Abi Okell

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.

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.

Background and Aim: Given the high risk of low back pain (LBP) in alpine ski racers, this study investigated episodes of LBP over a competitive ski season and examined associated factors. Methods: A prospective non-consecutive case series ( n = 5) of international alpine ski racers was conducted over 36 weeks. Participant characteristics, previous injury, and measure of trunk strength were collected at the start of the season whilst information on LBP was collected fortnightly. Descriptive statistics and odds ratio (OR) from a generalised linear model are presented. Results: Three female and two male cases were involved. Response rates ranged from 83 to 94%. All cases reported experiencing LBP (6.7–88.0% of responses). Most cases continued normal training or competition, though training was reduced (cases 2 and 5) or stopped (case 5) due to LBP in some cases. All but one case reported LBP impacting performance (minor to major) extent. Older (OR = 0.43, p = 0.048) and male (OR = 0.09, p < 0.001) racers had less odds of an episode of LBP. Taller individuals (OR = 1.39, p = 0.004), the pre-season phase (OR = 5.12, p = 0.045) and on-snow training hours (OR = 1.07, p = 0.192) were associated with greater odds ofepisodes of LBP. Inconclusive associations were found for trunk strength, competition, and off-snow training (OR = 0.54–1.01, p = 0.215–0.602). Conclusion: Alpine ski racers commonly report low back pain, necessitating training modifications and impacting performance. Practitioners working in alpine skiing should consider strategies to better manage the pre-season period and prolonged periods of on-snow training, particularly for athletes with known risk factors (e.g. taller individuals) or a history of LBP.