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”