st judes clinic articles
Knees, Toes & Bumps-a- Daisy!
Information on understanding your knees and that skiing holiday.
Knee injuries form a large percentage of skiing injuries. The knees are particularly vulnerable to injury when skiing, because your feet are fixed in the skis with your knees in a bent position.
To try to reduce the risk of injury, prepare well for your trip by exercising for at least six weeks beforehand. Concentrate mainly on working the quadriceps (front of thigh), hamstrings (back of thigh) and stomach muscles.
To understand knee injuries better, we need to understand the role of the different ligaments and menisci (cartilage) in and around the knee joint :-
1. The two cruciate ("cross") ligaments, anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are named in relation to where they attach to the tibia (shin bone). The ACL is essential for controlling pivoting movements and stops the tibia sliding forward from the femur (thigh bone). Injuries to the ACL are common among skiers and often occur when landing from a jump or pivoting. Patients often describe hearing a "pop" and symptoms include swelling, loss of movement, particularly when trying to straighten the leg and generalised pain. The PCL stops the femur sliding forward off the tibia. Injuries to the PCL are less common, but usually occur when the knee is hyper-extended.
2. The two collateral ligaments, medial collateral ligament (MCL) and lateral collateral ligament (LCL) run down either side of the knee and provide medial and lateral stability respectively. The MCL is more commonly injured than the LCL, particularly in skiing. The injury occurs when the knee is bent and either hit from the side, or put under sideways stress. The symptoms are usually specific tenderness on the side of the knee, with pain and laxity on stressing the ligament.
3. The two menisci (cartilage) medial and lateral, attach to the tibia. Their role is to act as a buffer, absorbing forces placed through the knee joint. The medial meniscus is more commonly injured than the lateral and the usual mechanism of injury is twisting, when the foot is anchored e.g. twisting your body when your ski is stuck in the snow. Symptoms are usually pain on squatting, tenderness and swelling on the joint, reduced movement and sometimes the knee gets "locked" in a position. As you get older, you develop "wear and tear" in the meniscus, which means you can get small tears with relatively minor incidents.
What can I do?
- Don't attempt to continue skiing once injury has occurred.
- Follow the basic first aid guidelines of R.I.C.E. (Rest, Ice, Compression and Elevation.)
- If pain doesn't settle then seek advice from a Chartered Physiotherapist.
- A Chartered Physiotherapist will be able to diagnose the injury, begin a treatment programme specific to your injury and provide you with a suitable rehabilitation exercise programme.
To help reduce your chance of injury:-
- Prepare for your trip by exercising beforehand
- Warm up thoroughly before skiing.
- Keep well hydrated.
- Take regular fuel stops.
- Don't go forgetting, in that one last run, fatigue leads to injury.
Nicki Lake MCSP SRP
Chartered Physiotherapist