Injuries - Figure Skaters

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2003 31: 511Am J Sports Med

Sanda Dubravcic-Simunjak, Marko Pecina, Harm Kuipers, Jane Moran and Miroslav HasplThe Incidence of Injuries in Elite Junior Figure Skaters

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The Incidence of Injuries in Elite JuniorFigure Skaters

Sanda Dubravcic-Simunjak,*† MD, PhD, Marko Pecina,‡ MD, PhD,Harm Kuipers,§ MD, PhD, Jane Moran, MD, FRCPC, and Miroslav Haspl,‡ MD, PhD

From the *Department of Physical Medicine and Rehabilitation, Sveti Duh General Hospital,and the ‡Department of Orthopaedic Surgery, School of Medicine, University of Zagreb,

Zagreb, Croatia, the §Faculty of Health Sciences, University of Maastricht,Maastricht, The Netherlands, and the University of British Columbia Faculty of Medicine,

Vancouver, and Department of Emergency Medicine and Sport Medicine, Vancouver Island Health Authority, Victoria, Canada

Background: There has been rapid growth in the technical and physiologic demands made on skaters who perform more andmore difficult jumps, spins, lifts, throws, and free skating movements.Purpose: To investigate the frequency of injuries and overuse syndromes in elite junior skaters.Study Design: Questionnaire.Methods: During four consecutive Junior World Figure Skating Championships and the Croatia Cup, we interviewed 236 femaleand 233 male skaters by questionnaire to determine the frequency of injuries and overuse syndromes.Results: Fifty-nine of the female skaters (25%) and 65 of the male skaters (27.9%) reported sustaining acute injuries; 101female (42.8%) and 106 male (45.5%) skaters reported overuse syndromes. Low back pain was reported by 19 female and 23

male skaters. The most frequent acute injury was ankle sprain. In singles female skaters, the most frequent overuse injury wasstress fracture (19.8%), followed by jumper’s knee (14.9%). In singles male skaters, jumper’s knee (16.1%) was the mostfrequent injury, followed by Osgood-Schlatter disease (14.2%). More than 50% of injuries in young singles figure skatersinvolved overuse syndromes. Pairs skaters and ice dance skaters had a higher risk of acute injury than overuse syndromebecause of falls from lifts and throw jumps.Conclusions: Programs to improve postural alignment, flexibility, and strength, especially during the asynchronous period ofbone and soft tissue development, should be instituted to prevent and reduce overuse syndromes.

© 2003 American Orthopaedic Society for Sports Medicine

As a sport, figure skating is recognized as a unique com-bination of art and athleticism. Figure skating is popular

all over the world, but it is a very demanding and expen-sive sport. Because there are many indoor figure skating rinks, the skating season is continuous, with ongoing var-ious major international competitions such as the GrandPrix series, the Grand Prix finals, the European FigureSkating Championship, the World Figure Skating Cham-pionship, and the Olympic Winter Games. Figure skating

includes four disciplines—singles men and ladies skating,pairs skating, and ice dancing. 20

In the past, compulsory figures were a necessary part of the training program, but since 1990, when figures weredropped from the competitive skating, skaters have spentmore time training in free skating. The result has beenrapid growth in the technical and physiologic demandsmade on skaters by the free skating programs. In the freeskating discipline, a skater performs jumps, spins, andfree skating movements. 20

Pairs skating combines free skating elements performedin unison by a pair of skaters, with other elements per-formed together, such as lifts, throw jumps, and coordi-nated and common-axis spins. When the partners aretogether or apart, their movements should be in unison.The lifts (overhead and twist lifts) in pairs skating are

† Address correspondence and reprint requests to Sanda Dubravcic-Simun- jak, MD, PhD, Department of Physical Medicine and Rehabilitation, GeneralHospital: “Sveti Duh” Sveti Duh 64, 10000 Zagreb, Croatia.

No author or related institution has received any financial benefit fromresearch in this study.

0363-5465/103/3131-0511$02.00/0THE A MERICAN J OURNAL OF SPORTS MEDICINE , Vol. 31, No. 4 © 2003 American Orthopaedic Society for Sports Medicine

511 at MCGILL UNIVERSITY LIBRARIES on March 15, 2011ajs.sagepub.comDownloaded from







becoming ever more daring and are increasingly the causeof fall-related injuries. 20

Ice dancing is based on various aspects of dance andemphasizes rhythm, interpretation of music, precisesteps, speed, and carriage. It includes varied dance holds,intricate footwork, deep edges, small lifts, and spins. How-ever, because of the intricate and at times rapid andentwined footwork, falls still occur, often at high skating speeds, causing lacerations and other injuries. 20

Figure skating is a physically demanding sport thatrequires a unique combination of artistic ability, speed,agility, flexibility, and power, all of which can be achievedonly by long-term, persistent training. 4,6,9,25 The increas-ing technical difficulty of figure skating has resulted inheightened demands on physical fitness. Elite figure skat-ers train at least 4 to 6 hours per day, six times per week,for 10 to 11 months per year. 20,25 Despite the amount of training and the intensity of ice skating programs, itseems that injury rates in figure skating are low comparedwith those of other sports. 9,10,15,18

At the competitive level there are increasing demandson athletes to perform more and more difficult elements intheir skating routines. This steady expansion of the “per-formance envelope ” has placed greater demands on thosewho assist the athletes in gaining and maintaining thecompetitive edge. This includes both the coaches whomanage the complex process of performance enhancementand the health professionals who work to prevent andmanage injuries. Unfortunately, injuries may sometimesinterfere with an athlete ’s performance and training. Thetwo types of figure skating injuries are acute injuries,defined here as injuries occurring during a certain, deter-mined, and limited time period, that cause tissue damage,

and overuse injuries, which occur due to microtraumatictissue damage in which the original cause of the injurycannot be proved and, in most cases, the skater neither feelsnot remembers the time of initial tissue damage. 1,8,14

Because of the increasing demands on young figureskaters, some medical concerns have arisen. Because ep-idemiologic studies of injuries in figure skating are rare,especially in junior skaters, the aim of this study was toassess the current incidence of acute and overuse injuries inelite junior figure skaters. A questionnaire was used to col-lect injury data in the elite junior figure skating population.

MATERIALS AND METHODS

This study was conducted at four consecutive JuniorWorld Figure Skating Championships: Zagreb, December1998; Oberstdorf, March 2000; Sofia, March 2001; Hamar,March 2002; and at the Croatia Cup, held in Zagreb inSeptember 1999. A questionnaire consisting of 22 ques-tions was distributed to all participants in all disciplines(men and ladies singles skating, pairs skating, and icedancing) at each competition separately. The question-naire took approximately 15 to 20 minutes to complete.Questions were included on the frequency, site, and typeof injuries (in overuse injuries, the age at which the injuryoccurred was included) incurred by elite junior figureskaters during their skating careers. Inquiry was also

made about injury treatment (nonoperative or surgical)and the amount of time skaters had to stay off the ice. Inaddition, skaters were asked for their current age; the agewhen they started to skate and when they started tocompete; their training frequency, both on and off the ice;and the specific triple jumps and number of triple jumpsperformed. We also inquired about use of orthoses as wellas the age of menarche for female skaters.

The results were collected at the aforementioned skat-ing events for 5 consecutive years and were analyzedtogether at the end of the 2002 –2003 skating season.Skaters who had participated in more than one Champi-onship event completed the questionnaire just once. Sub- jects often responded to the questionnaire with assistancefrom their coaches or team physician, or both. Question-naires were returned by the end of each competition to theInternational Skating Union (ISU) medical advisor incharge of the event. Descriptive statistics was used foranalysis of the data.

RESULTS

Of the 572 skaters who participated in the five events(skaters who participated in more than one event weregiven the questionnaire only once), 469 (82%) correctlyand completely filled out and returned questionnaires:236 were from female skaters (107 in singles skating, 61 inpairs skating, and 68 in ice dancing) and 233 were frommale skaters (104 in singles skating, 61 in pairs skating,and 68 in ice dancing). All of the respondents were be-tween 13 and 20 years of age, with a median age of 16years for female skaters and 18 years for male skaters.

Female skaters began skating when they were between 2and 10 years of age and male skaters began when theywere between 3 and 11 years of age. All of the skatersreported practicing from 2 to 6 hours per day, six times perweek, 9 to 11 months per year.

Injuries in Female Skaters

Among the 236 female respondents, 59 reported sustain-ing acute injuries, 101 reported overuse syndromes, and19 reported low back pain during their junior skating career (Table 1). The acute injuries, together with recov-ery time (time when skaters could not train and compete

because of injury), and their distribution throughout theskating disciplines are shown in Table 2. Some of thefemale singles skaters had more than one overuse injuryduring their skating career. The incidence of overuse syn-dromes, the time of occurrence, and the distribution of overuse syndromes throughout the skating disciplines, aswell as time off the ice because of injuries are shown inTable 3. Stress fracture was the most frequent overuseinjury reported by female junior skaters. They sustained atotal of 26 stress fractures in various locations (Table 4).Fourteen singles skaters and 5 pairs skaters reported thatthey had experienced low back pain during their skating career, but they did not specify whether it was due toacute injury or overuse syndrome.

512 Dubravcic-Simunjak et al. American Journal of Sports Medicine








Injuries in Male Skaters

Among the 233 male respondents, 65 reported sustaining acute injuries, 106 reported overuse syndromes, and 23reported low back pain (Table 1). The type of acute inju-ries and their distribution throughout the skating disci-plines are shown in Table 2. As with the female skaters,some of the male skaters reported the occurrence of morethan one overuse injury during their skating career. Theincidence of overuse syndromes, the time of occurrence,and the distribution throughout the skating disciplines, as

well as time off the ice because of injuries are shown onTable 3. Male skaters reported a total of 18 stress frac-tures (Table 4). Sixteen singles skaters and 7 pairs skatersreported experiencing low back pain during their skating career, but they did not report whether it was due to acuteinjury or overuse syndrome.

DISCUSSION

The frequency and spectrum of overuse syndromes, espe-cially in junior singles figure skaters appear to be increas-ing, as evidenced by a comparison of the data of thepresent study with previous data. In a retrospective study,

Brock and Striowski 5 reported that in 60 Canadian figureskaters, 50% of 28 injuries were acute and only 43% wereoveruse injuries. In another retrospective study, Brownand McKeag 6 showed that acute injuries accounted for thelargest proportion of injuries in singles skating, and thatthe lower extremities were the site of two-thirds of allinjuries. In 1999, Bloch 4 reported that figure skaters whotrain regularly primarily sustain lower extremity injuries,especially overuse injuries. He additionally found that footand ankle problems may be related to the rigidity of theleather skating boot.

Our study showed that the greater percentage of over-use injuries occurs in male and female singles skaters,whereas in junior pairs skaters and ice dancers, a predom-inance of acute injuries is seen. Almost all of the reportedoveruse injuries in our study involved the lower extremi-ties, except for one stress fracture of the lumbar spine inone male skater. Acute injuries involved the head andupper and lower extremities. Other studies have alsoshown that skaters predominantly incur injuries in thelower extremities, although there has been no differenti-ation between acute and overuse injuries. 4,5,15,21 Stressfractures in our study, except for one involving the lumbarspine, were located in the tibial, fibular, metatarsal, and

TABLE 1 Acute and Overuse Injuries in Male and Female Elite Junior Figure Skaters

Injury type

Female skaters ( N 236) Male skaters ( N 233)

Total N 469Singles( N 107)

Pairs( N 61)

Ice dancing ( N 68)

Singles( N 104)

Pairs( N 61)

Ice dancing ( N 68)

N (%) N (%) N (%) N (%) N (%) N (%) N (%)

Acute 16 (14.6) 36 (60.0) 7 (77.8) 23 (18.6) 32 (60.4) 10 (58.8) 124 (26.4)Overuse 80 (72.7) 19 (31.7) 2 (22.2) 85 (68.5) 14 (26.4) 7 (41.2) 207 (44.1)Low back pain 14 (12.7) 5 (8.3) 0 16 (12.9) 7 (13.2) 0 42 (9)

Total 110 (100) 60 (100) 9 (100) 124 (100) 53 (100) 17 (100) 373 (79.5)

TABLE 2 Acute Injuries and Recovery Times in Elite Junior Figure Skaters

Injury

Female skaters ( N 236) Male skaters ( N 233)

Total ( N 469)Singles( N 107)

Pairs( N 61)

Icedancing ( N 68)

Singles( N 104)

Pairs( N 61)

Icedancing ( N 68)

N (%) N (%) N (%) N (%) N (%) N (%) N (%)

Ankle sprain 10 (16.8) 8 (13.5) 2 (3.4) 10 (15.4) 7 (10.8) 2 (3.1) 39 (8.3)Knee ligament

sprain3 (5.1) 1 (1.8) 3 (4.6) 2 (3.1) 1 (1.5) 10 (2.1)

Shoulderdislocation

2 (3.4) 3 (4.6) 5 (1.1)

Laceration, leg 8 (13.5) 4 (6.8) 5 (7.7) 4 (6.2) 21 (4.5)Head injury 8 (13.5) 5 (7.7) 1 (1.5) 14 (2.9)Fracture, arm 2 (3.4) 4 (6.8) 4 (6.2) 2 (3.1) 12 (2.6)Fracture, leg 3 (5.1) 2 (3.4) 4 (6.2) 2 (3.1) 11 (2.3)Knee injury 2 (3.4) 3 (4.6) 1 (1.5) 6 (1.3)Fracture, wrist 3 (4.6) 2 (3.1) 5 (1.1)Fracture, finger 1 (1.5) 1 (0.2)

Total perdiscipline

18 (30.5) 35 (59.3) 6 (10.2) 24 (36.9) 31 (36.9) 10 (15.4)

Total injuries 59 (100) 65 (100) 124 (26.4)Recovery time 2 weeks –2 months 5 days –4 months

Vol. 31, No. 4, 2003 Incidence of Injuries in Elite Junior Figure Skaters 513








navicular bones. In a previous study on stress fractures infigure skaters we saw a lower rate of stress fracturesamong elite seniors skaters than we found among the elite junior skaters in this study. 25 This was especially true forfemale singles skaters, who incurred the stress fracturesin the same locations.

A number of changes in the sport have contributed tothe increase in overuse injuries. 16 Along with the rapid

growth in popularity of figure skating, the number of participants and the hours spent in training have in-creased. Skaters not only now spend more time in freeskating training, but there has also been rapid progres-sion in the technical and physiologic demands of free skat-ing programs. There has also been a trend for children tobegin training seriously at younger ages.

Over half of the injuries in the singles female and male junior skaters in this study were overuse injuries thatoccurred during their junior skating careers, except fornine figure skaters with Osgood-Schlatter disease thatoccurred when skaters were still in novice categories. It iswell known that most overuse injuries can be preventedwith proper education and training programs to improve

flexibility, muscle balance, and jumping and skating tech-nique. 13,24 – 26 Only 11 of the 469 questionnaire respon-dents indicated that their right leg was used for landing jumps. Our study indicates that the overuse injuries werefound to occur in both the landing and take-off legs. Thus,these overuse injuries occur not only because of thegreater impact on the landing leg, but also because of themany jump repetitions during each practice session. Ni-

kolic et al.21

studied 25 figure skaters (mean age, 13.9years) from all disciplines during a summer training camp. All 25 skaters took part in national and interna-tional competitions in the 1997 to 1998 seasons. For skat-ers between the ages of 8 and 14 years, 13 (60%) injuriesinvolved the lower extremity, whereas in skaters between15 and 20 years of age, 19 (70%) injuries involved thelower extremities. The most frequent complaints wereknee pain, shin splints, and, to a lesser extent, midfootpain. In the most experienced skaters, acute injuries andtibial periostitis occurred most frequently during summertraining. The study showed that methodical “off-ice train-ing ” could be useful in preventing injuries that result fromphysical imbalance.

TABLE 3Overuse Injuries (and Age Range at Onset) and Recovery Time in Elite Junior Skaters

Injury

Female skaters ( N 236) Male skaters ( N 233)Total

( N 469)Singles( N 107)

Pairs( N 61)

Ice dancing ( N 68)

Singles( N 104)

Pairs( N 61)

Ice dancing ( N 68)

N (%) N (%) N (%) N (%) N (%) N (%) N (%)

Jumper ’s knee 15 (14.9) 4 (3.9) 17 (16.1) 2 (1.9) 38 (8.1)(13 –17) (13 –17) (13 –18) (14 –16)

Stress fracture 20 (19.8) 6 (5.9) 14 (13.2) 4 (3.8) 44 (9.4)(14 –18) (14 –17) (16 –18) (15 –18)

Shin splints 14 (13.9) 4 (3.9) 8 (7.5) 4 (3.8) 2 (1.9) 32 (6.9)(14 –18) (14 –17) (15 –17) (15 –17) (15 –17)

Groin pain 8 (7.9) 2 (2) 1 (1) 10 (9.4) 3 (2.7) 4 (3.8) 28 (5.9)(12 –16) (13 –17) (18) (12 –18) (15 –19) (16 –18)

Ankle impingement 3 (2.9) 5 (4.7) 8 (1.7)(14 –16) (15 –17)

Achilles tendinitis 4 (3.9) 1 (1) 5 (4.7) 10 (2.1)(11 –17) (15) (12 –17)

Osgood-Schlatter disease 9 (8.9) 3 (2.9) 15 (14.2) 4 (3.8) 31 (6.6)(11 –14) (11 –13) (12 –15) (12 –14)

Plantar fasciitis 2 (2) 4 (3.8) 6 (1.3)(14 –16) (15 –17)

Hamstring syndrome 5 (4.9) 3 (2.8) 2 (1.9) 10 (2.1)(14 –18) (16 –18) (17 –19)

Total per discipline 80 (79.2) 19 (18.8) 2 (2) 81 (76.4) 19 (17.9) 6 (5.7)Total overuse 101 (100) 106 (100) 207 (44.1)Recovery time 6 weeks –5 months 5 weeks –18 months

TABLE 4Number and Location of Stress Fractures in Elite Junior Figure Skaters

LocationFemale skaters Male skaters

Singles Pairs Ice dancing Singles Pairs Ice dancing

L4 transverse process 1Navicular bone 3 1 2Metatarsal bones 8 2 4 2Tibia 7 2 5 2Fibula 2 1 2

Total 20 6 0 14 4 0









In pairs skating and ice dancing, acute injuries occurredmore often than overuse syndromes. The acute injuriesalso tended to be more severe, because of falls from orig-inal acrobatics and complicated overhead lifts and tripleand quadruple throw jumps. Smith and Ludington, 28 in a9-month prospective study among elite pairs and ice danceskaters, reported that 11 serious injuries were caused bylifts and 7 were directly related to the skating boot. Onlya few of the serious injuries appeared preventable. Theysuggested that only by changing the boot design and train-ing for lifting maneuvers can the unacceptably high injuryrate among elite pairs skaters be reduced. Brown andMcKeag 6 reported that most lift-related injuries in pairsskaters are contusions, lacerations, fractures, hematomas,and muscle strains.

Brock and Striowski, 5 in a study of injuries in 64 na-tionally ranked Canadian figure skaters, found that 29skaters (45%) sustained a significant injury over a 1-yearperiod. There were an equal number of overuse and acuteinjuries. Sixty percent of the acute injuries, in nine figureskaters, were jump-related. The authors attributed theoveruse injuries to the minimal time spent stretching. Inanother study investigating the career injuries of 19 com-petitive figure skaters, Smith and Micheli 29 found thatthere had been 52 overuse injuries and only 8 acute inju-ries. Both studies revealed few serious injuries, especiallyin comparison with sports involving similar training de-mands, such as gymnastics. Smith and Micheli believedthat the majority of overuse injuries could be preventedwith an appropriate warm-up period and improved flexi-bility exercises. In a later study, Smith 27 stressed thatskaters who participate in a well-designed off-ice training program that incorporates maintenance of the normal

flexibility of lower extremity muscles can decrease theincidence of overuse symptoms of the knee. She believedthis was especially true in the growing athlete.

Figure skating is the only jumping sport that limits themovement of the ankle joint and calf muscles by the use of rigid boot support. The high heel and inflexible ankleportion of the boot do not allow skaters to use their ankleseffectively in plantar flexion during jump take-offs or tocushion their landing. In our investigation, ankle sprainswere common injuries in figure skaters; similar findingshave been reported by Authorsen et al., 2 Bloch 4 andDanowski and Le Blond. 9 The skater ’s conditioning pro-gram should therefore incorporate exercises to maintain

and improve on the inherent proprioception and stabilityof the ankle. 9

The force absorbed by the knee extensor mechanismduring landing contributes to the development of anteriorknee pain and overuse injuries. Symptoms can manifestas jumper ’s knee and Osgood-Schlatter disease, both of which were reported by the female and male junior figureskaters (singles and pairs) in our study. Such injurieshave also been reported by Bloch, 4 Haspl et al., 12 Smith, 27

and Brown and McKeag. 6

Our research also revealed low back problems in elite junior skaters. This has also been reported by Omey etal., 23 who found that figure skating, as well as gymnasticsand dancing, was associated with a high risk of spondylol-

ysis, or a stress fracture of the posterior vertebral ele-ments. Other than overuse and acute injuries, low backpain was found to be the most frequent complaint insingles and pairs figure skaters; they believed this wasdue to the repeated hyperextension and disc loading of thelow back during frequent jumping and landing. It is rec-ognized that, in many sports, indiscriminate, repetitivetraining regimens are associated with pathologic lesionsat the tendinous junctions, tendoperiosteal attachments,and immature epiphyseal plates. 7,8,14

The median age of menarche in our study group was 15years. Lockwood, 16 in 1997, reported that the mean age atpuberty of male and female skaters was 14 1.73 (Tannerstage 3). Ross et al. 26 also, as Lockwood 16 in 1997, foundthat both male and female figure skaters matured laterthan the average population. Stress, intensive physicaltraining, and lean body mass are associated with delayedmenarche, by a couple of years, in women figure skaters,gymnasts, rhythmic gymnasts, synchronized swimmers,divers, distance runners, and ballet dancers when com-pared with the normal, noncompetitive popula-tion. 3,11,17,19,21,32,33 Vadocz et al. 31 observed in 159 com-petitive figure skaters (national level, pre-elite, and elite)that girls who matured early (menarche 12.0 years)were not represented in competitive figure skaters, andthey reported that later maturation was characteristic of competitive figure skaters, particularly in elite, more spe-cialized pairs skaters. Ziegler et al., 33 who studied associ-ations between body image, dieting behavior, and nutri-tional status in junior figure skaters, also found thatinadequate energy intake and delayed menarche werewidespread in women in this athletic group.

Asynchronous development of bone and soft tissue dur-

ing this stage of maturation, in which there are periods of rapid growth (growth spurts) and loss of flexibility, pro- vides significant additional risk of injury. During suchdevelopmental phases, it is clinically sensible to reducethe training load imposed on young athletes. Oleson etal. 22 measured the bone mass density in competitive fig-ure skaters and found that skaters without history of stress fracture have significantly greater estimated bonemass density compared with skaters with a history of stress fracture and compared with age-matched, nonath-letic control subjects. They concluded that stress fracturesin adolescent skaters are not caused by low bone massdensity but by excessive forces placed on a normal skele-

ton. By directly comparing the take-off and the landing foot, they found that the landing foot had a greater esti-mated bone mass density than the leading one. They sug-gested that coaches place greater emphasis on strength-ening the lower extremity and musculature of the take-off foot, even before the skater starts to land double jumps.

It is recognized that correcting the lower extremity bi-omechanics can prevent overuse injuries and that skatersfrequently have anomalies of their feet. 7,24,25 At thechampionships in which our 236 female subjects com-peted, only 55 wore orthoses, and, of the 233 male subjectsin this study, only 58 used orthoses. This was despite thefact that 98 of the female and 96 of the male skatersreported feet anomalies. Orthoses were made either by









footprint mold, especially for an individual skater, or bycomputerized walking analysis, and then placed either inthe figure skating boot or in other walking and training shoes.

Most of the injured skaters who responded to our ques-tionnaire were treated nonoperatively with various phys-ical therapy modalities. In the acute stage, rest, ice, com-pression, and elevation, combined with use of nonsteroidantiinflammatory drugs was the main method of treat-ment. Later on, modalities were used such as electrother-apy, ultrasound therapy, laser therapy, magneto therapy,electrical stimulation of hypotrophic muscles, hydro-kine-sitherapy, and kinesitherapy. Emphasis was placed onstrengthening and stretching exercises. Some of the inju-ries were also treated by acupuncture therapy. 30 Someinjured skaters needed minor surgical treatment (to re-pair lacerations of the scalp and leg) and, because of theseverity of injury, four skaters needed major surgery —onefemale skater underwent hip surgery and three male skat-ers had knee surgery (arthroscopy for meniscal and liga-ment repair).

In light of the increasing demands on young elite figureskaters and because of the increasing overuse injury inci-dence, medical care and preventive measures should beemphasized. It is important to stress that good posturalalignment, adequate flexibility, and sufficient strengthare basic requirements for the athletic and artistic com-ponents of figure skating. Correct biomechanics, gradualincreases in training time and intensity, as well as pro-gressive development of muscle strength and flexibilityare the keys to avoiding overuse injuries. The areas thatpredominantly require flexibility are the lower extremi-ties (quadriceps muscles, gastrocnemius-soleus muscle

complex, and hamstring muscles), trunk (extensors andflexors and lumbosacral fascia), and upper extremity (ro-tator cuff and other shoulder muscles). The areas thatrequire strengthening are the primary muscles for jump-ing (gluteus maximus, gluteus medius, hamstring, quad-riceps, gastrocnemius-soleus, and tibialis anterior mus-cles) and trunk stability, as well as the abdominalmuscles, which work to stabilize the spine. In pairs skat-ers, upper body strength is particularly important forpreventing injuries that occur during lifts. Figure skatersshould work on increasing ankle strength and propriocep-tive ability so that active muscular stability and responsetime is developed and maintained. 20,24

CONCLUSIONS

It is important to stress that there is a tendency toward anincreasing incidence of overuse injuries in junior singlesskaters and acute injuries in pairs skaters. Of the 469 junior figure skaters in this study, 79.5% had acute inju-ries, overuse syndromes, or low back problems during their skating career. Among overuse injuries in singlesfemale skaters, stress fractures had the highest relativefrequency (19.8%), followed by jumper ’s knee (14.9%). Insingles male skaters, jumper ’s knee was the most frequentinjury (16.1%), followed by Osgood-Schlatter disease(14.2%). More than 50% of injuries in singles figure skat-

ers involved overuse syndromes. Among pairs skaters andice dance skaters, acute injuries were more frequent thanoveruse syndromes, with the reason being falls from liftsand throw jumps. Almost all overuse injuries were locatedin the lower extremities, except for one stress fracture of the lumbar spine in one male skater. Acute injuries involved the head and upper and lower extremities.

Physicians, physiotherapists, and physical educatorsmust be responsible to advise, guide, and monitor thetraining of young skaters. It is also important to educatecoaches, administrators, and parents about the suscepti-bility of young athletes to both acute and overuse types of injury. A multidisciplinary approach to children in sportmust address both the external precipitants of injury(footwear, surfaces, weight training) and the intrinsic fac-tors (growth, muscle-tendon imbalance, flexibility), whichare unique to immature athletes and skaters. Onlythrough good postural alignment, adequate stretching andstrengthening training programs, especially during theasynchronous development period of bone and soft tissue,can overuse syndromes be prevented and reduced.

Competitive sport for children must integrate bothsafety and fun to have long-term positive impact on devel-opment. Only those with talent and patience for adequatetraining programs will become the stars of the future.

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Injuries - Figure Skaters