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X-C Ski injuries and ski bindings

Bindings1We had a thread recently on our NMCCSC Facebook Group Page recently that those of you interested in improving your skiing without compromising your safety should read. It talks about X-C Ski injuries and ski bindings. Here is an excerpted version of the thread.

The best research shows while releasable binding has helped protect against ankle and lower leg injuries , they have done little to protect against ACL/knee injuries. Lots of us do backcountry skiing with AT and telemark gear. The releasable AT binding were touted as the route to protect your ACL, because the bindings are supposed to release before the forces of a ski error rip your ACL.

This has been shown to be false. The ACL usually rips before the releasable binding releases. Most commonly, knee injuries occur as the skier catches the inside edge of the ski during the fall, causing sudden external rotation below the knee. In the process, the ACL deep within the knee snaps before the skis binding release can be triggered.

AT binding ski boots have a lot of advantages over telemark or front hinge bindings: better control , faster learning curve, technique that is familiar to a lot of skiers, no weight gain over telemark equipment and, as previously mentioned, more protection from lower leg and ankle injuries. Telemark and BC front hinge bindings seem to offer more knee/ACL injury protection in all but the most stiff telemark bindings/boots. Without the heel locked down the knee can immediately adjust to pressure in a large number of ski falls. This is shown in the medical literature many ski related knee injuries when alpine bindings vs telemark bindings. According to one expert, “after 10 years of mountain rescue on a ski patrol in 4 different resorts, I certainly can tell you that telemark skiers are less prone to injuries."

Ok these are ski stats from Scotland. But still, it clearly shows telemark is less prone to injuries than any other snowsports. Overall, most experts would agree that telemark skiing has a lower injury rate than both snowboarding and alpine skiing, perhaps because the free-heel allows falls to occur with less torsional damage on the lower limb. While this is still a highly debated subject and needs more more research , it is pretty well accepted that with a looser x-c binding you have some ACL/knee protection advantages. This protection may diminish with the stiffer Alpine like tele bindings and stiffer boots.

The point of this article is not to recommend AT over telemark gear. I've skied with both. Rather to consider individually which might work best for your knees. If one is a skilled Alpine skier who wants to pursue backcountry skiing and has strong healthy knees , they might be well served by AT gear. On the other hand if one has years of x-c/telemark experience , with little alpine experience , previous knee/ ACL injuries, then going to AT gear is not necessarily going to afford you full knee protection.

Without question AT gear most often offers a skier a stronger platform for performance BC skiing. Conversely, one can do a lot with moderate telemark gear, and not limit themselves to the tele stance but also do alpine turns as well as quick transitions from downhill to uphill which one often finds in BC skiing. Good luck if you are choosing a BC ski platform.

-Gordon Eatman

Ironically, the lightweight aspect of tele gear has been eclipsed by AT gear. Even I, a pinhead for 35 years now, am being drawn towards the AT flame. Ski weight is equal across the disciplines, unless you're talking about true feather-light skimo skis, but AT boots and bindings have continued to lose weight, while tele gear has stagnated. Even my beloved BD decided to back out of the tele boot market last year. Pairing an AT boot for soft snow/pow conditions and a tech [AT] binding can save over 2 pounds per foot. What's that adage, a pound on the foot is like five on the back? And even though I've always been a better tele than alpine skier, wider skis have allowed me to alpine more and more on my tele gear, until it's 4th and long in the black bumps and I have to tele.

Regarding research which shows tele is safer than alpine - please share some links to the research if you have them. I wonder how many data points they have for very active [modern] tele bindings, like the Hammerhead, BD 01/02, et al. with 3-4 buckle plastic boots. State of the art tele bindings, which I love and ski for the control and power, are almost scary in how locked and rigid they hold the heel down on the ski. Power corrupts, indeed! Even a contemporary semi-active binding like the Voile Switchback has gotten more active [a.k.a. potentially more dangerous] with their second generation. IMHO, Rottefella NTN Freedom/Freeride or 7 TM bindings raise the level of protection even more for tele bindings because they are essentially the only releasable tele bindings on the mainstream market. Note: when I attend my PSIA instructor clinics, the tele god examiners from CO all come with releasable tele bindings, since their ski area employers require they ski/teach in tele releasable binding. Since we're sharing anecdotal tales here, quite a few of my bad-knee aging tele friends now ski on AT/alpine gear because they feel it's easier and nicer on their knees. However, I'm sure YMMV.

-Barry Ritchey

That is why what I wrote is that moderately stiff x-c country and tele offer greater protection for ACL knee injuries in most cases, with lots of qualifications. I also stated that stiffer binding ( more active) and stiffer boots diminish the protective benefit of the loose heel. So yes if you go for super stiff boot binding combinations you are likely to get much of said benefit from above. However my chili binding and Garmont excursions offer me a fair amount of flexion. For the very reasons you mentioned (safety) I would go back to AT setup before super stiff telly gear. Although I can see the attraction with the power.

The wear and tear seems a large part due to the "lunges" by the medical lit. I did not imply that telly is any safer overall. I don't know, as conflicting data and personal opinions. Some of the literature out of Taos, and suggest Telly has a higher overall injury rate than Alpine. My article was limited to most knee/ACL injuries. One needs to consider that Taos will have a high percentage of Telly skiers on stiffer boot/binding combinations over a place like our beloved weak peak.

You can refer to http://www.ski-injury.com/specific-sports/nordic. Also you can google "acl injuries occurring before alpine binding releases." None of this is hard double blind experimental design, by the very nature of the beast, almost impossible, but you uses what data you have and consider all the non mentioned factors ( as above Taos skier equip. average stiffness vs. sandias) and stated variables and draw your best tentative conclusion.

-Gordon Eatman

Per the link above... [why injury rate for tele is lower than alpine] "...perhaps in part due to generally slower ski speeds (hence less force on the ligament and less damage).

Plastic boots ...reduce the likelihood of an ankle injury which has always been a risk with leather boots. However, as happened in alpine skiing when alpine boots went through a similar change, the reduction in ankle injuries has been at the price of a rise in knee injuries..." After reading that article, all I can come away with is that skiing slow is safer than fast and plastic boots tend to move injuries up to the knee. Not sure how anyone could deduce that a non-relesable tele binding, driven by a plastic boot, is going to be safer than an alpine/AT binding which usually has two modes of release. That's why I now use NTN at the ski areas. If I ever blow out my knee, probably a matter of when than if, I'd make sure any binding I ski with [on metal-edged gear] is releasable. There's probably one other thing that drives people's equipment decisions about safety... the high cost of a good boot/binding system. Another topic for another day....

-Barry Ritchey

2 Comments

  • Not to beat a dead horse, but what may seem to be logical does not always pan out in the data collected.by the people how do research in the field. While some of the best Telemark instructors may wear releasable Telemark binding , there releaseable bindings do more to protect against lower leg injuries than knee injuries. . Note also most of said top Telemark instructors are usually wearing very active binding and the stiffest telemark boots. If you are wearing 2 buckle boots and your cable bindings are tight enough to keep your boots in the binding but loose enough to allow good movement, you may want to consider “not throwing the baby out with the bathwater”. As most of the ski club wear lighter BC telemark boots and bindings and are not prone to
    spend there days going down hardpack double backdiamonds at a resort I think the data would back my previous conclusions. A simple yes or no answer in all cases is not what I wrote. As you asked here is some of the research:
    t is the view of the American group that first videoed and described the common mechanisms behind injury to the ACL that the cause of almost 90% of these injuries is actually independent of the ski binding worn by the skier at the time. Certainly, despite some rather ambitious claims, no commercially available ski binding to date has yet been shown to conclusively reduce the risk of ACL injury. http://Www.ski-injury.com

    Fact – injuries to the lower leg have always been a problem for alpine skiers. In the earliest years of the sport, fractures of the lower leg bones (the tibia and fibula) were common as the twisting forces generated by a fall were transmitted up unchecked from the ski. The subsequent development of release bindings has been very successful in reducing the incidence of such fractures, but unfortunately has not afforded as much protection to the knee
    Whilst modern alpine ski bindings have come on a long way in the last twenty years, they are still not perfect. It is important to remember that ski bindings are primarily designed to protect the lower leg against bony injury (i.e. fractures) not knee injuries.  In this regard they have been successful, as we see relatively few of these injuries nowadays. If you stop and think about it, bindings have to perform a difficult balancing act. On the one hand, we want them to hold onto our boots as we apply a multitude of different forces across them skiing at different speeds down a variety of pistes. On the other hand, we expect them to be able to recognise in a millisecond the application of an abnormal force and release our boot before the forces become so great that an injury occurs. No easy task. . Www.ski-injuries.com

    he advent of releaseable bindings largely solved the problem of boot-top “tib-fib” fractures once common among skiers. But that was half a century ago, and there’s been no equivalent advance in binding technology to solve the stubborn problem of ACL injuries. http://www.skinet.com/ski/article/safer-world-acls

    Telemarking has become increasingly popular in the last 15-20 years – rapid advances in both ski and boot designs have brought the speed and agility of telemark skiing up to (if not beyond) the level of alpine skiing. More and more alpine skiers are looking for a new challenge and giving the sport a go. In my own field of ski patrol medicine, the ability to climb and traverse relatively easily on lighter telemark skis makes the sport ideal for ski patrol work.

    The injury rate for telemarking has been quoted to be anything between 0.41 and 10 injuries per 1000 skier days. If you’ve read other pages on my site, you’ll know that the current rate for alpine skiing in Scotland is 2.38 injuries per 1000 skier days, whereas it is 1.13 (half as much) for telemark skiing.  http://www.ski-injury.com/specific-sports/nordic
    9. Which sport is the kindest on the knees?

    Short answer – Either snowboarding or telemark skiing.

    Long answer – Alpine skiing and skiboarding have the highest incidence of knee injuries, which account for 33% and 37% of all injuries respectively in these sports. Snowboarding is generally kinder on the knees, as long as you’re not planning lots of wicked jumps with heavy impacts. The main reason for the difference is that on skis and skiboards, each leg is able to twist independent of the other and thus cause injury to the knee. For the most time on a snowboard, both legs are fixed to the same board and therefore it is not easy for the knees to twist independent of the other. However, when a snowboarder is using a lift, most resorts require the rear boot to be out of the binding (so that boarders can use this foot to push themselves clear of the lift on dismount). This means that, whilst one boot is out of the binding, the boarder in effect has a large ski on and is vulnerable to twisting knee injuries. So take care when one foot is out of your binding. Fitting a stomp/slip pad (a friction plate) between the two bindings gives the free boot somewhere to grip, making things less slippy. Snowboarder’s knees also get injured (especially in the beginner phase) from repeated forward falls onto the front of the knees. Most of these injuries are minor bruises and as a doctor I don’t see many of them that are bad enough to need my attention. A pair of impact pads for the knees cost about £15 and are worth considering. If you really can’t give up skiing, then telemark skiing has a low absolute rate of knee injuries – but make sure you fit release bindings to your skis or else don’t dial your cable bindings up too tight!
    The current on-piste snow sport injury rates (taken from our latest Scottish injury study season 2009/10) in ascending order of injury risk are:
     
    Snow sport
    On piste injury rate
    (IPTSD)
    On piste injury rate 
    (MDBI)
       1. Telemark skiing
    1.13
    889
       2. Skiboarding
    1.99
    501
       3. Alpine skiing
    2.38
    419
       4. Snowboarding
    5.31
    188
    All sports combined
    2.59
    386

    IPTSD = Injuries per 1000 skier days – the average number of people who will be injured for every 1000 people skiing, snowboarding or skiboarding at a ski area on any given day

    MDBI = Mean days between injury = the number of days you would have to participate in a particular snow sport before being injured – so the higher the number, the lower the risk. If you’re confused, both concepts are fully explained here

    These figures only relate to on-piste injuries – injuries will obviously occur (especially telemark & snowboarding) off-piste but these are not recorded in our study to date.
    http://www.ski-injury.com/faq

  • Sure would be nice if this thread could be cleaned up and edited. I’m all about numbers and science, but OMG…
    Instead of cutting and pasting even more boilerplate to lull the reader to sleep, I’ll add this link which seems to dispute the 2-buckle tele boot is safe enough theme. Seems to also suggest releasable tele bindings are safer.
    I’ll take the liberty to distill what I think the two points are.
    1) If you ski with more supportive boots, you fall less, which means you probably get injured less.
    2) When [If, for some of you?] you tumble and fall, your injury rate might decrease if your skis release.
    Rocket science or common sense supported by statistics? If you want to rationalize, then your thought process should align with Mark Twain’s comment about the three kinds of lies – “…lies, damn lies and statistics.”
    http://faculty.washington.edu/mtuggy/equip1.htm

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