Stress Fractures in Figure Skating

[Query]

The most obvious question is whether it is even possible to reduce injury incidence in sports. My impression is that whenever someone tries to do something to make a sport safer, people find other dangerous things to do, or take advantage of a safety mechanism to do more dangerous things.

When all is said and done, I think athletes are willing to accept some raTE of injury, and maybe even death, and no matter what you do, they will act in ways so as to go back to be within that range. I can't prove that it is impossible to reduce injuries, but I suspect it.

Look at the injury incidence of Rugby vs American Football (not soccer). Two very similar sports. Except that American Football uses helmets, and lots of padding, while Rugby is performed without protection (though both sports use mouthguards), and Rugby has more minutes of play / game, with fewer and perhaps shorter stops. Yet the injury incidence per game is similar.

An example within the figure skating community would be Ice Dance. It can be argued that it came into existence to reduce injury incidence, relative to freestyle skating, by largely eliminating jumps. But instead, dangerous lifts partly brought back the injury incidence. E.g., see
pmc.ncbi.nlm.nih.gov/articles/PMC6204632

(It IS true that in that study, freestyle skaters have a higher total injury incidence - but ice dancers have a higher acute incidence.

Of course, that study might be biased by several effects - e.g., I think ice dancers tend to be older than freestyle skaters. They may also tend to be people who started out as freestyle skaters, and progressed to ice dance when the discovered they could not compete at the highest levels in freestyle. I had a coach with that history - and in between, she tried pairs, but discovered she could not compete at the highest levels of that either. Yet she always loved freestyle skating best. And she sort of implied she regretted switching; she was deeply disappointed when she didn't qualify for the Olympics - a very high bar for anyone to set for themselves.

Regardless, the differences between who participates in different figure skating disciplines may bias injury statistics.

BTW, based on
journals.lww.com/acsm-csmr/abstract/2024/10000/figure_skating_musculoskeletal_injury__evidence.3.aspx

it appears that figure skaters are willing to accept a fairly high injury rate. And I suspect this excludes most minor injuries like bruises, cuts, abrasions, and concussions that don't produce an obvious immediate long term effect. Most athletes don't report these sorts of thing.

 

[sisinka]

The most obvious question is whether it is even possible to reduce injury incidence in sports....

Yes, it is possible speaking about chronic injuries.
And things which have to be done to reduce number and seriousness of chronic injuries... may SOMETIMES reduce the seriousness of traumatic injury.

...it appears that figure skaters are willing to accept a fairly high injury rate. And I suspect this excludes most minor injuries like bruises, cuts, abrasions, and concussions...

Those are all results of traumatic injuries.

Stress fractures are overuse injuries. So question is how to avoid overusing of athlete's body.

Stress fractures-Stress fractures - Symptoms & causes - Mayo Clinic

Stress fractures are tiny cracks in bones often caused by overuse or osteoporosis. Learn how to prevent and treat them.

www.mayoclinic.org

- "...RISK FACTORS of stress fractures:

- ...women, especially those who have abnormal or absent menstrual periods, are at higher risk of developing stress fractures
- ...people who have flat feet or high, rigid arches are more likely to develop stress fractures
- weakened bones. Conditions such as osteoporosis...
- previous stress fractures
- lack of nutrients - Eating disorders and lack of vitamin D and calcium can make bones more likely to develop stress fractures..."

I would also add regime with enough time of sleeping, enough regeneration.

Another knowledge from rehabilitation is the fact that wrong posture and wrong postural stability (standing or moving with not centrated position of joints, muscle imbalance) are leading to overdose the joints, muscles / ligaments much sooner, causing injury much sooner comparing to right posture and right postural stability.

Looking at risk factors above, if skaters will be able to avoid at least some of those risk factors, it will reduce the possibility of chronic injuries stress fractures including.

 

[Query]

Unfortunately, the things you just mentioned mostly occur because of attempts to enhance athletic performance (e.g., female athletic triad). Especially at the highest levels, relatively slim profiles and low weight, and for females, delayed maturity (achieved through deliberate under and mal nutrition), up to a point, tend to allow people to get higher scores. It's a little different for male Dance and Pairs skaters - they have to be strong enough to lift (and for Pairs, throw) their partners - but they too have to be relatively thin and strong to get the highest scores.

For that matter, serious athletes in general return to the activity very soon after both acute and chronic injuries - much sooner than many doctors would recommend. E.g., they frequently perform and compete while still injured, and many remain injured (and to some extent inflamed) throughout their athletic careers. And they frequently do many things to enhance hyper-mobility, because it is necessary to be extremely flexible to get the highest scores.

So serious skaters mostly won't be willing to do what you want.

Posture also hugely impacts how well you are rated in figure skating. A relatively unhealthy posture, often with a very straight upright spine, is often what is required, to get high scores.

Perhaps you could argue that figure skating could have healthier standards for getting good scores. But, as with Dance, Gymnastics, and fashion modeling, you are not likely to be able to change the minds of the powers that be in that community.

And almost all the athletes already probably know that later in life, most former serious athletes have serious long term medical problems resulting from the way they treated their bodies when young.

Individual figure skating athletes, especially elite athletes, already get medical coaching and advice. In fact the typical elite athlete has an entire "team" of medical practitioners they consult with. They already know these things are unhealthy. But they have accepted them in order to enhance their judged performances. And they tend to choose "sports physicians" and other sport specific medical practitioners, who understand this particular psychology, and are willing to work within it.

A few things have nonetheless been done. Certain performance enhancing substances, that have bad side effects, have been banned. And some medical operations are only allowed to repair damage, or if they are medically necessary. The Olympics don't allow figure skaters to compete below age 17 - but they have to train intensely and compete well below that age outside the Olympics to reach the highest levels.

 

[sisinka]

Unfortunately, the things you just mentioned mostly occur because of attempts to enhance athletic performance (e.g., female athletic triad). Especially at the highest levels, relatively slim profiles and low weight, and for females, delayed maturity (achieved through deliberate under and mal nutrition), up to a point, tend to allow people to get higher scores. It's a little different for male Dance and Pairs skaters - they have to be strong enough to lift (and for Pairs, throw) their partners - but they too have to be relatively thin and strong to get the highest scores.

For that matter, serious athletes in general return to the activity very soon after both acute and chronic injuries - much sooner than many doctors would recommend. E.g., they frequently perform and compete while still injured, and many remain injured (and to some extent inflamed) throughout their athletic careers. And they frequently do many things to enhance hyper-mobility, because it is necessary to be extremely flexible to get the highest scores.

So serious skaters mostly won't be willing to do what you want.

.....

Interesting points. Thank you.

Thanks to skaters who opened up about their injuries and illnesses, we have some information about time before stress fracture happened.

For example skaters didn't follow the right regime - examples are given by skaters who suffered from stress fracture once or repeatedly.

Skaters with insuficient nutrition:

....
EXAMPLES:
- all skaters mentioned above
- Daisuke Takahashi - "...I practiced so hard and the rapid diet to lose weight also worked badly. The lack of nourishment affected human body." (https://www.insideskating.net/2013/...se-healing-process-and-long-term-consequences )
- Yuma Kagiyama - ...During his break from skating, he began to work with a nutritionist to improve sleeping and eating habits to reduce future injury. (https://www.goldenskate.com/forum/t...s-in-figure-skating.98339/page-2#post-3285985 )
- Adam Rippon - ...After over-exercising and heavily limiting his caloric intake for about two years, Rippon received a lot of praise for his appearance and performed at a quality he was happy with. This encouraged his unhealthy lifestyle. He began to associate a feeling of being hungry with working hard. That was until his body became so fragile that doing a simple off-ice jump led his foot to fracture.
(https://udreview.com/how-toxic-injury-culture-is-perpetuated-in-elite-figure-skating/ )
.....

Skaters who were practising 7 days per week (no day-off):

...
- Michael Weiss has history of 2 publicly known stress fractures - ankle stress fracture in fall 1999 and toe of left foot stress fracture in 2000.
Here is his change in approach after those injuries: "...Weiss made changes in his training this year, stifling his tendency to go hard all of the time. He takes a day off every now and then to rest his body." (https://www.washingtonpost.com/arch...lympics/50bd2c82-46bc-4fa0-8c9f-23242b28f23b/ )

- Evan Lysacek - "It can't be easy for a single 24-year-old in Los Angeles to live like a monk, but Lysacek's diligence and concentration border on the uncanny. "I want to know that I haven't left anything on the table," he says. "That there wasn't one night when I should have been doing cardio from eight to 10, but instead I was out with friends. So I live this lifestyle seven days a week, 24 hours a day." (2009) (https://ohnotheydidnt.livejournal.com/44413637.html )

- Evan had at least 3 stress fracture known publicly: in March 2004 (in time of his last Junior World Championships and last junior season), bone bruise in December 2006 (post-Olympic season), in March 2009 (preparing for last World Championships before the Olympic Games).
- I didn't find any article mentioning corrections of those "non-stop approach" during his career

- Jeffrey Buttle - interview after stress fracture (Augut 2006) - "Buttle usually trains for three or four hours a day on ice, six days a week. He also does an hour or two of off ice work every day. I started with more strength training after my surgery so I could handle more impact…" (https://www.goldenskate.com/buttle-bounces-back/ )

- Alexandra Trusova - she had stress fracture in 2021, I found article from December 2022 where she describes her training plan in Elena Sokolovskaya's group - "...Monday is usually my day off, that is why my first training day is Tuesday..."
(https://matchtv.ru/figure-skating/m...etsa_jeje_pervyj_trenirovochnyj_den_na_nedele )

- Yuma Kagiyama - after stress fracture in summer 2022 and being urged by his father - coach, Yama made adjustments -
"Crucially, he has also started taking off one day a week." (https://www.goldenskate.com/forum/t...s-in-figure-skating.98339/page-2#post-3285985 )
....

Skaters with excessive number of jumps at practise and increase load before stress fracture:

....
2. NUMBER OF JUMPS PER PRACTISE:
...
- Christopher Bowman - "...What Bowman had was a stress fracture of his fibula, a result of a training regimen in which it was commonplace to do 35 triple flips, landing on his right leg..."(https://www.latimes.com/archives/la-xpm-1986-07-27-sp-1703-story.html )

- Michael Weiss - "...Weiss made changes in his training this year, stifling his tendency to go hard all of the time. ...He no longer attempts quadruple jumps during both his morning and afternoon training session. Now, he tries the body-jolting quads only in the afternoon and, instead of grinding out 20 a day, he prefers to do around five." (https://www.washingtonpost.com/arch...lympics/50bd2c82-46bc-4fa0-8c9f-23242b28f23b/ )

- Shoma Uno - "...I remember that interview last season after summer training camp (in 2013) where he himself admitted that the 3A had become the main thing on his mind skating-wise, to the point that he would be training up to 100 a day and only landing a handful, without even getting the rotation right on most of those, while the rest were falls for the most part. And that, although falling hurt, he wanted to keep jumping until he at least got a good one since he "hadn't gotten seriously injured yet from all those falls." (https://www.fsuniverse.net/forum/threads/the-shoma-uno-fan-thread-go-for-número-uno.94182/page-2 )

- Daisuke Takahashi - "...According to the Japanese media, the injury happened on Tuesday, 26th of November (2013); but they also showed a video recording from Saturday, 23th, the last day of the weekly practice, when Daisuke Takahashi, attempting quad jumps, fell more than 30 times in one hour and a half..." (https://www.insideskating.net/2013/...se-healing-process-and-long-term-consequences)

- Diana Guseva - "...At the same time as Anya (Shcherbakova - season 2017-18), I had an injury - a stress fracture, very unpleasant. It took me a long time to recover, and after I got on the ice, I couldn't train like before. My workload was significantly reduced and I was unable to recover. Then Eteri Georgievna advised me to try dancing... I understood that after the injury I would not be able to jump two hundred jumps per training." (https://www.championat.com/figuresk...nie-s-zagitovoj-vostorg-ot-tuktamyshevoj.html )

- Alexandra Trusova - "...I jumped so many times... To learn the Axel I jumped 50 times per training after two free programs with five quadruples, for a month. Every time." (https://www.sports.ru/figure-skatin...-sezone-cherez-tri-dnya-vyshla-na-led-s-.html )

- Timothy Goebel - "...when we started putting in the numbers on the really hard stuff, if we had waited until we were older — when I was learning the [quad] salchow I was doing 20 to 30 a day at least, maybe more. When I was talking to Audrey, trying to figure out why I couldn’t really train, I was like, this is how I used to train, and when I told her the amount of repetitions I did when I was starting on stuff, she was like, “What were you thinking?!” And I know that the success I had from 1999 to 2002, it was a tradeoff. What I gave up for success early on, I lost in real longevity. Even with Frank I was doing six to eight of each quad on every session every day. That’s a lot." (https://manleywoman.com/episode-49-timothy-goebel/ )

- Roman Savosin - "...was mentioned in one of Petr Gumennik's interview - "...Roman Savosin recently talked about his training process in the “Skate Move” podcast and noted that he does quadruple jumps in small quantities - only a few times per session." (https://sport.rambler.ru/figureskat...at-mira-malinina-syao-him-fa-shou-tutberidze/ )

- Petr Gumennik - "...If everything goes well before the competition, then you shouldn’t do quadruple jumps just like that. Between competitions you can do a lot of jumps. The day before yesterday I did a 3-4 cascade about 30 times, there were few successful attempts, but overall there were a lot of attempts. Now I’ve decided to improve my quadruple toeloop, and it works well separately." (https://sport.rambler.ru/figureskat...at-mira-malinina-syao-him-fa-shou-tutberidze/ )


3. INCREASED LOAD IN TIME BEFORE STRESS FRACTURE:
...
- Adam Rippon - "...After over-exercising and heavily limiting his caloric intake for about two years, Rippon received a lot of praise for his appearance and performed at a quality he was happy with. This encouraged his unhealthy lifestyle. He began to associate a feeling of being hungry with working hard. That was until his body became so fragile that doing a simple off-ice jump led his foot to fracture."(https://udreview.com/how-toxic-injury-culture-is-perpetuated-in-elite-figure-skating/ )

- Andrew Torgashev - "...He was training a lot of jumps, putting a lot of reps in, and was very motivated after a fifth-place finish at the 2020 U.S. Junior Championships and an eighth-place finish at the World Junior Championships." (https://usfigureskatingfanzone.com/...-skate-america-with-an-eye-on-the-future.aspx )

- Amber Glenn - "...The intense training led to some overuse injuries, including multiple stress reactions in her foot and an ankle cyst that needed to be removed, forcing her to withdraw from the free skate of the Cranberry Cup in August 2021 and take three weeks off the ice to heal. She trained quads this summer and was getting close before her body decided enough was enough." (https://usfigureskatingfanzone.com/...amber-glenn-is-peaking-at-the-right-time.aspx )

- Lina Johansson - "...I practised jumps extra hard. It started to hurt my left foot, the one that was fractured before. I thought it was stress, overstrained. I continued to train but couldn’t go on the ice at the Swedish team camp in September (2008) because it hurt so much. ...I went to the hospital for an X-ray. It showed a stress fracture..." (https://www.absoluteskating.com/index.php?cat=interviews&id=2009linajohansson )

- Laura Lepisto - "...She then missed much of the season due to injury, having developed a stress fracture in her right hip as a result of practicing too many triple loops." (autumn 2006) (Wikipedia)

- Bradie Tennell - "...She also worked on including a triple Axel into her routines, which was ready at the beginning of the season, but a stress fracture in her foot in July 2019 prevented her from using it." (Wikipedia)

- Jeffrey Buttle - "...In August of 2006, Jeffery Buttle suffered a stress fracture in his back due to over training, and was off the ice entirely for two months." (https://www.goldenskate.com/buttle-bounces-back/ )
...

Question is: do you believe that all skaters or their parents (coming to child and teenagers) had perfect knowledge of consequences when not following the right regime?
Or do you rather think that they didn't have the complete KNOWLEDGE and EDUCATION of what consequences will look like? Because it doesn't give sense...most of athletes changed their training habits AFTER serious injury....why? Not to repeat that serious injury. Not to be forced to retire thanks to injury. If they wouldn't really care about injuries, they would not change the habits following injury, no?

I believe that better EDUCATION is needed to keep skaters more healthy and prevent from early retirements thanks to chronic injuries.

 

[Query]

I admit this article is a bit out of date (2018):

Epidemiology of Figure Skating Injuries: A Review of the Literature - PMC

As the popularity and technical demands of figure skating increase, so will the number of athletes presenting with sport-related problems. Searches were performed across PubMed from 1980 to 2017. The keywords searched were skating, skaters, ...

pmc.ncbi.nlm.nih.gov

It said

Figure skating is an evolving sport in which the technical and artistic demands continue to rise. The sport comprised intricate tracing of figures on the ice in the early 1800s and has now evolved to include technically demanding jumps and spins that were previously thought to be impossible.

So maybe we should go back to intricate tracing of figures, or at least back to School Figures.

But jumps are probably better for TV ratings. In other words, to an extent, it is all about the money.

Even for individual skaters, AFAICT, the potential to earn long term income as a coach is mostly based on a skater's peak performances at high profile competitions, not on the longevity of their skating careers. Of course, some skaters also make a long term career of skating performances after their competitive days are over - but to do so, they mostly had to have had highly rated competitive performances. So, to some extent, short term achievements tend to be emphasized over long term athletic participation. Which encourages athletes to push themselves very hard in the short run. Of course, that is true of many sports.

That study also said

In one of the earliest epidemiologic studies on skating injuries by Smith and Micheli<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6204632/#bibr24-1941738118774769">24</a> in 1982, the incidence of skating injuries appeared to be less than that of other sports. More recent studies report a slightly higher injury incidence.

So the injury rate isn't out of line with other sports. Not saying that the number of injuries should be acceptable. Just that it isn't atypical of sports in general.