Love to Ski and dread the Knee
Skiers and their ACLs - Have you torn yours yet?
By Kristi C. Johnson, MSPT, CLT-LANA
Do you have one of those favorite days on the slopes that sticks in your memory, even through 95-degree summer days? Mine is from four winters ago. It snowed six inches every night for weeks. A friend and I caught the 9 a.m. chairlift. Believe it or not, it was February, 30 degrees (not -20), and we had a royal-blue sky day (I moved here from Colorado nine years ago and usually call it a Colorado-blue sky day). We skied until 2:45 in the afternoon, only stopping for extreme leg burn and hunger. By then I was thinking: “One last run and please don’t crash and tear my ACL.” Ever been there?
Many of us are all too familiar with an ACL (Anterior Cruciate Ligament) tear – either you’ve been there and torn it, have a friend who has been injured it, or you have chronic knee pain and you wonder if it has anything to do with your ACL.
The ACL partners with the PCL (Posterior Cruciate Ligament) in the middle of your knee. It stabilizes the knee from too much motion, especially with hyperextension or rotation. Although a sprain or tear may bleed, the circulatory supply to the ligament is poor and does not heal independently. Yet, this ligament is rich with nerves, which means if you sprain it, it HURTS!
In the rehab world, we would rather hear that you have some pain, because usually that means you didn’t completely tear the ligament; instead you probably sprained it. Although some sprains may go on to require surgery, most sprains have a chance of returning to function with an aggressive rehab program.
A complete tear may not have as much pain as a partial tear or a sprain because the pain messengers, the nerves, have also been torn, thus there is no chance to get a message to the brain about pain. Interestingly enough, the brain will lack the normal message this ligament provides, and you may feel a bit unstable. For example, your knee may give out on you and your overall confidence may be comprised if these nerves have been injured (with tears or sprains).
Anyone who has a complete or partial tear of his/her ACL, may or may not choose to have reconstructive surgery. This choice depends on the person’s level of activity, competitive sport, level of instability, and whatever personal reason may come into play. Without surgery, you may be at increased risk of knee degeneration or arthritic changes. Interestingly enough, I worked with a professional football player in Colorado who was ACL deficient (he tore his ACL but chose not to have surgery). He wanted a rehab program to get back to, of all things, skiing (he had to retire from football). I should add that he was a recreational skier; he wasn’t pounding the bumps or racing gates. This person’s program aggressively focused on the hip and of course the muscles that cross the knee. Hip, pelvic and abdominal corset strength have a large influence on knee and foot control. The knee can be an innocent bystander of weakness at the hip, thus setting you up for a rotational sprain or tear.
A good rehab program for an ACL injury follows the surgical protocol for strength and range of motion, but must include extensive balance and proprioceptive training. Proprioception is a big word for nerves that give messages to your brain about where your limbs are in space. For example, you don’t have to look at your feet when you walk, because your proprioceptors tell your brain what the terrain is like (uneven, rocky, slippery). When you are sliding down a slope, your body makes millions of fine adjustments to keep your center of gravity over your skis. You absorb changes in terrain (bumps, slush, ice, powder, and even other skiers) with good strength, balance/proprioceptive control, and of course conditioning. Strength in these areas is the basis of a good ski-conditioning program to prevent injury.
There are other important ideas to consider if you want to prevent injury. Less advanced skiers are more prone to injury (usually their weight is too far back – thus setting up for an ACL tear). This level of skier should take the time and spend the extra money on some lessons. Other pearls of wisdom include listening to your body and taking a rest when it is needed (especially on those perfect Colorado blue sky/powder days), and even learning how to fall.
You say, “Learn to fall!” Yes, experts in the field have published the ACL Awareness pamphlet (www.bbvnsp.org/education) and video on how to fall, available at most ski shops, ski areas, and physical therapy offices. Researchers here in Vermont published this information and it is worth a read. In those split-second moments of trying to hang on to that edge or avoiding collision, or even a total blow out, you may be able to dig up some of that advice and prevent the dreaded ACL tear.
Have fun with your training program, and most of all have fun on the slopes. Please feel free to contact me at Timberlane Physical Therapy (864- 3785) if you have any further questions.
Kristi Johnson is an outdoor enthusiast. She is a Physical Therapist at Timberlane Physical Therapy in South Burlington, where you may reach her with questions about ACL/knee injuries or other injuries requiring rehab. She can be reached at (802)864-3785 or by e-mail, KristiJohnson_333@msn.com.
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