Over the 34 years from December of 1972 to April of 2006 the authors evaluated prospectively 18,696 injuries sustained by 17,193 skiers and reported to the injury clinic operated in the base lodge of a medium-sized northern Vermont ski area. Data from a total of 3966 randomly selected uninjured controls were also collected. Over the period approximately 6,780,940 skier-visits were accrued by the area. The overall injury rate dropped by 55 % over the 34 years of the study to 1.9 injuries per thousand skier visits. Among lower extremity injuries only tibial plateau fractures produced a statistically significant negative trend. Twist-related lower leg injuries improved the most with a net reduction of 87 % over 34 years. Bending-related lower leg injuries showed no improvement in the last half of the study. Overall, the incidence of knee ligament injuries changed very little. However, the incidence of minor to moderate sprains diminished by 77 % while severe knee sprains, usually involving the anterior cruciate ligament, increased by 268 % through the early 90s. Since then there has been a 37 % improvement. Among upper body injuries only clavicle and humerus fractures produced statistically significant negative trends.