < 0.050, and a higher percentage of snowboarders, p = 0.020, compared to participants without treated injuries. Injury prevention programs for snowboarders, who remain an important risk group for injury prevention, might benefit from considering a possibly higher percentage of alcohol-consuming participants and from providing information on injury-related risks of sensation seeking. Full article
(This article belongs to the Special Issue Mountain Sports Activities: Injuries and Prevention)
Open AccessArticle
Leg Dominance as a Risk Factor for Lower-Limb Injuries in Downhill Skiers—A Pilot Study into Possible Mechanisms
Int. J. Environ. Res. Public Health 2019, 16(18), 3399; https://doi.org/10.3390/ijerph16183399 - 13 Sep 2019
Abstract
Leg dominance has been reported as one potential risk factor for lower-limb injuries in recreational downhill skiers. The current study proposed and tested two possible mechanisms for a leg dominance effect on skiing injuries—imbalance of the knee muscle strength and bilateral asymmetry in [...] Read more.
Leg dominance has been reported as one potential risk factor for lower-limb injuries in recreational downhill skiers. The current study proposed and tested two possible mechanisms for a leg dominance effect on skiing injuries—imbalance of the knee muscle strength and bilateral asymmetry in sensorimotor control. We hypothesized that the knee muscle strength (Hypothesis 1; H1) or postural control (Hypothesis 2; H2) would be affected by leg dominance. Fifteen well-experienced recreational downhill skiers (aged 24.3 ± 3.2 years) participated in this study. Isometric knee flexor/extensor muscle strength was tested using a dynamometer. Postural control was explored by using a kinematic principal component analysis (PCA) to determine the coordination structure and control of three-dimensional unipedal balancing movements while wearing ski equipment on firm and soft standing surfaces. Only H2 was supported when balancing on the firm surface, revealing that when shifting body weight over the nondominant leg, skiers significantly changed the coordination structure (p < 0.006) and the control (p < 0.004) of the lifted-leg movements. Based on the current findings, bilateral asymmetry in sensorimotor control rather than asymmetry in strength seems a more likely mechanism for the previously reported effect of leg dominance on lower-limb injury risk in recreational downhill skiers. Full article
(This article belongs to the Special Issue Mountain Sports Activities: Injuries and Prevention)
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Open AccessFeature PaperArticle
Are Risk-Taking and Ski Helmet Use Associated with an ACL Injury in Recreational Alpine Skiing?
Int. J. Environ. Res. Public Health 2019, 16(17), 3107; https://doi.org/10.3390/ijerph16173107 - 26 Aug 2019
Cited by 1
Abstract
According to the risk compensation hypothesis, the use of a ski helmet might provide a false sense of security, resulting in a riskier behavior by skiing faster or more aggressively, which might lead to an increased injury risk. Injury of the anterior cruciate [...] Read more.
According to the risk compensation hypothesis, the use of a ski helmet might provide a false sense of security, resulting in a riskier behavior by skiing faster or more aggressively, which might lead to an increased injury risk. Injury of the anterior cruciate ligament (ACL) is a common diagnosis in downhill skiers. Thus, the aim of the study was to evaluate the potential impact of risk-taking and ski helmet use on ACL injury risk in recreational skiing. Eighty-two ACL injured and 446 uninjured skiers with a mean age of 37.3 ± 11.9 years (52% females) were surveyed during the winter season 2018/19 about age, sex, self-reported risk-taking behavior, self-reported skill level, perceived speed, and ski helmet use. Multiple regression analysis revealed that older age (OR: 1.3, 95% CI: 1.2–1.4), riskier behavior (OR: 5.4, 95% CI: 2.8–10.5), and lower skill level (OR: 6.7, 95% CI: 3.4–13.3) were found to be factors associated with ACL injury, while ski helmet use was not. In conclusion, no support for the risk compensation hypothesis was found with regard to ACL injuries. Therefore, we doubt that ski helmet use increases the risk for ACL injury and recommend wearing a ski helmet due to reported protective effects. Full article
(This article belongs to the Special Issue Mountain Sports Activities: Injuries and Prevention)
Open AccessArticle
Effects of Visual and Auditory Perturbations on Ski-Specific Balance among Males and Females—A Randomized Crossover Trial
Int. J. Environ. Res. Public Health 2019, 16(15), 2665; https://doi.org/10.3390/ijerph16152665 - 25 Jul 2019
Abstract
Injuries in skiing show sex-specific differences, especially when visual perception is reduced. Reduced visual perception impairs balance, which plays an important role in avoiding skiing injuries. However, males and females might cope differently with reduced visual perception. Thus, the aim of this study [...] Read more.
Injuries in skiing show sex-specific differences, especially when visual perception is reduced. Reduced visual perception impairs balance, which plays an important role in avoiding skiing injuries. However, males and females might cope differently with reduced visual perception. Thus, the aim of this study was to evaluate sex-related effects of environmental perturbations (reduced visual perception and listening to music) on ski-specific balance. Using a crossover design, ski-specific balance was tested in 50 young adults (50% female) in four conditions: with and without listening to music and/or with and without reduced visual perception (ski goggles with occlusion foil). A four × two (condition by sex) mixed ANOVA revealed a significant condition by sex interaction, partial η² = 0.06. Females showed an increase in balance from the condition without music/with normal visual perception to the condition with music/with normal visual perception, while males showed a decrease. Balance was significantly higher in females compared to males, partial η² = 0.31. The findings suggest that balance is affected differently by environmental perturbations in females and males. However, the differences observed were not in line with our initial hypotheses, which might be because the model was too simplistic for how visual/auditory perturbations may affect balance. Full article
(This article belongs to the Special Issue Mountain Sports Activities: Injuries and Prevention)
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Open AccessArticle
An Exploration of Hiking Risk Perception: Dimensions and Antecedent Factors
Int. J. Environ. Res. Public Health 2019, 16(11), 1986; https://doi.org/10.3390/ijerph16111986 - 04 Jun 2019
Abstract
Hiking is a form of green tourism which deserves promotion and popularization, especially in present day China. However, the risks inherent in hiking could have a negative impact on the development of hiking tourism. It is important to better understand how people perceive [...] Read more.
Hiking is a form of green tourism which deserves promotion and popularization, especially in present day China. However, the risks inherent in hiking could have a negative impact on the development of hiking tourism. It is important to better understand how people perceive the risks of hiking and what type of experience attributes they prefer. However, no studies have investigated the nature of risk perception from the perspective of hikers. This study explores the dimensions of the perceived risk of hiking and investigates the associated factors of hiking risk perception as well as hiking preference. A questionnaire with 18 items was used to capture people’s perception of hiking risks, and two groups of samples were surveyed. Generally, this study identified two dimensions of perceived risk towards hiking based on a sample of hikers, i.e., physical risk and psychological risk. Demographic variables such as gender, upbringing background, and hiking frequency were shown to predict hiking risk perception while gender and hiking frequency predicted route preference. The personality trait of sensation seeking appeared to be a significant predictor of hiking preference. These findings lend themselves to market segmentation and marketing strategies on hiking tourism. Full article
(This article belongs to the Special Issue Mountain Sports Activities: Injuries and Prevention)
Open AccessArticle
Amputation Risk Factors in Severely Frostbitten Patients
Int. J. Environ. Res. Public Health 2019, 16(8), 1351; https://doi.org/10.3390/ijerph16081351 - 15 Apr 2019
Abstract
In recent years, the incidence of frostbite has increased among healthy young adults who practice winter sports (skiing, mountaineering, ice climbing and technical climbing/alpinism) at both the professional and amateur levels. Moreover, given that the population most frequently affected is healthy and active, [...] Read more.
In recent years, the incidence of frostbite has increased among healthy young adults who practice winter sports (skiing, mountaineering, ice climbing and technical climbing/alpinism) at both the professional and amateur levels. Moreover, given that the population most frequently affected is healthy and active, frostbite supposes a substantial interruption of their normal activity and in most cases is associated with long-term sequelae. It particularly has a higher impact when the affected person’s daily activities require exposure to cold environments, as either sports practices or work activities in which low temperatures are a constant (ski patrols, mountain guides, avalanche forecasters, workers in the cold chain, etc.). Clinical experience with humans shows a limited reversibility of injuries via potential tissue regeneration, which can be fostered with optimal medical management. Data were collected from 92 frostbitten patients in order to evaluate factors that represent a risk of amputation after severe frostbite. Mountain range, years of expertise in winter mountaineering, time elapsed before rewarming and especially altitude were the most important factors for a poor prognosis. Full article
(This article belongs to the Special Issue Mountain Sports Activities: Injuries and Prevention)
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Review

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Open AccessReview
Mortality in Different Mountain Sports Activities Primarily Practiced in the Summer Season—A Narrative Review
Int. J. Environ. Res. Public Health 2019, 16(20), 3920; https://doi.org/10.3390/ijerph16203920 - 15 Oct 2019
Abstract
Millions of people engage in mountain sports activities worldwide. Although leisure-time physical activity is associated with significant health benefits, mountain sports activities also bear an inherent risk for injury and death. However, death risk may vary across various types of mountain sports activities. [...] Read more.
Millions of people engage in mountain sports activities worldwide. Although leisure-time physical activity is associated with significant health benefits, mountain sports activities also bear an inherent risk for injury and death. However, death risk may vary across various types of mountain sports activities. Epidemiological data represent an important basis for the development of preventive measures. Therefore, the aim of this review is to compare mortality rates and potential risk factors across different (summer) mountain sports activities. A comprehensive literature search was performed on the death risk (mortality) in mountain sports, primarily practiced during the summer season, i.e., mountain hiking, mountain biking, paragliding, trekking, rock, ice and high-altitude climbing. It was found that the death risk varies considerably between different summer mountain sports. Mortality during hiking, trekking and biking in the mountains was lower compared to that during paragliding, or during rock, ice or high-altitude climbing. Traumatic deaths were more common in activities primarily performed by young adults, whereas the number of deaths resulting from cardiovascular diseases was higher in activities preferred by the elderly such as hiking and trekking. Preventive efforts must consider the diversity of mountain sports activities including differences in risk factors and practitioners and may more particularly focus on high-risk activities and high-risk individuals. Full article
(This article belongs to the Special Issue Mountain Sports Activities: Injuries and Prevention)
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