The Winter Olympics have come to a close and spring break is coming up. This means ski trips for many people and, unfortunately, injuries for some. The most common skiing injuries are in the lower limb, predominately the knee. Leg fractures caused by skiing accidents have been reduced by 90% since introducing releasable bindings! However, knee sprains – including tears of the Anterior Cruciate Ligament (ACL) and/or Medical Collateral Ligament (MCL) – are on the rise, accounting for about 30% of all skiing injuries.
The most common injury for beginner and intermittent skiers is MCL tear. MCL tears are typically treated without surgery. This is because the ligament will almost always ultimately heal itself, due to the rich blood supply from one of its attachments at the semimembranosus tendon (a hamstring muscle). The reason that MCL injury is common for the newer skier is because often these skiers are learning to ‘snowplow’. This position, skiing down the hill with the tips of the skis pointed towards each other, creates a lot of stress in the inside of the knee, which is the location of the MCL. To reduce risk of injuring the MCL, it is important to make sure that your weight is balanced when in the snowplow position. It is also a good idea to ski on terrain that is not too challenging for your level of ability.
The second most common injury in skiing is an ACL tear. This type of injury often requires surgery. This type of sprain can occur when landing a jump incorrectly, hitting a large mound of snow unexpectedly, or falling while twisting. If the ACL is fully torn, it will not heal on its own. Surgery to repair an ACL tendon is common, and patients typically do very well after surgery. The post-operative rehabilitation process is extensive, however, with return to full sport or recreational activities expected only after about 6-8 months of care. Some people opt out of surgery even with a full ACL tear. Whether or not this is possible depends on how each individual copes without an ACL and on what activities they would like to ultimately return to. Regardless of the extent of an ACL injury, it is typical to work with a physical therapist before deciding to proceed with surgery, to work towards optimal function and to also consider what long-term treatment intervention (surgical or non-operative) will work best.
Here are a couple of tips for how to reduce risk of skiing injury:
- Ensure that you have appropriate equipment: It is important to make sure that skis, boots, bindings, and goggles are fit appropriately for your size. You should make sure that somebody at the ski shop with fitting expertise helps you with this process.
- Wear a helmet: Wearing a helmet significantly reduces the risk of concussion and traumatic brain injury, and can even save your life.
- Learn appropriate technique: Whether it’s your first time skiing or you’re trying to ‘up your ski game to the next level,’ it is important to learn the appropriate technique from a professional. There are generally individual or group classes available at most ski resorts.
- Rest: if you are tired, you should rest. Most injuries occur when people are fatigued or not paying attention to their technique.
- Always be alert: Whether skiing the bunny hill or double black diamond runs, you must always be aware of your surroundings. Sometimes skiing on terrain that is easy for you is a time when injuries occur, because you may not be paying attention as much and could hit a pile of snow or another skier. Or maybe you’re trying tricks that you’ve not done before which might best have been practiced off of skis. Skiing on runs that are too challenging is also risky, as incline or obstacles may provide challenges for which you are not ready. Whatever your level, stay in control.
- Ensure appropriate core and lower extremity strength: It is common knowledge that quad and glute muscle strength is important for skiing. An often neglected issue is lateral hip strength. If you have weak muscles on the sides of your hips, it can cause your knees to turn inward, increasing the risk of knee injuries. Here are a couple of helpful exercises that are designed to increase strength in your hips, core, and lower extremities.
- Hip Abduction Clams: Perform this exercise by lying on your side with both knees bent somewhat. Lift one knee off of the other, while ensuring that your pelvis doesn’t roll backwards. This exercise helps strengthen the gluteus medius, which is a stabilizing muscle on the side of your hip. You can increase the difficulty of this exercise by tying a resistance band around your knees or lifting your foot up slightly after lifting your knee.
- Lateral Plank: Perform this exercise on your forearm (as shown) or on a straight arm. This exercise helps strengthen your gluteus medius and oblique abdominal muscles, which are active while turning while skiing downhill. You can make this exercise more difficult by lowering your hip on the ground and then lifting it back up again, or by lifting the top leg up while maintaining the plank position.
- Lateral Lunge: Perform this exercise by lunging sidewise, making sure to keep your knee from turning inward (it should be roughly in line with your second toe). You can make this more difficult by hopping to one side and landing on the ‘lunge’ leg and then alternating to the other side. This exercise emulates the lateral stability that is required while skiing.
It would certainly be best to have a skiing fitness program designed specifically to meet your individual needs. It would also be best to start training for skiing several months prior to a planned trip. If you are already active and regularly perform strength training activities, it is likely that skiing will be well-tolerated this Spring Break. However, if you have been sedentary for an extended period of time before you attempt to ski, know that you are at a higher risk for pain or injury. It’s not too late to consider enjoying the snow this season, but it might be worth considering activity appropriate to your current level of fitness. This might mean cross-country skiing, or snow shoeing.
If you’ve sustained a skiing injury, or have further questions about how be ready to ski successfully, Symmetry can help. Though we live far from the nearest winter slopes, our therapists are expert orthopedic specialists well-familiar with assisting patients in achieving their optimal knee performance. Visit our website for further information.