Prevent Skiing Knee Injuries on the Slope

February 8, 2016 by Liz

BY: Meryle Richman, PT, DPT, Senior Director of Ivyrehab Briarcliff and Jefferson Valley

As the cold weather approaches, many of us turn out thoughts and energy to the ski slopes. With this ever increasing interest, we gathered information to enhance conditioning for downhill skiing to help prevent common knee injuries.

The most common skiing injuries that occur in the lower limb, as a result of collisions and falls, are knee sprains/tears, which include Medial Collateral Ligament (MCL) and Anterior Cruciate Ligament (ACL) sprains/tears. With new advances in ski equipment today such as releasable bindings, the statistics have changed to decreasing leg fractures to 90% and 30% for knee injuries.

According to the American Physical Therapy Association, (http://www.moveforwardpt.com/resources), (1) Medial Collateral Ligament (MCL) injuries are more common in the beginner and intermediate skier when the ski tips are pointed towards one another in a snow plow positon, when the skier is trying to slow down or stop.

Prevention Tips for MCL injuries:

● Make sure your weight is balance when you are in a snowplow position
● Stay on comfortable terrain

(2) Anterior Cruciate Ligament (ACL) injuries occur when the skier lands from a jump with their weight back on the boot. This causes a significant force on the back of the boot and the force pushes on the calf, which results in spraining or tearing the ACL

● Another common ACL tear is the “phantom foot” phenomenon. This occurs when the skier tries to stand up in order to prevent a fall. All the weight goes on the outside of one ski, and the arms and trunk rotates away from that leg.


Prevention Tips for ACL Injuries:

● Land safely with your weight forward. Start with simple jumps and gradually advance to more difficult jumps
● Do not try to stand up and go with the momentum of the fall and maintain good ski technique

Tips for Preparing for the slopes:

1. Make sure you have the proper equipment and take a skiing lesson if you have not skied in a while. Prepare yourself to three to four weeks before you go skiing with the recommended flexibility, strengthening and endurance program recommended below:

2. A safe and enjoyable ski season begins with a pre-slope program designed to promote adequate flexibility, strength and endurance. The scope of the conditioning program is dependent upon the physical condition of each individual.

Flexibility is among the most vital components of an effective conditioning program. Primary consideration should be given to maximizing the flexibility of the quadriceps, hamstrings, gastrocnemius, soleus, trunk rotators, shoulder girdle and low back musculature. Long, slow static stretching of these muscle groups is recommended.

Strength is another consideration. The quadriceps muscle group is of primary concern to the heavy demand placed on it when downhill skiing. Strengthening of the gluteals, hip adductors and the arms are also recommended. Inadequate strength affects ski technique and increases injury risk.

Endurance should also be addressed in a ski conditioning program. As with the other components of strength and flexibility, the amount of endurance training is relative to the fitness level of the individual. One can choose from running, swimming, cycling, rowing and Elliptical trainer. Endurance workouts may also incorporate a plan that strengthens the muscles used in skiing, as well as increasing endurance. Examples of ski- oriented training are: traverse running; box jumping.

Skiers should also prepare themselves with an adequate warm-up of stretching the upper extremities and the back before getting the skis on in the morning and can even include jumping jacks or jogging in place. Due to the nature of the physical demands of the sport, a run or two on an easier slope is recommended as a final warm-up.

Fatigue is inherent in a full day of skiing. Studies have shown that injury rates are increased toward the end of the day. Beginners should consider skiing a half day until their endurance improves. Care should be taken to monitor physical status and pacing your runs on the slopes with adequate food and water breaks in order to have a safe day.

Recommended Flexibility Program:

• Standing quadriceps stretch – pull heel toward buttock until a stretch is felt in front of thigh, hold 30seconds, repeat on opposite side.
• Standing hamstring stretch – Place heel on a bench. Slowly lean forward reaching down towards your shin until a stretch is felt at the back of the thigh. Keep the knee straight and back straight, hold 30 seconds, repeat on opposite side.

• Calf stretch – Keeping back leg straight, with heel on floor and turned slightly outward, lean into wall until a stretch is felt in calf, hold 30 seconds, repeat on opposite side.

• Standing trunk rotation stretch – Turn shoulders to one side while keeping hips forward, hold 30 seconds, repeat on opposite side.
• Standing trunk lateral flexion stretch – Reach over and upward while sliding opposite arm down leg, hold 30 seconds, repeat on opposite side.

Recommended Strengthening Exercises:

• Circuit training
• Free weights
• Isometric strengthening in the “downhill position”

Have fun on the slopes!
Ivy Rehab

Prevention Tips for Tennis Injuries

January 28, 2016 by Liz

By Meryle Richman, PT, DPT, MS, Senior Director at Ivyrehab Briarcliff & Jefferson Valley

Tennis elbow (lateral epicondylitis) typically affects middle aged (40 to 60 years of age) adults and only 1 in 20 play tennis. If you have pain and/tenderness on the inside of your elbow, that is not going away it could be caused by different reasons such as improper techniques, poor physical conditioning, weight of the tennis racquet, too much tension on the strings of the racquet, balls are too heavy, type of court surface you are playing on and the grip size of the racquet. Other causes for lateral epicondylitis come from repeated forcible extension of the wrist such as using a screwdriver, heavy lifting and shoveling snow. Overuse of the muscles that extend the wrist usually has no pain at rest, but will increase with activity.

Treatment of tennis elbow focuses on relieving pain, controlling inflammation, promoting healing, improving local and general fitness and controlling force loads and repetitive movements with the wrists. Physical therapy uses a variety of modalities to relieve pain and decrease inflammation, massage and soft tissue mobilization techniques to heal the tissues. In addition, the following stretching and exercises are also recommended:

NOTE: the recommended stretching and exercises should not cause any increase pain. In the event that they do, you should stop immediately and consult with your physician.

Stretching Tips

● Forearm stretch:
Hold arm straight out, fingers pointed towards the floor. Use your opposite hand and pull the fingers towards the body until a stretch is felt. Hold 10 seconds, repeat 3 times.
Repeat same as above, but fingers are pointed towards the ceiling. Use the opposite hand to fingers towards you. Hold 10 seconds, repeat 3 times.

● Racquet stretch:
Stand with your feet shoulder width apart. Hold your racquet at the top of its frame with the right hand behind your head. Grasp the grip of the racquet with the left hand and slowly pull the racquet down the back. Hold 15 – 20 seconds. Repeat 3 times. Switch hands and do in the opposite direction

● Scapular Stretch:
Cross the right arm in front of the left shoulder letting the elbow bend so that the hand droops over the left shoulder. With the left hand on the right elbow, push your arm in towards the back of the room. Hold for 15 – 20 seconds. Repeat 3 times.

● Arm overhead stretch:
Take your left hand over your head. Bend it at the elbow, so that your left hand is over your head near your right ear. Then take the right hand and push the left elbow with it more toward the right. Hold for 15 – 20 seconds. Repeat 3 times

● Hands behind the back stretch:
Grasp your hands behind your back while holding them at the wrist. Pull your left hand more towards the right and then do in the opposite direction. Hold 10 – 15 seconds. Repeat 2 -3 times

Recommended Strengthening Exercises

● Ball Gripping: Use a soft ball and repetitively squeeze to strengthen the forearm muscles. Do 100 – 200 times a day.

● Wrist curls: Support your forearm on a table and stabilize your wrist with your other hand. Hold a 1 – 2 pound weight and bring your wrist up toward the ceiling and then back down. Now turn your palm up and once again bend your wrist toward the ceiling. Do 10 times/ 3 sets. Increase in 1/2 pound increments.

● Broom – Handle Exercise: Take a stick and hang a 1 – 2 pound weight from a string to the stick. Keep the arms held out in front, with the palms down and attempt to roll the weight up and then back down. Repeat with palms up. Do 10 times/3 sets.

Call to set up a free appointment if you would like to attend this free Tennis Screening at Ivyrehab Jefferson Valley (914) 245-8807 on February 23, 2016 from 7:15-7:45 PM. In addition, if you would like to be seen right away for an injury or chronic pain under Direct Access (no prescription is required), contact us at or Ivyrehab Jefferson Valley (914) 245-8807 or Ivyrehab Briarcliff at (914) 762-2222. You can also visit our website at www.ivyrehab.com.

Ivyrehab accepts most insurance plans (which our office obtains pre-approval from your insurance carrier) and will submit your office visit treatments for payment. You will be responsible for your co-payment depending on your particular insurance policy.
With one-on-one care this permits the therapist to construct a personalized program for the individual. After all, when it comes to rehabilitation, “it’s all about the people”.

Ivy Rehab

Free Sport Readiness and Injury Prevention Screening

Location: Inside Ivyrehab Jefferson Valley
February 23, 2016 at 7:15 -7:45 PM with Deborah Cohen, MSPT