Knee pain amongst skiers

The current COVID-19 pandemic has made it increasingly challenging for people to find ways to stay active.

The health protocols and restrictions have resulted in an increase in outdoor activity with significant growth in the popularity of downhill skiing. While certain aspects of downhill skiing may promote components of health and wellness, the highspeed nature of the sport means injuries, aches, and pains are very common amongst skiers resulting in a need for injury prevention. While equipment has evolved greatly over the years to ensure safety on the hill, knee injuries remain a common complaint amongst skiers accounting for an estimated 35% of all ski-related injuries.

These knee injuries range from simple to complex, and commonly include:

• MCL injuries
• ACL injuries
• Torn Meniscus
• Knee bursitis
• Patellar Tendinitis
• Patellar Dislocation
• Patellofemoral pain syndrome

The list above begs the questions: 1) What is causing these injuries? and 2) How can we prevent them from occurring and reoccurring?

Causes

While studies have shown that knee injuries are more common in women due to certain anatomical factors, such as narrower joint spaces and increased joint laxity, knee injuries are reported amongst all skiers. The causes of these injuries can be broken into the following categories: on-hill technique and equipment, and musculoskeletal factors.

Positioning on the hill

Far too often, skiers position themselves by centering their weight behind them thereby forcing them into the “back seat” position (see figure 1). This position not only decreases control when descending the slope, but it additionally increases the likelihood of equipment failure and places undue stress on structures, in particular the knee. In addition to creating excess stress on the knee, this position further puts the skier in a vulnerable position by increasing the risk of catching the inside edge of their ski resulting in a great amount of force and torque being exerted on the knee. When skiers find themselves in this “back seat” position many will attempt to correct this by forcefully contracting their quadriceps muscle as a way of shifting their weight

Figure 1. “back seat” skiing refers to positioning the body in a way that places the majority of the skier’s body weight behind.

Figure 2. Proper skiing technique includes centering your weight over your base of support and keeping forward pressure through the front of the boots.
forward. This aggressive contraction has been seen to produce excessive forwards propulsion once again placing undue stress of the structures around the knee. This then emphasizes the importance of avoiding this “back seat” position (see figure 2) by strengthening the areas to best support proper form.

It takes strength!

While correct technique effectively reduces the chance of injury, conditioning is widely recommended to allow for the execution of proper technique and prevent injury. The muscle groups that are most important in terms of knee injury prevention include the quadriceps, hamstrings, and gluteal muscle groups. Although at first glance, the quadriceps and hamstrings seem to intuitively support the knee, gluteal strength is not to be overlooked.

Adequate gluteal strength is vital in the prevention of knee injuries as it has been shown to play a large role in stabilizing the knee and supporting efficient movement patterns. When it comes to determining the best strengthening exercises, the research currently points to the importance of eccentric contractions (otherwise known as the lengthening phase of the muscle) as a way of maximizing strength gains and preventing injury.

The accelerated forces combined with the sharp turns seen in downhill skiing consequently result in eccentric contractions being a predominant muscle contraction justifying their importance in strength programs. Figures 3,4,5 illustrates 3 exercises that target eccentric contractions for the muscle groups discussed. While developing adequate muscular strength is a crucial part of knee injury rehabilitation and injury prevention, maintaining mobility and incorporating balance exercises has been found to further support the reduction of injury incidence and severity. 

What physiotherapy can do for you

Physiotherapists are specialists in pain management, assessing muscular strength, and identifying areas of weakness and decreased mobility. Consulting a physiotherapist to assess your knee pain will allow you to better understand your injury and allow you to gain knowledge on the proper injury management and rehabilitation interventions needed to effectively rehab your specific injury. At Advantage Sports Medicine Physiotherapy, we use hands-on manual therapy to help promote recovery and healing and provide you with the necessary tools to take control of your rehabilitation journey and get back to having fun on the hill!