This study examines the developmental process of winter inbound tourism in Yuzawa where attracts tourists from China, Taiwan and Hongkong. Yuzawa is one of the most accessible ski destinations from Tokyo having direct transport connection by high-speed train and high-way. The developmental process of inbound tourism is analyzed by（1） Interviews for about 100 Chinese tourists at Gala Yuzawa and Naeba Ski Field and（2） Interviews for Yuzawa Tourism Office and two ski-lift companies. Yuzawa attracts many beginner Chinese skiers as well as tourists who do not ski. There are two types of ski tourism by Chinese tourists in Yuzawa. At Gala Yuzawa, “Short-time snow experience type” is dominant by using high-speed train. Daytripper visit here for snow sightseeing within their Japan-travel. An another is “resort-hotel staying type”, in which intermediate level skiers tend to spend about three nights at the Hotel within Naeba Ski Field. Chinse tourists do not visit other tourism attractions in Yuzawa, they stay only in ski fields. This type of ski tourism by Chinese is completely different from that of Australian staying in Japanese ski resorts.
Since Helset was invited from Norway as the first ski instructor in Japan in 1929, Japan's ski level has improved significantly. This paper clarifies the process of inviting Helset and activities in Japan. Historical materials used for research are diplomatic documents from both countries, ski federation materials, and letters written by Helset to their families. The study revealed the following:
1. Modern Schanze and technical guidance are necessary for the development of the Japanese skiing world, and the Ski Federation planned a training for the leaders with the advice of Chichibu and the financial support of Baron Okura. Therefore, the Norwegian
government and the Norwegian Ski Federation accepted the wish of an important invitation from the Japanese imperial family and dispatched the best ski leader Helset and two skiers to Japan.
2. Their activities are to search for candidate sites to create Schanze in Hokkaido, Tohoku, Hokushinetsu, and Gunma, and to teach and give lectures at ski competitions held in Hokkaido, Niigata, Nagano and Gunma.
Their activities attracted attention in various places, and many people gathered.
As for the Alpine skiing characteristics, lower limb injures were thought to be predominant. However, in our previous study, we have reported head, neck, and oro-facial injuries were more common than upper and lower limb injuries. Further, the incidence of the head, neck, and oro-facial injuries in GS（Giant Slalom） was significantly bigger than that in SL（Slalom）. The incidence of men's oral injury in SL was bigger than women's. The incidence of women's neck injury in GS was bigger than men. And around 25 ％ skier experienced a concussion. At a higher competition level, a skier seems to be required a faster speed and gruelling line related to injury incidence. The present study aims to clarify whether the competition leve linfluences on an injuries incidence.
A questionnaire survey was conducted in the 66th Inter High School Athletic Meeting（Alpine skiing competition）. Four hundred forty participants joined the survey. We used SAJ points for evaluation of competition ability.
The collection rate was 358（81.4％）. The high competition ability skiers showed bigger oral injury incidence in total SL and men's SL significantly（P＜0.01）. The high competition ability women skiers showed bigger neck injury incidence in GS significantly （P＜0.01）. The high competition ability skiers showed a higher incidence of concussion in both SL and GS.
The competition ability influences the head, neck and oro-facial injuries. A skiing area usually locates in a remote area of medical care. It is important to prevent and reduce injuries. It is thought that a mouthguard（MG） has protective efficacy against not only the oro-facial injury but also concussion and neck injuries. Therefore, it would be better alpine ski racers should wear the MG to reduce and prevent those injuries.
Knee is the most frequent joint to be injured among skiers. We report a case who suffered destructive osteoarthrosis of unilateral knee and could return to skiing after combined treatments including total knee arthroplasty, rehabilitation and wearing knee brace. 69 years old man has been skiing for more than 50 years. He has been suffering from left knee pain these 3 years. Though conservative treatments such as taking NSAIDs and wearing knee brace were tried,
his left knee pain was not relieved. He was consulted to our hospital and agreed to take total knee arthroplasty（ TKA）. The operation was performed under general anesthesia and KU type（ Kyocera Medical Co., Ltd.） artificial joint was fixed with polymethyl-methacrylate bone cement to the bones. Rehabilitation was started postoperative day 1. He was discharged to the home postoperative day 33. Hard knee brace was applied during skiing to reinforce stability of the operated knee. 9 months after the operation, he could ski at the gentle slope and at 1 year at the steep slope in the Alps area in Switzerland. He was able to ski also in next season without pain and functional condition of his left knee is maintained at 2 years postoperative. Combination of TKA, rehabilitation and wearing knee brace are essential to return and to keep skiing for damaged knee.