About 120,000 recreational skiers tear their ACL each year. Understanding how it happens can lower the risk.
If you’re planning a winter ski trip, you have probably given plenty of thought to the warm clothes, the gear and the lodge. Now it’s time to plan for injury prevention.
A common ski injury is a tear to the anterior cruciate ligament (ACL). It happens to an estimated 120,000 recreational skiers worldwide every year and usually ends the weekend or vacation with a ski patrol sled.
Despite the prevalence of ACL injuries in recreational skiing, little has been done to prevent them. A recent editorial in the British Journal of Sports Medicine noted that specialized injury prevention programs are very successful in ball sports, but they haven’t been utilized in recreational skiers.
“Research has found considerable benefits, more than a 50 percent ACL injury reduction, following specific ACL injury prevention programs in ball sports,” says Martin Burtscher, lead author of the editorial and a professor at the University of Innsbruck. “Why should this not work in Alpine skiing?”
When an ACL tears on a soccer or other sports field, it’s often because the body twists and the foot doesn’t, transmitting that torque to the knee. But snow and skis make for a different equation, says Tim Hewett, professor and director of research at Marshall University’s Department of Orthopaedic Surgery in Huntington, W.Va.
Understanding the position of the body when these injuries are most likely to happen can help people lower their risk. There are three main ways people tear their ACL while skiing:
- The slip-catch: This typically happens during a turn when the outside ski loses contact with the snow and the skier attempts to regain contact in a more vulnerable, extended-knee position.
- The dynamic snowplow: This occurs when the inside ski loses contact with the snow during a turn and re-engages with the snow in a snowplow position. This causes the inside knee to twist.
- The backward fall: An out-of-balance backward fall can happen when the skier sits on the back of the ski. It also occurs when the skier hits the snow with the backs of the skis while the legs are very straight.
Not all of these risky situations can be avoided, especially because they involve unanticipated movements, but some can. That’s why prevention programs for recreational skiers can be effective, Burtscher stresses.
What you can do to prevent ski injuries
Although it’s best to start a training program a few months before your trip and maintain it throughout the year, you can still benefit from training even if your trip is weeks away. Matt Jordan, former director of sport science/sport medicine for Alpine Canada, said injury prevention training programs should focus on the following areas:
- Core strength: Exercises that build your core will help maintain a stable position on the skis. Try a plank (hold a push-up position with straight arms or while resting on your forearms) or a bridge (lie on your back with your knees bent and feet flat, and use your glutes to lift your hips up).
- Knee and hip control: Exercises that develop dynamic strength and balance can help in situations when the snow is suddenly icier or bumpier, or when another skier runs into you. Try standing on one leg with your knee slightly bent and back straight. Lower your torso, so it’s parallel to the floor. Or try lunges on a balance pad. With one foot on a balance pad or disk, step the other foot back. Now lower your back knee to the floor.
- Hamstrings and quadriceps: Strong legs act as a brace for the knee, and balanced strength between the quads and hamstrings is an important factor when skiing. Do squats. Keeping your back straight, bend your knees and hips to 90 degrees.
- Lower-limb asymmetry: Exercise one leg at a time. This helps maintain the ability to stop and make turns in each direction, especially while fatigued. At the gym, do single-leg presses on each side. Or do squats or calf raises while standing on one leg, then switch sides.
- Dynamic movement: These exercises can improve power and explosiveness, which is important, because skiing involves quick contractions of muscles to turn, stop and jump. Try jump squats, broad jumps (jumping forward) or skater jumps (jumping from side to side, one leg to the other).
One such prevention program, which focused on competitive high school skiers in Sweden, reduced ACL injuries by 45 percent compared with injuries of skiers who didn’t take part in the program. The study, conducted over a 21-month period with more than 400 adolescent Alpine skiers, emphasized core strength, jumping and squatting movements. You can watch the video education program to see a demonstration of the exercises.
A similar prevention program involved a group of 184 teenage competitive Alpine skiers in Switzerland. The group followed a once-a-week, 20-minute injury prevention program for youth skiers that consisted of hip and leg strengthening and core stabilization training. The result was a decrease in the rates of all traumatic injuries by about 34 percent and overuse injuries by about 30 percent.
How well these prevention efforts would translate to middle-aged recreational skiers isn’t known, but experts are optimistic. They might even be more effective, hypothesizes Hewett, because less-trained individuals typically respond to training interventions more readily than elite or highly trained athletes.
“If you have a recreational athlete who hasn’t strength-trained in a long time, and you give them even a basic strength-dynamic balancing exercise, they are going to get better at that a lot in a very short period of time,” Hewett says.
Ian McMahan is a San Francisco-based writer and certified athletic trainer. He has a master’s degree in exercise physiology from the University of Maryland and has worked as an athletic trainer for Major League Soccer, the Women’s World Cup and the San Francisco 49ers.
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