Your Knees on the Skis: How to Prevent Skiing Injuries

Mr Simon Mellor, Total Orthopaedics’ consultant knee and hip surgeon discusses how to prevent a knee injury when skiing and what you can do to minimise the likelihood of an injury. 

At this time of year, as the snow begins to fall in the ski resorts of Europe, I get a lot of queries about how to avoid getting injured on the slopes.

As a skier myself, I can understand how great it feels to enjoy a ski holiday, so here are a few hints and tips to help those knees and avoid injury.

Preparation does help

Firstly, nothing beats a bit of sensible preparation. Skiing relies heavily on the good function of what we knee surgeons call ‘the extensor mechanism’. That means the quadriceps muscle at the front of your thigh, the kneecap to which it attaches, and the tendon which runs from the bottom of the kneecap down to the front of the shin bone. It’s a great idea to try and exercise the quadriceps muscle before your ski trip:

• Getting on a bicycle is a great ‘quads’ workout, but the weather outside may prevent this. Try an exercise bike indoors, or practice doing squats exercises.
• Another good quads workout involves standing with your back against a wall and then ‘sliding’ down the wall until you are in a sitting position (only there’s no chair to support you). Your knees should be at a right-angle. Hold that position and you will start to feel the quads muscles ache. Do this exercise daily over a few weeks and you should be able to slowly increase the time you can hold this position.

What about when you get to the ski resort?

Equipment and fitting is everything

It’s fundamentally important to get the right equipment, and by this I’d emphasise that you get the right length skis for your height and your skiing ability. And then most of all, ensure that the ski shop adjusts the bindings correctly. The majority of serious knee injuries that I see in skiers happen when they fall but the bindings don’t release correctly. If that happens, the skis can twist round, putting a huge strain on the knee joints, causing fractures or serious knee ligament injuries.

Warm Up

So, you have your equipment adjusted correctly, your muscles are well prepared, and you are itching to get out onto the slopes. It’s vital that you spend a little time doing some warm-up stretches before you attack that first run. I’d also suggest that you start your ski holiday slowly, and work up to the more difficult slopes and steeper pistes, especially if you are a once-a-year skier.

Knee Injury

What do you do if you injure your knee despite all these precautions? Well, firstly it’s important to try and get over to the edge of the piste, or at least out of the way of other skiers heading in your direction. If you can’t move, call out for help and get someone to stick some ski poles in the snow a few feet higher up the slope in the shape of an ‘X’ to warn oncoming skiers. Take a moment to feel around the knee to see if it’s very tender to touch. If it’s clearly a significant injury, you will probably need the rescue services to take you down the slope in the so-called ‘blood wagon’ (a sled that the rescue service use to transport injured skiers down the mountain). That’s when you are grateful that you remembered to take out the extra ski slope insurance like the French ‘care neige’ which covers the rescue costs.

Minor fall

You find yourself splayed across the piste, but you don’t feel badly injured. The knee isn’t particularly tender to touch. It doesn’t feel swollen. You can bend and straighten it without undue pain. Try slowly standing up. If the knee can support your weight, and you feel able to ski on, take some time for the adrenaline levels to settle and then gently ski on. If the knee won’t support you, or it buckles under you, then you won’t be able to continue.

Once back at base, you will have a chance to check your knee out more fully.

• If the knee swells up quite quickly after a ski injury, it’s advisable to get to the local emergency department to be checked out. You could have torn a ligament or sustained a fracture inside the knee.
• If there isn’t any swelling, try the well-known first aid measure – RICE stands for Rest, Ice, Compression and Elevation. You could take some anti-inflammatory painkillers like Nurofen or Ibuprofen or Voltarol as long as you don’t have any contra-indications to these medicines.
• If you have twisted the knee, it seems ok initially but becomes quite swollen overnight, then you may have damaged a meniscus. The knee has two ‘shock-absorber’ cartilages (the meniscus) one on each side lying between the thigh bone and the shin bone. These can be damaged or torn and typically the knee gradually swells. If it’s a significant tear in the meniscus, you may find that the knee becomes ‘locked’. That means you can bend the knee, but the knee won’t go fully straight. In these circumstances, I’m afraid you may not be able to ski for the rest of your trip. You could seek the assistance of the local physiotherapy services to help out in the meantime.

When back in the UK

Once back in the UK, if the knee remains painful and stiff and swollen, you should consider seeing a specialist.