Injuries in cross-country skiing: a critical appraisal of the literature.

This study comprehensively reviews and critically appraises recent literature on cross-country skiing injuries. Particular attention was paid to the study design when reviewing the literature, thereby producing a measure of internal and external validity. From these data, the factors associated with the aetiology, frequency, site distribution and types of cross-country skiing injuries are examined. The incidence of injury in cross-country skiing is estimated to be between 0.49 and 5.63 per 1000 skier days. The most common injuries are medial collateral ligament sprains of the knee, and ulnar collateral ligament sprains of the thumb. Overuse and cold injuries (e.g. hypothermia and frostbite) appear to be common as well, although the data do not provide an estimate of incidence. Comments in the literature on prevention of these injuries are mainly empirical: they recommend safer equipment, wise choice of terrain and a general increase in skier awareness of ways to prevent injury. However, rigorous studies that adequately evaluate preventive intervention strategies have yet to be conducted. Cross-country skiing is relatively safe and a suitable activity for physical fitness and rehabilitation. In the future, studies employing an analytical design will be required to evaluate the effectiveness of injury prevention intervention strategies.