| Edward Staub, M.D. drstaub.com |
Orthopaedic Surgeon, Sports Medicine, Knee, Hip, Shoulder, Ankle, Spine
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SKI INJURIES By Edward Staub, M.D. |
Once again, many are heading north to the slopes and most will return invigorated, tanned, and
happy. Some, unfortunately, will return with slings or crutches, pale and unhappy. Here are some
common ski injuries and how to avoid.
Well over half of the ski injuries involve the lower extremities, and most of these favor the knee and
leg.
Knee Injuries
Knee sprains are by far the most common injuries. The ligaments along the inside of the knee are
injured when a skier catches the inner edge of a ski in the snow and the foot rotates outward as the
body continues forward. Stress is then placed on the inner side of the knee, which is forced into a
“knock-knee” position as the skier falls. The ligament will be stretched (sprained) if the force is
minimal and if the bindings release. Otherwise, the ligament can be completely torn. Another
potentially dangerous position is the “snow plow”—where both knees are knocked and the body
weight is placed on the inner edge of the ski. A fall will place direct force against the inside of the
knee.
Catching the outer edge of the ski may injure the ligament that lies along the outside of the knee.
This can occur if the tips of the skis accidentally cross and the skier falls sideways. The leg on the
side of the fall will twist inward and will remain straight. Stress is placed on the outer ligaments.
The new shorter, shaped skis place more stress on the knees than the former, longer skis.
Especially stress on the medial collateral ligament (MCL).
Prevention of these injuries mainly centers around adequate bindings. It has been reported that a
high percentage of lower extremity injuries result from a failure of bindings to release. Quality
bindings properly mounted and maintained will prevent many knee injuries. Various knee braces can
also be worn and, to some extent, can provide protection. A brace with metal sidings and hinges can
comfortably be worn under ski pants and allow an acceptable degree of knee mobility.
Fractures
Another common injury is the tibial fracture—or broken leg. This occurs when the leg is forced
against the hard boot top during a fall. The leg can also break when the bindings fail to release and
the leg is twisted. This torque can snap the bone. Again, proper bindings are the best insurance
against this unfortunate and incapacitating injury.
Shoulder Dislocations
If inadequate bindings are a cause of knee and leg injuries, faulty pole technique can contribute to
upper extremity injuries—specifically the shoulder or thumb.
Shoulder dislocations are very commonly treated at base clinics. The shoulder can dislocate when a
backwards force is applied to the outstretched arm and the shoulder is levered forward. Thus, a skier
who falls on his outstretched (abducted) arm may sustain this injury. Frequently, however, the arm is
levered by a planted pole; as the body continues forward, the arm is forcibly stretched and rotated
outward, aggravating the injury and making a dislocation more likely. Slalom racers who grasp too
long on their planted poles are especially susceptible to this type of
injury.
A shoulder dislocation is very painful and requires immediate setting to relocate the joint. Multiple
dislocations can eventually produce a damaged, unstable shoulder, and surgery will frequently be
required to repair it. One way to avoid this injury is to be aware of the mechanism and try to eliminate
excessive pole planting. Poles with strapless hand grips, which release better from the skier’s hand,
may also prevent this injury. If a skier has a dislocated shoulder, he or she might consider a brace to
check excessive shoulder stretching. These braces are custom made, but they are light, comfortable,
and usually don’t interfere with normal skiing. They can be worn inconspicuously under the ski jacket.
( I have personal experience on this matter, as I dislocated my shoulder twice while skiing—once on a
bunny trail at Stratton-when I first learned to ski—but again, and less embarrassingly, on a real black
diamond trail—Nosedive—at Stowe, a few years later. I successfully skied down Nosedive without
falling and ,of course, at the bottom,on level terrain, I slipped and fell. I later had a custom made
brace made and I wore this thereafter, and never again dislocated my shoulder.)
Thumb Injuries
The other notorious injury caused by ski poles is damage to the ligament on the inside of the thumb.
Since the pole is grasped between the thumb and the index finger, sudden force along the pole can
jam the handle of the pole into the base of the thumb and injure the ligament. This is a serious injury
which is treated with a cast and perhaps surgery. Pole straps incorrectly positioned can result in
greater risk of this accident. A strap held around the palm just below the base of the thumb can be
stretched. The strap should properly lie around the wrist, well away from the thumb. The risk of
thumb injuries may also be decreased—although not eliminated—by using poles with a strapless type
of hand grip.
Finally, here are five useful tips for prevention of ski injuries:
1. Service your bindings at the start of each ski season.
2. Stay fit prior to the ski vacation.
3. Do warm-up exercises before you go out.
4. Quit whenever you feel tired.
5. Don’t be a daredevil.
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NOTE: A FEW YEARS AGO, THE FOLLOWING ARTICLE WAS WRITTEN FOR A NEWSPAPER. I
AM ADDING IT TO THIS PAGE AS IT CONTAINS FURTHER INFORMATION -ESPECIALLY
REGARDING CONDITIONING AND EXERCISES-- DR. STAUB
Ski Injuries
Summer days go by as quickly as a late afternoon thunderstorm, and before we
realize it, Labor Day is here. Next we approach Thanksgiving. And then, it
is time to bring the skis up from the cellar.
The early fall is a good time to start training for the ski season. While
every professional athlete who uses the off-season to shape up for the
first game is usually in excellent physical shape when the season begins. By
contrast, far too many weekend athletes use their sports activity - be it
skiing or racquetball -- as their sole source of training to stay in shape.
This is the wrong approach and often leads to orthopedic injury, says Dr.
Edward Staub, a prominent Connecticut orthopedic surgeon. The training time
should take place prior to the respective sport to maximize strength and
endurance and to minimize injuries.
Skiing may well be the ultimate case in point. To prepare for the ski
season,says Dr.Staub, first work on endurance and cardiovascular
conditioning. Get involved in an aerobic activity such as jogging, biking
or using an elliptical trainer. Obviously, if you are overweight and out of
shape, it is safest to consult your doctor and possibly first have a stress
test. ³
The knees are vital to skiing and the most important knee muscle is the
powerful quadriceps, which extends the knee and helps to stabilize the hip. .
Since skiers need to constantly bend their knees and
require knee power to go over bumps, the quads need to be very strong.
When there is quad weakness, the knee can give out or buckle. In other
words, advises Dr. Staub, the skier will fall and risk a serious injury.
Therefore, there are various exercises that can be done to build up the
quads in and outside of the gym setting.
In the gym use weight machines to strengthen the
quads. At home, with a set of ankle weights, one can do straight leg lifts,
which have the advantage of not putting stress the kneecap. Another good
home exercise is to sit against the wall with your knees bent and your
back pressed against the wall for support (obviously without using a stool).
This will tax and strengthen your quads and this is a great exercise for
skiers. While you are at it, also try to build up your
hamstrings and hip muscles, especially the hip flexors. Finally, skiers
may overlook the importance of toning up the trunk and back muscles, such as
the abdominal muscles. These are also crucial for stability and support.
What to do if you injure your knee while skiing?
To simplify, there are three main ski injuries to the knee.
A simple sprain usually to one of the ligaments on each side of the knee
(the collateral ligaments) produces pain and possibly some localized
swelling. A sprain means that the ligament is stretched or partially torn.
These injuries are usually not serious and they are treated with rest and
pain and anti-inflammatory medication. Ice applications early on and a
knee brace may also help( RICE ). Most sprains heal in two to three weeks. If you
have legitimately rested your knee and it takes much longer than that,
suspect a more serious problem.
A meniscus tear usually requires surgery, albeit not as an emergency. The
meniscus - or cartilage as it is commonly called is a rubbery crescent
shaped cushion inside the knee which functions as a shock absorber. A
twisting injury can tear it. Frequently a rip or click will be felt and the
knee will gradually swell up over several hours. Sometimes the knee will
lock up or fail to fully straighten . The knee can be painful, or, as many
patients complain, simply not feel right, says Dr. Staub. The diagnosis
is frequently made with a MRI and treatment is usually arthroscopic surgery to
remove the torn fragment. Surgical results are excellent assuming
there is no arthritis or other damage to the knee.
The third and most severe injury is a tear of the anterior cruciate
ligiment (ACL). This injury can occur when one lands from a jump
when the foot is planted and the knee twists. Or, in
skiing, when the skier falls and the bindings don¹t release. A definite
pop inside the knee is commonly felt and the knee swells quickly.
Frequently, the knee needs to be drained and bloodly fluid is removed. The
knee is lax, raising the suspicion of a tear, but the definitive diagnosis
is made with a MRI,
Since injured skiers are frequently away from home when the injury occurs
and the diagnosis is made, it is helpful to know what to do if you are told
that your ACL is torn, says Dr. Staub. The good news is that this is
usually not an emergency situation and patients are often able to return
home for treatment. In rare instances, the ACL is repairable, and thus,
if the pros and cons of a surgical repair are fully understood by the
patient, surgery, in these instances, may have
to be done fairly urgently," says Dr. Staub. But, in most cases, the ACL
is damaged beyond repair and therefore, the patient has time to sort out
all of his or her options. If a reconstruction with a graft is necessary,
it is actually best to wait a few weeks or longer, until the swelling and
inflammation subsides, says Dr. Staub.
Many people with torn ACL’s do not require a graft -reconstruction .Medical studies have
shown that approximately 60% of people with ACL tears do well with non
surgical management consisting of a good knee rehabilitation program and a
custom made brace for sports. Elite athletes or people involved in fast
moving sports with much stopping, jumping, and pivoting require the ACL
graft, but this is a minority of patients. Dr. Staub advises that
patients be cautious about having surgery immediately -- at the ski
resort for example and try to get a second opinion. He adds that even
after you return home, don¹t rush into surgery until you understand your
options. “I am amazed at how many people with an ACL tear assume that they
automatically need a reconstruction and this is certainly not the case.” Some skiers can try an ACL
brace to stabilize the knee-but probably an ultra-intense,daredevil type skier who cannot modify his or
her ski profile, should have the reconstruction.
| Obviously, if you have a similar medical problem, you should consult a physician and not rely on these articles in lieu of treatment. If you reside in Dr. Staub's area, he will be delighted to accept you as a patient, but his ultimate opinion and recommendations will be based on his personal examination of you. |
