Transcription:
Common Injuries for Skiers

Melanie Cole (Host):  As winter begins, skiers are going to take to the slopes for the ski season. What are some of the most common injuries that they will face and how do you prevent those injuries in the first place? My guest is Dr. Mark Miller. He’s board certified in orthopedic surgery and sports medicine at UVA. Welcome to the show, Dr. Miller. What are some of the most common injuries you see with skiers?

Dr. Mark Miller (Guest):  Thank you, Melanie. Yes, there’s a variety of injuries we see with skiers, ranging from knee injuries to hand and wrist injuries to simple overuse injuries. Prevention really is a matter of conditioning yourself ahead of time and taking lessons so that you’re a qualified skier and ski under control at all times.

Melanie:  That’s great advice, certainly advice that I’m hoping that even snowboarders will take from you, Dr. Miller. Let’s just start with can we prevent injuries by having proper fitting boots, binding skis, as you said ski in control and take lessons if you need to, but does the base of support have anything to do with our injury prevention?

Dr. Miller:  Absolutely. Bindings have gone through quite an evolution in even my ski lifetime. Used to be you just strap on whatever bindings happen to come on that particular ski, but nowadays, there’s a lot of technology in bindings. You should caution people not to set their bindings so tight that they won’t come out of the bindings. That’s the whole idea, to come out of those bindings when you have a significant injury. Otherwise, you can very likely get an ACL tear in your knee, for example. That’s how the bindings are designed, so you shouldn’t over-tension them, thinking that you’re a better skier than you really are.

Melanie:  What about maintaining a certain level of fitness or pre-training if you’re going to start skiing? Just hitting the slopes can predispose someone to injury, too, can’t it?

Dr. Miller:  Absolutely. There’s something to the fact that most of these injuries occur late in the day. That’s because at that point, your quads are tired and you’re really kind of not in control as you’d like to be and therefore, conditioning is critical. Also, take breaks and quit early if you’re tired. Never ski tired. You’re at risk for injury.

Melanie:  Do you happen to have some advice on how they’ll know if they’re tired? Because it is certain, I’m right there with you and I’m always stopping my kids and saying and they say, “No, we’re not done yet.” What do you think are some signs that you might be fatigued and that’s the time to stop skiing?

Dr. Miller:  Well, I like to call it quad burning. When you’re doing the bump for even just making a lot of turns and your quadriceps in your thighs start burning, that’s a pretty good sign that you’re getting pretty tired. That’s a good warning sign also if you’re having to stop frequently to catch your breath. Mountain altitude is sort of part of that issue. All of these come into play. If you’re tired, take a break.

Melanie:  Now, suppose you do get injury, whether it’s ACL injury or lower back or really anything, quad pulls, what treatments are available for skiing injuries?

Dr. Miller:  Well, it depends upon the individual injury, but obviously, if you tear your ACL, no matter what sport you tear your ACL, then you’re out for the season and then you need to have an ACL reconstruction. If you have a back strain, then that requires just some rest and time, more than anything else. It’s simply a matter of taking care of whatever problem there is and there’s experts available in every area to do that for you.

Melanie:  Where do you stand on braces, Dr. Miller? If somebody has previous knee, maybe instability, or just they had had a previous injury, do you advise wearing a brace when they ski?

Dr. Miller:  That’s an interesting question, and actually this is the one area in all of orthopedics that this has been shown to be effective, that is in preventing recurrent ACL injuries after ACL reconstruction in skiers, and so this has been proven that there is some benefits to that. It’s also beneficial to wear a brace just for proprioception feedback in people that need that. Braces are a very reasonable thing to wear in skiers.

Melanie:  What about icing afterward? Do you advise using ice after you’ve hit the slopes or is the hot tub the better place to go?

Dr. Miller:  I always tell people heat before and ice after. Ice is a very reasonable option after your skiing, particularly if your knee or your joint swells because this is a very effective modality after your activity. So, it’s “heat before, ice after.”

Melanie:  Now, what about things like just meniscus problems or really anything that may not be something that require surgery? How long if you have one of these injuries can you wait before you get back on the slopes?

Dr. Miller:  Well, I think it’s a matter of returning gradually, and I tell my patients this all the time. It’s wise to just kind of take things incrementally. Try some conditioning. Try some cross-training. Try elliptical trainer and then increase a little bit. Try to do more things or do some activities or you change direction, and as you progress, then you can progress accordingly. The first day you go back, maybe ski just a few hours, take a break, assess how you’re really doing and then gradually get back. Start on the easier slopes and then work your way back. Once you have an injury, you gradually work your back to the level you were before. It doesn’t happen immediately.

Melanie:  What about stretching before you ski? Do you stop mid-skiing halfway through the day and stretch out your muscles? Where do you stand on that?

Dr. Miller:  Stretching is somewhat of an individual thing. Some people get tremendous benefit from that and they’ve done that as part of their exercise regimen all along. Those people should continue to do that. Other people don’t require it as much. In general, it’s a good idea to stretch before you do exertional activities.

Melanie:  What about things like plantar fasciitis? If you’re somebody who suffers from this, Dr. Miller, you step into those boots in the morning and it’s pretty painful for the first, maybe, hour. Do you have some advice for people?

Dr. Miller:  Sure. For some reasons technology really hasn’t caught up with ski boots. They are uncomfortable no matter what for everybody. I think it might be reasonable for people who have suffered from foot injuries to maybe have their own custom boots and it’s maybe worth the investment for those people. You can also use inserts just like you use in your ordinary shoes. Try to not skinchon the boots and get more comfortable boots.

Melanie:  You mentioned cross training, which is so really important to avoid those overuse injuries. What other types of activities would help you become strong for skiing?

Dr. Miller:  Yeah, I think more than anything else, it’s aerobic conditioning, so it depends upon the status of your knees and your hips. If you’re a jogger, then I think that’s a good thing to do for conditioning. It’s more a matter of building up your endurance and your aerobic capacity. Because when you’re skiing at an altitude, it’s more difficult to catch your breath and stay fit.

Melanie:  It absolutely is. In just the last few minutes, if you would, Dr. Miller, please give your very best advice for preventing ski injuries and also why should patients come to UVA for treatment of their sports-related injuries.

Dr. Miller:  Sure. We can prevent ski injuries by being prepared – the old Boy Scout motto. In other words, be fit. Get your aerobics fitness together. Get your equipment together. Don’t skinch  on safety items. Ski under control. When you get tired, rest.
As far as UVA, we offer a whole variety of orthopedic treatment options for people from nine to 90 and we have all certified and specially trained orthopedic surgeons to take care of every need you have. In our sports division, we have surgeons that cover the entire gamut of sports medicine, from hip arthroscopy to multiple ligament knee injuries to complex shoulder problems. We’ve got it all covered with experts in their field and nationally and internationally known surgeons, so come to UVA.

Melanie:  That is absolutely great information. Thank you so much, Dr. Mark Miller. For more information about UVA Orthopedics, you can go to uvahealth.com. That’s uvahealth.com. You’re listening to UVA Health Systems Radio. I’m Melanie Cole. Have a great day.