Knee injuries have always been a problem for skiers, accounting for roughly 30-40% of ski injuries. The vast majority of knee injuries consist of damage to the ligaments, whether it is an ACL, meniscus or Medial collateral ligament tear. Soft tissue injuries can also occur.
Serious injury symptoms
- Obvious deformity to the knee
- Total inability to weight bear on the affected leg for 4 steps (i.e. 2 transfers of weight)
- Large degree of swelling in the knee within a couple of hours of injury
- Inability to fully straighten the knee (‘locked knee’)
- Severe tenderness when you press on a localised area
Medial Collateral sprains
This occurs when the knee joint is in the valgus position and excessive force is pressed onto the knee joint. This can happen during a fall, crossing of skies, a widen stance or in experienced skiers ‘catching an edge’ (ski is thrown outwards).
Diagnosis
- Tenderness over the MCL
- Pain on weight bearing
Assessment
- Test ligament stability by applying valgus stress (30 degrees flexion)
Treatment
- Splints
- Surgical Repair
- R.I.C.E
Prevention
- Conditioning of Quadriceps group
- Avoid wide snowplough stances which can be unstable
- As a beginner allow yourself to fall as resisting can lead to more damage
ACL
Research has identified three main mechanisms that predispose to ACL damage in alpine skiers. These are the backward twisting fall (‘‘flexion-internal rotation’’ or ‘‘phantom foot’’), the forward twisting fall (‘‘valgus-external rotation”) and the boot-induced anterior draw. I will attempt to explain each of these in turn.
Phantom Foot
A typical profile has been identified which comprises of six elements that come together in the event of (usually a backwards) fall and which characterises this mechanism of injury. These elements are:
- Uphill arm back
- Skier off balance to the rear
- Hips below the knees
- Uphill ski un-weighted
- Weight on the inside edge of downhill ski tail
- Upper body facing downhill ski
When all six elements of the phantom foot profile are present, injury to the ACL of the downhill leg is extremely likely. Situations that can predispose to this scenario developing are:-
- Attempting to get up whilst still moving after a fall
- Attempting a recovery from an off-balance position
- Attempting to sit down after losing control
Forward twisting fall
This occurs when the skier moves forward relative to the ski. From this, a bending movement is applied as the affected leg twists and roates outwards forces generate rapture to the ACL.
Treatment
- Build up muscle strength to help stabilise the joint
- Arthroscopy ligament repair and mobility
- Reconstructive surgery
- Knee brace
- Good rehabilitation programme
Prevention
- Body position- keep arms forward, feet together and hands over skies
- Don’t fully straighten your legs when you fall. Keep your knees flexed.
- Don’t try to get up until you’ve stopped sliding. When you’re down–stay down.
- Don’t land on your hand. Keep your arms up and forward.
- Don’t jump unless you know where and how to land. Land on both skis and keep your knees flexed.
Meniscal injuries
This injury is associated with damage to another structure. It occurs due to a valgus twist in a weight bearing knee (rotational stress). The lateral meniscus is more commonly affected.
Diagnosis
- Pain and difficulty weight bearing
- Swelling
- Joint line tenderness during extension of the knee
Treatment
- Arthroscopy and repair
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