Abstract
Objective
To evaluate the association between environmental conditions, specifically air temperature and cloud conditions (eg, sunny, partly cloudy, or cloudy/foggy), and types of injuries sustained by skiers and snowboarders.
Methods
We conducted a retrospective observational study of adult patients (≥18 y of age) who presented with skiing- or snowboarding-related musculoskeletal injuries at a Utah ski resort clinic during the 2022–24 ski seasons. Data were extracted from electronic medical records and included demographics, injury type, air temperature, and categorized cloud conditions. Statistical analyses included bivariate comparisons using χ2 analysis and analysis of variance and adjusted analyses using multinomial logistic regression.
Results
A total of 1813 patients were included; 62.2% were male, and 81.3% were skiers. Ligamentous knee injuries were the most common injury (31.3%). Unadjusted analysis showed a significant association between temperature and injury type (P<0.001), with higher temperatures linked to more upper extremity injuries and lacerations. Cloud condition showed no significant association with injury patterns (P=0.99). In the adjusted analysis, only head injuries remained significantly associated with temperature: For each 1°C increase, the odds of head injury increased by 6.4% (odds ratio = 1.06; 95% CI, 1.02–1.11; P = 0.01). Cloud conditions were not significantly associated with any injury type.
Conclusion
Higher temperatures are associated with a modest increase in head injuries among skiers/snowboarders, whereas general cloud conditions do not significantly impact injury type. These findings suggest that while temperature may influence injury risk, particularly for head injuries, other factors likely contribute to injury patterns.
Introduction
Skiing and snowboarding are popular winter activities, but they carry a significant risk of injury, including fractures, knee injuries, and dislocations.1–8 Although numerous studies have examined the types of injuries that occur during skiing or snowboarding, few studies have examined the impact of cloud conditions and air temperature on types of injuries. Moreover, these studies have focused primarily on collisions between skiers and snowboarders or falls.8–13 From 2000 to 2019, an estimated 1,620,576 patients were seen in emergency departments across the United States for skiing- and snowboarding-related injuries. 1 As such, the impact of snow conditions on skiing and snowboarding injuries is a topic of interest because it can help inform injury-prevention strategies.
Objective
This study aimed to evaluate the effects of environmental conditions on injury types sustained by skiers and snowboarders by examining (a) the influence of air temperature and (b) the impact of cloud conditions (eg, sunny, partly cloudy, or cloudy/foggy).
Methods
Design and Settings
This was a retrospective observational study. We reviewed patient records from a medical clinic at a major ski resort in Utah between November 2022 and May 2024. The clinic operates daily and is staffed by 1 physician, 1 nurse, 1 radiology technician, and 1 medical assistant at all times. During the 2022–23 ski season (November to April), the clinic served 1383 patients, averaging 230 patient per month.
Study Population
Inclusion criteria were adults (18+ y of age) presenting with musculoskeletal injuries sustained while skiing or snowboarding. Exclusion criteria included individuals under 18 y of age and those with non-musculoskeletal complaints. This study received ethical exemption from the University of Utah Institutional Review Board.
Data Source and Variables of Interest
Data were extracted from the clinic's electronic medical records, which included patient demographics, injury characteristics, and cloud conditions. Independent variables were air temperature (in °C) and categorized weather (eg, sunny, partly cloudy, or cloudy/foggy).
The primary outcome of interest was the type of injury sustained during skiing or snowboarding. This outcome was classified into 6 categories: head injury, upper extremity injury/fracture, back/thorax/abdomen injury, lower extremity injury/fracture (excluding ligamentous knee injuries), ligamentous knee injuries, and lacerations/abrasions/minor injuries.
Additional covariates included the participant's age, gender, sport type (ski/snowboard), injury time, residency status (local/visitor/employee), and injury laterality (left/right/midline/bilateral).
Statistical Analysis
Descriptive statistics were used to summarize the baseline characteristics of the full cohort. To assess bivariate associations between baseline characteristics and type of injury sustained, χ2 tests or Fisher's exact tests were performed. One-way analysis of variance was used to examine the association between the continuous variable (ie, air temperature) and the 6 injury categories because temperature data were normally distributed.
To further evaluate the impact of air temperature and cloud conditions on the injuries experienced by skiers and snowboarders, multinomial logistic regression was performed because the outcome variable consisted of 6 categories. Relevant covariates were accounted for in the models. Stepwise variable selection was employed as part of the model-building strategy. Multiple models were created and assessed for fit by comparing −2 log likelihood (−2LL) and Akaike information criterion (AIC). The final model was selected based on the lowest −2LL and AIC. All statistical analyses were conducted using IBM SPSS Statistics, version 30 (IBM Corp, Armonk, NY).
Results
The study included 1813 participants, of whom 1127 (62.2%) were male. The most represented age group was 18 to 29 years (38.3%). The mean air temperature was −2.6°C (SD = 5.4). Most cases occurred under sunny conditions (54.3%), followed by cloudy/foggy weather (37.0%) and partly cloudy conditions (8.8%). Regarding sport type, skiing was more common (81.3%) than snowboarding (18.7%). Most incidents occurred between 1100 and 1400 (45.7%), with fewer occurring in the early morning (15.6%). Visitors constituted the majority of participants (70.7%), followed by locals (24.9%) and employees (4.4%). The most common injury locations were the left (43.5%) and right (39.5%) sides of the body, whereas bilateral (15.3%) and midline injuries (1.7%) were less frequent. Ligamentous knee injuries were the most prevalent injury type (31.3%), followed by upper extremity injuries (23.9%) and lower extremity injuries (21.8%). Back, thorax, and abdominal injuries accounted for 9.8%, whereas lacerations and minor injuries made up 5.7% (Table 1).
Baseline Characteristics (N=1813).
a Lower extremity injury excluding ligamentous knee injuries.
Bivariate Association
Our unadjusted analysis showed a significant association between temperature and injury type. The mean temperature varied across injury categories, with upper extremity injuries occurring at higher average temperatures (−2.3 ± 5.6 °C), whereas back/thorax/abdomen (−3.1 ± 5.0 °C), lower extremity (−2.9 ± 5.3 °C), and ligament/knee injuries (−2.9 ± 5.3 °C) were more frequent at lower temperatures. Lacerations were observed at a mean temperature of −2.8 ± 5.7 °C (P<0.001). These findings suggest that higher temperatures may be associated with a greater likelihood of falls leading to upper extremity injuries and lacerations, potentially due to softer snow conditions.
In contrast, cloud conditions, categorized as sunny, partly cloudy, and cloudy/foggy, did not show a statistically significant association with injury type (P=0.99; Table 2). Interestingly, compared with females, males had a higher proportion of most injuries, including upper extremity injuries (69.1%), back/thorax/abdomen injuries (71.3%), and lacerations (84.5%). Females, however, had a higher proportion of ligamentous knee injuries (53.6%).
Injury Distributions by Weather and Demographic Factors: Unadjusted Analysis (N = 1813).
Effect of Weather and Temperature on Type of Injury: Adjusted Analysis
Our multinomial regression analysis examined the effects of temperature and cloud conditions on the likelihood of different injury types, using minor injury as the reference category. The model was adjusted for age, gender, time, and residency status. The model with the lowest −2LL and the lowest AIC was selected as the final model. The results of this model showed that temperature had a statistically significant effect only on the likelihood of head injury (odds ratio = 1.06, 95% CI: 1.02–1.11, p = 0.01). This means for every 1-unit increase in temperature, the odds of experiencing head injury (compared with minor injury) increased by 6.4%. However, temperature did not show a significant association with other injury categories (Table 3). In contrast, cloud conditions did not demonstrate statistically significant effects on any injury type (Table 3).
Effects of Temperature and Weather Conditions on Injury Type (Multinomial Regression Analysis).
Note: Adjusted for age, gender, time, and residency status.
a Weather reference category: cloudy/foggy.
Discussion
This study examined the effects of temperature and cloud conditions on the likelihood of different injury types. Both unadjusted and adjusted analyses indicated no significant association between cloud conditions and injury patterns. However, regarding temperature, we initially found a significant relationship between temperature and injury type, with higher temperatures being associated with a greater likelihood of upper extremity injuries and lacerations. After adjusting for age, gender, time, and residency status, this association was attenuated. In the adjusted analysis, temperature had a statistically significant effect only on the likelihood of head injury (odds ratio = 1.06, 95% CI: 1.02–1.11). No significant associations were found between temperature and other injury types. This attenuation suggests that the relationship between temperature and injury may have been influenced by other factors accounted for in the adjusted model.
The relationship between environmental conditions and injury type has been minimally explored in the existing literature. Prior work by Pierpoint et al at a Colorado ski resort found that injury rates were higher on days with minimal snowfall (<2.5 cm) and relatively warmer temperatures (−3.1°C or higher). 14 Similarly, Hasler et al identified poor visibility and older snow as significant risk factors for snowboard-related injuries. 15 In contrast, our study did not identify any consistent or clinically meaningful relationship between weather or temperature and specific injury types, aside from the modest association between higher temperatures and head injury.
Several factors may account for these discrepancies. First, terrain-specific characteristics may influence injury risk independently of environmental conditions. The ski area in our study is known for its steep, technical slopes, which may lessen the influence of snow conditions by attracting more experienced visitors with a higher baseline skill level. 16 Additionally, modern ski and snowboard equipment—including improvements in binding release mechanisms, protective gear, and materials—may help prevent injuries that were more sensitive to environmental variability historically.
Resort operations also may play a critical role in mitigating the effect of variable snow conditions. Grooming practices and avalanche-mitigation efforts can create a more standardized skiing condition across a range of weather conditions, reducing the impact of weather on injury patterns. Lastly, behavioral adaptations by skiers and snowboarders may buffer the influence of adverse weather. Individuals may ski more conservatively or avoid more challenging terrain during poor conditions, reducing their overall injury risk.
Although no significant relationship was identified between the variables in our study and injuries sustained (beside a modest relationship between increased temperature and head injury), there were significant associations on injury distributions between gender, sport type, and age category. Females experienced significantly more ligamentous knee injuries (44.3% female vs 23.3% male). Females are known to have a higher prevalence of ligamentous knee injuries, particularly in anterior cruciate ligament (ACL) injuries, compared with males. 17 Anatomic differences such as having a smaller ACL, hormonal influences that promote ligamentous laxity, and neuromuscular factors that promote greater valgus angles during landing are just a few reasons why females are more prone to ligamentous knee injuries.17–22Skiers also had a much higher rate of ligamentous knee injuries than snowboarders (36.2% vs 9.7%), also a well-known phenomenon demonstrated in the literature. 21 Additionally, ligamentous knee injuries were most common in the 40- to 49-y age group, accounting for 40.5% of injuries in that demographic. This is partially reflected in the literature, which has shown that although males have a peak incidence of ACL injuries in their early twenties, females have a bimodal distribution of ACL injuries—one in their teens and another in their forties. 22 Given that these findings are consistent with previously published literature, this concordance reinforces the validity of our results and suggests that the patterns observed in our population may be generalizable to similar ski resort settings.
Limitations
This study has several limitations. First, the sample size for certain injury subtypes, such as lower extremity dislocations, was limited. To address this, we merged certain injury types into broader categories, allowing for more robust statistical analysis but limiting the evaluation of injury subtypes. Second, the study was conducted at a single ski resort in Utah, which may limit the generalizability of the findings. Additionally, our weather categorization (ie, sunny, partly cloudy, or cloudy/foggy) lacked granularity and did not account for snowfall, visibility, wind, or snow types—factors that may affect injury risk.
Participant status (eg, local, visitor, or employee) introduced behavioral variability not fully controlled in the analysis. Unmeasured confounding factors, such as equipment quality, individual risk-taking behaviors, trail difficulty, terrain, or skill level of participants were not accounted for. Despite these limitations, our findings contribute to the existing body of knowledge on skiing and snowboarding injuries and underscore the importance of considering environmental factors in injury-prevention strategies. By understanding how these factors influence injury risk, ski resorts and medical professionals can develop more targeted interventions to enhance safety for winter sports enthusiasts.
Conclusion
Our unadjusted analysis demonstrated a significant association between temperature and injury type, with higher temperatures linked to an increased likelihood of upper extremity injuries and lacerations, possibly due to softer snow conditions. However, cloud conditions (ie, sunny, partly cloudy, or cloudy/foggy) were not significantly associated with injury type. After adjusting for age, gender, time, and residency status in our multinomial regression model, temperature remained a significant predictor only for head injuries. Specifically, for every 1°C increase in temperature, the odds of sustaining a head injury (compared with minor injuries) increased by 6.4%. No other injury categories showed a significant association with temperature after adjustment, and cloud conditions remained nonsignificant. These findings suggest that while temperature may influence injury risk, particularly for head injuries, other factors likely contribute to injury patterns. Further research is needed to examine additional environmental and biomechanical factors to improve prevention strategies in snow sports.
Footnotes
Ethical Considerations
This study received ethical exemption from the University of Utah Institutional Review Board.
Consent to Participate
This was a retrospective chart review and deemed not to require consent to participate from the University of Utah Institutional Review Board.
Author Contribution(s)
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability
Please contact the corresponding author at maiyajacqueline@gmail.com for data information.