Your Knees and Skis

ONS sports medicine physician, Demetris Delos, MD, a board-certified shoulder and knee surgeon, offers injury prevention advice for skiers at home and before hitting the slopes.

Skiing can be one of the most enjoyable winter activities and is a great sport the entire family can enjoy.  But nothing can ruin a great day outdoors (or even the next 6-12 months) like a serious knee injury, especially the dreaded anterior cruciate ligament (ACL) tear.

Unfortunately, most of us have heard or know of someone who injured their knee while skiing (hopefully not ourselves!). Skiers, in particular, are at greatest risk to strain the ACL to the point of tearing in several ways: when they try to recover from a fall with their body weight in back of the skis; if they don’t land a jump correctly; or if improperly set ski bindings don’t release during a critical moment. ACL tears usually require surgery and a lengthy recuperation to repair.

There is nothing glamorous or exciting about a targeted conditioning program but it can mean the difference between a successful and enjoyable ski season and one that is marked by prolonged aches, pains or even more serious injuries. For this reason, training for the ski season should (ideally) begin 2-3 months before that first run.

Skiing is predominantly a lower body sport and it pays to train the muscle groups of the entire kinetic chain. This means working the core muscle groups (abdominal muscles and the low back), the hips, the thighs, the knees and the calves.  Some upper body training can also be helpful.

Six key exercises that can greatly improve strength and conditioning and prevent injury include the following:

Core:

  • Plank stabilization
    • Begin by lying on your stomach. Lift your whole body up, supported by your forearms and toes. Lift your right leg and left arm straight out. Lower back down and repeat with left leg and right arm. Repeat for10 repetitions on each side.
  • Deadlifts
    • Begin standing with weights in your hands (can start with 5 lb. dumbbells or lighter). Keep your knees slightly bent, your stomach muscles tight and your back flat. Let your arms and trunk move forward, keeping your chest up. Lift back up and repeat for 2 sets of 15 repetitions.

Thighs:

  • Double legged squats
    • Begin standing with a medicine ball at your waist. (Alternatively, you can use weights in both hands.) Lower your hips to the floor, keeping your stomach tight, your back flat, and your knees in line with your toes. Lift back up and repeat for 2 sets of 15 repetitions.
  • Single legged squats
    • Stand holding a medicine ball. Squat down on one leg, keeping your hips, back and your knee in line with your toes. Try not to lean your trunk or let your knee fall inward. Repeat for 2 sets of 15 repetitions on each leg.
  • Lateral lunges
    • Begin with a medicine ball at your waist. Take a large step to the side; sit your hips back and squat down, keeping the opposite leg straight. Lift back up, step together and repeat for 2 sets of 10 repetitions with each leg leading.

Calves:

  • Heel raises
    • Stand with your heels hanging off a step. Pick up your left foot. Standing on your right leg only, lift your heel all the way up, then back down slowly. Repeat for 3 sets of 15 reps on each leg.

Additionally, there are things you can do to condition your body before you start a day on the slopes.

  1. Warm up: Simply put, taking the extra few minutes to acclimate yourself by doing some light runs on an easy trail can put the body and mind in the right framework for the more difficult runs that lie ahead. Some light stretching can also be helpful to stimulate the muscles that will play an important role in skiing.
  2. Cool down: Stretching (preferably by maintaining a certain pose for 15-20 seconds at a time, and repeating that for 3-5 repetitions) can loosen up the muscles and prepare them for the necessary recovery after skiing.
  3. Know the risks and minimize them: Most skiers know that the risk of injury increases in the afternoon or early evening as individuals become more fatigued. So it pays to STOP WHEN YOU ARE TIRED! However, the risk of injury also increases when visibility is decreased, when a skier skis above his or her level, or when the ski conditions become very icy or very soft. When these factors are present, instead of skiing the more difficult slopes, you should consider easier runs.

Will Your Knees Be Ready to Ski? Tips from ONS to Avoid Injury

Although the forecasts are not yet predicting snow, skiers and snowboarders would be wise to take up a targeted conditioning program now to avoid the aches and injuries that often plague them on KatherineVadasdiMD300x398the slopes. Winter activities tend to tax muscles and muscle groups that are used very little during the rest of the year. As a result, even the best athletes can suffer when taking on the extreme stresses of downhill sports.

Orthopedic surgeon Steven Hindman, MD of Orthopaedic and Neurosurgery Specialsts (ONS) in Greenwich and Stamford, CT, suggests that preseason conditioning exercises can help avert pain and the most feared knee injury of all – a season-ending tear to the ACL (anterior cruciate ligament) .

“Ideally, people should start a conditioning program two to three months before they get near the mountain,” said Dr. Hindman. “But it’s never to late to benefit from a preventive exercise routine.” Too often, he noted, people go from their car to the ski lift without a single stretch. Such lack of preparation greatly increases the risk of injury.

One of four ligaments that provide stability to the knee, the ACL can tear when there is a sudden strain, abrupt change of direction, or twisting of the knee joint while the feet remain in a single direction. Skiers are at greatest risk to strain the ACL to the point of tearing when they try to recover from a fall with their body weight in back of the skis, if they don’t land a jump correctly, or if improperly set ski bindings don’t release during a a critical moment. ACL tears usually require surgery and a lengthy recuperation to repair.

Since the major leg muscles work the hardest when skiing and snowboarding, exercises should focus on strengthening thighs, hamstrings, calves and hips. Workouts that incorporate these muscle groups will help maintain good balance, stabilize the knee during stress situations and build endurance for a full day on the mountain. Adding practices such as yoga and Pilates will also develop strength and balance while improving the body’s flexibility and core fitness.

As important as conditioning is off the slopes, knowing your body’s limit is key on the slopes. Studies show that the majority of injuries happen at the end of the day with the combination of fatigue, flat light, and deteriorating snow conditions. “When you get tired, stop,” said Dr. Hindman.

 

ONS Knee Specialist Dr. Katie Vadasdi discusses Olympic Athlete Lindsey Vonn’s Injury

The ONS Women’s Sports Medicine Center team of experts consists of current and former athletes and fitness enthusiasts who know firsthand what it takes to train and excel in a sport. With the 2014 Olympics just a few weeks away, ONS orthopedic surgeon and women’s sports medicine specialist, Katie Vadasdi, MD, shared her expert opinion on one of the latest setbacks in Olympic history.

DrVadasdi_WEB

In recent news, US skiing champion, and Olympic gold medalist Lindsey Vonn stated that she would be pulling out of the 2014 Sochi Olympics in Russia. The famed downhill skier experienced a series of knee injuries which led to her decision not compete.  When asked about Lindsey’s decision, Dr. Vadasdi said, “Vonn has made an appropriate but difficult decision to pull out of the winter Olympics this year in order to give her knee the medical attention it requires.  Her sport requires an incredible amount of strength and having an unstable knee puts her in a dangerous position where she might further injure her knee or cause other injuries.”

Last February, Lindsey tore two ligaments in her right knee and broke a bone in the same leg during an intense crash at the world championships. Upon returning to the sport, Vonn reinjured her surgically repaired ACL (anterior cruciate ligament) when she crashed during a training session. Two weeks later, Lindsey suffered another injury when she sprained her MCL (medial collateral ligament), during a downhill event. After reconstructive knee surgery in February 2013, Vonn posted on Facebook that she “is devastated” to miss the Olympics, “but the reality has sunk in that my knee is just too unstable to compete at this level.”

Each year, at least 1 in 3,000 Americans between the ages of 14 and 55 tear an ACL while exercising or playing sports.  Skiers are among the group of athletes who are more likely to experience an ACL injury. Dr. Vadasdi said of Vonn’s injury, “she will undergo ACL reconstruction which will provide her knee the stability it requires to return to such highly-competitive skiing.” A reconstructed ACL not only stabilizes the knee, but also prevents damage to the menisci cartilage that often occurs due to an unstable joint.

“By making the decision now to withdraw from the Olympics and to undergo the surgery, she will allow herself the necessary time to recover and fully rehab her knee to get her back on the slopes safely and at her height competitive level.”

To learn more about ACL Injuries, click here: https://onsmd.com/condition_treatment/acl-injuries/ and visit our Women’s Sports Medicine Center at https://onsmd.com/sports-medicine/womens-sports-medicine-center/.

Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit www.onsmd.com or call 203.869.1145.