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.

Ski Injury Prevention

Common Ski Injuries

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.


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.
  • Binding 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.


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 for five (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.

Medial Collateral Ligament

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.

Anterior Cruciate Ligament

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 too 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.

If you believe you are suffering from a knee-related injury and need specialized orthopedic care, the surgeons at Orthopedic Specialists of Seattle provide excellent treatment options available for you.

Avoiding and Treating Spring Sports Injuries

Spring arrives on March 20, and with it, the crack of a baseball or softball bat, the sound of a track coach’s whistle and the rough-and-tumble of other outdoor sports in the Pacific Northwest.  Spring sports not only herald the return of warmer weather, they are a forerunner of an increase in an athlete’s risk of many sports-related injuries. Doctors at Orthopedic Specialists of Seattle (OSS), who have seen just about every possible sports-related injury, offer tips on how to avoid and treat many sports-related injuries.

Dr. Weil states, “As an orthopedic surgeon specializing in hand surgery, the spring is a busy time for me.  I see many sports related injuries in the spring time as people in the northwest come out of winter hibernation.  Some of the more common injuries are due to bicycle crashes due to cycling on wet roads and overuse injuries as people ramp up their activities too quickly.  The old adage, “slow and steady wins the race”, is true in this case.  I look forward to the upcoming triathlon season and will be out in the water, on the bike, and running as well.”

Upper Extremity

In both pro and college baseball players, upper extremity injuries are most common and account for approximately 20 percent of all injuries.  Injuries include dislocations, sprains and strains, labral injuries, and rotator cuff injuries.  Shoulder problems are usually part of a bigger problem, alignment.  By correcting the alignment issues, most shoulder problems can be resolved as long as they haven’t passed the point of no return. Once this happens, surgery is usually the only option to truly fix the problem.

Elbow injuries account for approximately 16 percent of pro and 8 percent of college injuries. These injuries include sprains and strains, contusions, and more severe injuries such as ulnar collateral ligament injuries (Tommy John) and posterior impingement. Elbow sprains and strains are more likely the precursor to an ulnar collateral injury. And just as in the shoulder, by correcting alignment issues, most elbow problems can be resolved as long as they haven’t passed the point of no return.

Baseball Injuries

The 3 main lower extremity injuries in baseball are:

  • Muscle strains, such as a pulled hamstring or quad,
  • Ankle sprains, and
  • Contusions (ie getting hit by a pitch).

Rehab for sprains and strains can involve a short time off from play (if needed) and rehabilitation consisting of regaining range of motion/flexibility, strength, and balance. All of this should be done under the guidance of an athletic trainer or physical therapist.


Hand and wrist injuries account for approximately 10 percent of baseball injuries. These can be minor such as contusions to more serious injuries such as fractures and dislocations. The majority of these injuries are from being hit by a pitch or from sliding. Hand and wrist injuries should be evaluated by your athletic trainer who will refer to a sports medicine physician for more severe injuries such as dislocations and fractures. Minor injuries are usually treated with rest, rehabilitation, and taping/bracing if needed.

Track and Field Injuries

Many track and field injuries can be prevented by increasing the level of awareness and knowledge of prevention.  Muscle strains and sprains are the most common track and field injuries. 

Common track and field injuries include:

  • Shin splints
  • Microscopic stress fractures
  • Compartment syndrome
  • Tibial stress syndrome
  • Plantar fasciitis (pain on the bottom of the foot)
  • Runner’s knee
  • Chondromalacia
  • Patellar tendonitis and Osgood-Schlatter disease
  • Muscle strains to the quadriceps (front of thighs)
  • Hamstrings (back of thighs)
  • Hip adductors (groin) and hip flexor (front of hip)
  • I-T band syndrome
  • Scrapes and burns from falling
  • Blisters

OSS doctors offer the following tips for avoiding sports injuries, including baseball and track:

  1. Wear properly fitted shoes – Protective gear is vital, but shoes that fit well are the single most important piece of equipment in just about every sport.
  2. Properly warm-up before engaging in activities – Both youth and adults today seem to believe that they can just ‘flip a switch’ and begin competing.  By warming up properly, you gradually lengthen and stretch your muscles, increase your body temperature and blood flow, and alert your body to be prepared for more rigorous physical activity.
  3. Don’t continue to play when you are injured – It’s tempting to try to ‘play through’ an injury, or to go back out on the field before you are ready.  That is almost always when greater; often more significant damage is done to an athlete.
  4. Establish a good stretching program to include the gastrocnemius/soleus (calves), hamstrings, quadriceps, hip flexors and hip adductors. Initial stretches should    be static (no  bounce) and held for at least 30 seconds, then progressed to dynamic stretches such as walking lunges or high stepping.
  5. Hydrate 30 minutes prior to practice/game and drink a combination of water/sports drinks during activities.

If you believe you are suffering from a sports-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Dr. Ruhlman’s Trip to Kenya

Last month OSS reported that Dr. Ruhlman and his family were leaving for Kenya once again.

They are back and this is what Dr. Ruhlman had to say about his travels with his family,

“I had the pleasure once again to travel this winter to Kenya to serve in an underprivileged area, providing orthopedic surgical care to patients in a small rural hospital in Bomet, Kenya. This was my second trip to this hospital and first with my family as we enjoyed the hospitality of the locals and helped them medically as they graciously introduced us to their way of life. The predominance of surgeries I performed involved fractures and infections as dangerous roads and driving conditions unfortunately cause a very large amount of significant trauma to the working class. It is extremely important in their culture and economy to get these patients back on their feet to allow them to continue to provide for our family. I had the opportunity to let my family enjoy the trip with me and we were impressed with the beauty of the country and its people. We also had a chance to witness up close the amazing wildlife that has been so well preserved in Kenya – it was a trip of a lifetime for me and my family, though I hope to have the opportunity to go back in the future.”

Check out the pictures from his trip!

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Dr. Ruhlman and his family are leaving for Kenya this Christmas Eve!

Dr. Ruhlman and his family are leaving for Kenya this Christmas Eve. Dr. Ruhlman served at Tenwick Hospital in Bomet, Kenya last year and he is doing it again. According to Dr. Ruhlman, “The country was quite beautiful and the people are very generous and accommodating. Just about a 4-hour drive out of Nairobi, Tenwick Hospital is a rural 300- bed hospital serving a very large under served area. The hospital employs over 500 local kenyan workers and has significant international support. World Medical Mission supports the hospital with logistics and helping volunteers travel to Tenwick and that is how I got involved to help with their Orthopedic Surgical load.”

Last year, Dr. Ruhlman performed 3-5 surgeries per day working with the resident and attending surgeons and helped teach them techniques that he uses in his practice.

What a great way to pay it forward Dr. Ruhlman! Kudos to you and Happy Holidays to you and your family while you will be in Kenya!

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.