Twisted knees, dislocated shoulders, sprains, breaks and head injuries - ever more crowded pistes are making skiing more perilous than ever. But some simple planning can help you come home in one piece, says Dominic Earle

Rob Carter, an artist, is an experienced skier. But when skiing with friends in Meribel, in the French Alps, he strayed a few yards off piste - and flew off the edge of a 15ft cliff. On the way down, he hit a tree, lost his skis and landed in a twisted heap. "When I looked down, I saw the bottom of my left leg was sticking out at right angles to the top," recalls Carter. "In a state of shock, I picked myself up, forced my leg back into place and promptly collapsed again."

Rob Carter, an artist, is an experienced skier. But when skiing with friends in Meribel, in the French Alps, he strayed a few yards off piste - and flew off the edge of a 15ft cliff. On the way down, he hit a tree, lost his skis and landed in a twisted heap. "When I looked down, I saw the bottom of my left leg was sticking out at right angles to the top," recalls Carter. "In a state of shock, I picked myself up, forced my leg back into place and promptly collapsed again."

Friends called for help and Rob was stretchered down the mountain in a blood wagon. The resort doctor informed him he'd snapped all the ligaments in his knee. "I asked him if I'd be able to ski again. He told me I'd be lucky ever to walk again."

Carter was taken to the nearest hospital, in the valley town of Moutiers, where his knee was operated on and where he spent the next 10 days. He was told by doctors he would never play sport again, as he risked snapping the blood vessels and having to have his leg amputated.

Recently, he decided to get a second opinion and was told that the damage was not as serious as first thought. He was fitted with a £450 carbon-fibre knee brace, which prevents any sideways movement in the knee, and two weeks ago was back on the slopes near Chamonix. This time it was his friend who fell 40ft down a crevasse, but luckily he was wearing a helmet and escaped with a couple of black eyes.

As lucrative jobs go, being a GP in a ski resort must rank alongside, well, being a physiotherapist in a ski resort. With a daily rate of injury on the slopes at around five per 1,000 skiers and boarders, all you need to do is set up your surgery at the base of the pistes and wait for the blood wagons to roll in. And roll in they will, when your prospective patients are indulging in a sport where altitude, alacrity and acrobatics are combined in a lethal cocktail. Among my skiing colleagues, I can boast the following list of injuries: snow blindness, a sprained neck, a dislocated shoulder, two twisted knees and a broken leg. Even healthier for medical funds is the chance of repeat visits - all these victims are still addicted to their week on the slopes.

Statistically you're more likely to have an accident on your way to the resort than you are on the slopes, especially if you respect the International Ski Federation's skiers' code of conduct (see box below), stay on the marked pistes and ski within your limits. Unfortunately, though, it's not always your own conduct that's the problem. With more and more skiers and boarders vying for space on already crowded pistes, accidents are bound to happen, sometimes at combined speeds of 100mph or more. "If you do have a wipeout," says Tignes-based physiotherapist Lucy Miller, "what you twist or fracture will usually depend whether you're on skis or a snowboard."

Before the introduction of modern release bindings in the 1970s lower leg fractures were very common in skiers, but nowadays knee ligaments - the medial collateral ligament (MCL), anterior cruciate ligament (ACL) and lateral meniscus, or "the unhappy triad" as Lucy Miller calls them - take up most of a doctor's workload, accounting for 30-40 per cent of all alpine ski injuries. Whether it signifies the end of a skiing holiday depends on the severity - a mild sprain of the MCL could see you back on piste in a couple of days, while a ruptured ACL means it's time to change your flights. As with any injury, make sure you read the doctor's notes carefully before taking to the slopes again, as skiing against his or her advice can invalidate your insurance.

Next up in the doctor's waiting room are shoulder sprains - which I can personally attest are incredibly painful but not necessarily holiday-threatening - followed by thumb sprains and, finally, head injuries. Although serious head injuries make up less than 3 per cent of all injuries on the slopes, they are the leading cause of death and, as a result, helmets are a hot topic. Two celebrity ski deaths in 1997/98 - Michael Kennedy died when he hit a tree in Aspen, Colorado; less than a week later Sonny Bono was killed in similar circumstances in Lake Tahoe - highlighted the dangers of skiing without a helmet and governments are now starting to take action. Italy is currently passing a law making helmets compulsory for children, Norway provides ski helmets for children up to the age of seven and Sweden provides them for children up to the age of 11. Many ski schools also actively encourage "lids on kids" with free helmet loan. But while a spokesperson for the Ski Club of Great Britain says the club "strongly advises children and adults to wear a helmet on the slopes", the sight of a helmeted adult skier, at least in Europe, is still as rare as a seat on a cable car.

If two skis sound far too dangerous and you're thinking of taking up snowboarding instead, be warned: while it may be easier to learn, it's also easier to injure yourself, especially if you head for the terrain park. Lucy Miller says: "When you move over to snowboarding, the most common injury is wrist damage, because the instinctive reaction when boarding is to put out a hand to break a fall." Terrain parks, or "trauma parks" as some doctors refer to them, are the ideal place to get airborne and the ideal place to injure yourself: poorly performed jumps are the most common cause of concussion and broken wrists among boarders, often sustained when overambitious beginners take off without knowing how to land. But snowboarders are much more likely than skiers to wear a helmet - which is lucky, because they're also three times more likely to suffer a head injury.

While sprained wrists and ruptured ligaments are the nuts and bolts of snowsport injuries, the accident that off-piste skiers and boarders fear most is being caught in an avalanche. According to the Swiss Federal Institute of Snow and Avalanche Research in Davos, last winter there were 21 avalanche fatalities in Switzerland, 16 of which were off-piste skiers, while four were off-piste snowboarders. The moral of the story? Stay on piste and you might break your thumb, but you're less likely to be buried alive.

Surviving an avalanche is, above all, a matter of time - avalanche victims rescued within 15 minutes have a 92 per cent chance of surviving; after half an hour the chances fall to 30 per cent - so having the right gear really can be a matter of life and death. But getting equipped properly in the first place can be damaging to a young snowboarder's bank balance. Many skiers and boarders will be kitted out properly when they venture off-piste, but unfortunately many won't. According to the Ski Club of Great Britain: "No one should venture off-piste without the holy trinity - avalanche transceiver, avalanche shovel and avalanche probe. But the cheapest transceiver on the market at the moment costs about £170." If you're thinking of going off piste this winter, hire a guide and get properly equipped - the Ski Club (0845 45 807 83) rents out transceivers and can also advise on how to use them.


However much equipment you have with you, skiing and boarding, on piste or off piste, is an inherently dangerous sport. So how do you limit your chances of spending a week in a splint?

Get the right equipment for you

Be honest about your abilities when hiring equipment. If your boots hurt or your skis don't feel right, go back to the shop and change them.

Warm up properly

In an ideal world, you'd train for at least two months before your ski holiday, but even a 15-minute stretch before you set off each day can save a lot of agony later on.

Ski safely

Pick pistes that you can handle and always ski within your limits, as the majority of accidents are caused by people who are out of control. And if you are going off- piste, hire a guide and make sure you get properly equipped.

Protect your eyes

Wear sunglasses or goggles with maximum protection from UV rays. Otherwise you might end up like one of my colleagues, James Gregory, who suffered snow blindness in Alpe d'Huez. Not only did it ruin his holiday, but he had to suffer the indignity of asking staff to dim the lights in the local pizza restaurant.

Take it easy

The last run of the day can also be the most dangerous. When you feel like you're getting tired, you are tired - stop skiing and start après-skiing.

Get insured

With the estimated cost of a spine fracture in Europe, including mountain rescue, treatment and repatriation, coming in at more than £25,000, you must have adequate insurance in case of a tumble. After an uninsured accident in the French Alps, Sophie Walker had to cough up £100 on the ambulance driver's credit card machine before he would even drive her down the mountain to hospital. One of the cheapest and best winter-sports insurance policies in France is a Carte Neige (www.carte, which you can buy at lift pass offices for about €2.50 (£1.70) per day.


1. Respect: Do not endanger others.

2. Control: Adapt the manner and speed of your skiing to your ability and to the general conditions on the mountain.

3. Choice of route: The skier/snowboarder in front has priority - leave enough space.

4. Overtaking: Leave plenty of space when overtaking a slower skier/snowboarder.

5. Entering and starting: Look up and down the mountain each time before starting or entering a marked run.

6. Stopping: Only stop at the edge of the piste or where you can easily be seen.

7. Climbing: When climbing up or down, always keep to the side of the piste.

8. Signs: Obey all signs and markings - they are there for your safety.

9. Assistance: In case of accidents, provide help and alert the rescue service.

10. Identification: All those involved in an accident, including witnesses, should exchange names and addresses.