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1. How popular is cross-country skiing?

Cross-country skiing is very popular in Scandinavian countries, where it originated almost 5,000 years ago. It is becoming more popular in the United States as well, although its history here in only 70 years old. It is estimated that around the time of the 1932 Winter Olympics in Lake Placid, N.Y., 10,000 Americans participated in the sport. By the year 1980, this number reached 3 million, and by 1988, about 7.2 million enthusiasts enjoyed the sport in the United States.2. What makes Nordic skiing so enjoyable?

Cross-country skiing is an excellent sport that combines aerobic conditioning, a relatively low basic skill level and an opportunity to exercise comfortably outdoors and enjoy the solace of natural surroundings. Unlike alpine skiing, it does not entail costly equipment, lift lines or high fees and does not significantly alter the environment. It also has a relatively low injury rate, although it is not completely risk-free. Finally, skiers of all levels can participate together, making it an excellent family activity.

3. What kinds of injuries occur in cross-country skiing?

A Vermont study found that 94 percent of the injuries were to the lower extremity, 41 percent to the upper extremity and the remaining 10 percent were to the face, head or trunk. Of the injuries, 88 percent occurred on downhill terrain. The number of lessons taken did not alter the incidence of injuries, although the number of years of experience did have an effect (the more experience, the less injuries). As skiers gain experience, most of the injuries that occur are overuse injuries, with fractures and other acute injuries being less common.

4. Are there any new techniques in cross-country skiing?

Unlike many other sports, cross-country skiing has gone through a dramatic recent change in terms of techniques. The traditional "classic" technique of cross-country skiing with the skis parallel to each other in tracks has been replaced by the "skating" technique where one ski is alternately placed out in a "V" pattern, similar to ice skating. This latter technique became popular because of the 10-30 percent increase in speed that occurs with its use. There are many modification of these two techniques, and "double-poling" is used in both the classic and skating technique. In double-poling both poles are reached out in front of the body at the same time, the trunk is flexed to 90 degrees and then the body is propelled forward with skis parallel. Other modifications have included a longer pole length and a more rigid heel fixation to increase the edging capabilities of the skier when the heel is on the ski.

5. In what ways do these modifications affect the injuries seen in cross-country skiing?

With the development of skating techniques, speeds that are 10-30 percent faster than with classic techniques are possible. The skating technique uses longer poles and a more rigid heel fixation so that the skier can use the edges to control the ski better. The longer poles increase the incidence of triceps tendinitis, and the more rigid heel fixation makes injuries at the knee and hip injuries devastating, especially because the skis act to increase the torque that occurs. Double-poling is associated with low back overuse syndromes, as well as triceps tendinitis. This skating technique also puts more stress on the hip and the toes.

6. What kinds of cold injuries occur in cross-country skiing?

Cold injuries account for 20 percent of the injuries seen in cross-country skiing. Cold injuries include frostnip and frostbite but can also include hypothermia, which can be life threatening. The best treatment is prevention. Adequate caloric intake and protective clothing will allow for proper maintenance of body temperature. Heat loss occurs with the wind-chill increased. Ways to decrease heat loss include avoiding dehydration (adequate fluids, avoiding caffeine, alcohol), avoiding exposure (wear hat, mittens, face protection), and wearing layers of clothing that wick moisture (so that wet clothes are not on the body surface) and protect from the wind.

7. What are the other special concerns in cross-country skiing?

It can be very demanding aerobic activity, it often occurs in cold weather and at high altitudes, far from an organized medical support system. Skiers should not venture out alone; if an injury occurs, whether it be cold-induced, musculoskeletal or cardiac, having a companion can avoid significant problems. With thought, most individuals will be able to participate safely and enjoy cross-country skiing.