Pain Relief For Arthritis Happy Valley, OR

Skiing and Your Knee: Don’t Blow It. Part I

1Skiing Skiing and Your Knee: Don’t Blow It. Part IAuthors note:

Part 1 is a little daunting with facts, figures, and other nerdy body mechanics information. Feel free to skim and come back for part II, which will explain the how-to of knee injury prevention in skiing! Or better yet, read it all and impress your friends on the slopes next weekend.

1Skiing1 Skiing and Your Knee: Don’t Blow It. Part I

How dangerous can it be?

Honestly, if you look at the big picture, you are about 8x more likely to die driving than you are skiing (if you do them for the same amount of time). Nonetheless, we should always try to minimize risk with our recreation so wear a helmet when you ski (end of discussion). Skiing is unique in that it has a very skewed injury rate; knees making up about 1/3 of all significant injuries.

Knee injuries are currently the most common injury, with the dreaded ACL and MCL tear often being the victim. Many skiers, wrongly, believe that releasable bindings are improving knee injury rates. In truth your bindings are designed to keep you from breaking your shin bone (tibia). Tibial fractures were a real problem not too long ago, and skiing is much safer now that those rates have declined.

Unfortunately, knee injuries continue to be a problem. There are plenty of things suggested to help minimize your risk. We thought we’d wade through some of those recommendations and see what made sense. The advice we found ranged from pressing a lacrosse ball on some magic spots on your leg for 2 min a day to whatever this exercise is to a new binding on the ski (just another $600). Most of this was based on one persons opinion of what should be done. Needless to say, we weren’t impressed. Fortunately there is some research out there that can help guide us with how to actually reduce injury rates. Although we feel like we could weigh in on many of these home remedies, we are going to focus on just ACL/MCL injuries (knee injuries).

And, since the snow has arrived (yay!) we figured you’d be interested in getting to work preventing an unexpected season-ending visit to the orthopedist.

First: prepping the gear. There is more to getting ready than waxing skis, adjusting bindings, and watching every Teton Gravity and Warren Miller film ever made. Injury prevention in skiing starts with properly sized and tuned equipment but finishes with proper training. A lot of injury prevention can be done off snow, so after you wax your skis, move your coffee table and do some injury prevention.

How do knees get injured?

Looking to articles in sports medicine journals, we found the way that Tone Bere, PT, Tonje Florenes, MD and the rest of their team describe skiing accidents is most useful for our purposes.

They classified falls as 3 ways:

1. The first is a “slip-catch,” where one ski loses contact with the snow, and through trying to recover the ski is then forced in and across the body.

1Skiing2 Skiing and Your Knee: Don’t Blow It. Part I

In frame A the left ski loses grip on the snow, frame B the ski slides sideways across the snow and and skiers legs rapidly drift apart. In frame C to frame D the left ski suddenly catches and rapidly steers the left leg toward the right, causing the tear.

2. Next, they describe the “dynamic snowplow,” where knees end up pointing toward each other and the edge of the ski drives one leg across the other ski. From the perspective of injury mechanism the slip-catch and dynamic snowplow seem very similar except for how the skier got in trouble in the first place.

1Skiing3 Skiing and Your Knee: Don’t Blow It. Part I

The “dynamic snowplow” is actually taught as a beginning skiing progression, but likely leads to injuries when used to manage higher speed and steeper terrain. From this position if one of the skis accidentally engages the outside edge of the ski it will abruptly force the lower leg jerk. If one of the skis is partially weighted and bounces off of the snow it can move rapidly across the middle of the skiers body causing a “slip-catch” type injury.

3. Lastly, they described “landing back-weighted,” where a skier loses contact with the snow landing on the tail of the ski or starts to fall backward.

1Skiing4 Skiing and Your Knee: Don’t Blow It. Part I

Sitting or leaning back on the back of a ski is similar to landing back-weighted. This position not only decreases your control of the ski but also pre-loads the ACL making any bumps or loss of control dangerous for the knee.

1Skiing5 Skiing and Your Knee: Don’t Blow It. Part I

Landing a jump on the tail of the ski almost always means that your body weight is behind your feet and the long lever of the ski will pull the lower leg forward as the ski slaps down to the snow.

From the perspective of injury, these fall types can be simplified into two groups. Firstly, the slip-catch and dynamic snowplow, where knees are rapidly turned in and across (failing to control the hip and knee) . This isn’t always as obvious in pictures or videos because it happens quickly and the skier may be in the act of falling so “in and across” becomes vague. This type of injury is more common in a turn or falling to the side of the skis. Secondly, landing back-weighted, where pressure is put on the back of the ski (failing to stay upright), causing the back of the boot to effectively push the tibia (shin bone) forward on the femur (thigh bone). This is more common when attempting to land a jump (planned or unplanned) but also happens falling backward or “sitting down.”

What both of these styles of falls have in common is that they stress the ACL (anterior cruciate ligament) which is a major stabilizer of the knee. Slip-catch type injuries rotate the shin on the upper leg,and rips the ligament by twisting. The back-weighted type injuries pulls the shin forward from the upper leg, ripping the ligament in half by stretching it. These injuries happen about as often in all levels of skiing (beginner to advanced), likely because as skiers get better they move into more dangerous terrain.

What can I do about it?

The good news is that injury rates can be reduced. A study was done with ski instructors and patrollers and showed up to 50% reduction of knee injuries. Make sure that the skis that you use are the correct size, in working order and adjusted to you. Avoid the positions that will stress the ligaments of your knee (see above). And perhaps most importantly, do your homework. Exercises that help strengthen the hip (which controls the position of the knee) and training patterns that protect the knee will help you in unexpected falls. What exercises should you do? Read part II (I promise its less dense).