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With our first real snowstorm of the season this past weekend and more snow forecast for later this week, now is the winter of our discontent.

Unless you are a skier. And if skiing is your sport, not only is the current weather ideal but, over the last 20 years, your favorite activity has become far safer.

Except when it comes to anterior cruciate ligament injuries and fatalities, because those numbers have remained steady.

A literature review published this month in the medical journal Sports Health reported that international standards for ski-boot-binding systems has dramatically reduced the incidence of lower leg fractures. Furthermore, with helmet use now at 80 percent on the slopes, the number of head injuries has seen a similar drop.

As in other sports, the stubborn ACL injury occurs more frequently among women. Men are at greater risk of all other injuries and that statistic is largely attributable to males consistently engaging in far riskier behavior than females.

While skiing is much safer than it was two decades ago, the review authors found opportunity for improvement. Specifically, they pointed to an experimental ACL injury awareness program that reduced severe knee sprains by 62 percent at 20 participating ski areas. There were 22 other ski areas studied simultaneously that did not implement the program and experienced no such decline.

While snow may be cause for celebration among skiers, for everybody else it means shoveling, where knee injuries are the least of one’s worries. Instead, for someone who hasn’t done anything physical since the last time it snowed, shoveling means sore shoulders, an aching back or even a heart attack.

To avoid all three, the American Physical Therapy Association recommends the following:

• If possible, wait until the afternoon to shovel. Many disc injuries occur in the morning when there is increased fluid pressure in the disk.

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• Lift smaller loads of snow, bend your knees and lift with your legs rather than your back.

• Avoid excessive twisting and forward bending. Step in the direction in which you are throwing the snow to prevent the lower back from twisting.

• Take frequent breaks when shoveling. Stand up straight and walk around periodically to extend the lower back. Standing extension exercises will help reverse the excessive forward bending of shoveling — stand straight and tall, place your hands toward the back of your hips and bend backward slightly for several seconds.

• Don’t hold your breath. It puts unnecessary pressure on your heart, reducing blood flow and oxygenation, making cardiac arrest more likely.

Basketball is the indoor winter sport where cardiac arrest is most common. A study, also in the current issue of Sports Health, demonstrated how effective it is to have an automated external defibrillator on site. Published online in the fall and previously featured in this space, the study demonstrated an 89 percent survival rate when an AED was present and only 33 percent when one was not.

That same study showed how rare sudden cardiac arrest is in another winter sport, wrestling. A total of 132 cases of sudden cardiac arrest were documented nationwide among athletes age 11-27, between July 2014 and June 2016. Basketball and football accounted for more than half (72). Meanwhile, only two wrestlers were stricken.

A major risk for wrestlers, though, is skin infection. So said a third article in the current issue of Sports Health. Methicillin-resistant staphylococcus aureus, better known as MRSA, is a constant worry and will occur in roughly 1 percent of high school wrestlers each year. Worse, more than three-quarters of college wrestlers are carriers of the bacteria, a far higher rate than any other sport.

Other common infections among wrestlers include herpes gladiatorum, caused by a herpes simplex virus, and tinea corporis gladiatorum, caused by a fungus and also known as ringworm.

Authored by physicians from the University of Iowa, the literature review warned that prevention techniques are of limited value. Instead the article concluded by recommending early detection of such skin infections and withholding affected athletes from competition until no longer contagious.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.

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