Avoiding skiing-related knee injuries
Avoiding skiing-related knee injuries
Many of us will be getting ready to go on our skiing trips within the next few weeks or months and enjoyable as this will be, unfortunately can cause injuries. Skiing does not affect only one anatomical area and injuries can occur to the head, shoulder, wrist, thumb and of course the knee. The knee is the most commonly injured body part in skiing with the evidence indicating 42% in some studies. Further to this, the ACL (Anterior Cruciate Ligament) is the highest injury observed within the knee occurring in all ages, genders and technical levels.
Injuring the ACL
The ACL is one of the knees biggest stabilisers and injury normally occurs from a fall, either forward and with a twist or falling backward. Normally the knee will rotate internally causing knee valgus (knee caves inwards towards your mid line). It is not uncommon to injure the meniscus and the medial collateral ligament (MCL) at the same time as the ACL - this is known as the unhappy triad. Interestingly it has been seen that a lack of fitness is one of the most contributing factors indicating that physical preparation can assist in injury prevention measures.
Exercise Intervention
When we land on one leg the hip muscles help to prevent the knee joints rolling inward (knee valgus) while the quadriceps help reduce forces on the knee joint helping deccelerate the body. The hamstring and calf muscles also work to help reduce knee joint forces, stabilising the pelvis and knee and ankle.
Undergoing a basic injury prevention exercise plan can significantly help in not just reducing injury but also improving your skiing consistency as you can improve, muscular strength, endurance, anaerobic fitness, stability, agility and flexibility.
Muscular strength
Recreational skiing is associated with the high muscular use of the quadriceps, hamstrings, gluteal and calf muscles. Evidence has shown that prolonged skiing causes increased eccentric fatigue of the quadriceps and hamstrings that may contribute to injury. To help reduce this lower body exercise such as squats, lunges and single leg squats are all beneficial in improving your lower limb strength and stability.
Neuromuscular/Proprioceptive training
Undergoing some sports specific training, particularly neuromuscular or proprioceptive training, can be beneficial in helping to reduce technical mistakes while skiing. These are training methods that can involve jumping, landing or pivoting or balance work that can help stabilise your knee and leg. These can be undertaken by using a variety of equipment such as the Bosu, inflatable discs, foam pads, wobble boards and jump mats. Improved joint awareness and ability to stabilise can help in skiing performance and injury prevention.
Mobility/Flexibility
A reduction in flexibility of muscle groups and poor joint mobility can cause increase loading on joints and other tissues due to limitations in our movements. For example, tight calf muscles will reduce the ability to squat without lifting the heels. This may cause knee valgus that can then put higher forces into the knee joint. Maintaining good flexibility of the lower limb muscles can help you move more efficiently and improve muscular activation and proprioception.
How physiotherapists can help
We can perform a musculoskeletal screening to help to find your imbalances, biomechanical dysfunctions and then implement a plan to help address these aiding to your injury prevention and performance.
To book an appointment with Stuart or our other physios call us on 02030 12 12 22.
Words by Stuart Mailer.
Injury of the month: ACL Injuries
The Anterior Cruciate Ligament (ACL) is one of two main internal stabilisers of the knee. Along with the Posterior Cruciate Ligament (PCL), the cruciate ligaments work in concert to reduce shear (to the front and into rotation) of the tibia on the femur. This is only one of many functions of the ACL and is one of the main reasons why the ACL becomes damaged.
The anatomy of the knee
As you can see from the above diagram, the ACL has close links to the medial meniscus (cartilage), which is in turn attached to the medial collateral ligament. Remember this, it will become important later….
Main Functions of the ACL
The main function of the ACL is to reduce anterior translation and rotation of the tibia on the femur. It also has an important role in the brain’s understanding of where the knee is in space.
How Does It Go Wrong?
There are a number of ways ACL injuries occur:
intrinsic - i.e. occur due to movement or loading of the individual knee in a way that overloads the ACL to the point of damage or
extrinsic - i.e. trauma caused by a blow causing overload of the ACL to the point of damage.
Classically, the ACL becomes damaged during deceleration movements with the lower leg is turned outwards relative to the knee, which is why physios keep banging on about hip, knee and foot being in alignment as this reduces this type of shear. This can come from sudden changes in direction, poor landing from a height or pivoting with a fixed foot.
Extrinsic (traumatic) can be caused by force striking (usually) the outside of the knee. In the most severe cases, due to the close links between the structures, an ACL tear can also involve the medial meniscus and medial collateral ligament - also known as the ‘Unhappy Triad’ injury.
What can I do to reduce the risk of ACL injuries?
Much of this needs to be taken care of through management of well aligned movement patterns. If the resting position of the lower limbs tends towards either knees facing forwards with feet turned out or feet facing forward with kneed facing inwardly, stress on the ACL is increased. There are two main contributors to this, either poor hip and trunk control and/or tightness in the calf (especially gastrocnemius) muscle. There seems to be some unpublished data suggesting a predeterminant of ACL injury can be recent poorly/incompletely rehabilitated ankle injuries which then place more load upon the knee.
Read our blog post on how to avoid skiing-related ACL injuries.
What happens if it goes wrong?
An ACL injury is generally accompanied (but not always) by significant swelling. A feeling of the knee giving way (especially on going down slopes or hills) is also a good indicator, however there is usually a significant loss of range of movement and pain that are more obvious indicators.
What should I do?
That depends upon the severity of the injury and what you would like your lifestyle to include. A surgical opinion is highly recommended, however there is quite a trend currently to eschew surgery and rehabilitation in favour of non-operative management.
In my experience this tends to prolong the inevitable surgery and rehab if you are interested in an active lifestyle with multidirectional sports/activities. Rehabilitation can be a long, frustrating process (between 9 and 12 months) however whilst it won’t ever return the knee to the ‘perfect’ pre-operative state, it will give you a strong, functional knee that will allow you to continue the vast majority of activities with minimal restriction.
If you’re having knee trouble, call us on 02030 12 12 22 to make an appointment with one of our knee specialists.
Words by Paul Martin.