By Dr. J. Halbrecht, MD, Othopaedic Surgeon, San Francisco, USA

Preventing Ski Injury

Conditioning: Maybe you think you are in good shape. You jog once in a while or swim 3 times a week. This does not mean you are in shape for skiing. Skiing requires strength of the quadriceps, gluteal muscles and low back. Because of the high altitude, above average aerobic conditioning is necessary. How can you achieve these goals and improve your season?

Muscle Training: If you have access to a health club, an exercise bicycle or stairmaster are the two best pieces of equipment you can use. Both of these work the quadriceps and hip musculature as well as provide aerobic training. Of course outdoor bicycle riding is equally effective, and running stairs in a stadium or high-rise is another option. Step aerobic classes provide similar beneflts, and can be done with ankle weights to further improve the workout.

If you are on a long ski trip or far from any exercise equipment, a number of simple exercises will help build your ski muscles. The phantom chair exercise has you assume a seated posture without a chair beneath you. Wall sitting is another version of this exercise where you lean against a wall and slide down to a seated position. Maintain these positions for as long as you can. Two to five minutes should be your goal.

A Sport Cord is an elastic device which is easily transportable in any overnight bag and provides a means of resistance to perform strengthening exercises without weights, sort of a health club in a bag. Many of the US Pro Skiers use this device. For quadriceps strengthening, simply stand on the center of the cord, hold the ends in your hands and do short arc squats. For more advanced exercise, do a single leg squat. Many other muscle groups can be worked out as well.

Stretching is extremely important in the prevention of injury, particularly in the cold. The best way to loosen up and prevent a disabling back, neck or hamstring injury is to do 10 minutes of aerobic activity prior to skiing and to stretch for at least five minutes. If you are at a ski resort, try running the stairs or hallway for a few minutes to warm up.

Tips

Equipment: Bindings have improved dramatically over the past 6-7 years and are the most important piece of equipment for the prevention of injury. If you have bindings older than this you might want to consider upgrading your equipment. In any case, make sure to have your equipment checked at the beginning of every ski season by a qualified ski shop.

Knee Injuries: If you have problems with your knee, use of a knee brace and a specialized exercise program may help reduce your chances of further injury. If you injure yourself on the slopes, don't continue skiing without seeking medical attention. A bad problem can easily be made worse!

The most commonly injured ligaments in the knee are the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL). The MCL will usually heal with bracing and rehabilitation. An ACL injury often requires arthroscopic surgery for optimal treatment. One of the tell tale signs of a ligament injury is an audible "pop" at the time of the Injury followed by swelling of the knee. If either of these symptoms occur, you should see your doctor immediately.

The meniscus or "cartilage" can also be injured while skiing. This is usually caused by a twisting fall and results in pain and clicking along the joint. Unfortunately, cartilage tears do not usually heal and often require arthroscopic surgical treatment (outpatient surgery through small puncture holes.)

Shoulder: Dislocation of the shoulder can occur when a skier falls with the arm outstretched, usually after planting the pole. This injury can be avoided by letting go of the pole during a fall and by trying to keep the arms close to the body while falling. Once a dislocation has occurred, recurrences are likely and medical attention should be sought.

Skiers Thumb: Injury to the collateral ligaments of the thumb is one of the most common ski injuries and is caused by the pole straining the thumb during a fall. The risk can be reduced by placing your hand through the pole strap from the bottom up so that you are grabbing the strap and the pole at the same time. This way, when you fall, your hand has a better chance of disengaging the pole.

Fatigue: Do not ski when you are tired. It is not a myth that more ski injuries happen later in the day when muscles are fatigued and less responsive. Better to quit early and enjoy apres-ski.

Bail out: Many injuries can be avoided if you are willing to bail out of an uncontrolled turn rather than try, salvage your pride. Try to fall with your head tucked in, your skis together and your arms at your side. Tumbling, sprawling falls are much more likely to cause injury.

Ski in control: Collision is a common cause of injury. You are skiing too fast if you cannot avoid obstacles in your path. Remember the ski slope is a public thoroughfare!