Preventing Skiing-Related Knee Injuries
The most common injuries in skiing happen to the lower limb, most commonly the knee. The introduction of releasable bindings has decreased the rate of leg fractures by 90% in the past 30 years, but knee sprains (including ACL and/or MCL tears) are on the rise accounting for about 30% of all skiing injuries.
The most common injury is the medial collateral ligament (MCL) tear, which is typically treated without surgery. In skiing, the MCL is often torn when the ski tips are pointed toward one another in a snowplow position (the common slow or stop position) and the skier falls down the hill. MCL tears are more common among beginning and intermediate skiers than advanced and elite skiers. When skiing you may prevent an MCL tear by:
- Making sure that your weight is balanced when you are in the snowplow position.
- Sticking to terrain that is a comfortable challenge but not overwhelming.
The second most common injury is the anterior cruciate ligament (ACL) tear. Given the importance of the ACL to the functional stability of the knee, ACL tears often require surgery (however in some cases patients can avoid surgery). ACL tears are common in sports, but most of them are the result of "non-contact" injuries.
There are two ways that skiers most commonly tear the ACL:
- Landing a jump in poor form. When skiers land from a jump with their weight back, so the back of the boot is pushing on the calf, the force from landing can tear the ACL. The best way to avoid this injury is to learn to land safely, with your weight forward, by starting with simple jumps and gradually advancing to more difficult jumps.
- The "phantom foot" phenomenon often happens when skiers try to stand up to prevent an unavoidable fall. As the skier falls, all the weight goes on the outside of one ski, and the arms and trunk rotate away from that leg. When a skier falls into this position, an ACL injury is often the result. Avoid this position by never trying to stand up during a fall and accepting an unavoidable fall. Skiers should "go" with the momentum of a fall and maintaining good ski technique.
Preventing injury on the slopes
- Remember the keys to effective skiing technique: hands and weight forward, legs parallel, and hips, knees, and ankles flexing equally.
- Stay on marked trails: Going off trail can take you into ungroomed territory with many possible obstacles (such as trees and rocks) that can contribute to injuries.
Getting ready for the slopes:
- Prepare your body. A few simple exercises (listed below) can prepare your core and lower extremities for skiing. Three to four weeks of aerobic training such as walking, elliptical, or biking can be excellent ways to help you tolerate a full day on the slopes.
- Ensure you have proper equipment: Make sure ski boots, bindings, and ski length are fit and appropriate for your height and skill level. Wear a helmet. Wrist guards are a good idea if snowboarding.
- Learn proper technique: Take a skiing technique class with a professional before you hit the slopes.
- Rest: If you are tired, rest. Injuries happen more commonly when skiers are fatigued.
Exercises to Condition Core and Lower Extremities
The exercises below are not intended as a substitute for care from a health care professional. If you experience pain or other signs and symptoms of injury or pain, you should seek the advice of a physical therapist or other health care professional.
Double Leg Squats
Place your feet shoulder width apart. Squat down, keeping your heels on the floor. Keep your feet and knees facing forward. Stick your bottom out and don't let your knees go too far forward. Focus on using your gluteal muscles (buttock muscles) to lift and lower your weight. Your shins should be parallel to one another, with your knees no farther forward than your toes, just like in good skiing technique. Do 10-15 repetitions, then hold midway in the squat until you are fatigued. Repeat 3 times.
Above: Double leg squats with good form. Even though she is driving her hips backwards, she stays balanced over her feet and is not falling backwards.
Above: Double leg squats with poor form. The knees are knocked inwards, and she is driving her knees forward instead of lowering her hips backwards.
Single Leg Squats
Stand on one leg. Use a chair or counter to place a hand or few fingers to help you keep your balance at first. Work towards squatting without any help balancing. Keep your pelvis level and squat down. Just like in the double leg squat, keep your heel on the ground with your foot and knee facing forward. Make sure your pelvis is level; that it isn’t dropped down on the leg that is unsupported. Do 10-15 repetitions on each leg, and repeat 3 times.
Above Left: Single leg squat in good form. The model is flexing her hip, knee, and ankle equally and keeping her knee forward and her leg perpendicular with the ground. This will strengthen her leg, promote good ski technique, and teach her to avoid a dangerous position.
Above Right: Single leg squat in poor form. The model is letting her pelvis drop and her standing knee fall inwards. This is a component of the "phantom foot" position and should be avoided.
Stand on one leg and take a large step to the side with your other leg. Stand on that leg, and then take another large step back to where you were. Make sure that your pelvis stays level and that your knee doesn’t buckle inward. You can make this more difficult by wrapping a resistance band around your waist. Work up to doing this for 2 minutes. Don't rush. The slower you go, the more difficult this exercise is.
Lie on your side with your knees bent, and prop up on one elbow. Lift up your hips and push them forward, so you make a straight line from your shoulders to your knees. Slightly lift the top leg up. You should feel this working your hip and core muscles on the side that is down. These are the muscles that keep your knee from falling inwards. Make the exercise more difficult by starting with your knees straight so only your forearm and the outside of your foot are touching the ground.