Ski Injury Free: Make More Turns

An interview with physical therapist Patrick Naylor

What are you seeing in terms of the prevalence of ski injuries in recent years?

We’ve seen a 50 percent decrease in the number of injuries in skiers since the 1970s, due in part to improved gear, bindings, training and preparation by athletes. We see that children between the ages of 11 and 13 have the highest rate of injury, but that teenagers—who have the second highest rate— have more severe injuries. Women tend to have twice the injury rate of men. Specifically, anterior cruciate ligament (aCl) injuries in women racers are six times higher than in male counterparts.

Donny Roth Safety2_Winter2013

Why do you see higher rates of ACL injuries in women?

It comes down to two factors: anatomical and hormonal. anatomically, women’s hips are relatively wider than men’s, which leads to a greater quadriceps angle (the angle between the quadriceps muscle and the patellar tendon on the knee—also known as the ‘Q’ angle), and consequently more stress on the ligaments around the knee. This creates a situation where the knee tends to collapse inwards in
women. The hormonal effect in women can cause ligaments and tendons to be less taut and, therefore, reduce the overall rigidity and strength of the joint.

What are the most common ski injuries?

One third of all skier injuries occur in the knee. in snowboarders we see less knee injuries, but more hand and wrist injuries. head and neck injuries are also more common and there are higher rates of ankle-joint injuries due to impact. in skiers, tears to the medial collateral ligament on the inside of the knee are the most common mechanism by which beginners hurt themselves. here, the person ends up in a forward fall, usually in a snow plow, by crossing their tips and collapsing inward on the knee. injuries to the aCl account for another 10 to 15 percent. This most often happens when someone finds themselves in a backwards twisting fall. Sometimes people refer to this as the phantom foot injury: when you start to feel yourself falling backwards and leveraging your stiff ski boot, you begin to twist and it feels as if someone is stepping on the tail of your skis, hence the phantom foot.

TT_Winter2009 Skiing

Is there any way to help prevent this type of injury?

I always tell people that if they find themselves falling backwards on their skis, to throw their hands forward in front of themselves as hard as they can. The trade-off here is that this may prevent aCl injury, but may promote “yard sales.”

Do you see different injuries between backcountry skiers and resort skiers?

Skiers at resorts, with their predominantly hard-pack snow, are associated with more impact-based injuries, such as fractures. The heavy snow of the backcountry is associated with more torsion-based and twisting injuries.

How can skiers reduce their risk of injury?

Generally, the best way to prevent these types of common injuries is to strengthen the muscles around the aCl and across the knee, ankle, and hip joints. in our clinics, we teach athletes to take off and land properly from a jump or ski turn. Strengthening these areas of the body helps the impact to be directed straight forward.

What can I do to prepare for the ski season?

Condition. The fundamental concepts for the pre-season break down into developing an aerobic base. That comes first if you don’t have time for anything else. if you do have time, strength training is best. it’s a great idea to work on balance and agility training, and explosive/coordination training is a great extra.

Anything specific that I could work on?

Two minutes of continuous skiing uses 50 percent of the aerobic system and 50 percent of your anaerobic capacities. The shift towards the aerobic and endurance qualities of the body is only going to increase on a long day of skiing. The aerobic base is the most important to develop.
Having that aerobic base prevents the fatigue which can lead to more injuries. Fatigue prevents the muscles from operating optimally, and skiing at Colorado altitudes just exacerbates the problem. Skiing is a constant battle against gravity and centrifugal forces. Building an aerobic base helps you to combat those explosive forces.
For pre-season conditioning, inline skating is great cross training, as is skate skiing. They both combine edge control with the need to move in three different planes: side-to-side, front-to-back, and up-and down. For pure aerobic and coordination training, road cycling and mountain biking are great ways to cross train.
Endurance training can be as simple as completing 30- to 60-minute workouts, three to five times per week, for six to 12 weeks.
Once you’ve established an aerobic base you can add anaerobic training to your regimen. Anaerobic means “without oxygen” and refers to your muscles’ ability to function in a state of oxygen deprivation. By training your anaerobic system you improve your body’s ability to process lactic acid so that you can ski at a higher intensity for a longer period of time.
Anaerobic training is often done by performing intervals of hard work for 30 seconds to three minutes followed by a rest period of equal time. an example would be inline skating at a fast pace for one minute, coasting for one minute, then repeating five more times. You could then take a five- to 10-minute break and do another set. The total amount of time that you are working hard should be 10 to 24 minutes a session. Doing one or two anaerobic training sessions per week for one to two months, while decreasing your endurance workouts to two to three times per week, will ensure that your “engine” can actually handle a full day on the slopes.

What if I want to include strength training?

For strength training, focus primarily on the legs and core. Typical squats and lunges are great, as are free weights which require more balance and coordination than machines. make sure that you have someone you trust to show you proper technique. If not, machines are the way to go and may be safer, with just slightly less benefit.
Yoga and Pilates also offer great benefits as they strengthen while helping to make you more flexible.
For more advanced training, air disks and exercise balls (sometimes called physioballs) help to increase the difficulty of any movement and, therefore, increase the workout potential. The same can be said for decreasing the number of contact points (two legs down to one), by decreasing the stability of the surface, or by closing your eyes and relying on proprioceptive (the sense of the relative position of neighboring parts of the body) feedback. All of these techniques will help you to strengthen not just your muscles but those other qualities that make skiing a unique activity.
Finally, there is explosiveness/coordination training. This component can be developed through one to two sessions per week of plyometrics, which are jumping and bounding exercises that incorporate controlled landings with quick and powerful takeoffs. Plyometrics should not be performed until you’ve done a basic strength training program for at least six weeks. Plyometric training is designed to improve reaction time and increase explosive power, eccentric muscle control, and coordination of fast movements. For more advanced skiers, this type of training simulates on-slope conditions, reactions, and explosiveness. Box jumps, scissor- or tele-jumps, and hurdle bounds are a small sample of the many different types of plyometric exercises.

Patrick Naylor, MSPT, is a physical therapist and Physical Therapy Manager at the Boulder Center For Sports Medicine. He is a former competitor on the Pro Mogul Tour and won a gold medal in the downhill inline race at the 1998 ESPN X Games.

This article originally appeared in the Winter 2009 Issue (1001) of Trail & Timberline

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