Knee injuries common for tired skiers

It can happen in a cartwheeling crash down a steep slope, but for most people it's usually something very simple. Maybe a lazy effort getting into or out of a lift chair, or losing their balance standing in the lift line.

But the ending's almost always the same -- injured knees.

Knee injuries have replaced broken bones as the chief menace of Alpine skiing, mostly because of better boots, better skis and better skiing.

"The advances in equipment have helped people out quite a bit," said Dr. Marvin Royster of the Peachtree Orthopedic Clinic in Atlanta. "Binders release generally when they are supposed to. Yet knee ligaments are at the greatest risk because you have a ski on . . . and your body weight and the ski can torque those knee ligaments around to the point they either get strained or will actually even tear."

Roberto Infante, sports medicine supervisor at the clinic, said knee injuries have replaced broken bones as the No. 1 ailment in the patients he sees undergoing physical therapy.

"And by far the ACL (anterior cruciate ligament) is the most common," said Infante. He believes that the downhill skier is in a position to put harmful stress on the ACL.

"When you're in a skiing position and you have a misstep, the boot and the ski are perfect for stress on the ACL. As you fall backward, the boot is actually pushing your lower leg forward."

The ACL is the ligament that sports fans hear and read so much about. It is one of the major stabilizing ligaments in the knee, running diagonally behind the kneecap.

When a person is falling backward and the boot is pushing the lower leg forward, the ACL "is about the only thing holding the knee together at that point. If you can't control just how quickly that stress is put on it, it will snap just like that," Infante said.

Royster said it is unusual to see cases where the injury occurred because the skier was barreling down the hill at breakneck speed.

"It can occur at anything, (even) from a novice skier getting on the chair lift and having the ski tip drag because you have such a long lever on the leg. That's probably the biggest way that it happens -- something simple happens."

Royster, an avid skier, said there is one precaution he would offer to the once-a-year skier.

"I'd say they probably should not try to ski all day long. They probably ought to quit in midday when they are not too tired. Because most of the injuries do occur late in the day when someone is fatigued. They don't have the protective strength in their muscles to prevent them from twisting their knee if they get a little off balance. They don't have the strength to get up properly (if they fall)."

Royster said a year-round conditioning program helps "because you are not going to fatigue as much as the day wears on."

Infante believes skiers also need to incorporate strength programs into their workouts. "People will say to me, 'I play basketball all year. Aren't my legs strong enough?' My answer to that is probably no."

Infante suggests a generic program that includes weights or machines for quadriceps and hamstrings. If you have no conditioning program going but plan a ski trip, he suggests giving yourself eight to 10 weeks of exercise to get in shape.

And if you are a skier who has already experienced a knee injury, Infante said give yourself nine months before skiing again.