Montefiore in the News

By Jacob F. Schulz, M.D.

Winter brings many changes into a family's activities and schedules. Shorter days, colder temperatures, different weather patterns, seasonal activities and sports – all of these can affect the type and frequency of musculoskeletal injuries in children and adults. In 2018, around 200,000 people were treated for injuries related to winter sports, according to the U.S. Consumer Product Safety Commission. While most of these injuries were due to skiing and snowboarding, more than 60,000 were due to ice skating and sledding.

These impressive numbers don't reflect the full variety of winter-related injuries that occur from icy conditions, decreased visibility and cold weather that can lead to slips and falls, and make regular activities like driving more hazardous. While not every family will go skiing this winter, children in most parts of the country will be exposed to different risks in their daily activities. The single best way to avoid injury is to minimize risky behavior and activities in the first place. Sports like skiing and ice skating create uncontrolled situations, and even the most highly trained and experienced participants can sustain significant injuries. Not all injuries can be prevented, but simple precautions and planning can go a long way to keeping kids safe, whether they're flying down a mountain on skis or running to catch the school bus on an icy, wintry morning. Preparation

Maintain fitness: I like to remind kids that sports are optional, but exercise is not. Regular exercise throughout the year improves physical and mental well-being and can lead to fewer injuries. Sixty minutes of play (exercise) per day is easy to remember, but don't feel bad if you miss that goal from time to time. Regular exercise builds endurance that will come in handy at the end of a long day of skiing: Fatigue leads to the breakdown of our mechanics and increases the risk of injuries like anterior cruciate ligament tears.

Warm up: Most parents recognize that your muscles are not as efficient first thing in the morning when you creak out of bed. While children may not be as aware of that feeling, the same principals hold true. Cold muscles are less elastic and more prone to injury. Even five minutes of brisk walking can make a difference. I especially like jumping jacks, since everyone knows them and they get the whole body involved. Don't ignore your shoulders and arms, the arms are important for balance when skiing or skating and protect you when you fall. Wrist fractures and shoulder dislocations are very common in wintry falls.

Nutrition: Patients often ask about vitamins and while some people have specific deficiencies, the data on supplements for most healthy people is limited. The best way to get your nutrients is not from a pill, but from a varied, balanced diet. Calcium and vitamin D are important for bone health and because we have less sun exposure in winter, population levels of vitamin D are generally lower. Dairy products (milk, cheese, yogurt) have the highest levels, so if kids can't or won't eat those, daily vitamins may be beneficial. If you're skiing or will be very active throughout the day, healthy snacks such as nuts, fruit or energy bars are great ways to keep your body fueled.

Hydration: Considering that the human body is about 70% water we should all be drinking more water on a regular basis. Even mild dehydration can affect physical and mental ability. You may not feel as thirsty on a cold day as you do on a hot one; but your body still needs that water, especially if you're physically active. Beware: Sports drinks with lots of sugar or other additives like caffeine do not hydrate the body optimally. In general, water is best. Equipment

Clothing: Dress for the weather requires you to know what to expect but plan for change. For outdoor activities in the winter, several layers of light, loose clothing offer warmth, versatility and protection. A waterproof or water-resistant top layer is a necessity when skiing and probably a good idea most of the time. Appropriate gloves are a necessity when skiing to protect kids fingers from frostbite and to minimize the risk of fractures.

Activity-specific gear: Poorly fitting shoes, ice skates or skis are a recipe for disaster in all activities. Whatever you put on your feet should fit well and be firmly attached to minimize movement between your foot and the shoe, a great way to avoid ankle sprains. I like to remind my patients that shoe laces aren't just decoration. Ski boots and bindings are very technical and should be fitted by a professional. Ski poles can be very helpful on the slopes, but if they don't fit right or you aren't used to them, the risk of injury is higher. Skier's thumb is an injury that occurs when we fall with an outstretched hand while holding a ski pole.

Protective gear: If you haven't gone skiing in a long time, you may have missed the sea change in head protection. Head and neck injuries can be devastating, and everyone should wear a helmet when skiing or snowboarding just like when biking or scooting. Helmets are sport specific, so don't wear your bike helmet on the slopes. A well-fitted helmet will protect you – and also keep your ears nice and warm. Eye wear like goggles can also protect from direct injury and provide better visualization on sunny days.

Environment

Safety: Whether your kids are walking to school or hitting the slopes, taking a few minutes to review conditions for the day can make a big difference in safety. In the city, avoiding busy intersections may make your walk longer but safer. On the mountain, where the terrain is far less familiar than your daily commute, mapping out different trails for different skiing levels can help avoid the all too common situation of a beginner skier standing on the top of an expert trail and feeling trapped. Skiing is like driving: There are lots of other participants on the road or mountain. Watch out for reckless skiers, and please don't act like one.

Judgment: Especially if you're newer to a sport or activity, use the expertise that's available. Listen to the crossing guard and the ski school instructors. Follow all posted signs and warnings and avoid unmarked trails. Listen to your body and know your limitations, especially at the end of a long day when fatigue can make injury more likely. Even older kids and adolescents should always ski with a partner and stay in sight of each other. If you start to feel unwell or have early signs of an injury such as hamstring pain in the back of your thigh, listen to your body and take a break.

Even with the best preparation, equipment and precautions, injuries still occur. Please talk with your kids on a regular basis and before big activities about what to do in the event of an injury or emergency. Know where help is available and how to access it. If your kids get injured, seek medical assistance promptly with your regular pediatrician or at the emergency room. If specialized care is needed, a board-certified pediatric orthopedic surgeon is your best bet for most musculoskeletal injuries. Stay safe this winter, and enjoy the cold weather activities.

Jacob F. Schulz, M.D., Contributor

Jacob F. Schulz, MD, is a board-certified orthopedic surgeon at Montefiore Health System who ...