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Dr. Neil Patrick - Health Matters
Dr. Patrick will provide many helpful hints keeping us on track in order to
get
the most enjoyment from our activities
Skiers’ Knees
There are
plenty of activities to take advantage of in the winter, all of which get
you active and enjoying this time of year. Downhill skiing is a very
popular option, and certainly one of my favourites. Now that we can get our
boards on the slopes, it would be a good idea to keep in mind how to do so
safely and without injury.
Ski
equipment technology has advanced significantly over the past twenty-five
years, and as the sport has changed so too have the injury patterns. In the
past, when ski boots were soft and bindings were little more than clamps and
straps, skiers commonly injured their ankles and lower legs when they fell.
Now, with hard boots, quick-release bindings, and skiis that allow even a
beginner to carve an edge, things have changed. With advanced technology
skiing injuries have decreased overall; in fact injuries to the lower leg
have decreased by 90% since the early 1970’s. Despite this, the most common
ski injuries are still to the lower extremity, but now our knees are the
victims.
The knee
joint is held together by a series of ligaments, of which the ACL and MCL or
anterior cruciate and medial collateral ligaments, are most susceptible to
injury from skiing. In fact ACL injuries are the number one injury in
alpine skiing, with the incidence similar to those seen in collegiate
football players. Common mechanisms of injury are catching the inside edge
of a ski, falling back on the ski with the knee hyper-flexed and catching an
edge, and landing poorly from a jump where the boot jerks the lower leg
forward at the knee. Knee injuries can vary in severity from a mild sprain
to full ligament rupture, and the results can be quite devastating. Even
with surgical repair, knee ligament injuries can lead to early degeneration
or arthritis of the joint down the road.
The obvious
reaction here is to blame poor binding mechanisms for allowing the knee to
be contorted so drastically without releasing. It is true that a binding
adjusted to the proper tension or DIN setting is an important safety
device. Unfortunately, however, while current binding technology is
excellent at preventing ankle and tibia injuries, they are relatively
ineffective at preventing knee injury. The problem is that while the
bindings are set to release at a certain load threshold, this can only be
sensed where the boot meets the binding; not at the knee itself. Also, the
load required to injure an over-flexed and vulnerable knee is significantly
less than is required for normal skiing. In other words, in order to be
able to stay in your bindings at all while skiing, you have to put your
knees at a certain amount of risk.
This is an
imperfect situation, but there are things you can do to minimize your risk
and prevent injury. While the knee joint is held together by ligaments like
strapping, it is supported externally by your leg muscles. In fact, muscle
contraction around the knee provides a four-fold increase in knee strength.
The stronger and more flexible those leg muscles are, the greater the first
defence your knees have. The quadriceps at the front of the thigh,
hamstrings at the back, and calf muscles in your leg all help to support the
knee joint. Strengthening these muscles with resistance training is a good
idea before and during the ski season. Also, a warm, loose muscle works
better than a stiff and cool one, so stretching and warming up before skiing
is always a smart idea. Finally, proper technique in any sport minimizes
injury, so lessons from a certified instructor are an important investment,
especially when learning the sport or tackling new challenges. You might be
surprised to know that one of things I used to teach people when I
instructed was how to fall properly – it happens to everyone, so it makes
sense to learn how to minimize you injuries when it happens.
In my next article, I’ll cover a
few other typical ski injuries, compare these to injuries found more
commonly with snowboarding, and tell you what you can do to help prevent
them. Until then, have fun on the slopes!
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