Feature article

How MRI helps with winter sports injuries

Staying active during winter is often extremely important. If you live somewhere cold, you may need to find a snow-related sport. Some of these sports, like skiing, snowboarding and ice skating, account for a large number of injuries. In 2017, more than 220,000 people were treated for winter sports-related injuries, including sprains, strains, dislocation and fractures.1 On top of that, winter sports, excluding ice skating, caused 16,948 head injuries in 2009, while ice skating accounted for an additional 4,608 head injuries.2

Limb injuries

Injuries can happen to any part of the body, but most winter sports cause significantly more injuries to the lower half of the body.3 Skiing, snowboarding and skating are typically hard on the knee and its ligaments. Knee sprains and ligament tears are two of the most common injuries of these three sports. It would seem, however, that snowboarding is slightly easier on the knees but harder on the ankles, especially an athletes leading foot.3

There are four ligaments in the knee that can be injured: the anterior and posterior cruciate ligaments (ACL and PCL) and the medial and lateral collateral ligaments (MCL and LCL).4 Winter sports accidents can cause injury to one or multiple ligaments, especially the ACL. MRI has a high sensitivity and specificity rate of 94% for ACL tears.5 Tears appear as diffuse, or widespread, swelling and increased signal intensity, which shows up as an even brighter white section on an MRI. Likewise, MRI has a sensitivity rate of 91% with a 99% specificity for PCL tears. The PCL has low signal intensity normally and is even lower with a tear. This helps radiologists identify and assess the injury. Some patients may need surgery to repair their injury.

Head injuries

About 20% of all injuries to skiers and snowboards are injuries to the head. Of this 20%, 22% cause loss of consciousness or concussion.2 Concussion, or mild traumatic brain injury (mTBI), is fairly common among most sports, but winter sports are not commonly thought of as cause of concussion. However, if roughly 17,000 injuries occur each year (as they did in 2009), that's a lot of people suffering from winter sports, even if all of them didn't end up with concussion. Traditionally when assessing concussed patients, CT is used first.6 This is because it is quicker than MRI and can still show abnormalities. Though it takes longer, MRI has an increased contrast resolution compared to CT and can detect structural abnormalities before CT. MRI is reserved for follow up imaging after CT and can show deterioration over time. There are a variety of techniques that can be used during MRI to increase its sensitivity, which may assist doctors in monitoring patient recovery. Some of these head injuries can be avoided with the use of a specially designed helmet.

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Tips for prevention

Many of these ligament and head injuries can be avoided, as well as a variety of others, by wearing the correct protective gear. There are a number of steps that could reduce the risk of injury for winter athletes.1,2 These suggestions may help not only reduce the number of injuries, but also reduce injuries with long-lasting effects, and ensure quick treatment.

  • Warm up. Before playing sports or beginning a workout, warming up helps muscles loosen up. In the cold, muscles are tighter than normal and need more time to heat up. Warming up may reduce the chance of muscle cramps and some serious injuries.
  • Wear protective gear. Protective equipment and padding may lessen the damage caused by an impact. Mandatory helmets have reduced head injuries by 35% in Quebec, injuries which may be fatal.2,7
  • Take lessons. One or more lessons can help improve an athlete's form and technique. Some injuries may be avoided through the proper stance, while proper technique may prevent some muscle injuries.
  • Drink plenty of water. Some people don't remember to drink water while doing activities in the cold. However, dehydration can cause fainting or falling, which often lead to injury.
  • Make sure there are multiple people. Winter sport injuries are commonly to the legs and feet, meaning there's a chance the injured person may not be able to get help for themselves. Going with someone else increases the chance that the injured will quickly get help7

Warming up, wearing protective gear, taking lessons and staying hydrated can all help to reduce injuries on the slopes or ice. Stay safe to avoid injury and long-term recovery times. Going in pairs or groups will ensure that those who are injured can get help as quickly as possible, especially in cases where they cannot get themselves help. With people following these tips, the number of patients being treated for winter sports-related injuries will fall from the estimated 200,000 per year and more athletes will be able to continue to stay active during the winter.

References

1. "Winter Sports Injury Prevention." OrthoInfo.aaos.org. December 2018. Web. 9 January 2019. <https://orthoinfo.aaos.org/en/staying-healthy/winter-sports-injury-prevention/>.

2. "Sports-related Head Injury." AANS.org. Web. 8 January 2019. <https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Sports-related-Head-Injury>.

3. "Alpine Skiing and Snowboarding Injuries." American Orthopaedic Society for Sports Medicine. 2008. Web. 10 January 2019. <https://health.ucdavis.edu/children/download/sports_medicine/Skiing%20Injuries.pdf>.

4. "Types of Knee Ligaments." Stanford Health Care. Web. 10 January 2019. <https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/knee-ligament-injury/types.html>.

5. Ali M. Naraghi and Lawrence M. White. "Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series." Radiology. 19 September 2016; 281(1). Web. 10 January 2019. <https://pubs.rsna.org/doi/full/10.1148/radiol.2016152320>.

6. Sanjay P. Prabhu. "The Role of Neuroimaging in Sport-Related Concussion." Clinics in Sports Medicine. January 2011; 30(1): 103-114. Web. 10 January 2019. <https://www.sportsmed.theclinics.com/article/S0278-5919(10)00077-3/fulltext>.

7. "Don't Let Common Winter Sports Injuries Freeze Your Fun." OIP.com. Web. 9 January 2019. <https://www.oip.com/dont-let-common-winter-sports-injuries-freeze-your-fun/>.