{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T23:45:20Z","timestamp":1784072720831,"version":"3.55.0"},"reference-count":35,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Lower extremity injuries represent a major health concern in elite snowsport disciplines, where high mechanical loads, complex movement patterns, and demanding environmental conditions substantially increase injury risk. Understanding injury incidence and burden in this population is essential for developing sport- and sex-specific prevention strategies. This retrospective study determined lower extremity injury incidence and burden among elite snowsport athletes. Methods: Ninety-nine Turkish National Snowsport Teams Training Camp athletes (34 females; 65 males) consented to a review of their medical records for injury incidence. Overall, sex- and sport-specific injury incidence (number\/10,000 h) and burden (weeks missing\/10,000 h) were calculated. Results: Overall, medial tibial stress syndrome (MTSS) was the highest burden (9.5 \u00b1 38.7), and ankle sprain (1.7 \u00b1 0.4) was the highest-incident injury. However, injury incidence and burden patterns differed by sex and sport. Notably, medial tibial stress syndrome (MTSS) showed comparable incidence in female and male athletes but resulted in a substantial injury burden in both sexes, reflecting prolonged time-loss from training and competition and indicating a meaningful negative impact on athletic performance. Specifically, the highest-burden injury for women was anterior cruciate ligament (ACL) rupture (16.2 \u00b1 64.5), and for men the most common injury was MTSS (9.7 \u00b1 40.7). For cross-country skiers, MTSS had the highest burden and incidence. For all other sports, and across sexes, ankle sprain was the highest incidence injury\u2014women (1.3 \u00b1 3.0), men (2.0 \u00b1 4.5), biathletes (2.3 \u00b1 5.7), Alpine skiers (2.8 \u00b1 4.5), ski jumpers (1.6 \u00b1 3.1), and snowboarders (3.2 \u00b1 4.7)\u2014plus the highest-burden injury for biathletes (6.9 \u00b1 14.3) and ski jumpers (6.0 \u00b1 14.0). The highest burden injury for Alpine skiers was ACL damage (34.3 \u00b1 87.2), and for snowboarders it was knee collateral ligament injury (27.8 \u00b1 78.6). Moreover, patellar tendinitis, hamstring strains, calf strains, Achilles ruptures, anterior tibial pain, meniscus tears, and hip injuries were frequently observed in injury patterns. Conclusions: Ankle sprains were the most frequent lower extremity injury in elite snowsport athletes, whereas medial tibial stress syndrome (MTSS) and anterior cruciate ligament (ACL) injuries accounted for the greatest injury burden. Injury incidence and burden differed by sex and snowsport discipline.<\/jats:p>","DOI":"10.3390\/jcm15020695","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T08:26:36Z","timestamp":1768465596000},"page":"695","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lower Extremity Injuries in Elite Snowsport Athletes: A Retrospective Survey"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6662-4439","authenticated-orcid":false,"given":"Buket","family":"Sevindik Aktas","sequence":"first","affiliation":[{"name":"Faculty of Sport Sciences, Erzurum Technical University, Erzurum 25050, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0305-4632","authenticated-orcid":false,"given":"Esedullah","family":"Akaras","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Erzurum Technical University, Erzurum 25050, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Whitney G.","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6777-6540","authenticated-orcid":false,"given":"Ersagun","family":"Kepir","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, \u00c7ukurova University, Adana 01330, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Kulas","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9214-1948","authenticated-orcid":false,"given":"Gokhan","family":"Yagiz","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Amasya University, Amasya 05100, T\u00fcrkiye"},{"name":"Department of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo 92-0397, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Xu, Y., Yang, C., Yang, Y., Zhang, X., Zhang, S., Zhang, M., Liu, L., and Fu, W. (2020). A Narrative Review of Injury Incidence, Location, and Injury Factor of Elite Athletes in Snowsport Events. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.589983"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Shea, K.G., Archibald-Seiffer, N., Murdock, E., Grimm, N.L., Jacobs, J.C., Willick, S., and Van Houten, H. (2014). Knee Injuries in Downhill Skiers: A 6-Year Survey Study. Orthop. J. Sports Med., 2.","DOI":"10.1177\/2325967113519741"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"237","DOI":"10.26603\/ijspt20190237","article-title":"Injury Incidence in Competitive Cross-Country Skiers: A Prospective Cohort Study","volume":"14","author":"Worth","year":"2019","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_4","unstructured":"Hisdal, E., and Bahr, R. (2019). FIS Injury Surveillance System 2006\u20132019, FIS, F\u00e9d\u00e9ration Internationale de Ski."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Wu, Y., Dai, R., Yan, W., Ren, S., and Ao, Y. (2023). Characteristics of Sports Injuries in Athletes During the Winter Olympics: A Systematic Review and Meta-analysis. Orthop. J. Sports Med., 11.","DOI":"10.1177\/23259671231209286"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1136\/bjsports-2012-091524","article-title":"Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: The Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire","volume":"47","author":"Clarsen","year":"2013","journal-title":"Br. J. Sports Med."},{"key":"ref_7","unstructured":"Farelli, A.D. (2011). Sport Participation: Health Benefits, Injuries and Psychological Effects, Nova Science Publishers, Inc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"157","DOI":"10.2165\/00007256-199724030-00002","article-title":"An overview of some definitional issues for sports injury surveillance","volume":"24","author":"Finch","year":"1997","journal-title":"Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.bjpt.2021.04.013","article-title":"Prevalence of overuse injuries in athletes from individual and team sports: A systematic review with meta-analysis and GRADE recommendations","volume":"25","author":"Franco","year":"2021","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1111\/sms.13032","article-title":"Substantial injuries influence ranking position in young elite athletes of athletics, cross-country skiing and orienteering","volume":"28","author":"Heijne","year":"2018","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"262","DOI":"10.4085\/1062-6050-251-16","article-title":"High Injury Burden in Elite Adolescent Athletes: A 52-Week Prospective Study","volume":"53","author":"Heijne","year":"2018","journal-title":"J. Athl. Train."},{"key":"ref_12","unstructured":"Cook, J., and Finch, C.F. (2011). The long-term impact of overuse injuries on life-long participation in sport and health status. Sport Participation-Health Benefits, Injuries and Pyschological Effects, Nova Science Publishers."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1136\/bjsm.2009.066936","article-title":"No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports","volume":"43","author":"Bahr","year":"2009","journal-title":"Br. J. Sports Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.jshs.2020.03.009","article-title":"Training load characteristics and injury and illness risk identification in elite youth ski racing: A prospective study","volume":"10","author":"Hildebrandt","year":"2021","journal-title":"J. Sport. Health Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"176","DOI":"10.2165\/00007256-199724030-00006","article-title":"The severity of sports injuries","volume":"24","year":"1997","journal-title":"Sports Med."},{"key":"ref_16","first-page":"523974","article-title":"The Injury\/Illness Performance Project (IIPP): A novel epidemiological approach for recording the consequences of sports injuries and illnesses","volume":"2013","author":"Fuller","year":"2013","journal-title":"J. Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e001368","DOI":"10.1136\/bmjsem-2022-001368","article-title":"Still poorly adopted in male professional football: But teams that used the Nordic Hamstring Exercise in team training had fewer hamstring injuries\u2014A retrospective survey of 17 teams of the UEFA Elite Club Injury Study during the 2020\u20132021 season","volume":"8","author":"Ekstrand","year":"2022","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.jshs.2020.10.006","article-title":"Incidence of injuries in professional snow sports: A systematic review and meta-analysis","volume":"11","author":"Fu","year":"2022","journal-title":"J. Sport Health Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1177\/0363546511433279","article-title":"Snowboarding injuries: Trends over time and comparisons with alpine skiing injuries","volume":"40","author":"Kim","year":"2012","journal-title":"Am. J. Sports Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2325967120902908","DOI":"10.1177\/2325967120902908","article-title":"International Olympic Committee consensus statement: Methods for recording and reporting of epidemiological data on injury and illness in sports 2020 (including the STROBE extension for sports injury and illness surveillance (STROBE-SIIS))","volume":"8","author":"Injury","year":"2020","journal-title":"Orthop. J. Sports Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1136\/bjsports-2016-096226","article-title":"Preventing overuse shoulder injuries among throwing athletes: A cluster-randomised controlled trial in 660 elite handball players","volume":"51","author":"Andersson","year":"2017","journal-title":"Br. J. Sports Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Rotllan, C., and Viscor, G. (2023). Winter Sports Injuries in Elite Female Athletes: A Narrative Review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20105815"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1136\/bjsports-2014-094538","article-title":"Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games","volume":"49","author":"Soligard","year":"2015","journal-title":"Br. J. Sports Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1136\/bjsports-2020-102752","article-title":"Acute on-snow severe injury events in elite alpine ski racing from 1997 to 2019: The Injury Surveillance System of the Austrian Ski Federation","volume":"55","author":"Barth","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Hu, Z., Li, B., Qiu, X., Li, M., Meng, X., Kim, S., and Kim, Y. (2023). Gender differences in lower extremity stiffness during a single-leg landing motion in badminton. Bioengineering, 10.","DOI":"10.3390\/bioengineering10060631"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1136\/bjsports-2021-104198","article-title":"Injuries in elite women\u2019s ski jumping: A cohort study following three International Ski Federation (FIS) World Cup seasons from 2017\u20132018 to 2019\u20132020","volume":"56","author":"Stenseth","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1136\/bjsm.32.4.299","article-title":"Occurrence and trends in ski injuries in Norway","volume":"32","author":"Ueland","year":"1998","journal-title":"Br. J. Sports Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1136\/bjsports-2014-094206","article-title":"Sports injury and illness epidemiology: Great Britain Olympic Team (TeamGB) surveillance during the Sochi 2014 Winter Olympic Games","volume":"49","author":"Elliott","year":"2015","journal-title":"Br. J. Sports Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lewthwaite, R., and Wulf, G. (2010). Grand challenge for movement science and sport psychology: Embracing the social-cognitive-affective-motor nature of motor behavior. Front. Psychol., 1.","DOI":"10.3389\/fpsyg.2010.00042"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"572953","DOI":"10.1155\/2014\/572953","article-title":"Evaluation of the performance of females as light infantry soldiers","volume":"2014","author":"Finestone","year":"2014","journal-title":"BioMed. Res. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1080\/14763141.2012.704933","article-title":"Muscle activation characteristics in cross-country skiers with a history of anterior compartment pain","volume":"11","author":"Federolf","year":"2012","journal-title":"Sports Biomech."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/S0278-5919(20)30283-0","article-title":"Chronic leg pain in the athlete","volume":"13","author":"Clanton","year":"1994","journal-title":"Clin. Sports Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1177\/036354658701500616","article-title":"New cross-country skiing technique and compartment syndrome","volume":"15","author":"Gertsch","year":"1987","journal-title":"Am. J. Sports Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1177\/036354659202000619","article-title":"Anterior compartment pressures in cross-country skiers. A comparison of classic and skating skis","volume":"20","author":"Lawson","year":"1992","journal-title":"Am. J. Sports Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/036354658801600214","article-title":"Diagnosis of exercise-induced pain in the anterior aspect of the lower leg","volume":"16","author":"Styf","year":"1988","journal-title":"Am. J. Sports Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/695\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T09:48:48Z","timestamp":1768470528000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,15]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020695"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020695","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,15]]}}}