29 Nov Wrist Injuries
FOOSH! While in après ski resort bars this may be the sound skiers make to recant their best turn or take off for a jump in medical circles it is an abbreviation for „Fall on out -stretched hand‟. The reason why there is a universal acronym for note taking is that it is a very common way to cause an upper limb injury. As most people will know snowboarding involves quite a bit of foosh-ing, especially amongst learners, in fact one study showed 43% of those with wrist injuries were boarding for the very first time. It has been said that in a ski resort everyone you see with crutches is a skiers and everyone you see in a sling is a boarder and there is a certain amount of truth to that. Wrist injuries are the most common when falling onto the hand. The wrist is the single most common site of injury amongst snowboarders – an area that is rarely injured whilst alpine skiing.
Many times in Hakuba Physio we see boarders come in to tell us that they fell on their wrist, but “it‟s not fractured because I can still move it a little”. Sure enough when we convince them to get an X-ray, it is indeed fractured. As 75% of wrist injuries are fractures it‟s a good rule of thumb (wrist?) to assume it‟s a fracture unless proven otherwise.
So how do we prevent this all too common injury? Falling with the fist clenched in the hope that the impact is absorbed over a wider surface area and by several structures has been suggested. However, there is no evidence to support this theory and, because falls can occur so quickly, who would really remember to do this in the split second of a fall? Wrist guards have often been recommended, but many people will tell you not to wear them as they “move the fracture further up the arm”, or “make the break bigger when it does go”, so let me finally lay these chestnuts to rest.
Several laboratory and field based studies have proven beyond doubt that wrist braces are effective in reducing fractures. Four studies „harvested‟ both forearms and hands from cadavers one fitted with a brace and the other without, and both subjected to increasing loads to see when they would fracture. The load required to cause a fracture was more than three times larger in the wrist fitted with a brace. In field studies, the Colorado Snowboard Injury Survey, collated information from over 7000 snowboard injuries, this study demonstrated that snowboarders wearing wrist guards were half as likely to injure their wrists as snowboarders not wearing guards. In Norway two groups of first-time snowboarders were compared – 551 wearing guards the researcher gave them and 1800 who did not wear guards (acting as the control group). No wrist injuries were seen in the group wearing guards, compared to 40 such injuries in the group without guards on.
One problem is that there is a lack of standardization in guards. Look for ones that are larger and with a degree of flexibility. The French model Flexmeter are the best. So there is really no excuse for not wearing your guards, especially if you are a first time boarder. Best of luck out there fooshing!