Three seasons ago, FIS set up the so-called FIS Injury Surveillance System (FIS ISS) to systematically collect facts and figures on injuries that happen to elite athletes across the FIS disciplines. The FIS Injury Surveillance System operates under the guidance of the FIS Medical Committee and a special Steering Committee. After three seasons of data collection principally at the FIS World Cup level, a next step in the project, special video analysis on the ACL injury mechanisms, is underway. In this interview, Roald Bahr MD PhD, chair of the Oslo Sports Trauma Research Center, the research partner for the FIS ISS, comments on the findings and future focus of the project.
The FIS ISS would not have been possible without the generous support by DJO (www.djo.eu), a global specialist in rehabilitation and regeneration products for the non-operative orthopaedic, spine and vascular markets.
Q. What is the role of the Oslo Sports Trauma Research Center for FIS ISS and how did that come about? Who else is involved?
Roald Bahr: It is now more than four years since the FIS Medical Committee approached the Oslo Sports Trauma Research Center (OSTRC) to develop a surveillance system for injuries covering all FIS events. We were fortunate to receive financial support from DJO (then: donjoy), the leading global provider of high-quality orthopedic devices, which meant that the project could be launched in 2006. The project relies on many members of the FIS family: FIS technical delegates, team medical staff, skiers and coaches, to provide information on injuries and their circumstances. The research group at the OSTRC includes two PhD-fellows, Tonje Flørenes MD and Tone Bere PT MSc, as well as a number of our other senior research staff and students. The project is guided by a Steering Committee with Hubert Hörterer, Chairman of the FIS Medical Committee, Eero Hyvärinen and Hans Spring as members, and the follow-up projects involve ski injury researchers from Germany, Canada and Austria.
Q. The current season is the fourth season the FIS Injury Surveillance System is implemented. What are the most important findings you have collected during the first three seasons?
Roald Bahr: The data from the first three seasons show that although the injury rate, especially the rate of serious knee injuries, is high, there has been no increase in injury rate since the surveillance was started in 2006. The injury rate has been stable, with about 40 time-loss injuries per 100 athletes every season in the alpine, snowboard and freestyle disciplines. The injury pattern also seems to be stable. The main concern is that every third injury is classified as severe; these are generally season-ending injuries, mainly to the knee. Those who are interested in more detailed results from each of the different disciplines will be able to access these in reports under publication in leading sports medicine journals or here. So far, three scientific papers have been accepted for publication. Whether the 'avalanche' of serious knee injuries we have experienced at the beginning of the 2009-2010 season reflects a true increase, or if the many injuries we have witnessed during the first few weeks is just coincidental, we do not know until we have the full data after the season.
Q. What is the present focus of the FIS ISS and how is it developing?
Roald Bahr: The second phase of the FIS ISS project has seen a shift towards more practical orientation. Although the FIS ISS will continue to collect data on all injuries, the present and future direction for the project is being provided by the FIS Race Directors together with the Steering Committee. In phase two of the project, OSTRC's focus is on video analyses to understand the detailed and specific causes of injuries. Through the FIS ISS we have been able to identify injuries in the World Cup since November 2006, and we are using this information to obtain videos of the accidents. After the first three seasons, we now have a sufficient sample to begin analyses of the injury tapes in earnest and the Steering Committee has decided that the first focus area is serious knee injuries (anterior cruciate ligament injuries) in Alpine Skiing.
Video material is being analyzed by a group of biomechanists and ski injury experts, who are focusing on the injury biomechanics. The videos are also analyzed by a group of expert coaches and athletes, who are focusing on the events leading up to the injury situation. These analyses include evaluation of the circumstances of injury, the skiing situation, skier behavior/technique, equipment, skiing conditions, course setting, etc. During the week of the Kvitfjell races, we hope to include a number of the World Cup coaches and skiers in the analyses. In addition, with cases where we have two good quality camera views available, we are using the model-based image-matching method Poser to estimate joint kinematics more precisely. This is a novel method which has been developed at the OSTRC, and which allows us to assess joint motion much more precisely than previously possible.
When FIS first set out to establish an injury surveillance system, the first task was to determine how to best record the injuries occurring during the season. The first year, we tested three different methods; injury recording by FIS Technical Delegates, by medical staff of selected teams and by end-of-season interviews with athletes and their coaches. The data showed that the most reliable method was athlete interviews. However, because these will be time-consuming and costly we still have high hopes that the necessary data can be collected successfully by Technical Delegates and that this season will become a turning point in that respect. What is clear is that the issue of injuries is being taken very seriously by everyone involved.
Q. What are the practical next steps to implement the FIS ISS's findings at different levels of skiing?
Roald Bahr: As a part of the second phase, the FIS ISS has just begun the video analyses so it is too early to give much specific advice on the causes of injury and therefore possible ways to reduce injury risk. The second phase also engages teams at the University of Salzburg led by Professor Erich Müller and at the Technical University of Munich led by Professor Veit Senner who are working directly with FIS Chief Race Directors Atle Skaardal and Günter Hujara. Both of these universities have conducted several studies on ski injuries, have extensive experience in snow sports and have joined to contribute their knowledge into the FIS ISS.
Professor Müller will present his current work and the project launched just before Christmas to the FIS Alpine Executive Board in Kitzbühel and the World Cup coaches in St Moritz (ladies) and in Kitzbühel (men). Several meetings have already taken place with athletes and coaches as well as with the industry and this exchange will continue during the Audi FIS Ski World Cup during the season under the leadership of the Steering Committee together with Atle Skaardal and Günter Hujara.
The new project will in the short term be based on expert interviews with athletes, coaches, service staff, representatives of the equipment industry and other key stakeholders. It's purpose is to try to find consensus among these groups on the most important next steps for injury prevention. In the long term, Professor Müller's project is focused on methodological biomechanical measurements both in practice and in lab environment to seek solutions for injury prevention over time.
However, it is unlikely that it will be possible to develop a 'magic bullet', a single solution to the injury problem. Rather, a range of measures to prevent injuries will be reviewed, which will involve equipment regulations, course preparation, course setting and safety measures. There will always be an element of risk involved in skiing and snowboarding at the highest level; this will never be eliminated. The point is for everyone involved to do as much as they can to try to reduce the risk of injury.
Q. From a partner's perspective is there any special message that you would like to deliver to FIS and what do you expect from this season?
Roald Bahr: On behalf of the FIS Injury Surveillance System, I would like to thank the extended FIS family for its support following the project's launch in 2006. Since the first data on injury rate and patterns were available in the summer of 2007, we have seen awareness and interest in injury prevention grow rapidly. The FIS ISS greatly benefits from the leadership and knowledge of the FIS Medical Committee experts and the FIS Race Directors. Also, the strengthened engagement of the athletes and coaches this winter will help reach a better understanding of what goes wrong when skiers are seriously injured.
