A direct fall onto the shoulder may cause the collar bone to fracture. These clavicular fractures usually occur in the shaft of the bone. If the shape of the bone is not too deformed the treatment involves immobilisation in a brace. However, sometimes the fracture is displaced or angulated, when an operation to insert a metal plate may be required. Fractures towards the outer end of the clavicle are more serious and may not heal up properly without an operation.

The joint where the collar bone joins the shoulder blade is called the acromio-clavicular (AC) joint. There are four ligaments holding the joint in place, and the clavicle can become separated from the scapula depending on how badly the ligaments are damaged. In minor sprains, the ligaments are damaged but not stretched. With more force the ligaments can stretch slightly. These types of sprain are treated with a simple sling to support the weight of the arm. In severe sprains the ligaments can snap completely. This requires a special AC brace to push the collar bone back down or even an operation to fix it back in place.

The ball and socket joint of the shoulder is called the gleno-humeral joint. The ball-shaped part of the humerus is called the humeral head. The socket of the scapula is quite shallow, which allows a good range of movement, but makes it prone to dislocations. The humerus is held in place by ligaments and a group of muscles known as the rotator cuff. Rotator cuff sprains occur when the muscle fibres are stretched beyond breaking point. Sometimes a piece of bone can be ripped away from the head of the humerus where the muscle attach. This is known as an avulsion fracture. Treatment of rotator cuff sprains and minor avulsion fractures involves immobilising the shoulder with a sling or shoulder brace for a couple of weeks. Displaced avulsion fractures require an operation to fix them back into place.

If there is a direct blow to the shoulder or if the arm is wrenched suddenly, the head of the humerus dislocates out of the socket. Usually the humeral head comes to lie in front of and below the joint, but rarely it can dislocate backwards. Treatment involves manipulating the humeral head back into the socket using various techniques. The technique that you may have seen in the film ‘Lethal Weapon’ is not to be recommended ! An injection of painkiller and/or muscle relaxant is often required. X-rays are almost always necessary before and after the dislocation has been treated to make sure there is not an associated avulsion fracture.

Finally the neck of the humerus can break, at the point where the shaft of the bone joins the humeral head. Despite quite severe angulation these fractures usually heal up nicely with a simple sling for about three weeks. An operation is only required in really bad cases.

Believe it or not, the sun is strong enough to burn, even in March. The Ozone layer is not what it used to be and for some reason, people are still not using sun cream. The Medical Centre has already seen several cases of sunburn and April’s about to bring a whole load more….

So how do we tan? We have cells in our skins called melanocytes, which secrete melanin when exposed to ultraviolet radiation. Melanin protects the skin from exposure and is brown in colour. The darker your skin, the more melanin you have. However, even if you are dark or black skinned, you are still at risk (albeit a reduced risk) of cancer. Every time you burn, you are damaging your skin at the genetic level i.e. you are damaging your DNA. Usually the body’s immune system comes round mopping up these damaged cells. When this mechanism fails, cells multiply out of control – this is cancer. The skin cancer you hear about commonly is melanoma.The incidence of melanoma has more than tripled in the white population during the last 20 years, and melanoma is currently the sixth most common cancer (4% of cancers). However, it’s responsible for more than 74% of skin cancer deaths. Yes, it is nasty.

What are the signs of cancer?
If you have a mole that has been present for years but suddenly changes then look out for the following warning signs: Changes in size and colour, border irregularity, asymmetry, itching and bleeding. Any new mole that appears and fits the above criteria should also be checked out.What are the risk factors? Skin that is fair, with fair hair and blue eyes. Melanoma is also associated with the number of moles present. Ultimately though, degree of intensity and length of exposure to sunlight is the most important risk factor. Sun beds are particularly risky.

Generally speaking there are two types of sun worshipper: The type that sits in the middle of the half pipe for maximum reflection, with factor 4 oil on and a pair of Speedos; and the type who works on the goggle tan putting some time in on the balcony. You know who you are! At the end of the season you will have a tan, even if you use factor 40. Take your time over it, use a high factor and avoid looking five years older and acquiring considerable damage along the way.

Ski resorts are expensive, but if you head to Casino, you can pick up some sun cream for a little less than at the pharmacy. If you have visitors, ask them to bring out some sun cream, preferably at least factor 30. Waterproof stuff is ideal as you’ll sweat when skiing.

Remember to reapply regularly and note that cream only starts working thirty minutes after you apply it. Classically, people forget to apply cream to the neck and ears which become exposed at lunchtime. Acquaint yourself with the “bad mole” criteria, and see your doctor if you are worried, but prevention is definitely better than cure!

Signs of a suspected melanoma are: 1/it increased in size; 2/ its borders are irregular; 3/ it became asymmetrical; 4/ colour has changed; 5/ it became itchy and began to bleed.

You might think that injuries to the thumb are not that significant. However, the thumb allows you to grip with your hand and grasp objects with a pincer movement. Unless you’ve injured your thumb you’ve probably never given it a second thought. If you have injured your thumb you’ll know how disabling it can be.

Injuries to the thumb make up about 10% of all skiing injuries, compared to about 3% of snowboarding injuries. This difference is due to the fact that skiers use poles, which increase the liklihood of levering the thumb during a fall. Sometimes it is the pole strap which causes the damage. Opinions differ on how you should hold your poles. Some people advocate using the straps so that you don’t lose your oles,
but consider how important this is compared to increasing your risk of what could be a serious thumb injury.

Before I get on to specific injuries, a quick anatomy lesson. The thumb is made up of two bones, the distal phalanx and proximal phalanx. At the base of the thumb the proximal phalanx meets the first metacarpal bone at the metacarpo-phalangeal joint (MCPJ). Any of these bones can be fractured either from a direct impact or from a twisting mechanism. The treatment usually requires immobilisation in a cast, but occasionally an operation is required to insert metalwork, especially if the fracture is unstable. The joints between the bones can also dislocate, but this is uncommon and is usually easy to correct.

The bones are all held in place by collateral ligaments on either side. If a ligament is stretched or even snapped it generally heals up without any complications. However, the ligament at the MCPJ on the side nearest the index finger is the one most commonly injured. It is called the ulnar collateral ligament (UCL), and it is unusual because unlike the other thumb ligaments it doesn’t always heal up nicely if it ruptures. The reason for this is that the ends of the ligament fold back and cannot heal naturally. An urgent operation is then required to fix the UCL before it becomes beyond repair. Failure to repair a ruptured UCL can lead to arthritis in the joint, causing permanent pain and stiffness in a very important joint. Injuries to the UCL are known as ‘skier’s thumb’.

In some cases, the ligament is stronger than the bone it is attached to. As the thumb gets wrenched, the ligament pulls off a small fragment of bone, usually the base of the proximal phalanx. This is known as an ‘avulsion fracture’. If the fragment is displaced it will require an operation to insert a metal pin to put it back, even though the fragment is tiny. This is important because if there is a jagged edge to the joint, it will never work properly again and thumb movements will be permanently restricted.

So what should you do if you get skier’s thumb. First of all try not to move it. If you stretch an already damaged ligament you could convert a simple sprain (that would have healed up with a thumb splint) into a complete rupture that requires an operation. Similarly, you could convert an undisplaced avulsion fracture (that would heal up in a cast) to a displaced fracture that requires surgery.

The next thing you should do is get an X-ray. Patients often state that there cannot be a fracture because they can still move the thumb. This is so not true. An X-ray to exclude a fracture is the first thing the doctor will do if there is pain around the UCL. If there is no fracture the doctor will then assess how loose the ligament is. This is a specialised technique and is not something you should try yourself. If the ligament appears to have snapped completely you will be referred to an orthopaedic surgeon. If there is any doubt an ultrasound scan or MRI may be necessary.

People often do not realise the importance of thumb injuries, and it is not uncommon for them to leave it until the next day before seeing the doctor. They are then amazed when they require an X-ray and an emergency referral to hospital for what they thought was an insignificant injury. Don’t fall into the same trap!

This X-ray shows an avulsion fracture caused by the UCL at the base of the proximal phalanx of the thumb. Although the fragment is tiny and only slightly out of place, this fracture required pinning.

What exactly are we talking about? When you fall on to your chest, or your back, your ribs stop you from damaging your internal organs i.e. your heart, lungs and to a certain extent, your liver and spleen. The classic injury is a fall on to the snow, ‘winding’ the victim and leaving significant pain on movement and inspiration thereafter. This can often happen if you land on an arm that is tucked into the chest (usually in snowboarders), which can lead to a good going rib fracture. If you’re really unlucky, to add insult to injury, your board or skis may come up behind you and collide with your head: The classic Scorpion.

Back to chest injuries, the spectrum of damage is limitless. We see these injuries most days. The majority have suffered a tear in the muscles between the ribs. These are called the intercostal muscles and help you to breathe in. Unfortunately you can’t take a rest from breathing so this hurts a lot, especially as they have a rich nerve supply. Next up is the broken rib. This is a diagnosis made on examination and not on x-ray as most people believe. The majority of rib fractures do not cause problems and are difficult to see on x-ray film, so they are not routinely done. The treatment is good painkillers, rib strapping which takes the pressure away from the injury and instructions to take deep breaths regularly. Yes, this hurts a lot but it also keeps the miniature passageways open, discouraging bacteria from growing, because if you start coughing, that injury will really hurt.

“Have I popped my lung?” is a common question we get asked. The answer is usually no. So what is a popped lung? Excuse the analogy, but imagine that your fist is a lung, now put your fist into a half blown up balloon. It is now surrounded by two layers, right? These are called the pleura. If the outer layer is speared by, for example, a fractured and displaced rib, then suddenly air can enter the space between the layers and cause your lung (the fist, if you are still following) to shrink down. This is called a pneumothorax or collapsed lung. Usually, it’s not a problem, if you are young and fit, then it will re-inflate spontaneously over days or weeks, but a large one will cause you to feel breathless, contribute to pain and may need intervention in hospital (about four percent). Smokers are at greater risk of this injury.

The liver (right) and spleen (left) are also protected by ribs. However these ribs are called floating ribs as they are only fixed at the front but not the back. A blow to the left or right hand side, typically because of an overlying arm or by landing on a rail can damage these organs. They are delicate and have a very rich blood supply. They are each surrounded by a capsule which stems the bleeding in an accident, but once this bursts, the result can be fatal. If you notice a pain in the upper left or right of the abdomen (lower chest) then think about going to see the doctor. A racing pulse is another indication.

How do you prevent this from happening? Well, short of becoming a better skier/snowboarder, avoid carrying objects such as phones/keys/wallets in pockets around the ribcage. Avalanche transceivers are often a problem due to the strapping system, try to have these in the middle of the abdomen away from organs. In short, the difference between a muscle or rib problem compared to a collapsed lung is often a feeling of shortness of breath, so get yourself looked at.

Abdominal pain or racing pulse as described above should also be investigated. If you are worried about an injury, always go and see your doctor.

Ankle injuries are more common in snowboarders (16% of all boarding injuries) than in skiers (6% of all skiing injuries). This is because boarding boots allow more movement than ski boots. However, it is not true that you cannot seriously hurt your ankle in a ski boot, as the picture shows.The ankle joint is made up of the lower part of the leg bones (tibia and fibula) and the talus bone underneath. The bony prominence at the end of the fibula (the thin bone down the outside of the leg) is called the lateral malleolus. The other knobbly bit on the inside of the ankle is called the medial malleolus, and is a part of the main leg bone (tibia).

Ankle sprains are common. They occur when the foot stretches the ligaments that hold the bones together. The ligament fibres become torn, which causes pain and swelling. In severe cases it can take several weeks for the ligaments to heal. Rest, Ice, Compression and Elevation of the foot are the mainstays of treatment (R.I.C.E.). The healing process can be speeded up by immobilising the joint with strapping or a splint.

When more force is involved, the bones that the ligaments are attached to can snap. Usually it is the end of the fibula that breaks. Treatment depends on the severity of the fracture. In simple breaks all that may be required is a plaster cast. But if there is any displacement of the bone fragment, an operation to insert metalwork becomes necessary. Similarly, if more than one bone is broken an operation is a near certainty.

It is much les common for the talus to fracture, but it is still possible. Minor talar fractures are generally treated with immobilisation in a plaster cast. However, because this bone takes all of the body weight, surgery is sometimes required to stabilise the fragments with metal screws. A part of the talus called the lateral process can snap yet not show up on ordinary X-rays. This fracture is almost never encountered apart from in snowboarders. Pain over the outside of the ankle that is not responding to treatment should prompt your doctor to consider a CT scan to exclude this specific “snowboarder’s fracture”.

Finally, the Achilles tendon should not be forgotten. This tendon attaches the calf muscle to the heel. It is usually injured in a forwards fall. If a few fibres of the tendon are strained it is not too serious, and heals up quickly with the RICE treatment. But if the entire ligament snaps it will take a good three months to recover in a plaster cast. Sometimes it requires an operation to stitch it back together, but this doesn’t really shorten the recovery time. If you hurt your ankle, do not fall into the trap of thinking that “if I can walk on it, there can’t be a break”. This is not the case, but what is true is that if you do walk on a broken ankle you are more likely to displace the bone fragment and increase your chance of needing surgery (see picture).

Mythbuster: this fractured lateral malleolus occured in a ski boot, and after walking around on it for two days the patient did not think it needed an X-ray. It actually required an operation to insert a metal plate.

Many myths exist regarding STIs. Essentially, in the UK, one in nine 18-25 year olds has Chlamydia. This is an average. If you have Chlamydia, you are more likely to also have another STI. Forty percent of women and twenty percent of men with chlamydial infection are co-infected with gonorrhoea.
Let’s talk about Chlamydia first. It is a bacterium that lives within the cells of your urethra to begin with. Symptoms can include painful urination, testicular pain and penile discharge for men. Women may have painful urination, discharge, malodour, and later abdominal pain and pain during sex. Women may also notice unexpected bleeding between periods. The incubation period (period before symptoms appear) is 1-3 weeks. However, I have known men to only notice symptoms after eight weeks. Approximately 50% of infected males and 80% of infected females have no symptoms. So why is it so bad? Well, in both men and women it can travel to other areas of the reproductive system and lead to infertility. It is now the leading cause of infertility in women worldwide. This is called pelvic inflammatory disease. In addition, women with a chlamydial infection are at an increased risk of developing cervical cancer; risk is as high as 6.5 times greater compared to women without infection. It is tested for using swabs. The “umbrella” test for men is a myth. Herpes is a virus that exists in many forms. The form that is seen in genital herpes is different to that seen around the mouth (cold sores). Genital herpes is seen as painful open wounds in the skin on the penis or around the vagina. They are spread from skin to skin contact. Genital warts are spread in a similar fashion and are seen as raised often painless lumps. Again good treatments are available.

Warts, please compare with… herpes HIV (106,000 in the UK, and 7,000 new cases last year) and syphilis (ten fold increase over ten years), both exist in Val. These two illnesses can be detected by blood tests. Symptoms are varied and beyond the scope of this article. A few years ago, some life and medical insurance policies  were affected if you were tested for HIV but this is no longer  the case.

Hepatitis C, previously mainly spread through heroin use and blood transfusions is now mainly spread through unprotected sex. Depending which source you read, between 150 and 300 million people (2.5- 5%) worldwide are infected with the virus. It can have a long period of dormancy, but eventually attacks the liver leading to hepatitis. It is 100 times more contagious than HIV. It is also part of the screening test during a sexual health check.

One of the reasons for people not getting tested is embarrassment, but doctors and nurses are bound by confidentiality laws so you can be assured of privacy. Although you do have to pay for the tests, in March/April time,  Vie Val D’Is arranges free testing for many STIs. However if you have genuine concerns, get yourself checked out sooner rather than later.

The old expression “you‘re not sleeping with one person, but all their previous partners” is definitely valid. In summary, there’s a lot of rubbish spoken out there, but STIs are rife so just be careful. I actually saw a patient once who told me he’d been using two condoms at once. This is a little excessive, expensive and probably killed the mood. They are well constructed nowadays, so one will suffice, but you actually have to have one to hand for them to work, so stock up next time you’re in the pharmacy or down in Bourg.

For more information, please visit www.patient.co.uk

The wrist is the most common injury site for snowboarders, representing 20% of all boarding injuries. By contrast, wrist injuries account for just 2% of all injuries in skiers. The reason for this is fairly obvious. When skiers lose their balance they can move one of their feet out to prevent a fall. On a snowboard, however, both feet are generally fxed in the bindings, so boarders fall onto their outstretched hands much more than skiers.

This is the exact mechanism required to break the wrist. The most usual scenario is for the end of the main forearm bone (radius) to be forced upwards. The severity of the break depends on the amount of force involved. In hairline fractures, the bone is broken but not out of place. These are treated with a plaster cast for 6 to 8 weeks. With more force, the bone is pushed out of alignment. These fractures need to be manipulated back into place, usually under an anaesthetic, before being placed in a cast. In even more serious injuries the fracture requires an operation to insert metalwork in order to fx it, especially if the other forearm bone (ulna) is also broken.

The second most frequent wrist fracture involves the scaphoid bone. This is located between the base of the thumb and the wrist joint. The scaphoid is commonly broken by a fall onto the palm of the hand. It is a particularly troublesome bone to break because it has a poor blood supply and may not heal properly even with immobilisation in a plaster cast. To make things worse, the fracture does not always show up on X-rays straight away. If there is a suspicion of a fractured scaphoid after examination it is best to start treatment with a plaster cast even if the X-rays look normal. After ten days, check X-rays are necessary to confrm the diagnosis.

It has now been proven that wrist guards prevent wrist fractures in snowboarders. Several studies have all come to the same conclusion and a review article stated that one fracture could be avoided for every 50 boarders who wear guards. Don’t take my word for it, check it out for yourselves: The effect of wrist guards on wrist and arm injuries among snowboarders: a systematic
review. Russell K, Hagel B, Francescutti LH. Clin J Sport Med. 2007 Mar;17(2):145-50.

Another way of looking at it is that wrist guards reduce your risk of a wrist fracture by 85%. People still come out with the argument that guards are not 100% effective, but no protective gear ever is. Another objection is that guards can increase the likelihood a fracture further up the arm. This has not been shown in the studies mentioned above, and even it does occur it is a small price to pay for the proven protection that guards provide. Despite all this evidence, only about 10% of boarders wear guards.

I once treated a beginner snowboarder who had managed to break both of her wrists at the same time. She soon found out
who her best friends were when she realised that with a plaster cast on each arm, she wouldn’t be able to wipe her own backside for 6 weeks! You have been warned.

The main illnesses that we see as doctors are depression, eating disorders and psychoses such as schizophrenia. I’m going to talk mainly about the first, as it affects around ten percent of the population at some point in our lives. Major depression, also known as unipolar depression, is one of the more commonly encountered psychiatric disorders. It affects twice as many women as men. A lot of taboo still surrounds mental illness, one of the reasons accounting for many people not coming forward. So what causes it? Still an issue of great debate, it is now agreed that the chemicals (for the geeks among us, the main one is called serotonin or 5HT) between nerves in the brain become depleted in certain individuals. This is the basis for pharmacological therapy, which helps serotonin stick around for longer, making nerves fire again so that people feel more themselves.

The Blues, or if you’re a seasonnaire, Cabin Fever, hits us all at some point in our lives. Usually it’s because we’ve exhausted ourselves, we’re working too hard and this can all be compounded by a life event
such as a job loss, break-up, or even just that you’ve ruined your latest skis, or had your gloves stolen on a night out… The point is that depression is slightly different. So what makes depression different?
The tell tale signs to look out for in yourself or others are the following: Persistently low mood; lack of sleep or the opposite, excessive sleeping; early morning wakening; low appetite; difficulty concentrating or memory problems; thoughts about harming yourself or committing suicide. One of the earliest symptoms, often striking before any of the above, is loss of enjoyment in the activities that you used to enjoy. Many people with depression report a loss of interest in sex as well as sport, socialising, their jobs and so on.

So why am I depressing you all with this article? Well, the worst case scenario is suicide. It continues to rank as the second leading cause of death in adolescents and represents 10-30% of deaths in those aged 20-35 years. Major depressive disorder plays a role in more than one half of all suicide attempts. Ok, so on to how to avoid a run in with yourself…

There is now good evidence that for mild to moderate depression, spending time with animals helps (this does not include your room mates), even goldfish have been shown to help. More practical advice that is often ignored is exercise. Whilst it gets you out and about, meeting people and generally boosts self esteem, it also naturally increases serotonin levels. So get out of bed and go skiing / riding. Next up is talking to others… it is the basis behind cognitive, behavioural and other therapies for depression and basically boils down to ‘a problem shared is a problem halved’. Don’t isolate yourself. Talking to a friend, family or a counsellor can help immensely. Anti-depressants are effective but much more so when combined with counselling.

Now, for the things to avoid, yes, it’s alcohol and drugs. Most are central nervous system depressants (i.e. depressing), those that are stimulants almost invariably leave you depressed for some time afterwards, and long-term problems are now well documented. Cannabis is also well established as triggering and worsening schizophrenia. There is also the indirect problem of cost, which itself will lower your mood. A bender doesn’t come cheap in Val.

Depression is more common than you think, just because you don’t hear people talking about it in the pub doesn’t mean it isn’t an issue. If you are feeling low and the above measures haven’t helped then please go to see a doctor to put you through the right channels and get a plan in place. Have a happy rest of season!

The knee is much more complicated than a simple hinge joint. In addition to two ligaments either side (the medial and lateral collateral ligaments), there are also two internal ligaments (the anterior and posterior cruciate ligaments) that act as central stabilisers. There are also two menisci made of cartilage, that act like shock absorbers to prevent the femur from impacting directly against the tibia.

The most common skiing injury involves the medial collateral ligament being overstretched during a fall. This accounts for about 15% of all skiing injuries. The ligament’s fibres tear, which causes swelling and pain around the inside of the knee. It is relatively rare for the ligament to snap completely. Fortunately the more minor tears heal up without the need for an operation. The menisci can also tear (usually the medial meniscus) to varying degrees. In minor tears the meniscus bleeds into the joint, causing pain and stiffness. In severe tears a fragment ofcartilage can prevent the joint from flexing or extending, locking the knee. Meniscal injuries usually settle down with time, but may require an arthroscopy if they do not fully resolve.

The anterior cruciate ligament (ACL) is often injured when skiers fall, especially if the ski binding does not release. The mechanism of injury involves flexing and twisting the knee. Patients sometimes experience a popping sensation, and may describe that the knee feels as if it is about to give way when they try to put weight on it. Minor ACL tears can heal without an operation. Complete ACL tears
can cause the knee to become unstable, and do not heal on their own. An operation is then usually required. Unfortunately, stitching the two ends of the torn ligament together is not successful. Instead a piece of the patient’s hamstring or patellar tendon is grafted between the femur and tibia in place of the snapped ligament. The operation is not usually performed until at least a couple of months after the injury, in order to allow the inflammation to settle down. The rehabilitation afterwards takes several months, so it is certainly not a minor injury.

The initial treatment of these knee injuries revolves around the Rest, Ice, Compression and Elevation (R.I.C.E.) principle to reduce swelling. Rest means restricting knee movements, usually with a knee brace. The type of brace required depends on the type and severity of injury. Crutches may also be needed to take the weight off the knee. Icing the knee in the acute phase can reduce the amount of swelling by resticting blood flow to damaged structures. Many people instinctively jump straight into a hot bath to soothe an injured knee, and then wonder why it swells up afterwards. Compression can be achieved with a simple crepe bandage, and elevating the knee is also effective at reducing swelling. If the knee does swell up you may require an X-ray to rule out an avulsion fracture. These occur when a ligament snaps off one of its attachments to a piece of bone, and may require specific treatment.

Because the knee is such a complicated joint, it is worth getting a professional opinion rather than a self-diagnosis. Obviously, the sooner you start the right treatment, the sooner it will get better.

Myth Number 1: ‘Only snowboarders get head injuries’. If you’re unlucky enough to come to the medical centre with a ski injury, our statistics show that you have a 13% chance of it being for your head. If you’re a snowboarder, it goes up to 16%. So actually, the risks are only slightly elevated for snowboarders.

Myth Number 2: ‘I’m alright if I didn’t lose consciousness’. It is correct that getting knocked out makes an underlying severe injury more likely but this is not always the case. A small number of people experience a bleed on the brain known as a haematoma. This causes compression of the brain until it no longer functions. This happened in the case of Natasha Richardson (Liam Neilson’s wife). It can happen from a fairly minor knock, often to the side of the head where an important blood vessel lies.

Myth Number 3: ‘Only learners bang their heads’. It’s also the higher end snow users that are pushing their limits. There’s a reason why more and more pros are always riding with one. In addition, many people come in and describe how they were hit by someone out of control. You can be the best rider/skier in Val (unlikely), but it’s also the booze-laden others that you can’t predict, or even the sober ones.

Myth Number 4: ‘I don’t ski/ride steep slopes or park’. A large proportion of head injuries are on green or blue slopes as they maximise the force of impact. A nice steep kicker landing is safer than a flat one too, so you’ll want to be wearing a helmet when you don’t quite have enough speed to reach the landing.

Myth Number 5 : ‘Helmets make you cocky’. No more than wearing a seatbelt makes you speed.

Myth Number 6: ‘You can’t hear as well’. Modern helmets have sorted this problem out. I have not been able to find any evidence to suggest this leads to an accident, nor is there
evidence that people who ski/ride with music or that people with hearing impairments suffer more accidents.

Myth Number 7: ‘Helmets don’t look good on me’. Maybe rethink your priorities. You don’t need to wear it to Dick’s.

What are the advantages of wearing a helmet?:
1. It could save your life.
2. They help prevent lacerations caused by skis/rocks/chairlift/other people’s teeth.
3. They’re warmer
4. You don’t lose them when you rag doll down the hill

If you get a head injury, get checked out. Signs of head injury are: Loss of consciousness; persistent or worsening headache; amnesia; nausea or vomiting; visual disturbance or inability to concentrate. If you have neck pain, or pins and needles in your arms also see a doctor. Come to the Medical Centre if you have any concerns. If you are a regular mountain user, the chances are that you will sustain a head injury at some point, wearing a helmet significantly decreases your chances of brain injury when it does happen. On a personal note, I think mine has saved my life on two occasions. Go get one, and if yours has taken a few knocks, get a new one!

A scientific study has now finally disproved this myth about wrist guards. It is true that you can still break your wrist even if you are wearing guards. But I have another arrangement with my staff : if someone who was wearing guards breaks their wrist badly enough to require an operation I also fork out for a round. Again, I don’t pay out very often. It is a constant source of mystery to me why wrist guards aren’t offered automatically every time you hire a board.

Whenever a new piece of protective gear is mentioned, some smart Alec always comes up with an excuse not to use it. I was around in the 1980s when seatbelts became compulsory in the UK. The counter-argument then was that the seatbelt could dig into the abdomen, rupturing the liver or spleen, conveniently forgetting that without it the casualty would be catapulted through the windscreen.

Helmets are another example. If you ski over a cliff a helmet won’t necessarily save your life, just as a seatbelt wouldn’t be much use if you drove your car over a cliff. But I estimate that 80% of the people we see in the surgery with head injuries would still be out skiing if they had worn a helmet. The most common head injury is a laceration from a ski edge or being clonked by a chairlift, for which a helmet provides almost 100% protection.

The argument against helmets is that the weight of them can cause the head to be thrown around in a fall, increasing the chance of neck injury. Again, a scientific study has shown this is not a significant risk. It is another mystery to me why ski schools insist that children wear helmets in lessons, yet the role model instructor goes without one !

One argument against helmets is that they give you so much confidence that you are likely to ski more dangerously. This is similar to one of the arguments against wearing seatbelts in cars. I’ve heard it before and I’m not impressed. One possible theory that may have some basis in fact is that wearing a helmet reduces your hearing or vision, impeding your awareness of other slope users, and increasing your chances of a collision. To some extent this effect has been reduced with modern helmet design.

The case for back and coccyx protectors is less clear cut, but it makes sense that if you are going to be jumping it would be wise to have an extra layer to cushion your fall if you mess up your backflip !

One final tip for avoiding injury: don’t do that last run of the day. All of the resort runs here act as funnels for people coming down off the mountain after a hard day’s skiing. They will be tired, they may have had a few too many vin chauds over lunch, the pistes are narrow and are often bumpy and either icy or slushy. You might be the best skier in the world, but it would be a shame to be taken out by someone else piling into you. Take the cable car down instead, especially if you too have had some vin chaud

Whenever someone has injured themselves, the first thing the doctor asks is : How did it happen. It is said that 80% of the time the diagnosis can be made from simply taking a history, before even examining the patient. For winter sports injuries the most important piece of information for the doctor is the mechanism of injury. There are completely different patterns of injury for skiers and snowboarders. The overall statistics show that about 3 skiers will injure themselves per 1000 days skiing, versus 4.5 snowboarders per 1000 days riding. This is not necessarily because boarding is more dangerous than skiing, as ability has to be taken into account. In general, the skill level among boarders is lower because there are more beginners, which involves a lot of falling and therefore more injuries.

The most common injury for skiers involves twisting the knee, accounting for 40% of all skiers’ injuries. To a large extent snowboarders are protected from this as both feet are fixed to the board when riding (8% of boarders’ injuries). It’s obvious if you think of a ski as a giant lever that can corkscrew your knee if the binding doesn’t release during a fall. So it comes as no surprise that ligament injuries are common in skiers. Knee fractures are fortunately uncommon. Modern bindings protect against the boot-top tibial fracture that was common in the old days.

Another common injury for skiers is the thumb being bent back by the ski pole during a fall. This can rip one of the ligaments that attaches the thumb to the hand. If the ligament tears completely it needs to be fixed with an operation because it often won’t heal up naturally. Sometimes the ligament is tougher than the bone it attaches to, and the force of the thumb being bent back actually pulls off this bone attachement. These avulsion fractures also often require an operation. Don’t ignore a swollen painful thumb ! My advice is not to use the straps found on ski poles so that you can just drop them during a fall.

For boarders the most common body part to be injured is the wrist, as they often fall onto their outstretched hands (20% of all boarding injuries). Unfortunately this usually results in a fracture, and a simple sprained wrist is much less likely. I will be writing about the pros and cons of wearing wrist guards in a later article about injury prevention, but for now just take it from a doctor that they do work.

The second most common injury in boarders involves twisting the ankle (12% of boarding injuries). Skiers are protected from this to a certain extent by their rigid ski boots. There is much more give in boarders’ boots, allowing more room for the ankle to move around during a fall. Sprains are common, but if the ankle is swollen and you cannot put your weight on it you probably need an X-ray to exclude a fracture.

The snow conditions are another major factor that affects the types of injuries we see in the English Medical Centre. If the snow is hard packed and icy, then fractures are more common. If the snow is deep and heavy, then sprains are more likely. After working here for 12 years I can predict what sort of day I will have at work simply by looking at the snow as I walk across the nursery slopes on my way to the surgery!