ACL injuries on the rise

The most likely part of the body to get injured is the knee which accounts for some 45% of skiing injuries. Although general injury rates have decreased over the last fifteen years severe knee injuries such as ACL ruptures have increased 172% over the last 15 years.
Who is more likely to be injured?
Research suggests that younger, lighter and less experienced skiers are at highest risk of injury. Beginners are thought to be 33% more likely to be injured than the more experienced skier. Women are more likely to sustain knee injuries whilst men are more likely to injure their head or shoulder.
Common Skiing Injuries:
ACL injuries (anterior cruciate ligament)
The most common knee injury seen in skiing is the anterior cruciate ligament injury.
Skiers who have had a previous knee injury are more likely to sustain a more severe knee injury during the season. Skiers who are ACL deficient or have laxity in the ligament are three times more likely to injure their knee than the skier who has undergone reconstructive surgery.
Individuals who have undergone reconstructive surgery with the semitendinosus tendon technique are more likely to suffer a re-rupture than those who underwent the bone-patella-tendon-bone technique.
When is surgery indicated?
The decision to operate is dependant on the following:
The age of the patient.
The degree of instability
Associated abnormalities such as medial collateral ligament tear or meniscus tear.
Whether or not the patient performs sports requiring pivoting on the leg.
The patients occupation.
Any patient whose knee gives way under activities of daily living is likely to need reconstructive surgery.
Shoulder Injuries
Shoulder injuries are less common than knee injuries (7). AC joint separations, anterior dislocations, rotator cuff injury and shoulder contusions are the most common. It is thought that many minor rotator cuff injuries are unreported as medical attention is not sought immediately.
AC joint separations
This is a sprain on the acromio-clavicular joint at the shoulder. This injury can range in severity from a little bit of pain to a complete rupture of the joint where you might get a lump where the collar bone sticks up out of the neck. It is caused by falling onto the shoulder of onto an outstretched arm.
Anterior shoulder dislocations (dislocated shoulder)
Shoulder dislocations are also caused by falling onto an outstretched arm. Rehabilitation usually follows a three phase treatment plan:
Phase 1 involves rest, immobilization and ice or cold therapy. The period of immobilization may vary from three to six weeks. During this time isometric strengthening exercises for the wrist, elbow and hand may be done if pain allows.
The goal of phase 2 is to give the skier pain free internal shoulder rotation, elevation and a small amount of external rotation.
In phase 3 strengthening of the internal shoulder rotator muscles is emphasised but with the joint kept below horizontal to reduce soft tissue irritation and risk of re-injury.
Full recovery from an anterior dislocation can take from 6 weeks to 6 months.
Skiers Thumb / Thumb sprain
Injuries to the thumb make up an estimated 40% of all injuries to the upper extremity with the ulna collateral ligament of the metacarpophalangeal joint (known as skiers thumb) being responsible for the majority.
Skiers thumb is caused by forced abduction and hyperextension of the joint. In skiing this is the result of a fall whilst holding onto the ski pole which drives the thumb into the snow.
Signs and symptoms
Tenderness over the ulna aspect of the thumb on palpation.
The skier may have difficulty grabbing things or pinching between thumb and index finger.
Treatment depends on severity with complete ruptures requiring surgery. A partial ligament tear may be treated with four to five weeks of cast immobilization followed by strengthening. A minor sprain may be splinted with strengthening exercises to begin as soon as pain allows.
An excellent but simple taping technique can be applied to support the MCP joint and prevent injury or further injury.
Preventing skiing injuries
Skiing holidays are not cheap. To invest a great deal of time and money in the experience only to be injured on day one does not make sense. There are a number of things that both the experienced and beginner skier can do to reduce the risk of injury on the slopes.
Skier ability is an important factor. Attending ski lessons can reduce the risk by up to 50%.
Proper equipment and equipment maintenance is essential. Significant advances in boot and binding design with quick release systems there is no fool proof kit. Bindings should be checked and adjusted regularly by trained ski mechanics and boots should be fitted by skiing technicians who can advise on the correct equipment for the individual skier. Q-angle, high arches, wide feet, varus knee deformity could all influence the choice of ski boot.
Biomechanical problems of the foot such as over-pronation can increase injury risk. During skiing, control is maintained by pronating the foot to edge the downhill ski into the slope. A skier with biomechanical abnormality may already have their foot pronated flat in the boot and will therefore internally rotate the lower limb to have the desired effect. This will lead to a valgus knee position resulting in inefficient skiing, fatigue and medial knee pain. Orthosis can be used to correct foot biomechanics in the boot.
Selecting the appropriate difficulty of slope on the mountain is important. A uniform code exists with green being easiest, then blue and black for intermediate to advanced skiers. A double black diamond exists for advanced skiers only!!
Skier fatigue is often a factor and investment in a proper preparation and conditioning before undertaking a skiing holiday can prove worth while. Some gyms and leisure clubs may run specific classes to prepare for skiing holidays. Warming up before skiing is also important. A typical warm up may consist of a short jog to raise heart rate, followed by stretches for the hamstrings, iliotibial band, quadriceps and calf muscles.