How to avoid ski injuries

There is no question that skiing is a sport with some inherent risk but it’s important not to lose sight of how much pleasure and joy you can get from spending time skiing with family and friends.

This is where the old adage “risk versus reward” comes into play.

The good news is that there are some practical steps you can take to decrease your risk of getting hurt. Pre-season training should focus on overall body fitness, balance, coordination and agility training, combined with a careful warm-up before venturing back on the slopes.

Fitness and conditioning

TIP - Don't get stuck in a boring fitness routine 

Skiing is unique in the way the muscles are used.  Mogul and powder skiing require knee movement, but for the most part, when you’re carving down a groomed or smooth run, it’s the quads that are firing while the knee stays bent with only small mid range movement as you shift your weight from left to right.  This is plain to see if you watch downhill ski racers; they stay in the deep squat position with small changes in knee flexion/extension for shock absorption.   If you’re not conditioned for this type of constant contraction, your quads will “burn out” quickly.

Any muscle weight-training program should focus on doing squats as the primary, single exercise that most efficiently combines all the trunk muscles and leg muscles for building skiing fitness. Don’t get stuck in a boring routine. Unless you are a primarily a cyclist in the off season, we suggest a pre-season training program that combines squats and weight lifting with cycling plus soccer for speed and agility. We find that doing at least 20 minutes of weight training per day, combined with other sporting activities, is the minimum necessary to build muscle power in a healthy ski fitness program.  It’s best to exercise seven days a week, the “rest” days being the easy spin and swim days. Daily exercise leads to an addiction to the circulating endorphins, testosterone, pheromones, and adrenalin. Once you get to this level, it becomes very easy to maintain your ski fitness and your appropriate weight.

Mental errors

TIP - Prepare your body to help focus the mind

Over the course of our involvement in World Cup and recreational skiing, we have noticed that most ski injuries are the result of mental errors.  Regardless of whether the skier is a world class pro or a complete beginner, whether they are in top physical form or out of shape, skiing injuries most commonly happen when skiers are not 100 percent focused on what they are doing at the time. They made a poor decision about where to land or jump or how fast to go down the mountain, usually too fast for the conditions or their ability. A momentary mental error, a lapse of concentration or control has invariably led to the fall that caused the injury.  These errors can be avoided with better mental preparation.   At The Stone Clinic, we see warm up and pre-season conditioning exercises as being just as useful to help you prepare mentally for the slopes, as they are to prepare you physically. The process of preparing your body will help you focus your mind on the activity you are soon to participate in. You’ll be less likely to make absentminded mistakes and better able to respond to the unexpected gremlins that may pop up on the way.

Weight loss

TIP - Lose the force

At The Stone Clinic, we have skiers start their pre-season conditioning classes by weighing themselves and setting target goals for optimal weight. Consider that even with walking, ten pounds of added weight can mean up to fifty pounds of excess force in the joints with each step. And you take 2-3 million steps per year.  With skiing, the forces of impact are multiplied when landing from a jump or coming off the end of small moguls. Reducing excess pounds dramatically diminishes the impact of force on your knee joints as you ski. 

The following steps achieve weight optimization:

• Drink a tall glass of plain water every hour. This diminishes hunger, flushes out toxins from the body and decreases the intake of beverages with high calorie counts. Due to the high altitude, skiers are relatively dehydrated during the day. This is compounded by drinking coffee in the morning and often beverages like RedBull, which dramatically increase the rate of dehydration.
• Eat lean protein. Protein intacke leads to muscle building more effectively than any other nutrient. Carbohydrate intake leads to fat deposition more than any other nutrient. Decrease carbohydrates and get lean. You are what you eat.

Combining a lean protein based diet with a tall glass of water each hour and with a minimum of one hour of exercise a day will lead to a two to three pound weight loss per week, a safe rate for decreasing weight. 

TIP -  Reduce sudden impact to your body

In addition to weight loss you can: 

• Build strong legs and core muscles to help absorb the force of landing when skiing 
• Take off and land with good form to decrease the sudden impact on the body. 
• Make a good decision about where to take off and more importantly, where to land -  the biggest factor in how much trauma the body will see is how flat the landing is.

Ski equipment

TIP - Good skiing starts in the ski shop. 

Poorly fitting boots leads to poor foot mechanics and foot pain. The most common mistake we see with recreational skiers is that their boots are fitted too stiffly and too narrow. This is a throwback from the time when very stiff boots were needed to add pressure to long straight skis to make a turn.  These days, modern skis are shaped to turn easily using gentle ankle and knee motion.  Stiff boots are no longer necessary and instead you should opt for a softer flexing boot in the forward and back plane with lateral rigid stability. This is the ideal combination for initiating and completing a carving turn. 

TIP - Bindings: How low can you go?

The most common error we see is that bindings are set too tight. Almost everyone seems to think the tighter they set them, the less likely they are to come out prematurely and the less likely they are to hurt their knee and themselves. Exactly the opposite is true. Prerelease is a factor for ski racers who when launching themselves out of the start sometimes can come out of their bindings due to the tremendous amount of force they are able to exert on the ski and binding. However, few people come out of their skis due to a binding set too low. If you are renting, the ski shops will carefully set the bindings based on your height, weight, and skiing ability that you report. You should keep lowering the ski binding setting until you find the lowest level you can ski at without coming out of the binding in your normal skiing. You will be surprised at how much lower you can set your bindings than the ski shop sets them and how rare it is you come out of your ski binding. By doing this, you will dramatically decrease your chances of a knee ligament injury especially an ACL injury. It is possible that you will increase your chances of coming out prematurely and falling, however most falls after release from the binding rarely end up in an injury, just a slight ego bruise. Frustratingly, there is no data to use to compare binding quality from one brand to another or even within the brands. There is no evidence that more money spent on a particular binding changes the release characteristics or the safety margin.

TIP - Watch your ski width

While the new shaped skis can make skiing and initiating turns much easier, skiers need to pick the correct width of ski. Most skiers ski on well-groomed slopes. If skis are too wide, it is more difficult to turn and guide the ski through the slopes. Skis with widths in the 80 – 90 millimeter range are far easier to turn with much less effort than skies over 100 millimeters wide. 

TIP - Tune your skis

Ski tuning makes an enormous difference to the ease in which the ski makes a turn, holds a turn, and glides down the mountain. In our experience, skis need to be tuned after every five to seven days of skiing, not once a year, as so many skiers do.

TIP - Don't use ski pole straps

Ski poles still have pole straps attached to them and unfortunately, many skiers lock their hands tightly into these straps making it impossible to release the pole when they fall. Consequently they fall on an outstretched hand and thumb, leading to the tear of the ulnar collateral ligament at the base of the thumb. The chance of this happening is reduced considerably by not using the ski pole straps. During a fall, the pole is released and the hand will generally bunch into a fist, avoiding a thumb injury.

TIP - Wear a helmet

Highly publicized but nonetheless rare deaths from skiing have prompted more people to wear helmets. Certainly head protection and other body protection can be beneficial in collisions, although there is no clear data to support its reduction in head injuries.  We recommend a lightweight, well fitting, high visibility helmet. Avoid heavy helmets to reduce the swing weight on the top of the neck. (Whether or not helmets provide a risk to the neck by increasing weight on the head is a concern.)

A note on renting equipment

Ski equipment for rent is now so good that many skiers no longer purchase skis. Most people bring their own boots for the fit and comfort. Ski rental quality including ski rental bindings is extremely good compared to years ago. An additional enormous advantage of renting skis is that conditions of mountains change all the time. If it is a powder day, it is a lot more fun to ski with powder skis and also safer than a hard pack. On the other hand, knowing your equipment leads to confidence, which counts when the conditions get gnarly.

---

For more on how skiers can play for a lifetime and avoid knee pain after skiing, be sure to check out all Dr. Stone's blogs on skiing injury prevention and recovery. 

---