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.

Save the Dates for OSS Physicians Speaker Series!

Save the Dates! OSS physicians will be speaking about several orthopedic health and information topics from October – December 2013 at Swedish Ballard. Below is a list of dates and times for you to choose from:

October 2, 2013
Dr. Peterson: Joint Replacement: The Right Choice for You? 6-8 p.m. at the Swedish Ballard Campus. Free hip- and knee-replacement seminar. If you have arthritic joint pain and are considering joint replacement, you’ll want to attend this important class. If you have arthritic joint pain and are considering joint replacement, you’ll want to attend this important class. Dr. Peterson will discuss hip- and knee-replacement surgery, as well as the latest in robotic-assisted surgery for those who have advanced arthritis in part of their knee. There will also be a question and answer session with Dr. Peterson.

Find out more and register here!

October 9, 2013
Dr. Weil: Relief from Your Hand and Wrist Pain. 6-8 p.m. at the Swedish Ballard Campus. Learn about treatments for different types of fractures; ways to treat arthritis in the wrist, thumbs and fingers; and how to prevent and treat carpal tunnel syndrome and other overuse conditions.

Find out more and register here!

November 13, 2013
Dr. Reed: Relief from Your Foot and Ankle Pain. 6-8 p.m. at the Swedish Ballard Campus. The foot and ankle are two of the most often under-treated structures of the body. Dr. Reed, who specializes in the care of the foot and ankle will discuss the anatomy and common injuries and disorders of the foot and ankle, and treatment options for the conditions. There will be a question-and-answer session with the surgeon included in the class.

Find out more and register here!

December 4, 2013
Dr. Ruhlman: Relief from Your Hand and Wrist Pain. 6-8 p.m. at the Swedish Ballard Campus. Learn about treatments for different types of fractures; ways to treat arthritis in the wrist, thumbs and fingers; and how to prevent and treat carpal tunnel syndrome and other overuse conditions.

Find out more and register here!