Winter breaks are drawing near, and many of you (me included) are probably starting to look forward to the beginning of the skiing season. A chance to swop the city for mountains, blue bird skies and fresh powder snow. There is however, a flip side to this wonderful sport. No matter if you are an advanced skier or snowboarder or if you are a complete beginner, accidents do happen. Falling on the slopes may result in injuries virtually anywhere on the body, just as the severity can vary from bruising to breaks and other more serious injuries. However, there are injuries that happen more frequently than others and many we can do something about to prevent them from happening in the first place. That is what I will focus on in the next few posts.
Knees Knees Knees
First off. Knees. Since your foot is usually locked into a more or less solid boot of some sort and your hip is one of the most stable joints of the body, it is usually your knees that end up being compromised during pressure. Normally it is rotational forces that cause injury to the knees, like when you make a turn on the slopes and your upper body is going one way but your skis are going another. Why is the knee so susceptible to injuries during rotation, you might ask? Well, try to bend your knee. Now try to straighten it. And now try to rotate it left without moving your thigh. And now to the right, again without moving the thigh. Get it? The rotational movement in the knee is very restricted. The knee is mainly kept in place by a complex, but ingenious set of muscular (i.e. tendons) and non-muscular structures such as menisci and ligaments. This means that there are several structures that can be damaged.
I will briefly name a few, without going into too much detail about them:
* Cruciate ligament tears (normally the ACL)
* Meniscal tears
* Collateral ligament injuries (MCL or LCL)
* Unhappy triad/terrible triad/blown knee, which involves all of the above and is usually very painful. Hence the name.
Luckily to prevent injuries like these and many other knee-related injuries, the regime is more or less the same: knee control and stability training. There is a whole bunch of them, but I will however share a few of my personal favourites.
You can see it as my Christmas gift to you:
- The Swedish Dragon
* I’m not sure if this exercise has a proper name in English, but this is one of my favourites for knee stability.
1) Start in single leg stance, with a micro flexion of the knee (no more than 5 degrees). Keep arms down by the side of your body.
2) Bend from you hip, arms moving forward and up. The foot that is off the floor moves towards the ceiling, heel leading. Your aim is to look like a T from the side.
3) Go as far as you can without losing your balance.
4) Come back to starting position and repeat a full set. Then do the swop legs.
Notes: Make sure your knee isn’t wobbling and that you don’t rotate your pelvis. Your chest should face the floor the entire time. The goal is controlled the movement throughout the exercise. Better to go slow and controlled, than to rush and cheat your way through it (yes, your brain will cheat whether you want it or not, in order to make the task as easy as possible). I promise if you do this you will see and feel the difference.
- Ice skater jumps / lateral lunges
* Again, pardon my Swedish, but this is a great exercise for hip/knee stability. This one might also have another name in English, but no matter the exercise is still the same. It is the same movement that is repeated in long distance ice-skating, which is where the name derived from. I really like it because is easy to progress in order to make it even tougher as you build up your strength.
1) Start in with your feet hip width apart. Knees slightly bent.
2) Take a step out to one side, bringing your bodyweight onto that leg.
3) Squat down over the single leg, keeping your knee in line with your toes.
4) Straighten your leg back out as you step back towards the starting position.
5) Repeat movement to the other side.
Note: When you put your weight on the single leg, make sure hip, knee and foot are in line with each other. Start by putting some weight on your leg, and if you can do this without pain or exhausting the muscles you can gradually increase the weight you put on. They are called jumps because eventually you can move into jumping from side to side, but this requires adequate strength and knee control.
- The Clam
* The bread and butter of many physiotherapists. This is not a strict knee exercise, but rather focuses on your glutes (namely gluteus medius). Hip control is vital in order to keep your lower limb (including knee) stable during impact.
1) Lie down on your side. Knees and hip bent to 45 degrees.
2) Lift your knee towards the ceiling by rotating the hip out. Your feet stay connected.
3) Slowly bring your knee down again. With a bit of imagination your legs will look like a clam opening and closing. Do a full set and then repeat on the other side.
Note: Don’t rotate your pelvis during the exercise. Make sure the movement is slow and smooth. In the beginning it might be a bit jolty, that is because the brain needs a bit of time to learn how to perform the exercise correctly.
Aim to do 3 sets of each exercise, each set containing 8-12 repetitions, 3 times per week. You should feel tired after a finished set, but no pain. All these exercises can be made more advanced and heavier but make sure you know what you are doing before progressing the exercise. These are the general recommendations for strengthening according to American College of Sports Medicine (ACSM). If you are new to strength training I suggest you ask someone well experienced for advice and instructions.
Remember, if you’ve had previous knee injuries then you are more likely to incur new ones. That’s why it is even more important that you perform these exercises and that you do them correctly. If you get pain during or after an exercise, stop the exercise and consult your physiotherapist.