Preventing Skier Knee Injuries, Part 2: On The Hill.

You arrive prepared and excited to ski, with well serviced bindings, appropriate skis, decent fitness and a stylish helmet, as we discussed in Part 1.

Now that you are on the hill, how can you minimize injury risk while maximizing fun?

Lessons.

If you are a beginner skier, seeking to get on more challenging terrain, or keep up with your friends/family/significant other, take some lessons with a professional ski instructor. Research shows beginner skiers have a higher rate of injury. You will progress faster without putting yourself on terrain you aren’t yet ready for. Alternatively, chase your friends down terrain you have no business on, and get great instruction like “Just Turn!” Such quality instruction is even better when delivered by a spouse or significant other.

As a beginner, you can get a package deal on rental gear, lift pass and lesson at a bargain price at nearly every resort. At intermediate or higher levels, affordable “group” lessons frequently are private or semi-private, adding to the value. If you have a positive experience in your lesson, the instructor will appreciate a tip.

Warm up & Fatigue.

The critical value of warming up is universally accepted in all types of high level sport. Warm up will reduce muscle stiffness, improve muscle contraction speed, increase muscle recruitment and help with appropriate neuromuscular patterning. Conversely muscular fatigue alters biomechanics, reduces strength and power all of which may increase injury risk.

A german study found the counterintuitive result that most skiers did not feel they were very fatigued at time of severe knee (ACL) injury. Perhaps most are able to recognize their own fatigue and choose appropriate speeds and terrain.  Interestingly, many ACL injuries happened in the first days and hours (!) of the ski trip. This highlights the importance of a good warmup and getting appropriate neuro-muscular patterning established.

This doesn’t mean you should waste half your powder morning on the bunny hill. A ridge hike, a quick cruiser before taking the upper lift or even some parking lot calisthenics can also help ready your body for the bigger gnar. Try not to be skiing 90-100% or your ability you first run of the day.

Terrain & Line Selection.

You may feel that some of this is obvious. The skier responsibility code clearly states that one should ski in control and within their ability. Yet every weekend I ski at a resort, I see many people on terrain clearly beyond their ability and out of control.

If you play stupid games, you will eventually win stupid prizes.

Paying attention on the mountain, it is easy to notice that the condition of a run will change predictably through the day. As you progress into more challenging terrain, factor in your warm up, fatigue and conditions to when you will be skiing to the limit of your ability.

Some mountains have places where conditions, visibility, merging trails or other factors have caused repeated problems season after season. If you know of such a place on your local hill, avoid or proceed cautiously in that area.

Lastly, its ill advised to go speeding into unfamiliar terrain that you cant see well (such as dense trees or convex rollers).

Park: Performance & Perils.

Freestyle skiing and riding is an exciting discipline within the sport. It’s growth and popularity mean that most resorts now have at least a modest terrain park. It is important to know that the demands of the dynamic movements required in this discipline are more comparable to extreme skiing and cliff jumping than skiing on groomed runs. Injuries are more frequent and more severe in the terrain park. Most skiers riding park routinely are on purpose built skis. Park skiing has its own techniques and safety practices. If you are a strong skier and want to check out the action, have enough respect for the discipline, your equipment and your body to get some instruction.

Base depth.

Here in southwest colorado, many of our tree runs have a lot of downed trees, undergrowth, stumps and other hazards. A wise skier friend once advised me that skiing trees is an activity best done with 50-60”+ of base and 100”+ of season snow. When I ignore her great advice, I proceed slowly & cautiously, keeping my tips up to avoid early season sharks waiting just below the surface, waiting to damage your equipment and your body.

Group Selection.

If the people you want to ski with are significantly beyond you in ability, I again encourage you to get in some lessons, or at least find a group with more similar ability. Skiing beyond your ability ingrains bad habits and technique errors. You will be exhausted trying to keep up and manage terrain that is challenging for you, while your friends will be cold and bored while they wait for you.

The Witching Hour.

Talking to folks who work patrol and on mountain clinics, there is a clear trend that there are more injuries late in the day. This is obvious enough to most professionals involved there isn’t much research proving this; its accepted the way that we know the sun is going to come up tomorrow. Why might this be and what can we do?

We have already discussed the role of fatigue. If you feel your legs are achy and rubbery, its time to slow it down or take a break, regardless of the time. That could mean a cruiser run, a longer lift ride or calling it for the day.

Afternoons, particularly early season are notorious for flat light, making it hard to see lips, rollers, death cookies, mashed potatoes and other surface features, all rapidly hardening in the late day shade.

The Party Scene.

Most of us are on the mountain to have a great time. Many are on a vacation, and want to socialize and party. This adds a few factors that merit discussion.

Many skiers and riders enjoy listening to music on the mountain. This can be fun and help you develop more rhythm with your turns.  It can also reduce your awareness and ability to locate hazards around and behind you. Helmet speakers (vs ear buds) can allow more ambient sound to be heard, as can a modest volume. Crowded runs are probably not a good place to jam out.

Alcohol and marijuana are established and beloved parts of the skiing and riding experience for many. Be self aware enough to recognize when the local IPA or bud (not budweiser) was a little stronger than you were expecting and you or your friends aren’t performing at your best. Crashing into a tree or other person under the influence at a ski resort may or may not have the legal consequences as doing it in your car, but the physical consequences can be extreme.

Speed.

In study after study I reviewed preparing this post, excessive speed is cited as a factor in severe injuries. The mountain will still be there. Be smart about when and where you really open it up and blast down the mountain at top speed.

Check in later and read about what to do if you injure your knee in part 3.

References

Accid Anal Prev. 2016 Oct;95(Pt A):86-90. Feature-specific ski injuries in snow parks.

Can J Public Health. 2007 Sep-Oct;98(5):402-6. Risk factors associated with serious ski patrol-reported injuries sustained by skiers and snowboarders in snow-parks and on other slopes.

Am J Sports Med. 1999 May-Jun;27(3):381-9. Skiing injuries.

Sports Med. 2002;32(12):785-93. Alpine ski injuries and their prevention.

Sportverletz Sportschaden 2015; 29(04): 226-230 Impact of Self-Reported Fatigue on ACL Injuries in Alpine Skiing: A Sex Comparison

J Biomech. 2014 Jan 3;47(1):59-64.Effects of multi-joint muscular fatigue on biomechanics of slips.

J Sci Med Sport. 2012 Mar;15(2):164-8. Neural conduction and excitability following a simple warm up.

Br J Sports Med. 2015 Jul;49(14):935-42. A systematic review of the effects of upper body warm-up on performance and injury.

PLoS One. 2017 Jun 29;12(6):e0180152. Effects of different re-warm up activities in football players’ performance.

Sports Med. 2015 Nov;45(11):1523-46. Warm-Up Strategies for Sport and Exercise: Mechanisms and Applications.

Int J Inj Contr Saf Promot. 2006 Sep;13(3):151-7. Drunk, drowsy, doped: skiers’ and snowboarders’ injury risk perceptions regarding alcohol, fatigue and recreational drug use.

Accid Anal Prev. 2009 Jan;41(1):197-201. The perception of causes of accidents in mountain sports: a study based on the experiences of victims.

Med Sci Law. 2010 Jul;50(3):122-5.Impact of alcohol consumption on winter sports-related injuries.

J Stud Alcohol. 1998 Mar;59(2):216-21.Alcohol consumption, sensation seeking and ski injury: a case-control study.

Br J Sports Med. 2015 Jan;49(1):62-6.  Listening to a personal music player is associated with fewer but more serious injuries among snowboarders in a terrain park: a case-control study.

J Trauma Acute Care Surg. 2013 Aug;75(2):334-8. Let it snow: how snowfall and injury mechanism affect ski and snowboard injuries in Vail, Colorado, 2011-2012.

Br J Sports Med. 2004 Jun;38(3):264-8. Effect of trail design and grooming on the incidence of injuries at alpine ski areas.

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