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.  With some of the best skiing available in the Georgian Triangle area, 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 thirty 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!