Skis and Knees

It is that time of year again, when people start sharpening and waxing their skis, and start looking to the white-capped peaks to the west. Skiing is very popular and not as dangerous as its reputation once had it to be. It used to be the stereotypical image of a skier sitting in a cabin in front of a fire, snow swirling outside the window and their leg propped up in a cast. Now, the apres ski image is that of a gung-ho enthusiast wearing a knee brace at the bar, talking about their arthroscopy! Since improvements in boots and bindings have greatly reduced broken bones, injuries are mostly hitting the next weakest point in the system — the knees.

There are several kinds of knee problems skiers experience, and to understand them, it helps to understand a little about the anatomy of the knee. There are 4 major ligaments in the knees which restrict its range of motion, the medial and lateral collateral ligaments (the MCL and LCL), keep it from bending sideways. The anterior and posterior cruciate ligaments, keep the lower leg from sliding forward and backward on the thigh, and keep the knee from over extending beyond straight. In addition, there is a cushioning plate of cartilage in between the thigh and lower leg bones, and in the middle of the knee joint, called the meniscus. There are three bones in the joint the thigh bone (femur), the major lower leg bone (tibia) and the knee cap (patella). Ligaments, cartilage and bones can all take a beating in skiing.

Ligament injuries are probably the most common ski/knee injuries, as a leg can suddenly be pulled sideways when moving at high speeds, and put a lot of strain on the ligaments, often stretching or tearing them. Many of these injuries are just mild sprains of the MCL, when the inner side of the knee feels sore. This injury usually requires rest, perhaps some advil and a bit of time to heal. Severely sprained knees can require surgery to repair torn ligaments, or braces or casts to prevent them from remaining stretched out after an injury. Kneecaps are often the victim of mogul fans, since absorbing bumps with thigh muscles tensed and the knees bent puts a lot of pressure on the underside of the patella, often causing inflammation here and on the surface of the thigh bone where it rubs. Severe twisting injuries to the leg, especially with the knee partially bent can cause the thigh bone to grind the meniscus against the tibia like a mortar and pestle. These twisting injuries can tear the meniscus, an injury that rarely heals without surgery, as well as sprain all of the knees ligaments.

Luckily, arthroscopy has made knee surgery a much easier affair, with less scarring and much shorter recovery times. Small incisions are made over the knee joint and tubes are inserted into the injured area, where microsurgery is carried out with the aid of fiber optics and magnification. Rarely can knees be made good as new, so the best strategy remains prevention. This means skiing in control and getting your legs in shape before the ski season. This doesn’t mean skiing the bunny slopes like your grandmother would, but perhaps it means treating yourself to a ski lesson or two. If you already have knee problems, consider working on your slalom technique, rather than hammering those bumps. Leg strengthening helps support the knee joint better, and can sometimes get you out of sudden predicaments such as catching an edge. Strengthen those thigh muscles by doing squats, bicycling, or running (running hills is especially helpful) and warm up with a few light ski runs before going all out down the slopes.

Richard Jacobi, M.D. is a board certified family practitioner at Longmont Clinic.