Preventing Ski Injuries through Conditioning

A busy ski resort in the United States may see dozens of injuries on the slopes each day. As an orthopedic surgeon, I also see many patients with ski-related injuries throughout the season. Most injuries are the result of poor conditioning, or equipment failure.

The most common injuries amongst downhill skiers are knee sprains, shoulder injuries, head/face injuries and wrist/thumb injuries. The knee is the most commonly injured joint, resulting in about one third of all ski injuries. Injury rates and type vary with uncontrollable factors such as weather and snow conditions. Proper equipment and conditioning, however, are factors that we can control.

Equipment

When skiers examine their equipment, it’s important to make sure that: Skis, poles, and boots are in good condition and properly sized for the individual’s weight,size and skill. Bindings are adjusted and tested prior to each ski season.Helmets are properly fitted and checked for damage prior to the ski season.Sunglasses, goggles and sunscreen are part of one’s safety equipment

Conditioning

Skiers can increase their safety and performance this winter by starting with a pre-conditioning program that includes four components: endurance, strength, flexibility, and balance. Aerobic fitness is the key to preventing the end of the day injuries (the last run).Cross training, which includes multiple sports and activities in the conditioning regimen, has become popular, especially with a seasonal sport such as skiing. Strength and flexibility focusing on the legs and trunk are vital in injury prevention specific for skiing. Balance training has been shown to be the single most important exercise for preventing ACL tears in women.
A typical conditioning program can include:

1. Aerobic fitness (5 days/week for at least 30 minutes)

  • Running
  • Cycling
  • Swimming
  • Elliptical or stair climber
  • Jumping rope
  • Treadmill

2. Strength (3 days/week, 2 sets of 60 seconds each)

  • Leg press
  • Wall squats
  • Hamstring curls
  • Toe raises
  • Lateral leg raises
  • Sit-ups

3. Flexibility (daily, 2 sets of 60 seconds each)

  • Hamstring stretches
  • Achilles stretches
  • Quad stretches

4. Balance Exercises (daily, 2 sets of 60 seconds)

  • Standing on one leg, perform mini squats
  • Single leg hop, holding landing for 5 seconds, repeat

In addition to a conditioning program, skiers need to adequately warm up – an activity that is often neglected with skiing. No one would think of running out on the football field or onto the basketball court without warming up first. But with skiing, one typically sits in the car for an hour or more to get to the slopes, and then stands in line for tickets and for the lift, before finally sitting on the chair for several minutes. By the time one has arrived on the top of the hill, he or she is often stiff and cold.

It’s important for skiers to remember to warm up and stretch before starting down the hill.Often an easy, predictable run is a good idea before heading to the more challenging terrain.The few minutes spent warming up will be well worthwhile in injury prevention.

More about knee injuries

Every ski season, I treat many knee injuries. In the 1970′s, ankle injuries were more common, resulting from soft, leather boots. The development of stiffer boots has transferred much of the force to the knee.

The most common knee injury from skiing is the MCL (medial collateral ligament) injury. It often results from catching an edge or having the skis diverge, so that the foot is forced away from the body. This creates a distraction force on the inside of the knee. Fortunately, the MCL has a good blood supply, and can be treated non-operatively, with a period of bracing for 4-8 weeks, depending on the severity of the injury.

ACL (anterior cruciate ligament) injuries are also common skiing injuries. They are thought to occur from the forces created by the long lever arm of the ski that are transmitted to the knee ligaments. Commonly, the ACL is injured with a hyperextension mechanism. In expert skiers,we see ACL injuries when saving a backwards fall by a strong quadriceps contraction, pulling the tibia (lower leg) forward with enough force to rupture the ACL. Recent boot and binding technology has reduced the rate of ACL injuries. In young, active individuals, the ACL injuries often require surgical reconstruction. Success rates from surgery are excellent, but require aggressive rehabilitation and six months of recovery time before one can return to skiing or other twisting or pivoting sports.

No one wants to go down the path of surgery and recovery. But too many people wait to think about preparing for skiing until half way through the season, when snow has already accumulated and they are on their way to the top of the mountain. Many times, this is to late. Although injury is a risk we all take when participating in any sport, a conscientious approach to skiing – including equipment inspection and conditioning – will minimize the occurrence. Not only will these precautions reduce injury rate, but they will also enhance performance, decrease fatigue, and ultimately, increase one’s enjoyment of the sport.

We are fortunate in the Pacific Northwest to have great skiing terrain so close. Be safe and prepared so you can enjoy a great skiing season this year.

ski article

Carving Safety Tips for this Holiday Season

Carving article photoThanksgiving is just around the corner and almost everyone is planning a big feast, strategizing for the family football rematch, watching the Macy’s Day parade and of course, NFL football on TV.

With all these things going on in one day, there is no bigger star than the Thanksgiving turkey as it is paraded from the kitchen into the dining room where someone will be carving the revered bird. This holiday season, Orthopedic Specialists would like to caution all the carvers out there as they carve the main course and not their hands.

People sustain hand injuries during Thanksgiving and the entire holiday season. When friends and family are watching you as you carve the turkey, you may feel a little overwhelmed, so focus; don’t let your turkey day celebrations go fowl this year because of a hand injury.

Safety Tips for Thanksgiving Feast

Follow these easy tips and get your bird on the table in time so guests can start gobbling:

  1. Never cut towards yourself. One slip of the knife can cause a horrific injury. While carving a turkey or cutting a pumpkin your free hand should be placed opposite the side you are carving towards. Don’t place your hand underneath the blade to catch the slice of meat.
  2. Keep your cutting area well-lit and dry. Good lighting will help prevent an accidental cut of the finger and making sure your cutting surface is dry will prevent ingredients from slipping while chopping.
  3. Keep your knife handles dry. A wet handle can prove slippery and cause your hand to slip down onto the blade resulting in a nasty cut.
  4. Keep all cutting utensils sharp. A sharp knife will never need to be forced to cut, chop, carve or slice. A knife too dull to cut properly is still sharp enough to cause an injury.
  5. Use an electric knife to ease the carving of the turkey or ham.
  6. Use kitchen sheers to tackle the job of cutting bones and joints.
  7. Leave meat and pumpkin carving to the adults. Children have not yet developed the dexterity skills necessary to safely handle sharp utensils.
  8. Lastly, should you cut your finger or hand, bleeding from minor cuts will often stop on their own by applying direct pressure to the wound with a clean cloth.

Visit an emergency room or a hand surgeon if:

  1. Continuous pressure does not stop the bleeding after 15 minutes
  2. You notice persistent numbness or tingling in the fingertip
  3. You are unsure of your tetanus immunization status
  4. You are unable to thoroughly cleanse the wound by rinsing with a mild soap and plenty of clean water

Dr. Weil states, “I often see patients whose holiday season has been ruined by an accident in the kitchen. The most common kitchen injuries that I treat are lacerations. Lacerations sustained while carving pumpkins, turkeys, and other holiday fare can be quite serious. These injuries can include cut nerves, arteries and tendons. These types of injuries require immediate surgical management to restore function. Treatment can include microscope assisted nerve repairs, artery repairs, and tendon repairs. If you sustain a laceration where you lose sensation to your finger or hand or are unable to bend your finger please seek medical treatment immediately.”

These simple tips will help you enjoy that bird and the rest of your holiday season. If you would like more information on specialty care of the hand, call Orthopedic Specialists and make an appointment with one of our expert, orthopedic doctors at (206) 633-8100.

Fall Clean-Up and Rake Safety

Fall is a beautiful time of the year when the leaves turn color and in the Pacific Northwest, it is sometimes also wet because of the rain. Preparation and taking a common-sense approach to raking the beautiful leaves is important and raking requires a number of different activities, including twisting, bending, lifting, and reaching, that use several different muscle groups. Improper use of lawn tools along with the potential for tool-related accidents further compounds the risk of injury to the bones and muscles.

Fall leaves and Rake
Raking leaves is a vigorous exercise, and you need to warm up for at least 10 minutes with some stretching and light exercise. You also need to:

—Do some form of light exercise (such as walking) for 10 minutes to warm up the muscles before raking or other yard clean-up

—Use a rake that’s comfortable for your height and strength. Wear gloves or use rakes with padded handles to prevent blisters. If you have a rake that is too short you will have to bend over which will cause strain on your back. It is the repetitive movement in raking, not the weight that can strain the muscle.

—Don’t wear hats or scarves that interfere with vision and beware of large rocks, low branches, trees stumps and uneven surfaces.

—Alternate your leg and arm positions often. When you pick up piles of leaves, bend at the knees, not the waist. Use your legs to shift your weight rather than twisting your back. Do not throw leaves over your shoulder or to the side while raking as this involves twisting movements that can overly strain the muscles in your back. As a reminder from Dr. Shapiro, “Take care of your shoulders and use more bags, filled ¾ full. Lifting and throwing heavy, wet bags is a common way to hurt your shoulders and neck.”

—Wet leaves can be slippery. Wear shoes or boots with slip-resistant soles.

—Don’t overfill leaf bags, especially if the leaves are wet. To avoid back injury, you should be able to carry the bags comfortably.

—When raking, don’t throw leaves over your shoulder or to the side, because that kind of twisting motion places too much stress on the back.

—Don’t overdo it. Raking is an aerobic activity – you may need to take frequent breaks or slow your pace if you are an infrequent exerciser.

If you do experience a new strain or sprain, proper care can be easily remembered by using the acronym, RICE:

  • Rest (minimize movement of the injured body part)
  • Ice (apply a cold pack)
  • Compression (light pressure wrap to the affected body part can help minimize leakage of blood and swelling)
  • Elevation (raise the body part up so that the pressure from the blood and tissue swelling the affected area is reduced as the fluids drain from the area by gravity)

If you do experience an injury during your Fall clean-up, call Orthopedic Specialists of Seattle and make an appointment to see one of our expert doctors.

Barefoot Running

Who doesn’t want to run like a Kenyan? The speed, endurance, and efficiency of these elite distance runners is the stuff of legend, and those in the running community have tried to glean some insight as to what makes these African runners such a powerful force in marathon running. One of the obvious starting points is to analyze the biomechanics of the running stride and see if there are efficiencies inherent to the Kenyan athlete.

Of course, this has been done with more than one researcher noting one glaring observation: Kenyan runners do not wear shoes. They grow up, play, and often train barefoot. Could this be the secret to running faster? Certainly, some people think that it is. The barefoot running trend has gained a steady following over the past few years. But as the barefoot running contingent has grown, so have its detractors. Let’s take a closer look.

Barefoot Running

Advantages of Barefoot Running

First of all, most barefoot runners do not run in their bare feet. Even the fanatics realize that the roads and trails contain many hazards such as broken glass, nails and rocks that could cause potential injury or discomfort to the feet.

Instead, they use minimalist running shoes, a type of sneaker designed to mimic the barefoot condition in terms of biomechanics. Typically, these shoes are lightweight and feature a thin sole without the large heel cushion found in traditional running shoes.

Biomechanically, the research has shown that barefoot running eliminates or minimizes the heel strike during running. The runner attempts to absorb the impact of body weight by landing with the foot flat or slightly on the ball of the foot. This allows the lower leg and foot to distribute the body weight over a larger surface area. The heel strike found in those wearing traditional running shoes, called shod runners, creates a condition where the full force of impact is driven through the heel, and ultimately the heel cushion of the shoe.

Proponents of barefoot running claim reduced injuries as a result of this change, although there is not much research available to support this claim. One claim that does seem to be supported in the medical literature however, is that of reduced energy consumption while running barefoot.

Simply put, barefoot runners should not fatigue as quickly as shod runners. This would be a great advantage to distance runners and racers who want to attain peak performance or even achieve a personal best during local road races.

The finding is interesting as stride frequency and mechanical work were higher in barefoot runners, indicators which would lead one to believe that the runner would consume more energy. However, the cushioning material in a running shoe absorbs a considerable amount of energy in the shod runner. Energy that would otherwise be used to propel the runner forward is lost in the sneaker. Think of the traditional running shoe like a Cadillac. It gives a smooth ride, but not too efficient.

Disadvantages of Barefoot Running

The obvious risks associated with barefoot running such as puncture wounds can be mitigated with the use of a minimalist running shoe. With this type of footwear, much of the biomechanical adaptations which proponents claim as advantageous are maintained, i.e. reduced heel strike and improved efficiency.

However, there are other reasons why someone may not want to run barefoot. Without a traditional running shoe, the runner lands with a flat foot instead of the traditional heel strike seen in shod runners. This increases the pressure on the bones of the forefoot, which are quite a bit more fragile than the heel.

Over time and with high mileage, a runner could develop a stress fracture, a small break in one of the forefoot bones. This would sideline a runner for several weeks at best, and could become more severe if ignored. Proponents claim that barefoot running is more natural and that we as humans evolved in a way that makes the barefoot method more efficient. But cavemen rarely put in thirty plus miles per week.

The bottom line is that there has not been enough research performed to advocate one method or the other. More studies need to be conducted, and we need to be open-minded about the results. With the barefoot trend steadily gaining a following, the research is sure to follow.

In the meantime, let’s go back to our elite Kenyan marathoners. In an environment where every conceivable advantage is sought and analyzed, these athletes all wear running shoes in competition. Maybe shod running is biomechanically advantageous, or maybe the cumulative effect of pavement on flesh for 26.2 miles eliminates the inherent advantage of running barefoot.

Dr. Mark Reed is an orthopedic surgeon specializing in foot and ankle surgery in the Seattle metro area. He can address all of your questions regarding barefoot running as well as any other foot and ankle conditions.

barefoot running photo

MCL Tears and Repairs By Dr. Charlie Peterson, MD

MCL Tears and Repairs

The medial collateral ligament (MCL), located on the inside portion of the knee, is one of the more common sporting injuries to the lower extremity. It is usually an “acute” injury, meaning that it happens suddenly due to trauma. In sports, the athlete may take a sudden blow to the outside of the knee, creating excessive tensile force to the MCL, such as being tackled in football. This injury also occurs commonly in sports where the ankle is immobilized such as hockey and downhill skiing, where the ankle is stabilized in a skate or boot. This immobilization leaves the knee to absorb the full impact of a collision or fall and increases the risk of knee injury.

Functional Anatomy

The skeletal anatomy of the knee consists of three bones. The thigh bone, medically termed the femur connects with the shin bone, called the tibia. In the front of the knee is the knee cap, or the patella. Holding these bones together are the four major knee ligaments. Two are located deep within the joint and are called cruciate ligaments. They prevent excessive forward and backward motion, as well as rotation. The remaining two are the collateral ligaments, and are located on the sides of the knee. Their job is to prevent lateral, or sideways, motion of the knee. The MCL is located on the inside of the knee joint and prevents the knee from collapsing inward. In addition to the bones and ligaments, the knee has two cartilage pads called the medial meniscus and lateral meniscus. These pads act as shock absorbers within the knee.

Types of MCL Injury

Tears to the MCL are usually a result of direct trauma, either from a blow to the outside of the knee, such as with a football tackle, or a fall that pushes the lower leg sideways. Partial tears will cause varying degrees of instability within the knee, and are often treated successfully with conservative interventions including bracing and physical therapy to strengthen the surrounding musculature. Complete tears may cause significant instability in the knee, especially if in combination with other ligament injuries such as the ACL.

If isolated, even high-grade MCL tears can still often be treated with bracing alone. However, such tears often occur in conjunction with other structures such as the medial meniscus or the anterior cruciate ligament (ACL). The medial meniscus has a direct connection to the MCL, making it particularly susceptible to injury during an acute MCL sprain. Should this be the case, surgical intervention may be required to restore full function due to the degree of instability caused by multiple injuries.

Non-operative Treatment

MCL tears are most often treated successfully without surgery. With significant tears there may be an initial degree if instability following injury. A hinged knee brace may be prescribed to limit control of this aberrant movement. As the ligament heals, your orthopedic surgeon may refer you to physical therapy to strengthen the leg musculature surrounding the knee, and also to restore normal movement patterns that may have been disrupted following injury and immobilization. Patients are able to perform most of their normal daily activities during this process, with the possible exception of high intensity athletics, and generally have very good outcomes following four to eight weeks of rehabilitation.

Surgical Treatment

In cases where non-operative treatment has failed or in some multiple ligament injuries, the surgeon will recommend repair or reconstruction surgery. This means that the damaged MCL will be repaired with sutures if possible. If that is not possible, then a new ligament can be fashioned from a soft-tissue “graft,” a piece of tendon taken from either the patient or a cadaver. A small incision is made to gain access to the area, and the repair made, or the tendon graft is anchored in place with surgical screws.

Following surgery, there will be a period of immobilization, followed by physical therapy. The duration and intensity of the rehabilitation process is dependent on the type of MCL repair or reconstruction, and the other injuries present. In most cases, patients can return to full function including athletics at the conclusion of treatment.