Knee-related Skiing Injuries – from Prevention to Treatment

It depends upon the skiing conditions. When it is icy it can be difficult to decelerate and people tend to fall onto their hands, causing shoulder and wrist injuries. With softer snow, the vast majority of injuries are to the knee and the anterior cruciate ligament (ACL) and medial collateral ligament (MCL).

Those least prepared for their skiing holiday are most at risk. It’s difficult to go from an office environment to spending several hours each day on a ski slope. The physical aspect of skiing requires a combination of core strength, aerobic fitness, proprioception and balance. In order to manage this on the slope, it is essential to put the training in prior to your holiday.

The most “dangerous” time is in the afternoon, half way through your holiday. This is when the fatigue starts to build-in and the untrained skier is most vulnerable to injury.

We are certainly seeing more knee injuries during the skiing season and this is due to multiple factors:

• Ski design – More modern curved skis tend to “carve” through the snow rather than stick or drag on the snow. This often has the effect of steering the ski away from the body and twisting the knee.
• Boot design – Modern boots do a very good job of protecting the ankles and shins but this results in more load and rotation being transmitted to the knees.
• Poor preparation – Skiing is becoming more popular with an increasing number of people without any previous skiing experience, nor adequate fitness training, prior to hitting the slopes.

• Start your physical preparation at least 6 weeks prior to your skiing trip. Work on your core muscle strength and aerobic fitness. Regular swimming, cycling and using a cross-trainer would be an excellent start.
• If you are new to skiing, take lessons. A good skiing technique minimises your risk of injury.
• Take a rest day – muscle fatigue reaches its peak 48 hours after you hit the slopes. If you start to feel the fatigue after a few days take a rest day.
• Don’t drink alcohol at lunchtime – It increases your confidence and decreases your reactions, a perfect recipe for an injury.

Mr Toby Baring, Shoulder and Elbow Surgeon at OneWelbeck Orthopaedics explains how to minimise knee injuries during skiing.

• Make sure that you have adequate medical insurance before you leave home.
• Most ski resorts have excellent medical facilities and are very experienced at treating skiing injuries.
• If you are unlucky enough to break a bone, in the majority of cases it makes sense to have these treated (and if necessary operated on) before you fly home.
• A normal x-ray does not always tell the whole story and if you continue to have symptoms in your knee after returning home, a review by a knee surgeon would be advisable.

ACL injuries are the most common knee injury and (aside from a fracture) in general they should be treated once you have arrived home. Operating on a swollen stiff knee very soon after a knee injury often results in a poor outcome. In the first few days and weeks following an ACL injury, the priority is to reduce the swelling and increase the range of motion of the knee. Surgery can be safely performed weeks or even months, after the initial injury.

The most important thing is to prepare for your skiing holiday so that you can avoid injury, enjoy yourself and have fun skiing!