With winter in full-swing, many of you will either be booking or returning from holidays on the slopes. A long weekend, or better yet, a full week on the snowy peaks is a fantastic way to enjoy the frosty weather. As much fun as a ski trip can be, like many sports there is a risk of injury; but that’s not going to put us off a holiday anytime soon and shouldn’t for you either.
Knee and shoulder injuries are most commonly seen in skiers and in this blog, Dr Michael Burdon and physiotherapist Elisabeth Dacker discuss these common ailments, what can be done to relieve them and when it’s the right time to seek medical support.
The knee can be injured whilst skiing in various ways. The most common way is when the ski or boot gets stuck in the snow- with a rotation or twist occurring around the knee as a result. This can injure two main ligaments of the knee- the anterior cruciate ligament (ACL) and/or the medial collateral ligament (MCL). Each of these may be injured alone or together. A tear in the cartilage known as a meniscal tear may also occur.
Initially, any acute injury should be treated with rest, ice, compression and elevating the leg (RICE). This reduces swelling and pain.
MCL injuries occur to the inside of the knee. This can happen when the inside of the knee is stressed too much in a twisting or forced movement inwards. The pain can still be bad but there is usually no pop/snap or significant swelling afterwards. Most of these injuries will get better with physiotherapy and rehabilitation, surgery is rarely needed. As with any injury, an accurate diagnosis is essential to plan your recovery.
ACL tears are a more significant injury. Often a pop or snap may be heard- followed by pain and rapid swelling of the knee. With any injury of concern, it is, of course, important to be assessed and most ski centres have great medical facilities.
Once you are back home you may need to be assessed with an accurate diagnosis and management plan. A specialist examination by a sports medicine consultant may be followed by investigations such as MRI when appropriate, alongside physiotherapy and other treatment. ACL tears can be treated with surgery or physiotherapy alone depending on your individual circumstances. The main symptom of an ongoing ACL tear is collapse or giving way of the knee (knee instability).
There are specialised areas of cartilage in the knee known as the meniscus- you have one on the inside of the knee (medial) and one on the outside (lateral). The medial meniscus is more commonly injured in skiing, especially if the knee has been injured by a rotational force. The tear may happen in a previously healthy knee (acute meniscal tear) or perhaps when there is already some degeneration present in the knee joint (degenerate tear where less force is needed to sustain an injury). The pain from such tears is usually localised to the inside part of the knee- some swelling may happen. If the knee locks and gets fully stuck in one position then surgery may be needed.
Smaller tears and ones which do not lock may settle with some rest and rehabilitation. Sometimes a steroid injection to help settle the pain and swelling is appropriate.
The shoulder may be injured during ski and snowboarding activities. Direct falls onto the shoulder can cause fractures- including the collarbone. The joint at the top of the shoulder known as the ACJ may also be sprained or dislocated. Occasionally the actual shoulder joint itself can dislocate when the ball moves out of the socket. This will usually need immediate care in the ski resort to manage it properly.
The muscles and tendons around the shoulder are called the rotator cuff and these may be injured/torn in falls or when the shoulder is suddenly thrown into certain positions.
Once any necessary immediate treatment has been given in the resort, it is important to avoid further injury to the area by rest and protection. When you return home any further assessment can be performed. Sports doctors are able to assess and arrange appropriate investigations, including diagnostic ultrasound, an accurate diagnosis with the correct treatment plan is very important in recovery from the injury sustained.
Whilst the above injuries aren’t uncommon, this is no reason to avoid the slopes the winter. Make sure you prepare your body before jet-setting for the snow by checking out our blog on ski and snowboarding preparation exercises here. If you do come back from your holiday a little worse for wear, make sure you book in to see a consultant and have any injuries properly investigated and managed.
Returning from your mountain adventure with an injury is unfortunate, and depending on how the injury occurred, sometimes unavoidable. Snow sports have a reputation of being risky business, however the overall injury rate remains relatively low. The above injuries discussed by Dr Michael Burden require different approaches, rehabilitation treatment plans and have varying healing times. Having a thorough assessment and accurate diagnosis soon after an injury is the first step to a positive recovery outcome and is a very important first step. Therapists use this information to create an individually tailored rehabilitation programme. Physiotherapy aims to facilitate your bodies healing with a combination of manual therapy and exercise prescription for your best possible outcome.