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Figure Skating; Common Back Injuries and The Role of Physiotherapist

By: Paul Messner, Registered Physiotherapist

 

Figure skating is a technically difficult sport combining athletic power and artistic finesse. Most competitive figure skaters train 4-6 hours per day for 11 months of the year. Due to the demanding training regime, figure skaters are susceptible to atraumatic and chronic overuse injuries which generally occur in the foot, ankle, knee, hip, and lower back.

Lower Back Pain

Due to the nature of the sport, figure skaters are predisposed to a variety of over use low back injuries to the lumbar and pelvic region. The lack of flexibility of the skate limits ankle and knee movement. To compensate, skaters must increase the movement at the hip and back to maintain balance which accumulates stress in the area over time. Unlike ballet, figure skaters always jump and spin in the same direction (counter clockwise is most common).  Multiple falls and landings on the same leg causes constant loading and tension on the corresponding side of the pelvis. Treatment involves exercising the deep abdominal muscles that stabilize the skater’s spine and pelvis. A physiotherapist familiar with the sport will understand that if a skater is repetitively rotating to the left, this will significantly increase the core muscles on the left side of their body more than their right side. This imbalance in musculature predisposes an athlete to injury. Taking a proactive approach, a physiotherapist will have the athlete do core rotational exercises only to the opposite direction they turn during their off ice training  to prevent future risk of injury. This will help to balance the muscles stabilizing the back and pelvis, decreasing the strain from repetitive unilateral rotation and loading.

Spondylolysis

Competitive figure skaters have a high risk of a spondylolysis which is a stress fracture found in the pars interarticularis of the lumbar vertebrae. Skaters who rotate counter-clockwise and land on their right leg are more likely to obtain this injury to the right side of their vertebrae. Repetitive load bearing with a hyperextended lumbar spine increases the risk of fracture. This is especially prominent in male pair skaters performing overhead lifts with an arched back. Understanding the risk factors of overtraining is key because a spondylolysis in a patient past the age of puberty has a low chance of healing with a bony union. “Spondy’s” generally heal with a weaker fibrous union. Treatment includes complete rest and use of a back brace. If healing does not occur wearing a back brace 23 hours a day for 6 monthes , a surgical approach is warranted. A big problem with competitive figure skating athletes is they often do not like to take time off their sport. If a spondylolysis is not adequately treated there is a high risk of a spondylolisthesis.

 Spondylolisthesis

A serious condition where the fracture becomes unstable and the whole vertebrae shifts out of place, generally warranting surgery.  Physiotherapists play a crucial role of identifying potential vertebral stress fractures, managing them, and taking preventive actions to ensure the progression to a spondylolisthesis does not occur in figure skating. The classical clinical sign of a vertebral stress fracture is pain with combined extension and rotation towards the side of the fracture – warranting an x-ray. It is beneficial for any figure skater with long term low back pain to consult a physiotherapist.

Injury Prevention

 The literature indicates that 50-78% of figure skating injuries are preventable. A multidisciplinary approach involving a physician, physiotherapist, athletic trainer or kinesiologist, nutritionist, orthoptist and sports psychologist together with the skater, coach, and parents are key component to be healthy and successful in sport.

Reference List:

  • Omey, M., Micheli, L., Gerbino, P., (2000). Idopathic Scoliosis and Spondylolysis in the Female Athlete
  • Porter, E., Young, C., Niedfeldt, M., Gottschlich, L., (2007). Sport-Specific Injuries and Medical Problems of Figure Skaters.

 

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