Porter, Emily B. MD
Competitive figure skating has evolved drastically over the past century. The United States Figure Skating Association (USFSA) was developed in 1921 to promote and govern the sport. The popularity of the sport grew dramatically in the 1990s, and the USFSA now reports 680 skating clubs and more than 196,000 figure skating members (8). There are four different disciplines of the sport: singles skating, pair skating, ice dancing, and synchronized skating. This article summarizes the common injuries and medical problems commonly seen in singles skaters. Focus is given to injuries and illnesses that may be seen more specifically in figure skaters; while it is important to realize that injuries common to other sports, such as patellofemoral pain syndrome or spondylolysis, do occur in figure skaters, they are well covered in the literature and will not be discussed in detail here.
Most figure skating injuries in singles skaters are overuse injuries as opposed to acute injuries (2). Contributors to injury may include the skate itself, age and developmental stage of the skater, technique, training regimen (number of jumps and spins performed, periodization of training, etc.), nutritional status of the skater, and psychological status of the skater. Injuries predominately occur in the lower extremity and low back (Table). It is difficult to know the actual incidence of injuries, and more research is needed in this area. The few studies examining these numbers have been performed usually as a retrospective gathering of information from skaters at competitions, where stress is high and memories may not be accurate.
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Many foot problems in figure skaters are related to the skates. Figure skates consist of a stiff leather boot and a metal blade. Unique aspects of the figure skate include the high heel of the boot, which places the skater’s foot into a constant slight plantarflexion, and the large toe pick on the front of the blade, which is used for some jump take-offs and jump landings. Many competitive figure skaters purchase boots that are custom molded to their feet, which improves fit over a standard off-the-shelf boot, but boots still can fit poorly. Special orthotics, if needed, may need to be custom-built into the boot, as the shape of the boot makes placement of traditional orthotics difficult.
“Lace bite” is irritation of the tibialis anterior, extensor digitorum, or extensor hallucis tendons. It occurs from excess friction across these tendons. Ensuring proper placement of the tongue of the skate is usually sufficient treatment. If this does not decrease irritation, several treatment possibilities exist. Alternate lacing of the boot over the area of irritation may be helpful. Heel and lace pads also may provide some extra padding and can be applied to the skin underneath the tights if needed. The tongue of the skate also may be modified by extra padding.
A “pump bump” or Haglund’s deformity, is a protrusion of the lateral heel. It arises over time from an overly wide heel of the boot, which allows the skater’s heel to move up and down within the boot. They may or may not be symptomatic. Treatment involves modifying the heel of the skate to make it narrower.
Accessory navicular bones are thought to be present in 4% to 21% of the population (5). Excess friction from a tight-fitting boot may cause these to become symptomatic. Treatment may involve building up the arch of the skate or having the skate “punched out” in that area with a ball and ring contraption found at most skating stores.
Stress fractures of the foot are common, usually in the first or second metatarsals, and are seen more often in the figure skater’s take-off leg for toe pick jumps (6,7). The tarsal navicular also can be a site of stress fracture (1). Treatment involves rest, as well as screening for nutritional deficiencies, eating disorders, menstrual irregularities, and possible Female Athlete Triad. As the skater returns from this or any other overuse injury, a “jump count,” similar to a “pitch count” in baseball, may be helpful to prevent recurrent injury (1).
A 2003 study cited ankle injuries as the most common injury that nationally competitive figure skaters sustain (3). Many of these injuries are ankle sprains, which are likely the most common acute injury in figure skaters. It is uncommon for these to happen on the ice while in the skate, but more often occur during “dry land” training. With the development of the newer, stiffer boots designed to withstand the forces of triple and quadruple jumps, skaters’ peroneal muscles have become increasingly weaker, predisposing many skaters to ankle sprains due to poor strength and proprioception in the ankle. Fortunately, due to the realization of this problem, many coaches and skaters have been able to focus on this common deficiency and adjust training programs to try to decrease these injuries.
Malleolar bursitis occurs due to increased friction over the malleoli in the boot. It is seen more commonly on the medial side. Treatment again can include “punching out” the skate in that area or applying a donut pad or custom padding around the bursa. Ice and nonsteroidal anti-inflammatory drugs can be helpful for acute cases. Aspiration and cortisone injection can be considered, but long-term treatment likely needs to address the problem with the boot. Changing to a boot from a different manufacturer may be helpful in recurrent cases, as each “brand” of boots may fit slightly differently and change pressure points for that skater (1). Surgery is needed in rare cases to remove the problematic bursa.
As with any jumping athlete, Achilles tendinitis can plague figure skaters. It can be caused by overuse, and it also can result from compression of the Achilles by the posterior rim of the boot. Treatment may involve modification of the posterior aspect of the boot, rest from the offending activities, ice, stretching of the calf out of the boot, and working into an eccentric strengthening program.
Also commonly seen in jumping athletes, patellofemoral pain syndrome and patellar tendinitis can be seen in figure skaters. Treatment in figure skaters is similar to treatment in other athletes with this problem, and it involves rest from the offending activities, ice, and strengthening of the hip abductors and core musculature.
Figure skaters fall repetitively when learning new jumps. Contusions to the knee and hips are common injuries that occur weekly for most skaters. These rarely cause significant injury or lost training time.
Acute knee injuries commonly seen in other sports, such as meniscus or ligament tears, are uncommon in figure skaters. Fractures in the knee region, such as patellar fractures, are rare (6).
Sacroiliac joint issues can be seen in figure skaters. A skater always rotates the same direction in the air and lands on the same leg when performing a jump. Asymmetry in strength and flexibility can occur and contribute to sacroiliac and other low back and hip problems. When a skater is learning a new jump, it is common to fall to the side toward the landing leg. Repetitive falls on this hip can lead to low back and hip pain on this side.
Iliac crest apophysitis is an injury seen in teen figure skaters. It is thought that this may be seen more often in skaters performing triple and quadruple jumps (6). In order to rotate quickly enough to complete the necessary rotation for these jumps, significant torque must be created by the oblique muscles. Repetitive pull at the open physis of the iliac crest can lead to an apophysitis. Like other apophyseal injuries, treatment includes rest from the offending activity, improving flexibility, and strengthening of the core. Since the iliac crest apophysis is one of the last to close, with the average age of closure for boys at the age of 16 years and for girls at the age of 14 years, this can be an ongoing source of pain for teenagers (4).
Figure skaters perform repetitive extension of the trunk and thus are at risk for spondylolysis or spondylolisthesis. Lumbar strains, facet joint pain, and mechanical back pain also can occur. Contributing factors may include the skate, as well as the skater’s technique, training pattern, and nutritional status. Treatment of these injuries, especially spondylolysis, is not without controversy and debate and is outside the scope of this article. It is discussed in depth elsewhere in the literature, and that information can be applied to figure skaters as it is to athletes in other sports.
Upper extremity injuries are less common than lower extremity injuries in singles skaters. Wrist sprains and fractures can occur during falls. As with any fall on outstretched hand mechanism, the distal radius or navicular bone can be at risk with a fall, especially if the skater is unprepared or not expecting the fall.
Bronchospasm is common in figure skaters and may be triggered by the cold, dry air, as well as the fumes from the chemicals used to maintain the ice. Exercise-induced bronchospasm was found to affect 21% of the United States Figure Skating Team in the 1998 Nagano Olympics (9). While many of the newer Zambonis may be powered by electricity or “clean” fuels, some of the older Zambonis may emit fumes that contain air pollutants, such as carbon monoxide and nitrogen dioxide, and also can trigger bronchospasm (9). Albuterol may be helpful. Vocal cord dysfunction should be considered in the differential diagnosis, especially in adolescent female figure skaters.
As with other sports where athletes are judged on their appearance, eating disorders can occur in figure skaters. It is important to ensure that these athletes consume sufficient calories for the amount of energy they burn during their long practice sessions. If an eating disorder is suspected, a team approach to treatment is recommended, including the primary care or sports medicine physician, psychologist, nutritionist, coach, and parents. Disordered eating also may lead to irregular menses and eventual weakening of the bones, potentially progressing to the Female Athlete Triad (disordered eating, amenorrhea, and osteoporosis).
Figure skating continues to evolve as a sport, focusing more and more on increasingly difficult jumps and jump combinations, spins, and footwork maneuvers. Most figure skaters train for long hours year round to perfect these moves and are at risk for both acute and chronic overuse injuries. Injuries tend to involve the lower extremity and low back. The skating boot can often be a source of problems, but examination of the skater’s technique, training program, nutrition, and psychological status also is important. The sports medicine physician can aid figure skaters by making an appropriate diagnosis and starting the correct treatment plan to minimize time lost to injury or medical problems.
The author declares no conflicts of interest and does not have any financial disclosures.
1. Bradley MA. Prevention and treatment of foot and ankle injuries in figure skaters. Curr. Sports Med. Rep.
2006; 5: 258–61.
2. Dbravcic-Simunjak S, Pecina M, Kuipers H, et al. The incidence of injuries in elite junior figure skaters. Am. J. Sports Med.
2003; 31: 511–7.
3. Fortin J, Roberts D. Competitive figure skating injuries. Pain Physician
. 2003; 6: 313–8.
4. Kivel CG, d’Hemecourt CA, Micheli LJ. Treatment of iliac crest apophysitis in the young athlete with bone stimulation: report of 2 cases. Clin. J. Sport Med.
2011; 21: 144–7.
5. Kreher JB. Foot osteochondroses. In: Bracker MD, editor. The 5 Minute Sports Medicine Consult
. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 166.
6. Lipetz J, Kruse RJ. Injuries and special concerns of female figure skaters. Clin. Sports Med.
2000; 19: 369–80.
7. Pecina M, Bojanic I, Dubravcic S. Stress fractures in figure skaters. Am. J. Sports Med.
1990; 18: 277–9.
8. United States Figure Skating Association Web site [Internet]
. Accessed March 12, 2013. Available from: http://www.usfsa.org
9. Wilber RL, Rundell KW, Szmedra L, et al. Incidence of exercise-induced bronchospasm in Olympic winter sport athletes. Med. Sci. Sports Exerc.
2000; 32: 732–7.
ADDITIONAL SUGGESTED READING
Jaworski CA, Ballantine-Talmadge S. On thin ice: preparing and caring for the ice skater during competition. Curr. Sports Med. Rep. 2008;7(3):133–7.
Porter EB, Young CC, Niedfeldt MW, Gottschlich LM. Sport-specific injuries and medical problems of figure skaters. W.M.J. 2007;106(6):330–4.
Smith AD. The young skater. Clin. Sports Med. 2000;19:741–55.
Vetter CS, Porter EB, Newman S. Ice skating. In: Madden CC, Putukian M, Young CC, McCarty ED, editors. Netter’s Sports Medicine. Philadelphia: Elsevier; 2010. p. 622–6.
Copyright © 2013 by the American College of Sports Medicine.