ATTENTION ALL DOWNHILL SKIERS!
The ski season is approaching and now is the time to start preparing your body for the coming season. Over the last several years I have treated my share of ski-related injuries and even more skiers that talk about wanting to know what to do to get ready (get in shape) for the pending season. Well, this year I decided to do my research and provide some guidance for those interested in doing what they can to try and prevent injury and for those that want to get in shape.
For this article I would like to focus on the orthopedic injuries that are most commonly seen with skiers and to an extent preventable. The knee joint is the most commonly reported orthopedic injury site for skiers; specifically, the Medial Collateral Ligament (MCL), the Anterior Cruciate Ligament (ACL), and the meniscus (cartilage).
The MCL is a ligament on the the inside of the knee that is vulnerable to sudden movements where the knee is forced toward the midline of the body while the foot and hip stay towards the outside of the body. The momentum of the body with the knee in this type of position can happen on terrain that is too advanced for the skier, but it can also be the result of weakness and lack of muscular control. Often this is the result of fatigue and lack of endurance. This is why training in preparation for the ski season may save you in the long run.
The ACL ligament is a more well-known ligament that we hear in the news when professional or high level athletes injures/tears the ligament while playing sports. This ligament will often rupture from “deceleration” injuries when the athlete is attempting to slow the momentum of his/her body. It is commonly the result of difficult terrain and/or poor control of the muscles. Again, lack of training is often thought to be a contributing factor. There are programs to reduce the risk of injuring the ACL and they involve strengthening the core (think of an apple core...it goes all the way around), the hips/pelvis, the thighs. It can also be helpful to teach proper mechanics with basic movements like the squat and dynamic activities like landing when jumping. Learning how to work towards performing these movements can be as important as doing the action itself.
The Meniscus (cartilage) can be torn when the body pivots over the knee. There are a multitude of ways this can happen from mishaps on difficult terrain to more innocuous ways like when a skier gets their ski stuck getting on/off the ski lift and twists their knee. In the end the extent of the injury will decide the intervention that is needed.
There are a multitude of ways skiers are injured but research indicates that beginners have three times the injury rate of experts, but their injuries are typically less severe. Experts have less frequent but more severe injuries (head injuries, fractures and high grade ligament sprains). This is probably due to their higher speed on the ski slope. Intermediate skiers fall somewhere in-between. Getting beginners prepared for the season by teaching strengthening exercises is a safe way to start the season.
Females have twice the injury rate of males. One study looking at female ski racers found that their anterior cruciate ligament (ACL) injury rate was six times that of their male counterparts. Physical conditioning may have a significant impact on injury rates. This means that the better shape a skier is in, the less frequent the injuries.
The most common times for injury are the first couple runs, which may be due to the skier being deconditioned and having not trained before they ski or when the skier is not warmed up.
Another common time is before midday when the skier is fatiguing due to not being conditioned. The end of the day also has a high incidence of injury and is likely from full body fatigue and inability to handle the forces that add up as the day goes on.
How can you prepare for the ski season? Well, the best way is to see if you have an underlying injury or potential issue that can lead to an injury. In order to address the potential injuries, it is wise to have someone assess your joint mobility, major muscle group strength and functional strength. At very least starting to prepare for the coming season through strength training and general conditioning would be recommended. You would want to give yourself some time, so although the end of the summer may be a bit premature, planning ahead is a good idea to ensure it is not postponed to the last minute when it will be too late!
Joint mobility plays a big role in injury prevention because, for example, if your hip mobility is limited you will often make compensatory movement choices that affect the knee. In the clinic we see all types of athletes that come to us with knee pain or knee injuries that are at least in part due to a loss of hip motion or a loss of strength through the full range of motion of the hip. I often tell my patients that the “knee is not the knee...it’s the hip or the ankle/foot that’s the source of the problem.”
Similarly with strength, the hips and pelvis strength will often influence what control we have on how our knee moves. One of my favorite things to do in the clinic is to leave the knee alone and work on the hip and ankle mobility and hip/pelvis strength to show the patient how their knee can feel better and is stronger without doing “knee exercises.”
When fatigue or improper use of major muscle groups influences the movements at the knee, you are susceptible to preventable knee injuries. Working out can reduce these type of injuries and knowing what exercises is important for lasting success. The key to minimizing the likelihood of a knee injury is to build the strength and endurance of the muscles that influence the knee. Often a generic program will serve as a “better than nothing” approach but to have confidence I recommend a more thorough assessment by a clinician that performs a whole body assessment. Focusing on the muscles of the hips/pelvis and thighs are a good starting point, and using general conditioning ideas will help to improve your tolerance/endurance and reduce your risks of injury.
Ski season is right around the corner and now is the time to start preparing yourself. I am happy to announce that I recently opened a new physical therapy practice...I am calling it FysioFit Physical Therapy. (My wife is from Denmark and Physical Therapists are Fysio Therpists). This practice is a “cash-based practice.” Every visit is 1 hour long and always one-on-one. My staff and I will have multiple locations in the the Capital District (including Saratoga) where you can be assessed and taught our “injury prevention program.” You can find more information on FysioFitPT.com
I can be seen at Goodemote Physical Therapy five days a week and at FysioFit Physical Therapy by appointment only. Please email me at This email address is being protected from spambots. You need JavaScript enabled to view it. if you have any questions for me!
