Figure skating has grown over the years, with an explosion of interest in the 1990s.  There are many ways to be involved in the sport: youth lessons, competitive singles, dance and pairs, synchronized skating, and professional performances.  Skaters are prone to overuse injuries because of early, single-sport specialization, intense practice (> 20 hours a week), and year-round competitions.  The majority of injuries are in the lower extremities and low back.  

Acute Injuries:  Ankle sprains, fractures, and stress fractures may occur as skaters devote more time to “off-ice” training.  The landing ankle is more likely to be injured.  Falls onto an upper extremity can result in a wrist injury like a sprain, fracture, or injury to a cartilage structure in the wrist called the triangular fibrocartilage complex (TFCC). Contusions to the knees and hips are common in skating, yet they rarely lead to significant injury or lost training time.  Acute knee injuries including injuries to themeniscus or ligament tears are uncommon in figure skaters.

Overuse Injuries:  “Lace bite” is a painful irritation of the front of the ankle caused by the pressure under the laces.  Modification of lacing, padding, and manipulation of the skate tongue may help relieve pain.  A “pump bump” or “Haglund’s deformity” is a prominence on the outside of a skater’s heel with or without Achilles tendon irritation.  This may result from excess movement of the heel in the boot.  Accessory navicular bones (“floating bones” in the foot) may create bony pain above the inside arch of the foot.  Ankle bone pain or malleolar bursitis over the inside and outside of the ankle can result from pressure from the skater’s boot.  Modifying the fit of the boot’s heel, padding, or punching out an area of the skate may provide relief.  Stress fractures can occur in skaters’ first and second foot bones (“metatarsals”).  Repetitive toe take-offs are a risk factor for a stress injury in the take-off foot.  Similar to other jumping athletes, skaters are prone to anterior knee pain, Osgood Schlatter disease, and patellar tendonitis.  Rest, ice, stretching, of the quadriceps (muscles on the front of the thigh) and iliotibial band (a tough band of tissue on the outside part of the thigh), and strengthening of the hip abductors, core, and quadriceps may help.  A cause of pain at the top of the hips, “iliac apophysitis,” is a common injury in teen figure skaters.

Repetitive back-bending places increased stress across the lower back.  Back pain may be related to fractures in the lower back such as in spondylolysis, slippage of a backbone (spondylolisthesis), lumbar disc injuries, and spinous process pain, such as in “apophysitis.” 

Injury prevention involves technique modification, improving core strength, and working on lower back and hamstring flexibility. 

Medical Issues: Bronchospasm is common in figure skaters.  Triggers may be cold, dry air, fumes from chemicals used in the ice or from the Zamboni.  Albuterol may be helpful.  If albuterol does not improve symptoms, vocal cord dysfunction should be considered. Vocal cord dysfunction is a condition that may lead to wheeze-like sounds and difficulty breathing, just like asthma, but is instead due to the abnormal closing of the vocal cords when an athlete breathes in or out.

The female athlete triad is a combination of insufficient energy, menstrual irregularity, and low bone density.  Patients with the triad are more likely to sustain stress fractures.  If suspicious, a bone health evaluation is advised.  Treatment includes nutritional and training modifications, and sometimes, psychological counseling.