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.


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


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.

5 Common Hockey Injuries

Hockey photo

The regular NHL season is well underway and the Seattle Thunderbirds are respectively improving their stats with their recent win over the Vancouver Giants at ShoWare Center.

In the regular season as well as the off season, players experience a variety of sports-related injuries as a result. Ice hockey is a contact sport where the players and the puck move at high speeds, so when players run into each other or objects, great force is used. This is why hockey is considered a collision sport. Injuries are fairly common, but efforts can be made to avoid them with training and proper equipment. Listed below are five common injuries that can occur while playing hockey.

AC Joint Injury

The acromioclavicular joint, or AC joint, is one of the joints in the shoulder responsible for motion and stability. The ligaments that hold the AC joint together can be torn through sudden impact to the shoulder, which can cause separation to occur in the AC joint. This sudden impact can happen in hockey when players skating at high speeds collide with one another or into a rigid surface. Swelling, bruising, pain, and motion range loss are all symptoms of AC joint separation. There may also be visible bumps on the shoulder if the bones separate.

Shoulder Dislocation

Shoulder dislocation generally refers to a dislocation in the glenohumeral joint in the shoulder. This happens when the top of the humerus, or upper arm bone, is forced out of the glenoid, the socket in the shoulder joint it usually nestles in. If a player falls or receives a heavy blow or sudden impact on the shoulder, it can cause dislocation if the upper arm is forced to move in an abnormal way. Symptoms of shoulder dislocation include pain, weakness, and mobility issues. The arm may also appear to hang incorrectly off the shoulder.

Muscle Strain

Muscle strain occurs when a muscle is pushed past its limit. This can happen if a player’s muscle is suddenly presented with a heavy load or stretched beyond its normal ability. If a player’s muscles are tight but not warmed up or not conditioned well, tearing or straining is a risk. Symptoms of a muscle tear include pain at rest or when the muscle is used, and weakness or inability to use the muscle.

Meniscus Injury

The meniscus is a C-shaped piece of cartilage in the knee. There are two menisci in each knee joint, and if they are torn they can affect stability in the knee. This tearing can happen if the cartilage is worn down or through the quick movements and stress put on the knees by ice skating. Symptoms vary depending on how and where the meniscus is torn, but symptoms can include pain, instability or feeling the knee “giving,” stiffness, swelling, and an impaired range of motion. Sliding, popping, or locking may occur if the tear is left untreated because loose fragments from the meniscus tear will drift into the joint.

Gamekeeper’s Thumb

The ulnar collateral ligament, or UCL, connects the bones at the base of the thumb, which prevents the thumb from moving too far from the hand. When an acute sprain or tear of the UCL occurs, it is called a UCL injury. When the injury is chronic and develops over time from repeated UCL stretching, it’s called gamekeeper’s thumb. UCL injuries are commonly caused by injury or trauma in which the thumb is bent away from the hand at the MCP joint. This can happen in sports hockey, or in any situation in which a fall is landed on an outstretched hand.

This injury might also be sustained when a person is gripping something that is suddenly moving, like a hockey stick during a fall. Swelling, pain, and tenderness on the ulnar side of the thumb are all symptoms of UCL injury. You may also have difficulty pinching and gripping with the thumb, and you may have limitations in your range of movement. In severe cases, a bump under the skin, called a Stener lesion, may form due to the ends of the torn ligament being held apart by a nearby tendon.

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

Seahawks DE Michael Bennett taken off field on stretcher

On Sunday, September 29, reported that Seahawks defensive end Michael Bennett, who has been a big story this season as Seattle’s sack leader, was taken off the field Sunday on a stretcher after he was injured on a play against the Texans in Houston. The article reported, “Late in the second quarter, Bennett was rushing Texans quarterback Matt Schaub when he was pushed from behind by a Houston defender into Schaub’s leg. Bennett’s head appeared to snap back, and his helmet flew off as he hit the ground. Bennett laid face-down on the turf for several minutes as trainers tended to him.”

According to the news article, “Bennett suffered a strained muscle in his back that was close to his vertebrae. The location of the injury was why medical personnel were extra-careful and carted Bennett off the field on a stretcher.” Head coach, Pete Carroll said that he was “fine” and a tweet was sent out the next day stating that Bennet was practicing and that he may be able to play in their upcoming game against Indianapolis.

Treatment of a lumbar muscle strain is important to understand. Once you know the cause of your symptoms, you can proceed with treatment. It is important that if you are not sure of the cause of low back pain, that you are evaluated by a physician. According to Dr. Charlie Peterson, “Back injuries can be painful, frustrating and even scary, but are also common. As such, the vast majority can be managed with a few simple techniques. However, if you have unusual symptoms or your pain persists, it’s time to seek advice from a specialist.”

If you are experiencing pain in your lower back or it has been injured as a result of physical activity, below is a list to help you treat your injury:

Step 1: Rest

The first step in the treatment of a lumbar muscle strain is to rest the back. This will allow the inflammation to subside and control the symptoms of muscle spasm. Bed rest should begin soon after injury, but should not continue beyond about 48 hours. While it is important to rest the injured muscles, it is just as important to not allow the muscle to become weak and stiff. Once the acute inflammation has subsided, some simple stretches and exercises should begin.

Step 2: Medications

Two groups of medications are especially helpful in treating the acute symptoms of a lumbar back strain. The first of these are anti-inflammatory medications. These medications help control the inflammation caused by the injury, and also help to reduce pain. There are many anti-inflammatory options, talk to your doctor about what medication is appropriate for you.

The second group of medications commonly prescribed for the treatment of lumbar strains is muscle relaxing medications. Again, there are several options that you may discuss with your doctor. These medications are often sedating, so they need to be used with care. For patients who have back spasm symptoms, these muscle relaxing mediations can be a very useful aspect of treatment.

Step 3: Physical Therapy/Exercises

Proper conditioning is important to both avoid this type of problem and recover from this injury. By stretching and strengthening the back muscles, you will help control the inflammation and better condition the lumbar back muscles. The exercises should not be painful. Without some simple exercises, the low back muscles can become “deconditioned,” or weak. When the low back muscles are “deconditioned”, it is very difficult to fully recover from low back injuries.

It is also important to understand that even if you are “in good shape,” you may have weak low back muscles. When you have a low back muscle injury, you should perform specific exercises that stretch and strengthen the muscles of the low back, hips and abdomen. These exercises are relatively simple, do not require special equipment, and can be performed at home.

Step 4: Further Evaluation

If your symptoms continue to persist despite treatment, it is appropriate to return to your doctor for further evaluation. Other causes of back pain should be considered, and perhaps x-rays or other studies (MRI, CT scan, bone scan, laboratory studies) may be needed to make an accurate diagnosis.

If you believe you are suffering from a back injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.