The Knee the Ski and Thee

Between three and 10 skiers per 1,000 skier days will incur an injury. Approximately 25 percent of those injuries are to the knee.

by Dick Dorworth

Even the best skiers in the best possible physical shape incur knee injuries. There are no magic formulas or foolproof methods for immunity from the risk of damaging that most essential of joints. However, educating yourself on the risks and preparing yourself for the rigors of the skiing season can help reduce the chance of injury.

Endurance, strength and flexibility are three essential ingredients to reducing risk, says Ketchum-based personal trainer Connie Aronson. “Over-reliance on one form of exercise at the expense of a well-rounded ski conditioning program is a mistake.”

A good fitness program considers age, weight, past injuries, current level of fitness, number of days skied each season, time available for pre-conditioning and skill level.

Physical fitness is a year-round endeavor. Don’t begin a program in October and expect to be fit for skiing in December, cautions Aronson. And, contrary to some beliefs, one does not ski oneself into shape. A skier who starts the season in good shape and relies only on skiing to maintain fitness loses degrees of fitness as winter progresses and is at greater risk of injury than one who has an exercise program outside skiing.

“All major leg muscles, as well as the erector and spine muscles, work to maintain a good stance on skis, and they all need to be functionally fit to avoid fatigue and the risk of injury,” says Aronson, who is a certified American College of Sports Medicine health and fitness specialist.

The largest joint in the human body, the knee is versatile and complicated enough to support most of the body’s weight through all the things people do to and with their bodies. It is also highly prone to serious injury, particularly among skiers.

Below the hip, only the knee and ankle joints absorb, adapt to and control forces from a pair of skis moving down a snow-covered hill at 2, 20 or 60 miles an hour.

Modern ski boots essentially enclose the ankle in a cast, so any error in balancing the dynamic forces of skiing places immense stress on the knee—in particular, the ligaments that hold the joint in place.

Ligaments are tight bands of tissue connecting bone to bone and crossing a joint, providing stability against biologically illicit movement. Ligaments do not stretch, contract or move; they tear, either partially or completely. The four ligaments of the knee are the MCL, LCL, ACL and the PCL (medial collateral, lateral collateral, anterior cruciate and posterial cruciate ligaments).

The most common skiing knee injury is to the MCL. This usually heals naturally with good rehabilitation and bracing. Injuring the ACL is more serious and can require surgery. Once the ACL is torn, the knee is just as loose one or five or 10 years later.

About 20,000 skiers in America tear their ACLs each year. Once it happens, there are three options: modify activity; don’t modify activity and recognize the increased risk of serious knee injury; surgery.

A study of professional skiers by the Steadman Hawkins Clinic in Vail, Colorado, concluded that “ACL deficient athletes had more than a 20x increased risk of sustaining a knee injury requiring surgery.”

According to the study, sewing the ACL works about 65 percent of the time. Replacing the ACL with either a cadaver graft or with a portion of the patient’s own hamstring or patellar tendon has a success rate of 98 percent.

Ketchum-based orthopedic surgeon Del Pletcher does not entirely agree with the theory of a 20 times risk factor. “About 25 percent of people without an ACL will function well,” he says, noting that this includes some top racers. Pletcher does not always recommend surgery for torn ACLs, and in his experience close to 10 percent will suffer some post-operative complication such as pain, stiffness or other discomfort.

Either way, the lesson is this: Seeking professional help to develop a year-round fitness program may take time and money, but dealing with an injured knee takes more.

Connie’s knee conditioning

Stand with feet shoulder-width apart. Place the ball at waist level, against a wall. Keep your feet under your knees. Squat, as if sitting into a chair, keeping knees in line with the toes, and navel pulled in. Keep the chest up, put pressure into heels and try not to lean into the ball. Hold for two seconds. Come back up until hips and legs are fully extended, keeping the gluts contracted. 12-15 reps. Progress to squats without the ball.

Step onto the center of the BOSU (both sides up) ball, foot pointing straight ahead. Keep chest lifted, retract shoulders and draw navel in. Lift one leg out to the side of the body as you lower into a 3/4 squat. Hold for two seconds, and slowly return to starting position. Keep hips level. Keep the bend coming from ankle and knee, not your back. 12 reps.

The foam roller helps release knots in the tensor fasciae latae and iliotibial band, the fascia that run alongside the thigh. The pressure heats up the soft tissue to allow the muscle to release and stretch. Lie on your side, the foam roller in front of your hip. Cross the top leg over, touch the floor, and keep the bottom leg off the floor. Using hands for support, take your time rolling down your hip an inch at a time, until you feel a tight spot. Stay there for 30 seconds, relaxing, until the pain starts to diminish, then continue rolling down until you hit another tight spot. Stop just above the knee.

Copyright © 2009 Express Publishing Inc. 
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