Skating Injuries - Changes in the Sport

by Christine E. Lawless, MD MBA, Lee Cabell, Ph.D., and Edna Chang-Grant

The Parents Committee recently received a letter from Kathie McDonald-McClure, the parent of a 15-year-old novice skater who experienced chronic back pain due to skating. The committee asked members of the U.S. Figure Skating sports medicine community to co-author this article and address some of McDonald-McClure's concerns.

In her letter to the committee, McDonald-McClure wrote: "Figure skating has undergone some significant changes ... that I believe have dramatically changed this sport's training and competitive aspects and have contributed to a higher risk and incidence of overuse injuries."

Figure skating has indeed undergone significant changes over the last 15 years. These changes included the elimination of figures, the implementation of moves in the field, increased technical and choreographic difficulty, and higher competitive demands for all levels and disciplines. However, the suggestion that these changes have contributed to a higher incidence of overuse injuries requires further analysis.

Figure skating is, by its very nature, prone to overuse injuries. Because of the need to constantly repeat an element in practice, and the resultant repetitive motion of the same bones, muscles and tendons, figure skating is similar to sports such as golf, baseball pitching and tennis. Thus, it is subject to overuse injuries. Golfers' elbow, tennis elbow, and pitchers' elbow are all examples of overuse injuries.

Overuse injuries are not new to skaters nor to experienced coaches. Common overuse injuries include pump bumps, lace bite, tendonitis and stress fractures. Overly stiff boots are believed to cause the majority of these injuries in the foot and ankle, but boots may also contribute to injuries further up the "kinetic chain," like chronic knee pain, shin splints, or back and hip pain.

Boots may not be the only contributing factor to overuse injuries. It is possible that the injury is due to other factors such as the skater's posture and body alignment, the skater's body habitus, skating technique, number of jump attempts, spin position, nutritional status, the skater's psychological state, training methods, level of conditioning, participation in other sports, skater age and stage of development and genetic factors.

There is a lack of sufficient research on figure skating athletes, so the exact incidence of these overuse injuries cannot be stated, or can it be shown whether the incidence is increasing, decreasing or staying the same. It is not known which factors are most important to skaters' development. It's also not known whether the new judging system or the new boot design (new hinged boots allow the skater's ankle to bend more readily, allowing less stress on sensitive joint regions during landing) impact the incidence of these injuries. To suggest that these injuries are on the increase is highly speculative, and such speculation must be followed up by rigorous scientific inquiry.

The U.S. Figure Skating Sports Medicine Committee plans to survey and track data in regional competitors to determine the risk factors and incidence of these injuries. The preliminary work will be followed by a more rigorous comprehensive epidemiologic study.

McDonald-McClure also states in her letter ... "Young growing bodies need time to recover after a hard season of training."

It is true that an athlete's body needs a rest period. This is true not only for a skating athlete but for any athlete. The concept is known as "periodization." Competitions are now year round, making whole-year periodization more difficult, but not impossible, to apply. Figure skating coaches need to be knowledgeable in that regard and convey the information to the skaters and parents. Some authorities feel that extended rest after a grueling skating season is not the answer. It may be more important to not overdo it during each skating session. The challenge is to determine what "too much" is for a given skater, since some skaters can handle a lot more than others.

McDonald-McClure also wrote ... "Unfortunately we never received advice from anyone connected with U.S. Figure Skating that competitive figure skaters should take time off from on-ice training at the end of their competitive season to recuperate."

This brings up a much broader issue. There are many excellent resources that are available through U.S. Figure Skating, International Skating Union and the Professional Skaters Association.

U.S. Figure Skating has long been committed to sports medicine and sports science through the Sports Medicine Committee and Sports Medicine Society. The committee has 30 members who represent various medical and athletic disciplines, and the society is composed of 100 U.S. Figure Skating members who have an interest in figure skating sports science or sports medicine.

Members of both serve as speakers for PSA seminars and U.S. Figure Skating training camps, and write articles for SKATING. Articles are archived at Headquarters.

U.S. Figure Skating Online has great information in the Athlete Programs section (choose Athletes>Athlete Programs>Training Tips). For instance, a periodization schedule can be found here (PDF). The web site also contains a list of sports medicine professionals with their contact information. Those wishing a more specific recommendation can contact Juliet Newcomer at jnewcomer@usfigureskating.org.

The ISU web site contains a document called "Medical Information Book." This booklet, easily downloadable and about 29 pages, is a wonderful resource for all skaters, not just those competing at the international level. It contains general information on figure skating injuries, sports nutrition, traveling smart and off-ice conditioning regimens to prevent injury. Young skaters, because of the vulnerability of their growth plates, are particularly susceptible to overtraining and overuse if rest periods are not fit into their training schedules. Page 16 of the ISU booklet states "the growth of a young skater should be monitored so training can be tapered during phases of rapid growth to avoid injuries specific to children during this phase of development."

The PSA is committed to sports science and sports medicine and includes these subjects in its PSA Ratings Examinations. To prepare for the exam, the PSA has published the "Coaches Guide to Figure Skating Sports Science and Medicine." Contributors included U.S. Figure Skating team physicians, athletic trainers and physical therapists. This 80-page book costs about $24 and is available at the PSA online store.

In order to move forward in communicating this information, the Sports Medicine Committee and Parents Committee have partnered to create a series of seminars on figure skating sports science and sports medicine for parents and skaters. These seminars will be held in 15 cities throughout the country beginning in Denver in June of 2006.