Ortho on the go
Ortho on the go
Common Ski and Snowboard injuries
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Welcome to the Ortho on the Go podcast. My name is Chuck Dowell, host of the podcast. This is an educational orthopedic podcast focused on discussing both clinical and functional orthopedics. We will discuss a variety of topics within the field of orthopedics, including reviewing interesting cases, hearing from different professionals throughout the orthopedic profession, and discussing common musculoskeletal injuries and complaints. This podcast is meant for anyone that wants a better understanding of orthopedics, including all levels of practitioners, coaches, parents, and athletes themselves. Hello, everybody, and welcome back to the podcast. I hope you guys enjoyed this episode. I had a lot of fun with this episode. Myself and Darren Yantis, one of the supervising physical therapists at the orthopedic group I work at, discuss ski and snowboard injuries. This episode was done as part of the Motion Lab podcast, the podcast I help with at the orthopedic group. I work at Colorado Springs Orthopedic Group. I hope you guys enjoy this episode. Please tune in to the YouTube version. Darren does have a video at the end of the YouTube version that does show exercises that you can do to both warm up and prepare yourself for both ski and snowboard season. I think these are quite helpful. So if you want to see these, these are at the end of the YouTube version, the video version of this podcast. Otherwise, just the audio version is obviously available on any listening platforms. Again, I hope you guys enjoy this episode. Alright, welcome back. My name's Chuck Dow. I'm one of the PAs here at Colorado Springs Orthopedic Group. I'm here with Darren again.
SPEAKER_01I'm physical therapy supervisor down here at Colorado Springs Orthopedic Group.
SPEAKER_00So we thought it'd be good to do a video andor a discussion on ski and snowboard related injuries. We're in the middle of ski season. We're in Colorado. Skiing is huge here. And as we transition into this colder weather in the ski season, in the orthopedic clinic, we tend to see a lot of common injuries regarding both skiing and snowboarding. And there are some preventative measures that we can do to help reduce the risk of these injuries. So we thought we'd have a discussion regarding what these injuries are that we commonly see and potentially how you can prevent them. So what are you seeing in the physical therapy clinic as far as common injuries?
SPEAKER_01So with skiing, typically we're seeing something related to the knee. Most commonly ACL injury, just based on the mechanism of injury with those ski accidents. Other thing we're seeing a lot of is shoulders, usually related to a fall. On the snowboarding realm, a little bit less knee, more impact-related injuries. We're seeing concussions, forearm fractures, shoulder fractures, just impact-related accidents from going down on the snowboard. You'll occasionally see a knee injury in more advanced snowboarders impacting the ground again.
SPEAKER_00Yeah. Yeah, I think it's interesting. Um, you know, from an orthopedic perspective or an orthopedic urgent care perspective, um, we see a lot of ACL injuries typically in fall sports because that's when sports pick up and you have football, volleyball, sometimes basketball going. But honestly, one of our busiest times of the year for ACL injuries is ski season. Um, and that's because the lever arm that's created by the ski creates an uh you know extra rotational force to the knee. And oftentimes when we're falling, um, that rotational force causes an injury or at least the ligamitous injury to the knee. Most commonly, that ligamitous injury is the ACL. Sometimes it can be the MCL and the meniscus as well. Um and so if you look at the literature, um, somewhere between 40 and 70 percent of ski injuries are typically lower extremity injuries, and 40 to 50 percent of those are usually related to the knee. Uh, when I first started in my career, we had a lot of fractures of the tibia that happened, but as the bindings have you know kind of developed throughout the years, we've reduced those tibia fractures, and now these knee injuries are more common. And unfortunately, the development of the bindings weren't developed to reduce the stress on the knee.
SPEAKER_01They're going a long ways in the ski industry with kind of pivot bindings to help reduce that stress on the ACL. Yeah. So they're they're trying, but it's just there's no way to fully prevent it.
SPEAKER_00Yeah, I think that's what's happened is the original bindings came out to reduce these boot top tibia fractures, and that was kind of one of the purposes of having them. So if you have andor the bindings feel a torque to the to the knee or the tibia, they'll release, and then you won't have that rotational force that'll cause the fracture. And now we're trying to develop the bindings that can now reduce the rotational forces to the knee to potentially reduce these ligamentous injuries. Um, but some of those ligamentous injuries are unavoidable. Sometimes you hit a patch of ice, sometimes somebody cuts you off, it's bad weather. But there is some inherent ability to avoid those injuries, and so I thought it'd be good to talk about potentially how can we avoid maybe knee injuries or lower extremity injuries with skiing. What do you think are some of the best ways we can do that?
SPEAKER_01So, warming up again, we've talked about it before, doing some kind of dynamic warm-up, warm up the tissues before you get on the mountain. Um, I like to say do it before you put your ski boots on. Yeah. Because if you're sitting there doing some leg swings in the parking lot, you slip and fall, well, it's gonna start your day off pretty rough. Yeah.
SPEAKER_00Um start the day.
SPEAKER_01Yeah. So doing some kind of dynamic warm-up in the parking lot ahead of time, yeah. Just to get everything ready to move. Um, and then we got some exercises we can go through as far as strengthening and building some stability and proprioception um around that knee joint, around the ankle joint.
SPEAKER_00Uh I think one of the biggest things is that we all try to prepare for sports and athletics. Uh we all try to prepare for ski season. You know, in October we start to kind of develop our musculatures and say, hey, can we get strong for ski season? But it's life is life. We're all busy, we have kids and responsibilities and work and things like that. But sometimes putting a short duration of a program into implementation can be helpful. There's good literature that shows that if we could strengthen our lower extremities and improve our dynamic stabilizers, we can reduce the risk of ski injuries or lower extremity injuries.
SPEAKER_01Exactly. So it's a fancy word called proprioception. It's basically receptors in your joints that tell that joint where it is in space. So it lets you know if you're shifting forward, sideways. Um, so building that up kind of inherently builds a foundation to kind of stabilize your knee without having to think about it.
SPEAKER_00Yeah, and I think that's like your body's self-defense mechanism to know if I'm gonna be injured and how can I prevent the injury. So if you're falling and skiing and your body senses that I'm getting a rotational force to the knee, it'll fire certain muscles to kind of correct that. And if your uh mind muscle kind of development's not there, which sometimes takes a little bit to develop, um, that may not be there to correct it, and you're at an increased risk for injury. So that's where we can do specific exercises, develop that proprioception, so then we can potentially reduce that risk. Um, we also discussed, you know, me and you were discussing before we started that despite having two skis on, skiing is a very single-leg activity. And a lot of us do squats in the gym and develop bilateral leg activities, but we don't develop this single leg activity, which often increases our risk of injury as well.
SPEAKER_01Definitely. You never know one ski might catch a patch of ice, slide out, you're left stabilizing on one leg. Also, every time you turn on skis, you're unweighting that uphill ski, driving weight down through that bottom leg. So there is a lot of single-leg component with skiing.
SPEAKER_00Correct. Yeah, I mean they describe that kind of shadow foot mechanism of injury that you can happen. So, as he said, that unweighted upper leg, that rotational force to the lower leg. And so a lot of the times your arm will be behind you and you'll kind of have that torque force. So they say, you know, for falling, if you can keep your arms together and kind of fall with your arms together, kind of try to push, you know, your feet together, that will reduce the risk of injury to the knee. Um, and so I think a lot of those things are good things to practice and or kind of keep in mind.
SPEAKER_01That's where we see a lot of the shoulder thumb injuries too, or you get it kind of outside that base, rotating, sticking an arm out, catching your thumb on a pole, something like that. Those kind of injuries, there's not a whole lot of prevention, but stabilizing the legs could could take a step in that right direction.
SPEAKER_00So I think the big question would be okay, so what if I am skiing and I injure myself skiing? When do I know if I should come into the orthopedic group and see somebody, or when can I can maybe continue to ski or just ski through it the next day?
SPEAKER_01So typically something severe like ACL, ski patrol is gonna get involved. Um people can ski down off of it. If it's torn, you're not gonna tear it worse. Um if it's torn all the way, you're not gonna tear it worse. But I'd say significant swelling that lasts three days. So if you do it on a Saturday and it's still pretty swollen, tough to put weight on it, come in and see us on Monday or Tuesday, have Chuck check it out.
SPEAKER_00Yeah. Like he said, I mean, I think the questions I ask when anybody comes in with a ski injury is number one, did your binding pop off? Because that tells me potentially how much rotational force to the knee happened. Number two, did you feel a pop, hear a pop, or was there a cessation of that? And number three, could you ski down? You know, if you can potentially ski down and you try to do one or two more runs and you're done, that makes me concerned that it's more of a higher level injury and potentially that's something that should get checked out. If you skied the rest of the day and it was sore the next day, but you skied the next day, then probably more of a lower level injury. Still can get it checked out, but maybe can try to treat that with three to five days of rest, ice, compression at home.
SPEAKER_01Yeah, and it sounds like something like that would be like a partial tear, which you can stabilize work on some of these exercises to try to kind of repair those receptors in there.
SPEAKER_00Yeah. And one of the questions I get a lot of the times, which I I think is a good question maybe to address, is is braces with skiing. Um, I think if you have a pre-existing history of a knee injury or you have some osteoarthritis in your knee, um, I get asked, should I wear braces or should I not wear braces? What are your thoughts on that?
SPEAKER_01Typically, I'm not a huge fan of braces because you rely on the brace rather than the muscles around the joint to help stabilize. But this is a little bit different. There's a lot of different components that could impact your knee that you can't control. So if you have a history of ACL injury, I say wear wear the brace. Yeah. Um if it's pretty stable and you feel good, you can wear something like a sleeve brace. It doesn't give as much support. Um if you're still real unsure and unsteady, like a hinged knee brace, something that gives you a little more of that medial lateral support could go a long ways to just stabilize the knee and protect you a little bit.
SPEAKER_00Yeah, and it's interesting, there's actually some pretty good literature that shows that something as simple as a knee sleeve will actually improve your knee's proprioceptive capabilities. Um that's often what I recommend is that you know the bigger bulk your hinge braces, the post-op ACL braces, the you know, functional specific ACL braces, I don't usually recommend, but a lot of the times I think a knee sleeve will improve your knee's proprioception, potentially reduce injury risk. Plus, you're getting some compression, some warmth there, which will reduce that arthritic flare type risk. So that's what I usually recommend.
SPEAKER_01We also have upstairs here um like a sports brace for post-op ACLs, which a lot of people will use for skiing, basketball, you know, different sports activities after ACL repair. Yeah.
SPEAKER_00We'll briefly mention the upper extremity and the skis and then we'll go to snowboarding. So you mentioned the thumb injuries, so thumb injuries can happen secondary to ski pole accidents, right?
SPEAKER_01Yeah, plant a pole and just kind of twist around it, funny.
SPEAKER_00Shoulder injuries can happen secondary to fall. So if I fall on my shoulder, I can get an AC joint injury or a clavicle injury. If I have an underlying history of maybe some rotator cuff things, I can injure that rotator cuff as well. So similar as we talked about, maybe if you have some limited motion, some limited strength afterwards, come and get checked out.
SPEAKER_01Definitely. Yeah. You know, a couple visits, come up with a rehab program to try to restabilize that shoulder.
SPEAKER_00Yeah. And I think exercises for the shoulder can also help to reduce the risk of injury to that as well. So if you have a known history of some shoulder injury, you could potentially do some exercises, go see the therapist maybe before ski or snowboard season, and strengthening that shoulder will improve those dynamic stabilizers as well.
SPEAKER_01100%. Yeah.
SPEAKER_00And then on to the snowboarders, we don't want to forget about you. Actually, interestingly enough, the injury risk in snowboarding is significantly higher than skiing. Um, and as we were talking about, most snowboard injuries happen with beginners, right?
SPEAKER_01Exactly. Almost 50% is beginning snowboard levels.
SPEAKER_00Yeah, and that's because we fall a lot when we when we're learning to snowboard, right? So I mean they teach you how to fall and they teach you potentially the right way to fall, but the natural instinct for all of us is to put our arms out when we fall. And you know, most of snowboarding injuries are upper extremity injuries.
SPEAKER_01Exactly. So primarily forearm fractures, you know, shoulder injuries, shoulder separation, AC joint, um just from sticking your arms out. Other thing we're seeing is head injuries. Yeah. So falling backwards, catching that back edge, hitting the head. Same with coming forward.
SPEAKER_00Yep, so concussion risk is a lot higher, I think, in snowboarding because of the risk of falling than it is necessary in skiing, but also definitely recommend wearing a helmet skiing. I think if you're doing the parks and things like that, spinal injuries and concussion risks are much higher because it's a higher dynamic activity. Um, we were talking about this, and you know, I think some of the literature shows that actually those braces for snowboarding can significantly reduce your risk of wrist injuries. You would mention it's not cool to wear braces, which is true. Like nobody wants to wear them and have their friends kind of like say, Hey, why are you wearing those? So I was saying that there you there's actually gloves that they make now that have the race the braces built into them. And if we know that it will reduce your risk of injury to your wrist by 85%, I think that's worth wearing because the last thing you want to do is go out there and start to learn how to snowboard, and you know, your second run down, you fall and injure your wrist, whether it's ligamentous or break the bone, and then you're kind of done for the season.
SPEAKER_01I had a friend, she was a ski instructor, phenomenal skier. First run on a snowboard, caught an edge, snapped both wrists. Yeah. So it it happens.
SPEAKER_00It happens a lot, um, and that's why one of the major risks of snowboarding is the upper extremity wrist injuries. And if you can wear those braces, I think that will help. Uh, we had mentioned so the other things like in ski injuries that you can have with snowboarding is if you fall directly onto that shoulder, the AC joint separation, the clavicle injury, or you know, injure that rotator cuff.
SPEAKER_01I mean, primarily upper extremity. We're seeing some knee, not to the degree of skiing, um, but more ankle injuries also. Correct. So the snowboard boots, um, a lot more mobile, not as rigid as a ski boot, so you have a little bit more torsion on the ankle, um, high ankle sprain, stuff like that. As you shift forward, you can kind of get extra pressure on that tip fib complex and create a high ankle sprain that way.
SPEAKER_00Yeah, so I think as he mentioned, the knee injuries are slightly different because your knees are kind of you know stuck to the board, so a lot of the times that's more collateral ligament injuries, MCLs, sometimes meniscal injuries from kind of falling back on a twisted position. And then as you said, I think we see a lot of these ankle injuries, um, outside ankle injuries that can sometimes happen and sometimes are missed, at least in the urgent care clinics or uh, you know, pr family practice clinics, because they're very subtle on the exam findings. Um, and so similarly, I think, um, are the exercises different, would you say, from a prep for snowboard season than a prep for ski season?
SPEAKER_01Very similar. Yeah. I'd say it's still, like we mentioned, a lot of proprioceptive dynamic exercises. Um, snowboard, both feet work in tandem a little bit more versus you get more single-leg activity with the skis. Um, but most injuries, about 75% of ankle injuries, are that lead foot. Okay. So if you're riding regular, it'll be your left foot, riding goofy, it'll be your right foot. Okay. Um, but that lead foot tends to be the one that suffers most of the injuries.
SPEAKER_00And I think snowboarding is more a dual-leg balanced proprioceptive activity, right? I've never snowboarded. I'm too tall, I think, to snowboard. I have a long way to fall. Yeah. Definitely break him snowboard. Yeah, my injury risk is very high with those falls. Uh, but um you snowboard, and so you would know better than I would. Uh do you think those proprioceptive exercises, now we're gonna do maybe some single-leg proprioceptive exercises for skiing? Are we gonna do bi, you know, modal by-leg proprioceptive exercises for snowboarding?
SPEAKER_01Yeah, I'd say combining both legs and snowboarding is a lot more weight shifting versus versus just balance. So using both legs in a stability point with some kind of external force, be it a band, a ball, something like that would be a good prehab for snowboard season. Yeah.
SPEAKER_00So, you know, I thought we thought it would be good to kind of have a discussion regarding injury risks and common injuries that we see in both the ski and snowboard athletes. Um, in the orthopedic clinic, especially this time of year, we do see quite a bit of them. There is some uh preventive nature, um, whether you can do an exercise program beforehand during warm-up, as you said, I think is very important. Definitely. Um, I think as a physical therapist, when you pull into the parking lot at a ski resort and you see somebody doing leg swings, you just smile, right? They've been there, they've done it before. Like that's one of my patients. They're warming up, they're reducing their injury risk. I can see what they're doing. Or if you see somebody like, you know, doing a couple air squats to trying to warm their knees up, I think we in the orthopedic community smile because we know that's not somebody we're necessarily going to see later as far as an injury risk. Yeah, definitely. So I think these are small things that we can do, but huge things that we can do as far as reducing our risk of injury, warming our joints up, allowing us to have a good vacation, to participate, to be able to have a full ski season without having any injury risk. But if we do have a risk of injury, um the orthopedic clinic, the you know, we have the express care, which is a walk-in clinic open nine to five. We have the physical therapy clinic, as Darren said, where you can come in and maybe do some of these prehab exercises.
SPEAKER_01Definitely. Yeah, you can see chuck, get a referral, pop into the clinic. Um, just say you want to set up a PT visit, if it's simply to get some exercises to work on at home, or rehab from an injury.
SPEAKER_00Yeah, I mean I think a lot of the therapists do winter sports, skiing, snowboarding activities, so they're very familiar with the appropriate exercises to do. Sometimes it's just one or two exercises for them to show you the right way to do them and the appropriate technique to do them, and then you just do it at home on your own, um, trying to prepare for the season, or if you do have a minor injury and you want to rehab that injury to get back for the season, a lot of the times they can help you with that.
SPEAKER_01Yeah, I think every one of our of our PTs, PTAs, skis are snowboards.
SPEAKER_00Yeah. And it's I we were talking about this. It's funny, I get asked a lot if I ski because I see these injuries a lot, and I, you know, I was saying anecdotally, I don't anymore. Um, I stopped skiing because I had young kids, and now I see injuries all season. And every time I think about it, I say, I'm not sure if I want to go up there and risk my injury risk with how tall I am, and I haven't done it for a while. But we'll see, maybe I'll get back out there.
SPEAKER_01I'll take you up one day. Yeah, yeah, I'll take me up.
SPEAKER_00It'll be all greens. It'll be all greens. Yeah, I'll I'll be the bunny slope the whole time. Follow me. And that's I think that last thing that we can mention, which we talked about, is is skiing within your means, right? A lot of injuries happen at the end of the day, a lot of injuries happen because maybe um I I tried to over-ski and that got me into a position. So I think skiing within your means is a big thing.
SPEAKER_01Yeah, fatigue, end of the day. Just be extra careful of those runs. And a lot of it's other people on the mountain. So try as best you can, keep your eyes out, keep your eyes downhill for anyone making a traverse in front of you. Um, someone you might not see, you know, coming in around the side. Just be aware of everyone else on the mountain because that's typically where most accidents occur.
SPEAKER_00And that's probably why a lot of things occur in the beginning athletes or the beginning skiers, is because you're so focused on your form and your technique and your muscles and your balance, you're not peripherally aware of things around you. And if somebody cuts you off and you're not able to correct that, but and in more advanced skiers, you know, their injuries happen because they're doing high-level of you know, moguls and black diamonds and parks and things like that. They're confident in their technique, but you know, those other factors then play into that.
SPEAKER_01Yeah, you're gonna that's where you're gonna see the impact injuries, yeah. You know, the twisting, catching rocks, trees, ice, stuff like that. Yeah.
SPEAKER_00Well, we appreciate you. Thanks for joining us. Anything you want to add?
SPEAKER_01Nah, stop in and see us if you have any questions.
SPEAKER_00Thanks again for listening to the episode. I hope you guys enjoyed that. If you were able to watch the YouTube version andor want to tune into the YouTube version, uh definitely do that and see the exercises and or stretches that Darren was able to show uh that can help you prepare for ski and snowboard season. Uh, next week we'll be with Vanessa Smith. She's the CEO and founder of Orthorefresh.com, a website that's focused on hand and upper extremity injuries. Uh, it has great resources regarding splinting and casting, as well as evaluation techniques for hand and upper extremity. She's a hand and upper extremity PA in the South Dakota area. Uh we had a great conversation and a great episode discussing acute and chronic uh common hand and upper extremity conditions that we see. I hope you guys uh tune in for that. And again, please feel free to follow us on any social media platforms. We are on both Instagram and Facebook. Follow us on any platforms that you listen to your podcast on. Spotify, Apple, iHeartRadio, and YouTube versions do show video versions. Uh please um comment andor give feedback regarding how we can improve these episodes or if there's anything you'd like to hear about in the future. Thank you again. And have a good day.