Oriol Bonell Monsonís

Returning to a high level of performance after injury is a significant challenge for athletes. However, current best practices for return-to-performance in competitive snow sports are not well understood due to a lack of research evidence and international harmonisation. The International Ski and Snowboard Federation commissioned this consensus statement to provide recommendations for the safe and successful return of competitive alpine and freestyle skiers and snowboarders to competitive performance. An international consensus panel was formed to contribute their knowledge and perspectives on return-to-performance. The panel included experts with extensive experience in return-to-performance. The panel consisted of 23 experts (7 women and 16 men) from various skiing and snowboarding disciplines and levels of competition. It included 16 researchers, 6 snow sports or International Olympic Committee officials, 9 physicians, 6 physical therapists, 2 sports psychologists, 2 coaches and 2 former athletes, some of whom had two backgrounds/functions. However, it was disproportionately European (78%) and North American (13%), with minimal representation from South America (4%) and Africa (4%) and no representation from Asia or Australasia. The RAND-UCLA Appropriateness Method was adopted for the underlying consensus process. First, the panel discussed which topics and questions should be included in the consensus statement before developing an overall structure. The consensus process then involved providing key content based on the literature or statements from experts/panel members. These were voted on three times by all the panel members, resulting in a list of 196 statements. The jointly developed overall structure and the final statement list then formed the basis for preparing the manuscript. This consensus statement aims to assist athletes, coaches and medical staff of international and national federations in planning and implementing safe and successful return-to-performance strategies for competitive alpine and freestyle skiers and snowboarders.

To enhance performance, increase resilience and prevent injuries, training and testing (T&T) are the most important strategies for preparing athletes for the demands of their sport. However, for competitive snow sports such as alpine skiing, freestyle skiing and snowboarding, there is little evidence and a lack of international harmonisation of current best practices. This consensus statement, commissioned by the International Ski and Snowboard Federation (FIS), aims to provide recommendations for the physical and psychological T&T of competitive alpine and freestyle skiers and snowboarders within National Ski and Snowboard Associations. A diverse international consensus panel was selected to represent the subject matter regarding gender, nationality, expertise/background, level of competition and skiing and snowboarding discipline. Researchers, officials, physicians, physiotherapists, coaches and former athletes with extensive experience in the field were among the experts. However, the panel had a limited gender balance (seven women and 13 men) and was over-represented by European members (65%) and North American members (20%), whereas there was limited representation of perspectives from South American (5%), Australasian (5%) and African (5%) experts and a lack of experts from Asia. In the first step, the panel established an overarching structure of topics and questions to be addressed by the consensus statement. Following the RAND-UCLA appropriateness method, the consensus process subsequently included panellist ratings, discussions and revisions informed by statements derived from the literature or expert/panellist opinions. These two outcomes served as the basis for manuscript writing, which was finalised through two iterative rounds of manuscript feedback and revision. This consensus statement aims to help athletes, coaches and medical staff of international and national federations plan and implement effective T&T activities for competitive alpine and freestyle skiers and snowboarders.

Previous research has shown that stakeholders in the competitive alpine skiing communities consider risk management to be crucial in sports injury prevention. However, to date, there is a lack of a publicly available systematic and structured risk management approach for the competitive alpine skiing context. This work describes the codevelopment process of a risk management framework with stakeholders in the field of competitive alpine skiing. A panel of international experts invited through personal requests and with expertise in health protection and performance enhancement in competitive alpine skiing convened three times through online group meetings to co-develop a risk management framework through different activities. The underlying discussions focused on the fundamental questions of ‘why’, ‘what’, ‘who’, ‘how’ and ‘for whom’ and included the debate on specific examples from sports practice. The outcome after three meetings was a risk management framework. This framework includes a competitive alpine skiing-specific prevention wheel that integrates different stakeholder views relevant to different levels, their risk priorities, the main five domains and intervention areas identified from the literature, the graded and progressive timescale to intervene and the potential targets for risk management interventions. Moreover, the framework includes a decision-making tree, which operationalises the prevention wheel into a step-by-step sequence for risk management, including risk identification, risk assessment and risk mitigation. It should help stakeholders recognise their responsibilities and the potential actions they can take. Practical examples are provided to demonstrate how to apply the framework and to illustrate the complexity and dynamic interaction of the various factors in the competitive alpine skiing setting. The risk management framework developed lays a strong foundation for creating a safer environment for alpine skiers. It likewise contributes to providing overall awareness of the complexity and inter-relations of risks and prevention measures in the sport. By doing so, this framework has the potential to initiate further processes and on-field translation to sustainably and long-term improve athlete health and safety in competitive alpine skiing.

In diverse sports, warm-up (WUP) and cool-down (CD) activities are highly effective at improving performance-relevant factors and reducing the risk of injury when applied systematically; however, scientific evidence is widely lacking in snow sports. Similarly, there is a lack of international harmonisation with current best practices; this especially applies to prevention efforts targeting younger athletes. This International Ski and Snowboard Federation (FIS) consensus statement aims to develop and promote recommendations regarding physical and psychological WUP&CD in competitive alpine and freestyle skiers and snowboarders. The selected panel members represented a group of experts diverse in terms of gender, expertise/background, level of competition and skiing and snowboarding discipline. They included researchers, officials, physicians, physiotherapists, coaches or former athletes with extensive experience in the subject area. However, there was a gender imbalance in the composition of the panel (7 women and 13 men) and certain freestyle disciplines (eg, aerials and moguls) were under-represented. Most importantly, there was a strong over-representation of European members (85%) on the consensus panel. For the consensus process, the RAND-UCLA Appropriateness Method was used. The panellists were asked to rate, discuss and rerate statements derived from the literature or expert/panellist opinions. The process was based on three online consensus sessions with different preparatory and follow-up tasks and three rounds of an online survey to vote on the statements. The final version of the FIS consensus statement was developed and approved after two iterative rounds of manuscript revision by the panel members. It is intended to guide athletes, coaches, medical staff of international and national federations and other entities who can promote and support appropriate WUP&CD practices for competitive alpine and freestyle skiers and snowboarders by providing support, resources or infrastructure.

Background: Injury and illness prevention practices in competitive snow sports must be better understood among stakeholders. In particular, there is a need for a greater understanding of what context-specific stakeholders require for prevention. Therefore, this study surveyed stakeholders’ current practices, needs, responsibilities and knowledge dissemination preferences related to injury and illness prevention in competitive snow sports and described the main commonalities and differences between stakeholder groups. Methods: We conducted a cross-sectional study that used an online survey developed using Kipling’s principle (the “5W1H” method) and targeted athletes, coaches, team staff, ski racing suppliers, and representatives from all competition levels and all competitive snow sports governed by the International Ski and Snowboard Federation. The data were analysed following both quantitative and qualitative descriptive analyses. Results: Most of the 436 respondents believed in and reported needing more information on injury and illness prevention. The participants stated that the main goal of prevention was to avoid injuries and minimise their time away from being on snow, and they stressed their different underlying motivations. Despite the differences across subgroups, participants highlighted knee and head injuries and concussions as their primary injury prevention targets and priorities for additional information. Respiratory and cardiovascular illnesses were reported as their main targets of illness prevention, but more information on all illnesses was reported. Current practices and priorities for additional information fell under athlete-, equipment-, snow/environment-, and course-related prevention areas. Moreover, stakeholders highlighted their need for more information on mental health and training. Shared responsibilities were identified across the development, dissemination, and implementation of prevention, along with stakeholders’ preferred communication channels. Conclusions: Our study provides meaningful insights across athlete, equipment-, snow/environment-, and course-related prevention areas related to snow sports, roles, and competition levels. These insights may inform the development, dissemination and further implementation of any tailored and context-driven preventive measure by better addressing end-users’ needs. These findings may support successful future preventive interventions by providing key elements and a clear path to improve athletes’ health and safety.

Background and Objective: Competitive alpine skiing, snowboarding and freestyle skiing, all different in nature and risks, are known for their high injury and illness burden. Testing measures and training methods may be considered for athletes’ preparation to support performance enhancement while safeguarding their health. We explored the perspectives and perceptions of competitive alpine skiing, snowboarding and freestyle skiing stakeholders regarding testing and training practices in their competitive snow sports. Methods: We conducted an exploratory qualitative study based on grounded theory principles through 13 semi-structured interviews about testing and training practices with athletes, on-snow and off-snow coaches, managers and healthcare providers from different national teams. The interviews were inductively analysed through a constant comparative data analysis. Results: Participants described winning as the end goal of testing and training practices, which requires athletes to perform in their best condition. To do so, they mentioned two main targets: performance enhancement and health protection. Participants acknowledged health as a premise to perform optimally, considering testing and monitoring approaches, goal setting, and training to support and protect athlete performance. This continuous cyclic process is driven by communication and shared decision making among all stakeholders, using testing and monitoring outputs to inform goal setting, training (e.g. on-snow and off-snow) and injury prevention. Such an approach helps athletes achieve their goal of winning while being fit and healthy throughout their short-term and long-term athletic career development. Conclusions: The ultimate goal of testing measures and training methods in such competitive snow sports is winning. Performance enhancement and health protection act as pillars in systematic, tailored and flexible processes to guarantee athletes’ best preparation to perform. Moreover, athletes’ assessments, goal setting, monitoring tools, open communication and shared decision making strongly guide this cyclic process.

Objectives High-performance snow sports (HPSS) athletes compete in a performance-driven context with a high risk of injury. While there is a lack of evidence on effective prevention measures in snow sports, this study explored the perspectives and perceptions of HPSS stakeholders on sports injury prevention. Methods We conducted an exploratory qualitative study based on the grounded theory principles through 11 semistructured interviews with athletes, coaches and healthcare providers from different national teams about sports injury prevention. The interviews were inductively analysed through constant comparative data analysis. Results Participants defined risk management as a central concept in which they approached injury prevention by assessing, managing and sometimes accepting risks. Many factors, such as athlete-related and external factors, are considered in this process, ultimately influencing their decision-making. Participants acknowledged the value of experience when managing and dealing with risks, a key aspect of their learning process and career development. Within this context, open and trustworthy communication and shared responsibilities among all stakeholders influenced and shaped injury prevention strategies and behaviours. Understanding and balancing out speed and risks was considered pivotal in their daily practice. Therefore, injury prevention awareness, ownership, communication, teamwork and shared responsibilities may contribute to the success of sports injury prevention in HPSS. Conclusion These findings substantiate the significance of such contextual factors in sports injury prevention. Considering the high-risk nature of HPSS, injury prevention suggests a shift towards risk management strategies, with a strong emphasis on contextual factors and their interactions. Young athletes might benefit from educational interventions centred on developing skills to assess and manage risks.

Background: Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues.Materials and Methods: We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title–abstract screening, and one performed the full‐text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix.Results: Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season.Conclusions: We provided an in‐depth and comprehensive overview of the current state‐of‐the‐art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context‐driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.