How to avoid injury this ski season

Although some injuries are inevitable such as a collision or a fall, others may be prevented by improving your body’s strength and co-ordination as well as by improving your technique. Lower limb injuries are the most common followed by upper limb and spinal injuries. The risk of getting injured can be lowered by the right advice and a bit of pre-season training to ensure that you get the most out of your holiday.

1. Equipment

Firstly, having the right equipment is essential. The new bindings used in skis have greatly lowered the incidence of ankle injuries therefore you should ensure that yours have been adjusted correctly and are supplied by a certified shop that regularly maintains and tests their equipment. Wearing a ski helmet is vital in preventing head injuries and can save your life therefore don’t be nonchalant about wearing one.

2. Safety

Knowing how to fall safely can help reduce the risk of injuries therefore skiing lessons are highly recommended, especially for beginners although even advanced skiers can benefit from having their technique refined. Checking the weather forecast and staying to marked trails within your skill ability are other ways that you can stay safe. Stay hydrated and wear sunblock as the high altitude and reflective surface of the snow makes it easier to get sunburn.

3. Conditioning

On a more physical level, skiing injuries can be prevented by conditioning your body. Injuries to the ACL in the knee is the most common injury, followed by shoulder and wrist injuries and then back related injuries. Correct alignment in the skis are essential to reduce the strain on the knees and back. It is very important to keep the spine in a neutral position to reduce the amount of strain paced on the lower back therefore most of the bending should be coming from the knees and the hips and not from the spine. You can do the following exercise to find your neutral spine and practice keeping it in position:

Pelvic tilt

Stand with your hands on your hip bones. Your thumb should be at the back and the fingers at the front. Next, tuck your tailbone between you legs to round your lower back and tilt the pelvis backward. Then push your tailbone to the ceiling to arch your lower back and tilt the pelvis forward. This might be a new and difficult concept for some so perhaps do a few repetitions to loosen up the spine and create a bit of spatial awareness in the spine. After a few repetitions, find the point where your back is not arched nor rounded but in the middle. This is the neutral spine.

Practice holding the spine in this position as you change positions such as sitting down and then standing up, going into a half squat and leaning to the sides. The more you practice, the more natural it will become.
Another important alignment when skiing is the position of your knees. Ideally your feet should be hip width apart and when bending the knees your knee should be in line with your second toe, not facing inwards which is more strenuous on the knee. For many people, maintaining this alignment can be challenging and it requires a strength and endurance form your glutes. The following exercises may help with that:

The Clam

Lying on your side with your knees bent at a 45-degree angle. Keep your pelvis forward and your feet together. Lift the top knee up and feel the buttocks muscle working. If you feel your upper thigh is doing most of the work, rotate your pelvis slightly forward and hold here while you lift he leg up. You can make this more challenging by tying a resistance band around the top of your knees. Repeat 30 times each side.

Wall Ball

This is a more advanced exercise and relies a lot on correct technique to ensure that you are activating the right muscles. Doing this in front of a mirror might help you to self-correct. Stand with your side against a wall facing a mirror. If you have a ball you can place it between your knee and the wall, if not then use a towel/pillow. Place your hands on your hip bones and find your neutral spine as discussed above. Now maintain that alignment of the pelvis, keep your shoulders in line with the hips (so no leaning sideways) keep the knees in line and bend the knee that is closest to the wall. You should feel the buttocks muscle in the leg furthest from the wall working hard. Make this exercise more challenging by gently pressing the bent knee into the ball. Hold for 10 seconds and repeat until tired. To make this the ultimate exercise, with your one knee bent and pressed against the wall and your pelvis in neutral, bend the weightbearing leg to go into a single leg squat while maintaining the alignment of the knee over the 2nd toe. Repeat as many 15 times each side or as many as you can.
Other exercises that may help build muscle strength in the legs are lunges and agility drills.

Lunges

Take a large step and keep the toes forward. Again, square your hips and maintain a neutral spine. Keep the back straight as you bend the front knee and slowly drop the back knee directly to the floor. Try keep the front knee aligned over the 2nd toe.
Balance exercises are important to improve the body’s spatial awareness and in so doing reduce the risk of falls. Here are a few exercises to help improve your balance:

Single leg stance – stand on one leg for 30 sec – 2 minutes. To make it more challenging, close your eyes, stand on a thick pillow or add arm movements. If you have children or a willing friend, have them through a ball for you to catch and throw back.
Wobble boards and Bosu balls- these are great if you have access to them. Turn a Bosu ball upside down to turn it into a wobble board! Start with both feet on top and the knees bent with good alignment in the knees and pelvis. Try to keep the board in the middle and as still as possible. Once those becomes too easy try making clockwise and anticlockwise circles without letting the rim touch the floor.
Lastly agility exercises to help with propulsion and change of directions.

Square jumps

Keep the knees and feet hip width apart with appropriate alignment in the knees and spine. Bend the knees and jump sideways and land with the knees bent in the same alignment. Next jump forward and then sideways and lastly backwards to complete a square.
Skiing can be strenuous on the body, especially at high altitudes therefore keep your cardiovascular fitness up and try these tips to make the most of your skiing holiday, hopefully injury free. There are many more exercises to help rehabilitate specific injuries and ensure that you are physically ready for you trip. These exercises may be challenging to do by yourself, especially with checking your alignment. If you feel you may need some help or if you have any specific injuries, contact your physiotherapist for advice.


References:
Koehle, M.S., Lloyd-Smith, R. & Taunton, J.E. Sports Med (2002) 32: 785.
Morrissey MC et al, Journal of Orthopaedic & Sports Physical Therapy (1987) 8:9, 428–437
http://www.telegraph.co.uk/travel/ski/advice/Ski-fitness-how-to-get-fit-for-the-slopes/


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