Cross-country skiing is a popular alpine sport. It can be one of the most physically demanding of all sports, involving most of the body's muscles, and requiring a sustained cardiovascular and respiratory output. It is also ideal as a recreational sport, and can be enjoyed by individuals of all ages. Cross-country skiing includes ski-touring, defined trail skiing using the diagonal stride or skating techniques, and cross-country/downhill skiing. Cross-country skiers have been estimated to account for approximately 20% of all participants in alpine sports. The most common type of cross-country skiing injuries are sprains/twists, fractures and bruises. The most frequently injured body regions are the knee, arm/hand and the ankle. Risk factors for injury include poor condition of ski tracks; unsuitable or inferior equipment; poor balance, inadequate mastery of the cross-country skiing technique and overuse. The aim of this report is to present a critical review of the extent to which the effectiveness of cross-country skiing injury countermeasures has been evaluated and to make recommendations for further research, development and implementation. Countermeasures specifically reviewed in this report include: ski pole handle design, ski bindings and equipment, skiing technique, pre-season conditioning, ski lessons, clothing, adequate nutrition and reduced alcohol intake, standards for skiing equipment, environmental factors, ski patrollers, first aid, rescue equipment and general resort safety. Little is known about cross-country skiers, their characteristics, aetiology and injury patterns, equipment related factors and the relationship between injury patterns and causal factors such as skiing ability, equipment, snow conditions and terrain. Some cross-country injuries are similar to those among alpine skiers. This suggests that countermeasures that have been effective in preventing alpine injuries, such as improvements in equipment design, may also prevent cross-country injuries. More attention needs to be directed towards preventing cross-country injuries, including data collection and epidemiology studies of injury patterns, studies of the mechanisms of injury and the safety of equipment.
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