Dr. Scott: Can my knees take ski season?

Q: I worry more about skiing injuries. Is there anything you recommend to help someone like me to keep on skiing? 

A: If your leg and hip muscles are just burning up on the runs, then realize that your skiing style is incorrect. Though you may have skied for decades, this may be a sign that you need a lesson in your technique. Proper conditioning before the ski season can make the big difference between a fun weekend on the slopes and one marred by injury. Several weeks before hitting the slopes, begin training with an elliptical trainer or stationary bike or walking. Build up to 30 minutes three times a week.

Stretching before skiing will protect you against injury and enhance freedom of motion; stretching afterward returns your muscles to their normal length.  Stretching is the single most important thing people can do for body health maintenance. Muscular tissue shortens with time. Stretching also maintains good alignment of the bones.

Severe muscular imbalances are very common in skiers. Schmid (1984) studied the main postural muscles in 8 members of the male Olympic ski teams from Switzerland and Lichtenstein. He found that among this group of apparently superbly fit individuals, fully 6 of the 8 had demonstrably short right iliopsoas muscles that flex the knee and leg onto the chest, while 5 of the 8 also had left iliopsoas shortness and the majority also displayed weakness of the abdominal muscles. Hurley (2004) found that the most common predisposing factor for osteoarthritis of the knee is weakness in the muscles that attach to the knee. The long term repercussions of such imbalances can be easily imagined. 

A common skiing injury we see frequently is damage to the hamstrings and/or quadriceps muscles (usually both), resulting from violent stretch or rapid contraction. Falls account for 75 to 85 percent of all skiing injuries, according to the American College of Sports Medicine. (2012) Most common is damage to the knee. Predisposing factors to a skiing injury include poor flexibility, fatigue, unbalanced reciprocal actions in the opposing muscle groups of the knee, imbalances between quadriceps and hamstring muscle strength, inadequate warm-up before skiing, restrictions in associated joints, and previous unresolved injuries, etc. Weakness in any of these muscles is a predictor of injury. (Reed, 1996) Many knee problems are the direct result of improper support to the knee from the muscles that attach above and below it.

For example, if the muscle(s) on the middle side of the knee is weak, there is little to keep it from bending further toward the center. If this condition is present and the individual strains his knee by canting in that direction, it may lead to injury. This can cause something as simple as a trick knee or a much more serious condition, such as a catching of the cartilage as the knee goes through its range of motion, causing a tear. Pelvic and low back structural distortions are also connected to weakness in the muscles of the knee. If you go into your ski season with imbalances in these joints or muscles, you are asking for trouble.

The foot and ankle, when functioning improperly, may cause strain in the skier too. The knee is one of the primary areas receiving strain from the foot. You can observe this by standing and making your foot go into a flat-footed position. Watch your knee roll inward. If a person has a pronated or flat foot, the knee receives shock with every cut or bump on the slopes. This is a mechanical strain that may cause leg and knee pain and possibly knee damage.

Skiing careers can be shortened by poor preparation and poor technique in the early years of a skier’s life. It is the responsibility of the coach, doctor, and parent to acknowledge the particular susceptibility of young skiers to injury. If a child is injured, parents should be alert and seek proper attention early on. Non-attention in the early stages is one of the biggest factors leading to permanent problems.

Fatigue is a big factor. If I had a dollar for every patient who got hurt on the last run I might be able to buy you that condo right off the slopes in Vail.

Dr. Scott Cuthbert is a chiropractor at Chiropractic Health Center in Pueblo, Colorado, as well as the author of two textbooks and multiple research articles. PuebloChiropracticCenter.com.

More information on his books on applied Applied Kinesiology can found at thepulp.me/drscottbooks

If you would like to ask Dr. Scott a question at email:  cranialdc@hotmail.com.


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