How Physio helps recovery from Anterior Cruciate Ligament skiing injury

With the Easter holidays underway, it’s that time of year again for skiing fun!

Hopefully you will have done your pre-skiing preparation but unfortunately, even with the best laid plans, injuries can still occur.

Katherine Ashmore is one of our team of Physiotherapists and a keen skier herself. In this blog she runs through the common mechanisms of ACL injury, how the diagnosis is made, the options for treatment and how Physio is vital to recovery whether you choose surgery or not.

Common mechanisms of injury

Common down-hill skiing injuries to the knees occur when landing from a jump or going over moguls, colliding with another skier as you exit the ski lift, or simply falling and twisting your knee.

We also see upper limb injuries when falling onto the outstretched hand or landing heavily onto the shoulder.  The injuries are often brought on by one too many at lunchtime, bad snow, tiredness at the end of a day or when bindings do not release!

The most prevalent types of injury are bone fractures, joint dislocations or soft tissue injuries such as ligament strains, tears and ruptures. The knee is the most common area to injure and more specifically –  injuries to the ACL (anterior cruciate ligament), MCL (medial collateral ligament) and medial meniscus (inner cartilage) tears being top of the list!  A combination of all three is called ‘The Unhappy Triad’.

Focusing on the Anterior Cruciate Ligament

sourced from www.sportsmedicineeuk.co.uk

The anterior cruciate ligament (ACL) is located deep inside the knee joint and attaches the thigh bone (femur) to the main shin bone (tibia). It keeps the knee stable by preventing the forward motion of the shin from going too far and the knee from rotating too much.

The vast majority of ACL injuries happen during slow-speed turns, often in sticky, slushy snow, towards the end of the day when the skier is distracted and tired. The ski goes one way and the skier’s body weight goes the other causing rotation of the knee. Because of the slow speed the bindings don’t release.

This tends to happen to beginners, but can also happen to experts who have their bindings very tight and get momentarily distracted in the conditions described above. At higher speeds, the bindings release and the injury is less likely; hence, the advice is to ski positively and ensure that the ski bindings set properly.

How do I know it’s an ACL injury?

With severe injury, one hears a loud pop or feels a snapping sensation, followed by intense pain and immediate swelling and difficulty walking.   Diagnosis is confirmed by a specialist (Physiotherapist or Orthopaedic Consultant) and MRI.  An arthroscopy can detect a partial tear. Much less usually very experienced skiers can carry on skiing after injury.

How can Physiotherapy help?

sourced from milfordphysio.co.nz

Once you have your diagnosis there are two routes – surgery versus non-surgery.

A surgeon will weigh up the factors with you: your age, lifestyle and sports interests and whether you wish to go through the surgical route.  The knee can be very strong and able without requiring a functioning ACL and these options will be discussed with you, including any associated risk of further injury or limitations in exercise or mobility.

Whether or not you opt for surgery, Physiotherapy is vital to strengthen the knee and get you back to full fitness. Without Physio the knee can remain weak and more susceptible to recurrent injury.

What is prehab?

Often if surgery is required, the surgeon will wait for the swelling to go down first.  This is a great opportunity to receive ‘prehab’. Our Physios will help you to strengthen your knee muscles prior to surgery and get you physically and mentally prepared for your operation. Having knowledge of the exercises you will need to do post surgery is a great help and we find our clients do better with this preparation.

Post op rehab

Where the prognosis indicates surgery, the surgeon will discuss with you whether you use one of your own tendons (commonly a bit of the hamstring) to repair the ACL or use a synthetic option. It is a very common procedure and depending on your level of exercise will take 8-12 months of graded physiotherapy rehabilitation to get back to full sport.  You may even be back to skiing within the year!

What does rehab involve?

Treatment will involve:

  • a carefully graded exercise programme
  • advice on swelling reduction measures
  • graded return to exercise (we can tell you what exercise, how much and at what stage) and
  • latterly sports specific exercise drills if required

Some surgeons have very specific protocols they like us to follow and others are not so prescriptive. but either way we have the expertise and experience to guide you through the process.

We work closely with Orthopaedic Consultants locally and in central London clinics and can fast track you to be seen quickly with one of them if necessary.

Should you receive a skiing injury we are here to help you with both diagnosis and treatment. 

Please don’t hesitate to book an appointment with our Physiotherapist,  Katherine Ashmore, or another member of our Physio team. 

To book an appointment:

Call 0203 916 0286

Book an appointment online

Email us here

Or just drop in for a chat with one of our Physios!

If you have enjoyed this blog and would like to read our other skiing blogs click here.

 

12 top tips for avoiding a skiing injury this Spring!

At Physio on the River we work closely with the Orthopaedic Consultants at Wimbledon Clinics (at Parkside Hospital) who are specialists in managing skiing injuries. They are experienced and keen skiers themselves so understand the sport completely. If you are unlucky enough to get injured this Christmas or Spring we can refer you quickly to their fast track clinic for injured skiers.

However, prevention is so much better than cure!

We run a Get Fit to Ski class to help you prepare for the slopes and we will be continuing this class in the New Year to help those preparing for the half term or Easter holiday break. The class is Physio led and covers all aspects of fitness, flexibility, strength and conditioning and balance to get you in tip top condition. It’s also a great way to shed those extra pounds put on during the festive period!

Jonathan Bell from Wimbledon Clinics has written this excellent top 12 tips for avoiding injury, which I would like to share with you in this blog.

1. Take lessons

The better your technique, the less chance you’ll put undue strain on your joints.

2. Get the right kit

Have your ski or board bindings set up by a pro because, if your bindings are incorrectly adjusted, or you borrow a friend’s skis, you’re more likely to injure your knees. In the hire shop, provide an accurate weight and estimate of your ability and don’t use boards or skis that are too short or long.

3. Have a rest day

Ignore the “first lift / last lift” banter and take a break. You’re likely to get more from your holiday. Why? Because the highest risk of an accident is after 3pm on day three of your holiday as muscle fatigue reaches its peak 48 hours after you hit the slopes.

4. Take the lift at the end of the day!

vector graphics, modern flat illustration, eps 10

Later in the day, you’ll be tired, the pistes may be icy and crowded, and there will possibly be bare patches in the snow – all of which are risk factors for injury. So take the lift!

5. Control your weight

Good advice for life is to maintain a healthy weight. It’s also good to prevent injuries. The heavier you are, the more strain you put on your knees and the harder you fall.

6. Keep within your comfort zone

Control is good, bravado is bad, and icy moguls – especially if you already have any damage to your knees – are a menace. Mogul falls can result in serious injury, especially to the shoulder in
firm conditions.

7. Minimise alcohol at lunchtime

Alcohol slows your reactions and makes you more reckless.

8. Be careful getting off the chairlift

It’s easy to fall when trying to get off a chairlift. And, while it might be funny, it can be serious. We also see many people who’ve ruptured their knee ligaments when the person next to them
falls across their skis.

9. Ski off-peak

The quieter the slopes, the less danger there’ll be of being called on to take sudden evasive action. If your ability allows, learn to ski off-piste where it’s often quieter. Do make sure you learn about the risks before going off-piste and have the correct equipment and insurance.

10. Don’t wear a knee brace but do wear wrist guards if you snowboard

We recommend knee braces only for a small number of people. These include skiers returning to the sport with an old or partially healed ligament injury (they might want to use a hinged brace) or
those with mild arthritis (who might benefit from a neoprene sleeve).

Otherwise, skiing without a brace improves the ability of the muscles around the knee to respond effectively to the different stresses and strains. Wrist guards for snowboarding are useful and
significantly reduce incidents of wrist fractures.

11. Seek advice immediately after injury

Clinics in ski resorts are versed in treating ski injuries. Above all, do not ski with an injury – get it checked out. Even though it might be tempting to carry on skiing through an injury, ignoring it may result in a longer lay-off. Then, once you are home, speak to your physio about a referral to Wimbledon Clinics.

12. Wear a helmet

Helmets can reduce the severity of mild to moderate head injuries.

If you are interested in joining our Get Fit to Ski class or giving a loved one a voucher just:

Call us on 0203 916 0286

Email us by clicking here

Or simply pop by for a chat!

Do you want to hit the ski slopes in peak fitness this year?

Skiing is for some a serious sport, for others an adrenaline rush, and for most of us a much needed winter break from the routine.

Skiing is a demanding activity and places high demands on our bodies, especially the legs.

Injuries can occur for many reasons, but what we know for sure is that when you are more conditioned for an activity, you are able to significantly reduce the level of risk you are exposed to.

With this in mind, we are running a 6 week program of strength and conditioning in preparation for your ski trip. In this blog we will be explaining the various knee injuries that can occur and offering some useful preventative advice.

40% of skiing injuries are to the knee. The binding release mechanism on skis has caused a successful reduction in broken bones, but there is no protection for the knee ligaments or cartilages. The 3 most frequently injured structures are the medial collateral ligament – at risk in the snow plough position, the anterior cruciate ligament and the meniscus or cartilage usually injured when bending and twisting. When you injure all three this is called the ‘unhappy triad’!

People particularly at risk are unfit recreational skiers taking their annual ski holiday and fatigue is one of the biggest factors. Does this sound familiar?

As with all sports, just playing that sport is not really enough to optimise performance or manage the risk of injury well. Participating in conditioning exercises that incorporate many different areas of fitness – aerobic, strength, balance, co-ordination and flexibility for example, will give you the necessary all round skills to ski well and stay injury free.

After all PREVENTION IS ALWAYS BETTER THAN CURE!

How can I prevent these injuries?

We strongly recommend attending a Get Fit to Ski program and we have designed a six week course to help you prepare in time for the coming season.

Here are some other hints and tips we have put together:

  • Pre-season quadriceps strengthening:  we recommend building up the thigh muscles using the stepper or bike and weights machines. To improve endurance keep the number of reps per set quite high (about 20).
  • image from www.fitnowtraining.com

    Core stability and balance exercises:  it’s essential to have good control of your trunk, pelvis and hip muscles and Pilates exercises are excellent for this – we run Pilates classes in our studio here. Having quick reactions and good balance will help you cope with that unsuspecting mogul! Swiss ball exercises are a great way of improving balance.

  • Recognising dangerous situations: don’t try to get up until you have stopped sliding. Don’t jump unless you know how to land! Keep knees soft when you fall to cushion the impact.
  • Preventing fatigue: pacing yourself during the day’s skiing will help prevent fatigue. For example, warm up on an easy slope and take short regular breaks for refreshments. Remember, injuries are most likely to happen first thing in the morning when you’re cold and in the afternoon when you’re tired.
  • Après ski: no, not the drink at the end of the day! We recommend carrying out a thorough stretching routine to help the muscles relax and recover. Important muscles to stretch are quadriceps, calves, hamstrings, gluteals, lower back and hip flexors.
  • Equipment: it is very important not to ‘make do’ with loose or ill fitting bindings or the wrong type of ski for your experience and skill level. A bit of time spent hiring or buying the right equipment is a must.

Should the worst occur – how do I quickly access treatment?

Accurate diagnosis and treatment is essential in ensuring that any injury recovers as quickly and successfully as possible.

sourced from milfordphysio.co.nz

Many injuries are not severe enough to require surgery and will get better with Physiotherapy. We can help reduce the swelling, restore the normal movement of the knee and strengthen the surrounding muscles so that some stability is restored. However, some injuries will require surgery and, here at Physio on the River, we have excellent links to specialist ski Consultants for fast referral.

If you need any help with this or you’d be interested in booking yourself onto our Fit to Ski class before the season starts,  please contact us here. Our Physios are always happy to chat about a problem on the phone before booking an appointment and you can reach us on 0203 916 0286 or pop by in person.

If you enjoyed this blog then take a look at our other skiing blogs.

How Pilates is helping skiers to achieve fitness in just 6 weeks!

 

Many families will be looking forward to their half term and Easter skiing holidays. But did you know that there are just 7 weeks from now until Easter?!

That’s not much time to get fit for the slopes and cut down your risk of injury.

Here I explain why skiers are choosing a new 6 week Pilates course that we hold at Physio on the River – tailor-made for skiers to get prepared in time.

What does skiing require?

Most of us sit behind a desk all day and then head for the slopes expecting to ski for a week with no preparation. Unfortunately, that is one sure-fire way to find yourself suffering from muscle soreness and stiffness that inevitably can impact on your confidence skiing – you don’t want to get hurt.

The physical demands of skiing require a fit and healthy body and in particular:
images

Good posture: being able to hold the correct skiing posture for long periods of time.

Body awareness: knowing how your body is positioned is vital especially in a white out.

 

 

sourced gsmtweet.com

sourced gsmtweet.com

Good balance: the ability to keep your balance whilst moving down the slope and at the same time avoiding others!

Good core stability: by this I mean strength in the postural muscles around your pelvis, trunk and shoulder blades so your arms and legs can work efficiently around this stable centre.

Muscle strength: we’ve all felt that soreness at the end of day one and the difficulty getting down the stairs the next day. Sound familiar? Good strength in your arms and legs is a must.

Flexibility: if you are a bit stiff and tight you are not going to move freely on the slopes and you’ll risk injuring yourself.

Cardiovascular endurance: you want to be able to enjoy your holiday to the full without flaking out early on the first day!

sourced from www.spiritvoyage.com

sourced from www.spiritvoyage.com

 

How can Pilates help prepare you for these demands?

Pilates is a mind-body technique that aims to increase your kinaesthetic awareness of moving from a central stable core. If you can keep your centre firm then your legs and arms can work efficiently to power you along.

In a nutshell:

  • Pilates strengthens the postural muscles of your body which will help you to maintain the correct skiing posture
  • By making you aware of your posture and where your centre of gravity falls Pilates increases your body awareness when skiing

 

What happens at the Pilates for skiers class?

www.ausphysio.com

www.ausphysio.com

The focus will be on stretching all the essential muscles and joints you’ll be using in skiing- including improving ankle flexibility.

What makes this course different is that you get to balance and perform exercises on half foam rollers designed to mimic the balance demands of skiing.

Learning to maintain the correct and most efficient posture will also be covered.

You will learn leg exercises specifically for strengthening your thigh, buttock, calf and upper arm muscles – those that have to work hardest in skiing.

The class will help increase your cardiovascular fitness.

Preparation is so important if you want to enjoy every day of your skiing holiday and limit your risk of injury.

Interested?

Our 6 weeks Pilates for Skiers course starts Wednesday  February 25th at 8.15pm.

It could make for an appreciative Valentine present for a family member or friend going skiing. And is a great way to meet with other skiers – enjoying some fun but very worthwhile preparation.

Sign up now by calling reception on 0203 916 0286 or click here to contact us.

If you enjoyed this then do take a look at our other Pilates blogs.

 

  • Physio on the River

    The Old Ticket Office
    Barnes Bridge
    Barnes
    SW13 0NP
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