Thursday, December 8, 2016

Sentinel Events for Skiers, Snowboarders, and Mountain Bikers

Ski season is starting here in the Pacific Northwest, so many of my patients are getting ready to enjoy the winter

An important concept with sports like skiing, snowboarding, and mountain biking is a sentinel event, which is a term I use for a small biomechanical mishap that may be a precursor to a more significant injury
The model I base this on is from strokes. If we look at patients who have a devastating stroke, a significant percentage of them have a smaller "mini-stroke" in the month preceding the major stroke. Some patients ignore these mini-strokes because they are either unaware of what happened, don't recognize their significance, or feel a sense of relief that they don't have any long-term disability. This is a shame, because in the period following a mini-stroke, there is a window of opportunity where they can intervene and prevent a more devastating stroke from occurring.

The same concept applies to devastating injuries during skiing, snowboarding, and mountain biking. There are a few common elements of these sports that make them prone to devastating injuries, namely:

A. The body can gather significant momentum

B. Falls are common. High speed falls are common

C. The terrain is inconsistent

D. They require a persistent vigilance to notice changes in terrain so that you don't fall

Prior to having a devastating fall in any of these sports, it's common for the athlete to have a "sentinel event", where they have a smaller stumble that is often ignored. This is a mistake, and athletes should pay attention to these smaller mistakes, even if there is no lasting consequence

For example, a skier may notice that as they become tired, they may not notice a small change in terrain and end up taking a turn more aggressively than they should. They may have a mild fall, or merely require an atypically higher level of exertion

I encourage athletes to pay attention to these sentinel events, they are often a sign of fatigue. Specifically, they can be from two forms of fatigue:

A. Cognitive fatigue. Their brain may not be acclimated to the duration of exercise, so they are paying less attention to the small details

B. Muscular fatigue. They may be using muscles they haven't used in a while, so while their muscles were fine for the first hour of exercise, they are not as efficient after an hour or so

What is the treatment for these sentinel events? Give yourself permission to take a break

This may seem like common sense, but there are a few reasons, particularly for skiers and snow boarders, that may make them less willing to take breaks. The biggest of these is time investment. Especially for people driving to their ski facility, there is a substantial time commitment to even start skiing, so the idea of not "maxing out" their time on the mountain seems wasteful. I encourage these patients to think long term, and taking a short break to prevent a devastating injury is a good use of time and resources.

Big picture - taking a short break following a sentinel event is one of the best investments an athlete can make to prevent permanent disability.