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 the 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.
Chalon Lefebvre is the Clinical Manager and Coordinator for Education at ONS Physical Therapy. Chalon is from Vermont where she was a ski racer and continues to lecture on ski injury prevention, the following is her expert advice for the season:
Certain exercises come to mind when I think about growing up as a ski racer in Vermont. Wall sits, crunches, push-ups, lateral bounds and lots and lots of box jumps got me into shape but were they really the best exercises for ski conditioning? Not necessarily, but they were on the right track. As a physical therapist, I now understand skiing and the biomechanics that go along with the sport. I understand the appropriate exercises that help to prevent injury while conditioning people so they are ready to enjoy the season.
Skiing can be broken down into concentric (muscles shorten/lifting portion of the movement against gravity) and eccentric (lowering portion while lengthening) movements. Skiing starts at the top of the mountain, as you ski down, you perform eccentric movements the entire way, resisting gravity’s pull by controlling your body’s movements. EMG studies have shown that throughout the ski turn, the prime movers and stabilizers change at different points in the turn and therefore it is important to work your muscles in functional patterns consistent with the sport.
1) Lunges are an amazing exercise for skiers. Lunges work the quadriceps, glutes and hamstrings. Both your legs are working independently of one another in concentric and eccentric motions. To perform a good lunch, stand with both feet positioned shoulder width apart and step forward with one foot making sure to step far enough so that your knee does not extend past your toes and your shin is nearly vertical, and then step back into the start position. This exercise can progress to walking lunges or by lunging while holding dumbbells in your hands. Once you are proficient, you can make these a plyometric exercise by jumping in between each lunge.
2) Squats, whether one footed and two footed, work your quadriceps and glutes. Start with your feet shoulder width apart with your back slightly arched. Initiate the squat by sitting back and down keeping your weight through your heels. Lower yourself so that your thighs are parallel to the floor (or as low as you can) being careful not to let your knees fall in front of your toes. This exercise should be done at high repetitions for endurance.
3) The Romanian deadlift is one of the best and most functional hamstring exercises. ACL tears often occur because people have a strength imbalance between their quadriceps and hamstrings. Stand holding a barbell or a dumbbell in each hand with your feet shoulder width apart. Maintain the lordosis in your lower back and keep a slight bend in your knees, lower the weight towards the floor until you feel a slight stretch in your hamstrings. Reverse the movement by contracting your hamstrings and glutes and push your hips forward as you return to the starting position. This exercise can also be done on one.
4) Planksand side planks work your abdominals, erector spinae, and glutes. Both of these exercises will provide you with the core strength that you need to be able to hold yourself upright while skiing. Lie on your stomach; place your hands at either side of your chest and tuck your elbows in at your sides. Keep your back flat, and push up onto your toes and elbows so that your body is off the floor. Pull your abdominals into your spine and try to maintain this position for 10 seconds to two minutes. If this is too challenging, this can also be down on your knees. A side plank is done using one arm and on one side at a time.
5) Lateral bounds work on agility and reaction time and when done consecutively will carry over to your ski turns. They can be done one footed or two footed. Create a line on the floor and jump sideways across the line, when your feet land, immediately jump back to the other side. This can be done for time as well as number of repetitions.
Although this is just a taste of what I would include in a ski conditioning program but are some of my favorite exercises for keeping my clients injury free and having fun on the mountain.
The ONS Foundation’s Annual 5K Run/Walk is coming up this Sunday, September 21st in Old Greenwich! ONS supporters, staff and former patients will participate in this fun-filled event. It would be great to see you all come down and enjoy a nice morning jog. Some of you may be casual joggers, others might want to participate in the local race circuit, or you might be training for the NYC Marathon.
Whether you are a casual runner, training for the marathon, or just someone who supports local causes with a 5K run…all runners are at risk of developing injuries if they are not training properly. A question I ask all my runners in the clinic is, “What else do you do for training, besides running?” More often than not, the answer is, “nothing” or “I stretch sometimes.” What many runners do not know is that research has shown an effective leg and core strengthening program can reduce the incidence of hip, knee and ankle pain.
A proper program needs to have exercises specific for running: weight bearing on one leg, focused on shock absorbing muscle groups, and emphasizing hip and core strength. Many runners feel that stretching in their training can help prevent injury. However, many injuries occur because of inherent muscle weakness, not necessarily because of tightness. To address this weakness, incorporate the exercises below into your routine: 3 times per week. Good luck with your training!
Hamstring Curls with the Ball:
1. Lie on your back with your legs up on a ball.
2. Lift your hips, bend your knees and roll the ball in towards your buttocks.
3. Roll the ball back out and lower your hips.
One Legged Bridges:
1. Lie on your back with one knee bent, the other straight in the air.
2. Pushing through the bent knee, lift your hips off the ground. Lower back down.
Repeat: 3 sets of 15 reps on each leg.
1. Lie on your side, heels in line with your shoulders.
2. Supporting yourself on your elbow, lift your body off the ground. Lower back down, repeat:
3. Lower back down, repeat:
1. Stand on your left leg only.
2. Let your trunk bend forward while extending your right leg straight back. Let your arms fall freely, keep your left knee slightly bent. Keep your stomach muscles tight and your back in neutral, bend through your hip.
3. Return to start position, repeat: 2 sets of 15 reps on each leg.
One Legged Heel Raises:
1. Stand off the edge of a step, letting your heel hang below the step.
2. Push up onto your toes. Lower back down slowly.
Repeat: 3 sets of 15 reps on each leg.
1. Stand sideways on a step.
2. Sit your hips back and bend your knee, lowering your opposite leg to the ground. Do not let your knee fall inward and do not let it bend past your toes.
3. Lift back up and repeat: 2 sets of 15 reps
Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.
If you love racket sports, you might already know what it’s like to experience a rolled ankle or shoulder strain. Injury prevention is the key to staying in the game and ONS is here to help you keep your swing healthy! On Tuesday, May 13th at 6:30 p.m. in the Noble Conference Center at Greenwich Hospital, come hear sports medicine physicianGloria Cohen, MD, orthopedic surgeonKatie Vadasdi, MD, physical therapist Tatyana Kalyuzhny, PT, DPT, MDT and Patrick Hirscht, Tennis Pro, Round Hill Club in Greenwich discuss how to avoid the most common injuries in racket sports like Achilles tendon tears, shoulder and wrist injuries and rolled and sprained ankles. Learn to recognize injury warning signs and know when it’s time to see a doctor. The panel will discuss injury prevention and the latest orthopedic treatments.
Dr. Katie Vadasdi, head of the ONS Women’s Sports Medicine Center shares her medical expertise and experience in treating these types of injuries saying “racket sports can lead to overuse injuries due to the repetitive motions required in these sports. We most commonly see shoulder and elbow injuries including impingement of the rotator cuff and inflammation of the tendons in the elbow also known as tennis elbow. Early in the season, it is important to gradually increase intensity and duration of play to reduce the risk of developing such overuse injuries. If an athlete develops pain, it is important to rest in order to allow for appropriate recovery. This can often prevent the development of more serious injuries. If pain persists in spite of rest, then an athlete should reach out to a medical professional for further diagnosis and management options”.
For more information on shoulder injuries/surgery click here!
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 https://onsmd.com/ or call 203.869.1145.
The knee is the most vulnerable body part for any athlete, including skiers. Downhill skiing produces large amounts of torque on the knee, challenging the integrity of ligaments and tendons. Whether from a fall or overuse, the most common injuries in skiers are tears to the MCL (Medial Collateral Ligament) or ACL (Anterior Cruciate Ligament), two important structures that give our knee stability. When a skier is thrown off balance, his skis will sometimes shoot out in front of him, creating extra torque on the knees and damaging our stabilizing structures.
Both novice and experienced skiers are at risk of hurting their knees. We frequently see novice skiers hurt themselves when they do not know how to turn, stop or fall properly. Taking lessons and working with an instructor goes a long way in preventing knee injuries for beginner skiers. Experienced skiers frequently take risks and assume that they can manage faster speeds on any slope. Many injuries, whether you are a beginner or an experienced skier, are related to weather conditions. It is important to realize that as visibility and surface conditions deteriorate, the slope or trail level goes up. In poor visibility or icy conditions, a beginner trail becomes an intermediate trail, and an intermediate slope becomes advanced slope. Keep injury prevention in mind, if the conditions are difficult, ski down a level.
A second reason injuries occur is fatigue. Most skiers’ bodies are not accustomed to exercising 6-8 straight hours. In addition, many skiers push their bodies to take advantage of the whole day, even when they start to feel tired and stiff. For this reason, injuries tend to happen at the end of the day.
Having the knowledge of what places skiers at a higher risk for knee injuries, we are passing on recommendations about how to stay safe on the slopes. Both beginners and experienced skiers can benefit from these tips!
Start a conditioning program a few months before your first ski trip. Leg strengthening, flexibility and balance are important aspects of an adequate ski conditioning program.
Ski with good technique. Maintain your balance and control, keep your hips above your knees, keep your arms forward, and maintain a safe speed.
Learn how to fall correctly: keep your legs together, keep your chin to your chest and your arms up and forward.
Pay attention to weather conditions and remember to ski down a level if conditions deteriorate.
Listen to your body. If you start to feel pain or stiffness upon exiting the lift chair, then you should probably make that run your last. Head to the lodge and enjoy a warm drink by the fire.
Good luck and stay warm!
If you become injured, while skiing, remember, ONS sports medicine physicians are trained at the top universities and hospitals in the country and have expertise in the latest treatments for sports-related injuries in high-performance and recreational athletes.
ONS orthopedic and trauma specialist surgeon Steven Hindman, MD, who specializes in foot and ankle surgery and is a panel speaker for topics such as ski and snowboarding injuries shared his expert opinion on Shaun’s decision saying, “I think he made the right decision in taking a break this weekend and not attending the X Games. Shaun White, being one of the best, if not, the best athlete in his sport, knows what he can and cannot handle. He knows he can push the very difficult tricks and moves that he does. The Olympics are once every 4 years, it is critical to prepare and not over-do it especially when healing a previous injury.”
Another expert opinion came from ONS orthopedic surgeon Michael Clain, MD, who specializes in foot and ankle surgery and sports medicine. Dr. Clain said “most ankle sprains are fine with rest, immobilization and rehab. I’d expect him to be able to compete just fine at the level for which he qualified for.”
When you have a mild sprain, remember rest, immobilization and rehab are best before you head back to the slopes.
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.
On Tuesday, November 19th, 2013 at 7:00pm at the Cole Auditorium at Greenwich Library, The ONS Foundation and the NFL Alumni Chapterwill present a free seminar on Youth Sports Concussion Awareness and Prevention. The Greenwich Branch of Wells Fargo Advisors is pleased to sponsor the ONSF/CT NFL Alumni Chapter Concussion Seminar.
Concussions are a hot topic in the NFL and in high schools and colleges across the country with particular concern about the brain health of players of contact sports. The ONS Foundation and the NFL Alumni Connecticut Chapter want to raise awareness and educate parents and coaches of youth athletes about the signs and symptoms of concussion.
The discussion will cover the latest information on concussion management on the field, in the doctor’s office and what parents/coaches/teachers need to know to support recovery from concussion.
Speakers include: Tim Hasselback– ESPN Analyst, retired NFL Quarterback: Greenwich Youth Football Coach
Steve Thurlow– President NFL Alumni CT Chapter- Retired Running Back for the Redskins and New York Giants
President of the ONS Foundation, ONS Orthopedic Surgeon and Sports Medicine Specialist, Paul M. Sethi, MD
Tim Greene, MD is an orthopedic surgeon who is fellowship trained in sports medicine and hip arthroscopy, a cutting edge technique that has revolutionized the treatment of various hip problems. He graduated Princeton University and earned his medical degree at the Medical College of Georgia. He performed a residency in orthopedics at Emory University and served as associate team physician to the athletic teams at Georgia Tech.
Dr. Greene completed fellowship training at the Steadman Hawkins Clinic in Vail, Colorado under the direction of Dr. Marc Philippon. While there, he served as associate team physician for the U.S. Ski Team.
What are the most common ski injuries?
Although skiing might appear to be a high risk sport, the incidence of ski injuries has actually been declining for the past 20 years. This is partially attributed to better boot and binding technology and may partially be due to the raising awareness of common ski injuries and what can be done to prevent them. The risk of sustaining a fracture is now minimal since the advent of breakaway bindings.
Today, the knee is the most vulnerable body part for a skier. The most common injury is a tear to the MCL, the Medial Collateral Ligament that supports the inside of the knee, and in second place is a tear to the ACL (Anterior Crutiate Ligament), which runs through the center of the knee and is important for stability. In skiing, the knees serve as shock absorbers. They undergo a lot of stress, absorbing the bumps and turns as you navigate the mountain. Beginning skiers may be susceptible to a torn MCL due to the mechanics of the “snowplow” technique, ironically often the first method taught. When in the snowplow position with the skis forming an arrow and the knees bent inward, there is a lot of stress put on the inside of the knee. Falling in this position can result in a sprain or strain of the MCL.
The ACL is at greater risk during skiing because the ankle is locked into position by the boot and the knee is absorbing much of the turning motion. If a skier is thrown off balance and leans back, his skis will sometimes shoot out in front of him or her creating extra torque on the knees that may rupture the ACL. The ACL can also be torn by impact to the knee or severe stress from bouncing down hard on a bump. This can also happen when turning hard and “catching an edge”. A quick jolt and rotation can also cause an injury.
Do you see the same kinds of injuries with snowboarders?
Generally the injuries are different. You don’t have the twisting motions in snowboarding that you have in skiing, so we don’t see nearly as many knee injuries as we see in skiing. Snowboarders do however tend suffer more upper extremity injuries like the shoulder or hand, which occur when they try to catch themselves during a fall.
Who is most susceptible to these injuries?
There are two sets of people who tend to get ski injuries; very beginning skiers who are not supervised on the slopes, and very experienced skiers who tend to take more risks with speed and terrain.
Why do they happen?
Many injuries, whether you are a beginner or an experienced skier, are related to weather conditions. It is important to realize that as visibility and surface conditions deteriorate, the slope or trail level goes up. If the conditions are difficult, ski down a level. In other words, In poor visibility or icy conditions, a beginner trail becomes an intermediate, an intermediate slope becomes advanced and on and on.
Another reason injuries occur is fatigue. Most people only take one or two ski vacations a year, so they try to cram the most into each day. Their bodies aren’t accustomed to exercising of 6-8 straight hours and they get tired and weak. Most injuries happen at the end of the day and that’s because the light is poor and skiers are fatigued. The combination can be very bad.
What is the best way to prevent those kinds of injuries before hitting the slopes?
Starting a conditioning and strengthening program a few months before your first trip up the mountain is a very good way to help prevent injuries. By developing good core strength your body will be in better shape to handle the stress and strength needed in skiing. Leg strengthening and balance should also be central to a conditioning program. Aerobic training will help build stamina which will help prevent fatigue which is the cause of many injuries.
Are there any other precautions to take, once on the slopes?
Ski in control. Loss of control can lead to a crash, which is the cause of the most serious accidents.
Recognize the condition of the terrain you’re on and of your own condition. Pay vigilant attention to your own level of fatigue and rest when you feel tired or weak. Weakened muscles can lead to a loss of control that can lead to a fall or a crash into another skier or stationary object like a tree or lift tower. If you are tired, take a break, if it’s icy or the snow is extra heavy, ski down a level and if you are inexperienced, take a lesson. You’ll have more fun, and the instructor will help you avoid mistakes that can lead to injury.
In addition to your own mindfulness, pay attention to weather conditions. When I was in Vail working at the Steadman Hawkins Clinic, we could tell from the weather what kinds of injuries we would see that day. If the snow was soft and powdery, you would typically see more ligament injuries from skis getting stuck in a bank. If the snow conditions were harder, you would have more fractures.
If someone is injured, what kind of treatment is involved?
Treatment depends greatly on what type of injury you sustain. Unless an injury requires emergency treatment, if you think you’ve been injured, have it evaluated by the ski patrol. Many sprains and strains can be addressed by applying the RICE principle; Rest, Ice, Compress the area, and Elevate. It is always best to follow up with an orthopedic surgeon once you get back home, who will most likely access your injury by physical exam and sometimes x-rays or an MRI. Your doctor will make a determination of the best course of treatment depending upon the severity of the injury and your general physical condition. In the case of a ligament tear, surgery may be an option but that depends on how bad the tear is, your general health and your normal level of activity.
The ONS Foundation for Clinical Research and Education presented their 9th annual Ski Conditioning and Injury Prevention Seminar on Tuesday evening, December 7 at ONS on Valley Drive. Orthopedic surgeons Dr. Steven Hindman and Dr. Tim Greene addressed 46 eager skiers on a range of topics from the most common skiing injuries to injury prevention strategies and information on the latest treatments for injuries such as a ruptured ACL. Chalon Lefebvre, PT of ONS Physical Therapy gave a presentation about the benefits of adopting a ski conditioning and strengthening exercise program before going skiing.
All the presenters agreed that each year, excited skiers and snowboarders head to the slopes but many do little to prepare for the physical demands of their sport. Even the best athletes are susceptible to injury when under-prepared muscles engage in activity they haven’t done for many months. “Physical conditioning can make all the difference,” said Dr. Hindman. “Most people go from the car to the ski lift without even a single stretch. Skiing requires muscles and muscle groups that are used very little the rest of the year. If you don’t prepare, your risk for injury increases.”
“Don’t think you will ski yourself into shape,” warned Ms. Lefevbre, who was a ski racer in Vermont. “The sooner you begin a conditioning program, the better off you’ll be. Start with basic stretches and strengthening exercises and build slowly. It’s never too late to benefit from a program. Find one that’s geared to winter mountain sports and you won’t be making an
appointment to see me in the coming months.”
“Have a good time on the slopes but be mindful of injury factors that I call, the three Ts; Tiredness, Terrain and Timing,” said Dr. Greene who worked with the US Ski Team in Vail, CO during his Fellowship training. “Your risk for injury goes up when you’re tired, when the terrain conditions aren’t good, and at the end of the day when the light and the conditions have deteriorated, and you become fatigued.”
“DON’T WAIT FOR THE SNOW TO START FALLING TO PREPARE YOUR BODY FOR THE SKI SEASON,” SAYS ORTHOPEDIC SURGEON DR. STEVEN HINDMAN OF THE ONS FOUNDATION FOR CLINICAL RESEARCH AND EDUCATION. “THE SOONER YOU START A CONDITIONING PROGRAM, THE BETTER.”
As further impetus, the ONS Foundation is holding its annual Ski Conditioning and Injury Prevention Seminar on Tuesday, December 7 at 6:30 p.m. at ONS building, 6 Greenwich Office Park at 10 Valley Drive. Dr. Hindman and orthopedic surgeon and sports medicine specialist Dr. Tim Greene will discuss the causes of common skiing injuries and how they may be avoided. The free seminar will include tips on safe skiing, and information on the latest treatments for common injuries such as a ruptured ACL. Chalon Lefebvre, PT of ONS Physical Therapy will talk about and demonstrate ski conditioning and strengthening exercises. Registration is requested. Call 203-869-3131 or email firstname.lastname@example.org to register or for information.
Each year eager skiers and snowboarders head to the slopes but many do little to prepare for the physical demands of their sport. Even the best of athletes are susceptible to injury when under-prepared muscles engage in winter sports activity for the first time in many months. Physical conditioning can make all the difference.
According to Dr. Hindman, there is a lot that can be done to avoid the common aches and more serious strains to joints and muscles that many experience. “Most people go from their car to the ski lift without even a single stretch,” says Hindman. “Skiing requires muscles and muscle groups that are used very little the rest of the year. Ideally, strengthening and conditioning should begin two to three months before the first trip up the mountain, but it’s never too late to benefit from a program. Find one that’s geared to winter mountain sports. If you don’t prepare, your risk for injury increases.”
The free ONS Ski Injury Prevention Seminar will take place on January 26 at 7 PM. It’s not too late to get ready for the ski season. Don’t miss this opportunity to hear important tips for safe skiing, information about the most advanced treatments for common injuries such as a ruptured ACL, and a presentation on the latest ski and snowboard technology by Hickory and Tweed of Armonk. Orthopedic and sports medicine specialists Steven Hindman, MD and Katherine Vadasdi, MD will discuss the causes of the most common skiing injuries and how many of them may be avoided. Physical TherapistChalon Lefebvre, PT will discuss the importance of a pre-season conditioning and strengthening program.
Admission is free but registration is requested. Call 203-869-3470 or send email to email@example.com to register.
The ski injury prevention seminar is offered by the ONS Foundation for Clinical Research and Education. The goal of the ONS Foundation is to improve standards of excellence for the treatment of musculoskeletal disorders through clinical research, physician and patient education, and community outreach programs. For more information about the ONS Foundation for Clinical Research and Education, call Ifeoma Inneh at (203) 869 3131. The ONS Foundation for Clinical Research and Education is an alliance with Greenwich Hospital. For further information, visit www.ons-foundation.org or call (203) 869-3131.
Skip Beitzel of Hickory and Tweed in Armonk, New Yorkwill be joining the ONS ski seminar crew again for the ONS annual free ski injury prevention seminar this year. Skip will bring along a selection of examples of the latest skis, ski bindings and snowboard equipment. He has just signed on to distribute the new “KneeBinding” which the manufacturer claims is designed to prevent ACL injuries. Skip plans to try the binding out himself so he can speak about it from experience but, with reservations, he says it certainly sounds promising.
He also said he was excited about the re-release of the Look Pivot ski binding that was such a popular binding many years ago. According to the manufacturer, the Look Pivot 14 features a metal pivot heel which rotates with the boot directly under the tibia. The Turntable Heel ensures that the binding releases when it should and holds the boot in when it should for more reliable binding performance in stressful situations.
Come to the ONS Ski Injury Prevention Seminarat 7 PM on January 26th to see these new bindings and hear more about them and lots of other useful information on how not to get injured on the slopes this season. Admission is free but registration is requested. Call 203-869-3470 to register. For more information visit www.onsmd.com.