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Ski Injury Rehab

The Road to Recovery

By Jake Hutchinson

Gravity and speed are a wonderful combination. That’s a large part of why skiing is so damn fun. Unfortunately, the human body doesn’t absorb impact without damage, with obvious result in the occasional truncated season. In my 20 plus years ski patrolling, I’ve seen and stabilized all kinds of injury and even suffered a few myself. Nowadays, in my role as a physical trainer, I spend more time with skiers working their way back from injury than I do hauling them off the hill. If or when it happens to you, here are a few pointers to speed your rehab and get you back on snow as quickly as possible.

To be clear, I’m not a doctor or physical therapist, I’m a physical trainer. Be sure to start any injury rehab discussion with the appropriate medical professionals.

This article focuses on injuries to joints (like an ACL tear), with a little mention about fractures and muscle injuries.

Once a diagnosis has been confirmed, I like to break the process into three distinct phases:

Phase 1. Repair

This is obviously the realm of the physician, but it’s the first step in the process. The doc will also steer the direction of phase two in conjunction with a Physical Therapist.

Phase 2. Rehabilitation

There are four phases of a successful rehab program and they must be completed in order. This article will focus on parts C and D, as a doctor and/or licensed PT should oversee the first two stages.

  1. Rest, protect injured area, control swelling and pain.
  2. Restore joint motion and muscle flexibility.
  3. Restore muscle strength, power and endurance.
  4. Restore function (coordination, balance, agility and sport-specific skills).

Phase 3. Return

Get back on the slopes when your body is ready.

Fast forward on this timeline. You’ve had a successful repair and your PT or doctor has cleared you to start weight training. Take it slowly. To avoid reinjury, start small and focus on technique and form instead of pushing extra weight, until you have restored a full range of motion and are mostly pain free.

Speaking of pain, rehab often is uncomfortable, but there is a difference between being sore and causing yourself harm. I see a lot of tough guys set themselves back months or weeks because they couldn’t tell the difference between pain due to a rehabbing joint and pain of re-injury. Know your thresholds and understand the line between gain and (re)injury.

 

Let’s start with restoring strength, power and endurance. It would be impossible to cover every injury (in this article), so to simplify we will focus on rehabbing a knee after surgery. The stationary bike is an obvious tool for knee rehab for several reasons, because it

  •       encourages full range of motion,
  •       is low-impact and
  •       as muscle endurance returns, resistance can be added to begin increasing strength.

I make everyone with knee problems start and finish each training session on the bike. We use the Stairmaster AirFit bike, but any bike will do. Every warm-up should include 10-20 minutes at a vigorous enough pace to break a sweat but not to the point of fatigue. The goal is to get the blood flowing, loosen up the knee and leg muscles and “prime the pump” so the body is ready for the real work.

As we begin building strength and power, we start easy with bodyweight-only exercises like air squats, wall squats, lunges, and single-leg box squats. This phase may last for days or weeks depending on progress, pain, and swelling. Don’t push it, and listen to your body. The recovery (ice, rest, etc.) each day is as vital as the work itself.

With time, we gradually add weights and power movements to the workout. I like to continue with the same exercises but add dumbbells or kettlebells to the equation to increase strength. At this point, I recommend lighter weights with more reps per set, rather than heavy weights. For instance, I may have a client do 3 to 5 sets of 7 to 10 reps of each exercise, with appropriate rest (1.5 to 3 minutes) between sets. The key here is to be as pain-free as possible. We don’t want to do more harm!

Jimmy Picard, one of my clients at Gym Jones, is a licensed physical therapist. I asked him about suggestions for rehabbing and strengthening after surgery. He offered the following advice:

“In the beginning exercises should be in stable planes where we are unlikely to cause re-injury or destabilize the joint. As strength builds and mobility returns, think about all the different ways the knee is stressed while skiing. Because of this, training should not only emphasize movement in all planes, but the knee should be trained to tolerate the stresses being applied in all planes.”

How do we do this without re-injuring the knee? One way is to pick up weight and move in all planes and all directions. Weighted carries, step-ups and lateral hops are all great. Avoid movements that focus on muscle isolation, as the body rarely, if ever, works any muscle in isolation. It makes no sense to focus on the quad and neglect the hamstring and glute: the quad will overpower the hamstring, causing imbalance and ultimately re-injury. Or the body will compensate in some way that causes new problems down the road.

How are power and strength different? We define strength as max force production, like pushing a truck across the parking lot, slow grinding movements that require pure force. Power is defined as the rate of force production, i.e. jumping or sprinting. For power work during knee rehab, we start looking at box jumps, seated box jumps and broad jumps. This also helps to stress the knee in various directions and begins to mimic movements that will translate to skiing strength.

Once sufficient strength and power have been developed, it’s time to focus on restoring function. Walking without assistance or even a limp is a huge step forward, but it’s a long way from skiing. A huge part of the Gym Jones philosophy is that training is only preparation for the real thing.

Specifically, to prepare for skiing, work on the important muscles and muscle groups involved. For skiing, the obvious one is the legs. Most of us focus on our quads because that’s what is usually the sorest at the end of a long run or day. But the knee is stabilized by a multitude of muscles. The quad is an extensor, and we don’t simply extend the knee as we descend. Instead, skiing downhill is a series of complex movements with multiple muscle groups working in unison.

Beyond the legs, I look at a strong core, including a strong back and posterior chain, combined with a high level of mobility. Mobility is different than flexibility and it’s critical to understand the two. Flexibility is defined as “the ability of a muscle or muscle group to lengthen passively through a range of motion,” whereas mobility is the “ability of a joint to move actively through a range of motion.” Many structures contribute to mobility — not only the muscles stretching over a joint but also how far the joint moves within the joint capsule. Mobility also takes into account the component of motor control within the nervous system.

As we begin to restore function, I add complex movements that require these muscle groups to engage simultaneously, the way they were designed to do. I introduce deadlifts, GHD extensionskettlebell swings, sprints and bounding. I compliment with core work, including planks, hanging knees to elbows and mountain climbers. I encourage single-leg work for balance and to build trust in the repaired joint. Weighted overhead lunges are great, and now may be the time for additional weight on the single leg box squats. To keep my mobility game strong, I turn to yoga. In addition to improving flexibility and balance, it’s a killer core workout and helps to keep the lower back strong.

At the end of the day, it’s really hard to replicate the forces created by high speed downhill travel over varying terrain with a five-foot plank clamped to each foot. But by strengthening the muscles that support the joints, we set ourselves up for a solid return to the slopes. 

Interested in learning more about ski injuries? Check out these articles:

Jake has spent more than 25 years working as an avalanche professional. He is currently a lead instructor for the American Avalanche Institute, an avalanche forecaster for Glacier National Park, and an avalanche consultant. Off the snow, Hutchinson is the Head of Instructor and Seminar Development for Gym Jones in Salt Lake City.