Cross-country (XC) skiing is one of the most demanding endurance sports, featuring different formats of cross-country races with varying lengths. Cross-country ski championships have been a part of the Winter Olympics since the first edition in Chamonix, France, in 1924. However, during the latter of the twentieth century a rapid evolution of the technique was observed, with new disciplines, improved equipment, and preparation of tracks. Accordingly, these changes led to a considerable increase in speed in this event. Although it is generally accepted that the majority of cross-country ski injuries are from overuse, there is a place for acute trauma in this sport. Interestingly, most trauma patterns occur during training, and not within the competition period. Lower extremities are at the greatest risk of injury in this sport, including stress fractures, medial tibial stress syndrome, overuse Achilles tendon problems, and traumatic knee and ankle ligaments sprains. Among upper extremity lesions, the ulnar collateral ligament tear at the MCP (Stener's lesion) is the most common. © The Author(s), under exclusive license to Springer-Verlag GmbH, DE, part of Springer Nature 2022. All rights reserved.