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Skiing on a ski slope

Calling All Downhill Skiers! Prevent Knee Pain From Occurring And Reoccurring

Physiotherapy

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 high speed 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.

downhill-skier
Figure 1. “back seat” skiing refers to positioning the body in a way that places the majority of the skier’s body weight behind.
skiier
Figure 2. Proper skiing technique includes centering your weight over your base of support and keeping forward pressure through the front of the boots.

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. 

medicinal-ball-exercise

Figure 3. Eccentric squats
Begin this exercise by securing a theraband just above your knees. When performing this exercise, slowly lower for a count of 6 seconds from a standing position into a squat by driving your hips behind you. Return to a standing and repeat for 5-10 repetitions within your tolerance. To make this more difficult, hold a medicine ball or weight in your arms.</>

swiss-ball-work-out

Figure 4. Eccentric Hamstring curls
When performing this exercise start in position A. Contract your gluteal muscles and abdominals to maintain balance while using your heels to roll the ball towards you. Slowly return for a count of 6 seconds to position A. Repeat this for 5-10 repetitions within your tolerance.</>

lunge-exercise

Figure 5. Lateral Walks
Begin this exercise by securing a theraband just above your knees. When performing this exercise, start by lowering into a squat by driving your hips behind you. Hold this position while taking small steps to the side and maintaining tension on the band. Take 5-10 in one direction before switching to the other direction. To make this more difficult, lower the theraband to your ankles.</>

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!

References
Barton, C. J., Lack, S., Malliaras, P., & Morrissey, D. (2012). Gluteal muscle activity and patellofemoral pain syndrome: A systematic review. British Journal of Sports Medicine, 47(4), 207-214. doi:10.1136/bjsports-2012-090953

Buckthorpe, M., Stride, M., & Villa, F. D. (2019). ASSESSING AND TREATING GLUTEUS MAXIMUS WEAKNESS – A CLINICAL COMMENTARY. International journal of sports physical therapy, 14(4), 655–669.

Barton, C. J., Lack, S., Malliaras, P., & Morrissey, D. (2012). Gluteal muscle activity and patellofemoral pain syndrome: A systematic review. British Journal of Sports Medicine, 47(4), 207-214. doi:10.1136/bjsports-2012-090953

Burtscher M, Federolf PA, Nachbauer W, Kopp M. Potential Health Benefits From Downhill Skiing. Front Physiol. 2019 Jan 14;9:1924. doi: 10.3389/fphys.2018.01924. PMID: 30692936; PMCID: PMC6340074.

Coppack, R. J., Etherington, J., & Wills, A. K. (2011). The Effects of Exercise for the Prevention of Overuse Anterior Knee Pain: A Randomized Controlled Trial. The American Journal of Sports Medicine, 39(5), 940–948. https://doi.org/10.1177/0363546510393269

Davey, A., Endres, N. K., Johnson, R. J., & Shealy, J. E. (2019). Alpine Skiing Injuries. Sports health, 11(1), 18–26. https://doi.org/10.1177/1941738118813051

Davidson, T. M., & Laliotis, A. T. (1996). Alpine skiing injuries. A nine-year study. The Western journal of medicine, 164(4), 310–314.

Deady LH, Salonen D. Skiing and snowboarding injuries: a review with a focus on mechanism of injury. Radiol Clin North Am. 2010 Nov;48(6):1113-24. doi: 10.1016/j.rcl.2010.07.005. PMID: 21094401.

Graepel, S. (2017, December 14). Avoid Knee Injuries While Skiing: Tips to Keep You Healthy. Retrieved January 10, 2021, from https://gearjunkie.com/how-to-avoid-knee-injuries-while-skiing-tips

Franklin, J. (2017, February 09). Knee Pain and Skiing. Retrieved January 11, 2021, from https://orthopedicspecialistsofseattle.com/healthcare/injuries/knee-pain-skiing/

Hébert-Losier, K., Holmberg, HC. What are the Exercise-Based Injury Prevention Recommendations for Recreational Alpine Skiing and Snowboarding?. Sports Med 43, 355–366 (2013). https://doi.org/10.1007/s40279-013-0032-2
Hunter RE. Skiing injuries. Am J Sports Med. 1999 May-Jun;27(3):381-9. doi: 10.1177/03635465990270032101. PMID: 10352778.
Johnson, R. J., Ettlinger, C. F., & Shealy, J. E. (2009). Myths Concerning Alpine Skiing Injuries. Sports Health, 1(6), 4

Koehle, M.S., Lloyd-Smith, R. & Taunton, J.E. Alpine Ski Injuries and Their Prevention. Sports Med 32, 785–793 (2002). https://doi.org/10.2165/00007256-200232120-00003
Macdonald, L. (2013). How to avoid knee pain when skiing. Retrieved January 10, 2021, from https://www.coachmag.co.uk/exercises/sport-workouts/2183/how-avoid-knee-pain-when-skiing
Prlić, J., Grle, M., Moro, G. i Grle, I. (2019). Balance as a Risk Factor for Injury Occurrence in Recreative Skiing. Collegium antropologicum, 43 (2), 103-110. Preuzeto s https://hrcak.srce.hr/225662

Shea, K. G., Archibald-Seiffer, N., Murdock, E., Grimm, N. L., Jacobs, J. C., Jr, Willick, S., & Van Houten, H. (2014). Knee Injuries in Downhill Skiers: A 6-Year Survey Study. Orthopaedic journal of sports medicine, 2(1), 2325967113519741. https://doi.org/10.1177/2325967113519741

Turner, S. (2019). 4 Tips to Avoid Knee Injuries While Skiing. Retrieved January 10, 2021, from https://www.sports-health.com/blog/tips-avoid-knee-injuries-while-skiing</>

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Mar 21

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EXERCISE OF THE WEEK:
Slider Wall Push Up

Emilie’s pick for this week’s exercise is a slider wall push up. This exercise targets core stability as well as shoulder/scapular stability!
Wanting a harder variation? Try the above from the floor!

Start your day off on an active note and give it a try! Remember to listen to your body when performing the above.

#yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives

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Mar 14

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✨ ASM Athlete Highlight ✨

This week marks 1 year post Achilles Tendon Repair for ASM athlete Alex!
Alex has been diligent with his rehabilitation program and has worked hard with the team at ASM. 
Alex is now mastering high level rehabilitation exercises and is returning to sport.
Great work Alex!!! 👏 #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy

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Mar 8

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🚺 INTERNATIONAL WOMEN’S DAY 🚺

Today we recognize all the amazing women that make-up our staff at ASM North and South! You all rock! #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives #internationalwomensday

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Mar 6

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Strengthening Up The Chain

While the initial treatment plan following an injury might include basic strengthening exercises, it is important to eventually address the areas that are “ further up the chain”.

In other words, once progressed past the initial phases of injury, looking beyond the injury and targeting muscles groups that may be influencing and contributing to the injured area is crucial to maximize healing and return to performance.

Have you experienced an injury? Our team of physiotherapists, athletic therapists, occupational therapists, and kinesiologists are experts in helping you identify all the things contributing to your injury. Call us today for an assessment.
☎️ 780-229-0174  #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives

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Feb 28

Open
EXERCISE OF THE WEEK:
Overhead Pallof Press 
(darn autocorrect in the video; our apologies!)

Koji’s pick for this week’s exercise is a pall-off press with an overhead variation. This exercise targets core stability as well as shoulder/scapular stability.

Start your day off on an active note and give it a try! Remember to listen to your body when performing the above.
#yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives

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Feb 22

Open
EXERCISE OF THE WEEK:
Front foot elevated split squat 

Austin’s pick for this week’s exercise is the front foot elevated split squat. This excise targets single leg strength and stability, core strength, and balance.

Start your day off on an active note and give it a try! Remember to listen to your body when performing the above. #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives

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Feb 17

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Taping “How To”: Buddy Taping 👯‍♀️ 

Buddy taping refers to tapping an injured finger or toe to an uninjured/healthy one. The healthy digit thus acts as a digit act as a splint to support the injured digit and promote healing.

Stay tuned for more taping tutorials coming your way!  #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives

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Feb 15

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EXERCISE OF THE WEEK

Tannis’ pick of the week is: heel elevated back squats 🏋️‍♀️ 

This exercise is an excellent way to increase the depth of your squat and target your quadriceps muscles. In addition to this, it also allows activation of various hip stabilizers allowing for greater muscle group utilization. 

I don’t have a squat rack or not quite ready to use one? Try the above without any weight or hold a dumbbell as a goblet weight!
Don’t forgot to listen to your body when attempting the above! #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives

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Feb 9

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EXERCISE OF THE WEEK - “Therapist pick edition”

Danielle’s pick for exercise of the week is:
Single Leg Lateral Ball Squat

This exercise is an excellent way of strengthening the hip stabilizer muscles in a dynamic way. The exercise works a combination of single leg strength, core stability, and balance to provide an excellent dynamic strengthening exercise! 
Remember to listen to your body when attempting the above!  #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives

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Feb 7

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Introducing: 
H Y P O P R E S S I V E S

Hypopressives utilize deep breathing and core activation to increase the strength of postural muscles, and help regulate the nervous system.

Hypopressves train and restore the deep core and pelvic floor function from the deepest layer inside out under low pressure.

Here’s how the Hypopressives technique has helped our clients over the years: 

💬 “Helped with postpartum recovery”
💬 “Find it helpful for back pain & chronic pain
Improved posture” 
💬 “Calming when feeling stressed”
💬 “Stopped peeing with coughs & sneezes”
💬 “Not afraid to jump on the trampoline with kids”
💬 “Run without fear of peeing”
💬 “Stopped living in fear of prolapse symptoms” 
💬 “Helped with period pain during menstruation”

Want to learn more?
Call us today!
780-229-0174  #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy #hypopressives

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Feb 6

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We love hearing about our client and patient’s success! Hearing things like “I have progressed so much further than I ever thought it possible” is music to our ears! 👂 

At ASM, we pride ourselves on being an integral part of your rehabilitation journey! 

Call us today to book your assessment!
📞 780-229-0174

 #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy

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Feb 3

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‼️ N E W • B L O G • A L E R T ‼️ 

We are now 1 month into New Year’s Resolutions. 
Are you looks for tips for long term success? 💁 ✅

Making a resolution or setting a goal is the first step in making a change to your lifestyle or behaviour. Goals can be big or small, short or long term and they can be geared towards creating a new habit or reducing one we already have. Whether you want to get more sleep, eat better, or be more physically active, your goals will be the stepping stones to get you on the right track!

Check out of website to read the full blog post on how you can remain successful with your New Year’s resolutions! #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy

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Feb 2

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🌟 ASM SPOTLIGHT: INTRODUCING SYLYANNE 🌟 

Sylyanne Foo graduated from the University of Alberta with a Master of Science in Physical Therapy. Previously, Sylyanne completed a Bachelor of Science in Environmental Sciences with Distinction.
 
Sylyanne is passionate about working with clients of all ages and activity levels – she will take the time to understand how your injury is impacting your life and work with you to meet your own unique goals. Taking the time to set specific goals will allow her to appreciate what is important to you and to integrate rehab into your daily routine. Sylyanne’s goal is to empower each individual by helping you understand and manage your injury/condition and by providing tools and the latest evidenced-based treatment to aid in your own recovery. Her treatment style emphasizes education, manual therapy, exercise prescription, and self-management techniques, to optimize recovery. She is also determined in staying up to date with the latest evidence-based treatment through research and continuing education courses. Sylyanne has been fortunate enough to have experiences in acute care/ICU, community neurorehabilitation, geriatrics and orthopaedic settings throughout her education.
 
Outside of work, Sylyanne loves to spend time with her two senior dogs (Milo and Bella). Sylyanne enjoys different ways to stay active, such as running, hiking, biking, skiing and snowboarding, ice skating, and volleyball. Sylyanne also loves having a good brunch, spending time outdoors, and exploring different travel destinations. Her goals for 2023 is to complete a marathon and continue to be involved in the community through skating lessons and volunteering. 

☎️ Call today to book with Sylyanne!
(780) 229-0174

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Jan 30

Open
MOBILITY • MONDAY

“Mobility Monday” is making a comeback this week to feature “Around the World”
Thoracic Rotation 🌎 

Get your week started with the exercise above to help improve the mobility of your mid back.

Remember to listen to your body when attempting the above. 👂  #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy

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Jan 26

Open
We pride ourselves on providing the best possible care for our patients and clients 👥

Returning people to full function in their every day lives and increasing people’s quality of life is what we strive for 

We are so glad that we can help get people back to what they do!  #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy

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Jan 24

Open
E X E R C I S E • O F • T H E • W E E K

This week we are featuring a thoracic rotation exercise that combines lower body and upper body mobility.
Get moving this week and give it a try!
Remember to listen to your body when attempting the above.  #yeg #yegphysio #yegphysicaltherapy #yeglift #yeghealthandwellness #yeghealth #yegathlete #edmontonlife #edmontonathlete #stalbert #stalbertphysio #stalbertfitness #physicaltherapy #physio #edmonton #yegsportmedicine #education #advantagesportmedyeg #athletictherapy #yegathletictherapy
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