Ski fitness: exercises for skiing and snowboarding, the injuries they bring, and what actually prevents them

Skiers hurt their knees, snowboarders their wrists

Over 18 seasons at a Vermont resort, ACL sprains were 17% of skiing injuries but 2% of snowboarding injuries, and wrist injuries were 28% of snowboarding injuries but 3% of skiing injuries.

Source 1

Two common ways skiers tear an ACL

The commonest is falling backwards with your hips below your knees and your weight on the inside edge of the downhill ski's tail. Another is landing a jump back on the tails with your legs straight.

Sources 2, 3

Learning to spot them helped ski staff

Patrollers and instructors who learned to recognise and respond to those situations had 62% fewer serious knee sprains, with no fall in areas that didn't train. It wasn't randomised.

Source 4

Helmets and wrist guards work

Helmets cut the odds of a head injury by about a third, with no rise in neck injuries. Wrist guards cut snowboarders' wrist injuries by about three-quarters.

Sources 5, 6

Fitness helps, but isn't proven to prevent injuries

No study shows that pre-season training prevents recreational ski injuries. Being fitter does help you ski more runs with less fatigue.

Sources 7, 2

Altitude and your heart

Altitude sickness usually starts above about 2,500 m. Sudden cardiac deaths while skiing are linked with a past heart attack and high blood pressure, so check with your GP first if that's you.

Sources 8, 9

Runs of a minute or two, again and again

Recreational skiing is a series of runs, often of 1 to 2 minutes, with rests on the lift; in one study, skiers spent 44% of their time on the hill actually skiing. In 6 older recreational skiers (average age 61), heart rate averaged 77% of maximum while oxygen use averaged only 45%, and systolic blood pressure rose to about 170 mmHg after 30 minutes. In 38 recreational skiers, the slope and the speed drove heart rate more than age, sex or skill, and in 19 healthy adults, short turns took heart rate above 90% of maximum.

Sources 10, 11, 12, 13

A bent-knee stance under load

Skiing is mostly lowering (eccentric) work by the thigh muscles, with holding and some lifting, depending on skill, speed and terrain. In ski racing no single system dominates: strength, aerobic and anaerobic fitness all matter, and technique matters most.

Sources 10, 14

Knees for skiers; wrists and shoulders for snowboarders

Skiers most often injure a knee, and snowboarders a wrist, shoulder, collarbone or ankle, often in a fall forwards or backwards onto the hands.

Sources 1, 15

Altitude and cold

TravelHealthPro, the UK's travel health service, calls 1,500 to 3,500 m high altitude, and the UK's National Health Service (NHS) lists some places in the Alps among those where you can get altitude sickness. Blood pressure and heart rate rise at altitude.

Sources 16, 8, 10

How often skiers and snowboarders get injuredEmerging evidence

Studies count injuries in different ways, from ski patrol reports to clinic records and self-report, so their rates differ widely and can't be compared directly.

• Western Canadian resorts, 2008 to 2018 (107,540 injury reports): 2.24 injuries per 1,000 skier days, slowly falling. Knees were injured most often in skiers and wrists in snowboarders, and 12.8% of the injured needed emergency transport.
• Amateur skiers and snowboarders (43 studies pooled): 1.9 injuries per 1,000 skier days, with very large differences between studies.
• A Vermont resort, 1988 to 2006: on average one injury for every 345 days of snowboarding and every 400 days of skiing.
• Eight Norwegian resorts (3,277 injured people and 2,992 uninjured): snowboarders had about twice the odds of injury of skiers, and beginners nearly three times the odds of others.

Sources 15, 17, 1, 18

The ACL: the skier's knee injuryEmerging evidence

The ACL is the commonest serious injury in skiing. In 282 recreational skiers whose knee injuries were confirmed by scans at an Austrian clinic, every one involved the ACL. A 2025 review linked ACL injury in skiers with being female, less skilled or older, taking risks, worn boot soles and bindings that didn't release; a case-control study added fresh, grippy or icy snow, very cold weather and easy slopes. Our ACL injury guide covers what happens next.

Sources 2, 19, 20, 21

The MCL and the meniscusEmerging evidence

Of the 182 ACL injuries with damage elsewhere in the knee, about half also involved the medial collateral ligament (MCL), on the inside of the knee, and 40% the inner meniscus. In Vermont, MCL injuries became less common over time. Our MCL sprain and meniscus tear guides cover these.

Sources 19, 1

Wrists, shoulders and collarbones in snowboardersStrong evidence

Wrist injuries were 28% of snowboarding injuries in Vermont, and snowboarders had more shoulder sprains and strains, collarbone fractures, ankle injuries and concussions than skiers. Beginners in their first 5 days and people on hired equipment had the most wrist injuries. Our wrist sprain and shoulder dislocation guides cover what to do.

Sources 1, 22

Head injuriesStrong evidence

Head injuries were 17.6% of injuries in Norwegian resorts, and snowboarders had more concussions than skiers in Vermont. The warning signs below give the NHS and UK concussion guidance.

Sources 23, 1

Leg fractures and skier's thumbEmerging evidence

Lower leg fractures were more likely in skiers, beginners and children. Thumb ligament injuries, known as skier's thumb, became less common in Vermont over time.

Sources 18, 1

ACL awareness training, as trialledEmerging evidence

Using videos of ACL injuries and data on more than 1,400 of them over 22 years, Vermont researchers identified two common ways skiers tear the ACL. In the 1993 to 1994 season, ski patrollers and instructors at 20 ski areas watched videos of knee injuries happening and learned to recognise and respond to the risky situations; 22 areas without the training were the comparison.

Among 179 serious knee sprains, those in trained staff fell by 62% compared with the two previous seasons, with no fall in the comparison areas. It wasn't randomised, and it was in ski staff. A later review by the same team describes about 4,000 people taking part and a 76% fall in ski patrollers, and notes it hasn't been rolled out to the public. The knee section below gives the advice.

Sources 4, 2

Bindings and bootsEmerging evidence

Bindings protect the shin bone, not the knee: lower release settings don't cut ACL injuries and do mean more skis coming off when they shouldn't. But worn boot soles and bindings that fail to release are linked with ACL tears. In 763 Danish skiers, an instructional video on the coach to the resort raised binding testing from 59% to 86%, and the share who reported an injury fell from 23% to 16%.

Sources 2, 20, 24

Snow, slopes and coldEmerging evidence

In 392 recreational skiers with an ACL tear and 392 matched skiers without one, fresh snow, grippy snow, icy slopes, very cold or cold weather and easy slopes were all linked with ACL injury. These are associations, but they are conditions you can choose or ski more carefully in (editorial).

Source 21

Pre-season fitness: the honest answerMixed evidence

A review of 30 papers found 80 injury prevention recommendations for recreational skiers and snowboarders, on equipment, education, behaviour and experience, but none on fitness training. The Vermont researchers found "no convincing evidence that conditioning of any type can reduce the risk of alpine skiing injuries": at the 1994 Winter Olympics, 42% of the women and 10% of the men in alpine racing had torn an ACL, despite being very fit.

Among Swedish ski high school students, 305 given an ACL prevention programme (an education video, single-leg hops and squats, and on-snow drills, aiming to be equally good on both legs) had 12 ACL injuries (3.9%), against 35 (8.1%) in 431 students from earlier years. It wasn't randomised, and few returned the compliance questionnaire. In 370 young racers, weaker core strength went with ACL tears, and a 2025 review lists poor fitness among the factors linked with ACL injury in skiers: associations.

So we can't say training prevents ski injuries. We include it because fitter skiers get more runs with less fatigue, and because the strength, landing and balance work that prevents ACL injuries in other sports is reasonable to borrow (editorial).

Sources 7, 2, 25, 26, 20

TirednessMixed evidence

The evidence on fatigue and ski injuries conflicts. At an Italian trauma centre, 579 injured skiers and snowboarders had been on the slopes for about 2.6 hours on average before their accident, and 5.7% of the injuries were put down to tiredness; with no comparison group, that doesn't show tiredness caused them.

Sources 2, 27

Beginners and lessonsEmerging evidence

Beginners have the highest risk of injury. Lessons build skill, but in most studies they didn't lower the risk of injury, though one Norwegian study linked instruction with fewer injuries; the Vermont researchers call "formal ski instruction will make you safer" a myth.

Sources 18, 28, 2

What ski fitness meansEmerging evidence

We found no performance trials in recreational skiers. Racing needs strength, aerobic and anaerobic fitness together, with technique most important. Recreational skiing raises heart rate a lot for the oxygen it uses, and short turns can be high-intensity training in their own right.

Sources 14, 11, 13

Hard exercise and heart risk: an associationEmerging evidence

In 68 men who died suddenly while skiing, a previous heart attack (41% against 1.5% of matched skiers) and high blood pressure (50% against 17%) were far more common, and regular strenuous exercise less common (4% against 15%). In a later analysis, more than one hard session a week went with 83% lower risk. These are associations, but they support keeping one hard interval session a week through the winter if you're healthy (editorial).

Sources 9, 10

Fitting it in before your tripEmerging evidence

Our suggestion: start 6 to 8 weeks before your trip, with the ski fitness workout 2 or 3 times a week plus one interval session, and an easier final week. The ingredients come from ACL prevention in other sports, strength, landing and balance work for 10 to 30 minutes 2 to 3 times a week, and from the Swedish ski schools' focus on equal legs. No trial has tested the timing (editorial).

Sources 32, 33, 25

The first day of the tripEmerging evidence

About half of the sudden cardiac deaths among skiers and hikers happened on the first day, mostly in the late morning and longer after the last food and drink. We suggest fewer, easier runs on day 1 and regular food and drink (editorial, built on that association).

Source 10

The phantom footEmerging evidence

The commonest pattern: you're off balance to the rear with your uphill arm back, your hips below your knees, the uphill ski unweighted and your weight on the inside edge of the downhill ski's tail, with your upper body facing the downhill ski. If you feel it happening, the response is "Arms forward. Feet together. Hands over skis."

Sources 3, 2

The boot-induced injuryEmerging evidence

Landing a jump back on the tails of your skis with your leg straight lets the boot drive your shin forward. The advice: "Don't jump unless you know where and how to land. Land on both skis, if possible, and keep your knees flexed." In World Cup racers, half of 20 filmed ACL injuries followed a different pattern, the slip-catch, in which the outer ski catches its inside edge as the skier straightens the knee.

Sources 3, 29

How to ski and fallEmerging evidence

Keep your hips above your knees and your arms forward while you ski. In a fall, "Don't (fully) straighten your legs when you fall", keep your arms up and forward, don't land on your hand, and "Don't try to get up until you've stopped sliding": when you're down, stay down.

Sources 3, 2

Helmets cut head injuriesStrong evidence

Across 12 studies, skiers and snowboarders wearing helmets had 35% lower odds of a head injury, and children under 13 had 59% lower odds, with no rise in neck injuries. In Norway, helmets went with 60% lower odds of a head injury and 57% lower odds of a potentially severe one. These are case-control studies, the usual design for this question, and they agree. A helmet lowers the risk; it doesn't remove it.

Sources 5, 23, 28, 30

Wrist guards for snowboardersStrong evidence

A review of 6 studies, including randomised trials, found wrist guards cut wrist injuries by about three-quarters, wrist fractures by about 70% and wrist sprains by over 80%: one injury prevented for every 50 snowboarders who wear them. In a trial of 5,029 snowboarders, 8 with braces and 29 without injured a wrist, and none of the injuries was put down to the brace; in a second trial of 721, severe wrist injuries were 1 against 9. Non-randomised data hinted at more finger, elbow or shoulder injuries, which the trials didn't find.

Sources 6, 22, 31

Altitude sicknessStrong evidence

The NHS says altitude sickness is possible at high altitude, usually more than 2,500 m, and symptoms usually start 6 to 10 hours after you get there: a headache, loss of appetite, feeling or being sick, tiredness, dizziness and difficulty sleeping. Rest at the same height, and if symptoms get worse or don't improve after a day, go 300 to 1,000 m lower. TravelHealthPro adds that fitness doesn't appear to protect you, and that how you coped at altitude before is probably the best guide.

Sources 8, 16

ColdStrong evidence

Hypothermia is a body temperature below 35°C. Frostbite can happen at 0°C or below, most often in the fingers, toes, nose and ears. The NHS advises several loose layers with a waterproof outer layer, a hat, gloves or mittens, thick socks and boots, and eating and drinking regularly.

Sources 34, 35

Sun and snowStrong evidence

The NHS warns that reflected sunlight from snow is "particularly dangerous" for your eyes: wear sunglasses with wraparound lenses or wide arms, and sunscreen with a sun protection factor (SPF) of at least 30.

Source 36

A heart condition or high blood pressure

More than 90% of sudden cardiac deaths while skiing were in men over 34, strongly linked with a previous heart attack and high blood pressure, and skiing raises heart rate and blood pressure. See your GP or cardiologist before the trip, and take the first day easy.

Sources 9, 10, 11

New to hard exercise, or a yes on the PAR-Q+

The NHS advises speaking to your GP first if you haven't exercised for some time or have medical conditions or concerns. The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) asks about heart conditions, chest pain, dizziness, other long-term conditions and joint problems, and suggests seeing a qualified exercise professional first if you're over 45 and not used to hard exercise.

Sources 37, 38

Altitude sickness before, or going high fast

The NHS advises seeing a GP or travel clinic before you go if you've had altitude sickness before or will be going up quickly.

Source 8

In pregnancy

Our pregnancy guide lists skiing among the activities with a risk of falling to avoid, and TravelHealthPro advises against going to high altitude in the first trimester.

Source 16

After an ACL injury

The ACL is skiers' commonest serious knee injury, so get your physio's clearance first. Our ACL injury guide notes that, without surgery, a brace can help in sports where the knee tends to give way, such as skiing.

Source 19

Snowboard beginners

Beginners in their first 5 days and people on hired equipment had the most wrist injuries: wear wrist guards, take lessons and check your gear.

Source 22

A head injury: call 999

The NHS says to call 999 if someone has hit their head and has been knocked out and not woken up; can't stay awake; has a fit; has problems with their vision or hearing; has clear fluid from their ears or nose; has new numbness or weakness; has problems with walking, balance, understanding, speaking or writing; or their behaviour has changed. The UK concussion guidelines add a worsening headache, repeated vomiting, increasing confusion and severe neck pain as red flags needing urgent assessment.

Sources 39, 40

A suspected concussion

Stop skiing for the day: if in doubt, sit them out. Get assessed within 24 hours by a healthcare professional or through NHS 111, and follow the UK guidelines' graduated return, which cover every sport: no competition before day 21. The NHS advises no contact sports for at least 3 weeks after a head injury.

Sources 40, 39

A knee that gives way

The NHS says to get advice from 111 now if your knee is very painful; you can't move it or put any weight on it; it's badly swollen or has changed shape; it locks, gives way or clicks painfully; or you have a very high temperature with redness or heat around it. A pop, quick swelling and a knee that gives way point to an ACL injury.

Source 41

A wrist or arm after a fall

Call 999 or go to A&E (accident and emergency) if you heard a crack, the injured part has changed shape or points at an odd angle, it's numb or tingling, or the skin has turned blue or grey or is cold. Get help from NHS 111 if it's very painful or very swollen or you can't use it normally. Our wrist sprain guide explains why pain at the base of the thumb after a fall needs checking the same day.

Source 42

Altitude: get medical help straight away

The NHS says to get medical help immediately, and go 300 to 1,000 m lower if you can, if you or someone with you has altitude sickness and feels very unwell, is confused, has problems with balance or coordination, has hallucinations, is short of breath at rest, has a cough with frothy or bloody spit, has blue or grey skin, lips, tongue or nails, or is very sleepy or hard to wake.

Source 8

Cold: hypothermia and frostbite

Call 999 or go to A&E for signs of hypothermia, such as shivering, pale cold skin, slurred speech, slow breathing, tiredness or confusion, and for frostbite with hard, frozen skin, swelling, loss of feeling or blisters. Don't rub frostbitten skin or warm it with direct heat.

Sources 34, 35

Chest pain: call 999

Call 999 for sudden chest pain that doesn't go away, pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness.

Source 43

"Getting fit prevents ski injuries"Mixed evidence

The Vermont researchers found "no convincing evidence that conditioning of any type can reduce the risk of alpine skiing injuries", and a review found no fitness-based prevention advice for recreational skiers. Fitness does help you ski more runs with less fatigue.

Sources 2, 7

"If you're going to fall, just relax"Emerging evidence

The Vermont researchers call this a myth. Keep your legs bent rather than straight and your arms up and forward, don't land on a hand, and don't try to get up until you've stopped sliding.

Sources 2, 3

"Helmets don't work, or they cause neck injuries"Strong evidence

Helmets cut the odds of a head injury by about a third across 12 studies, with no rise in neck injuries, and by 60% in Norway.

Sources 5, 23

"Lower binding settings protect your knees"Emerging evidence

Bindings protect the shin bone. The main ways skiers tear the ACL don't depend on the binding releasing, and lower settings mean more skis coming off when they shouldn't.

Source 2

"Wrist guards just move the break up the arm"Strong evidence

Wrist injuries fell by about three-quarters, and the large trial found no injuries caused by the guards. Non-randomised data hint at more elbow and shoulder injuries, but that's unproven.

Sources 6, 22, 31

"Snowboarding is safer because it spares your knees"Mixed evidence

Snowboarders have far fewer ACL injuries but more wrist, shoulder, ankle and collarbone injuries and concussions, and they had a higher overall injury rate in Vermont and Norway. A 2026 pooled analysis of very mixed studies found the opposite for amateurs, so overall risk is unsettled.

Sources 1, 18, 17

"Most accidents happen on the last run, when you're tired"Mixed evidence

The evidence on fatigue conflicts. At one Italian trauma centre, injured skiers had skied for about 2.6 hours that day, and in Western Canada most injuries came from falls on the easiest marked runs.

Sources 2, 27, 15