• paralympic
• injury
• alpine skiing
• downhill
• risk reduction
• Paralympic Games
• Pyeongchang

The sport of Para alpine skiing at the Sochi 2014 Paralympic Winter Games has been under the spotlight as having the highest injury incidence rate (IR) compared with other sports on the programme,1 and also compared with alpine skiing at any previous Paralympic Winter Games.2 3 A secondary analysis of the Paralympic Injury and Illness Survey for the Sochi Games has allowed for a more detailed reporting of injury mechanism.

In Sochi, a total of 175 athletes (131 male, 44 female) participated in the Para alpine skiing competitions. This comprised 65 seated athletes and 110 standing athletes. The overall injury IR in alpine skiing was 48.3 (95% CI 40.1 to 56.4) injuries per 1000 athlete-days, while the overall injury proportion was 30.9 (95% CI 24.0 to 37.7) injuries per 100 athletes. The comparative injury IR in the different athlete categories is shown in figure 1.

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Figure 1

Injury incidence rate (IR) in Para alpine skiing at the Sochi 2014 Paralympic Winter Games.

Upon further analysis of the data, it was concerning that large proportions of athletes (see table 1) failed to complete the course. Additionally, 42% of injuries required more than 1 day missed from training or competition.

In fact, the injury IR in Para alpine skiing at the Sochi Paralympic Games represented a sixfold increase in acute alpine ski injuries from the Vancouver 2010 Paralympic Games, which cannot be due only to chance.2 Indeed, the downhill event and steeper (upper) course settings should be targeted for preventative measures.

Furthermore, previous literature has demonstrated a relationship between ambient temperatures (and thus snow conditions) with injury incidence.4–7 The Sochi 2014 Paralympic Winter Games were indeed exceptional in this regard. An average temperature of +3.6°C and +5.1°C, respectively, was recorded in the alpine skiing venue for the full duration of the Games (IPC, unpublished data), with temperature data ranging from −1.9°C (start, slalom) to +10.8°C (finish, Super G). Furthermore the Para alpine skiing events were held at Roza Khutor (altitude 940–2320 m, with race starts no higher than 1600 m). Thus, it is hypothesised that environmental factors related to temperature and altitude, with resulting effect on snow conditions, were likely contributors to the high injury IR observed.

In turning our focus to the Pyeongchang 2018 Paralympic Winter Games, it is notable that many of the same environmental risk factors, such as high ambient temperatures, may again be at play. To be as proactive as possible, the IPC Medical Committee has been in productive discussions with the World Para Alpine Skiing management team to ensure that injury risk and prevention is part of the agenda for Pyeongchang. Planned measures include:

• There has been an increase in provision of training runs, especially for the downhill event, to familiarise athletes with the course and to allow for continuous adjustments to the course line prior to the official competitions. Earlier start times in the day to take advantage of more optimal snow conditions.

• The Alpine venue allows for a more optimal start location on the course avoiding steep grades in response to previously reported high injury risks on steep sections in Sochi.

• Based on experiences during the 2017 test event, the course design will be widened, given that narrow courses are associated with tighter turns and by inference higher incidence of injury. This 2017 course setting will be accurately replicated through GPS methodology.

• The course design and preparation includes ‘waves’ as opposed to jumps—a particularly high-risk manoeuvre for Paralympic mono skiers.

• Members of the IPC Medical Committee will be in constant radio communication with the race officials to understand race conditions and race facts in real time.

• Official pre-Games technical and medical briefings will include an education programme for team medical and coaching staff.

• Appointment of an independent race director, who will facilitate an independent view regarding safety issues and will have the final call to amend start times, postpone or cancel an event if the conditions are deemed too hazardous.

It is acknowledged that there is an inherent risk associated with downhill skiing, and in particular in para athletes who push the limit at a pinnacle event such as the Paralympic Winter Games. Yet, the pertinent question is how high of an injury rate is just too high? At what point would repeated severe injury mandate cancellation or postponement of an event? To witness more than one in three athletes sustain injury may be just one step too far, at least for healthcare professionals entrusted to protect the health of the athlete. It is our hope that the combined preventative efforts of the IPC Medical Committee and the World Para Alpine Ski management team prove to be effective, and that a far lower injury rate is observed at the Pyeongchang 2018 Paralympic Winter Games.