Skiing/Injuries

Injury Modifications

5 injury guides

Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.

Acl Injury

ACL tears are one of the most common serious injuries in alpine skiing, occurring at a rate 3x higher than the general athletic population. The unique mechanism involves boot-induced leverage on the knee during falls or loss of control. Understanding ski-specific ACL injury mechanisms can help with prevention. The "phantom foot" mechanism is the most common pattern in recreational skiers.

Red Flags - Seek Immediate Care

  • ●Pop with rapid swelling and instability - likely ACL tear, end ski day
  • ●Deformity or obvious malalignment - possible fracture/dislocation, immobilize
  • ●Unable to bear weight with severe pain - possible associated fracture
  • ●Numbness below knee - possible nerve or vascular injury
  • ●Locked knee (cannot straighten) - possible meniscus involvement

When to Seek Professional Care

  • →Any suspected ACL injury
  • →Unable to bear weight
  • →Significant swelling within hours
  • →Knee instability
  • →Any red flag symptoms

General Principles

  • •Bindings MUST release appropriately - have them professionally set
  • •DIN settings should be set by certified technician
  • •Fatigue increases ACL injury risk - know when to stop
  • •When falling backward, COMMIT TO THE FALL - don't fight it
  • •Proper technique reduces injury risk
  • •Knee braces may provide some protection but are not proven to prevent ACL tears

Contraindicated Movements

All skiing until cleared (if ACL torn)Attempting to save yourself from backward fallsSkiing when fatiguedSkiing terrain beyond ability

Concussion

Head injuries in skiing can occur from falls, collisions with other skiers, trees, or fixed objects. Helmets reduce but do not eliminate concussion risk. Speed and terrain parks particularly increase risk. Concussions can occur even with helmet use - the brain moves inside the skull regardless of external protection.

Warning Signs

  • ⚠Symptoms worsening over time
  • ⚠New symptoms appearing
  • ⚠Difficulty with thinking or memory
  • ⚠Balance problems persisting
  • ⚠Sensitivity to light or noise continuing

Red Flags - Seek Immediate Care

  • ●Loss of consciousness - ER EVALUATION
  • ●Worsening headache - POSSIBLE BRAIN BLEED, ER immediately
  • ●Repeated vomiting - ER evaluation
  • ●Seizure - ER immediately
  • ●One pupil larger than other - BRAIN EMERGENCY, call 911
  • ●Cannot recognize people or places - ER evaluation
  • ●Increasing confusion or agitation - ER evaluation
  • ●Slurred speech - ER evaluation
  • ●Weakness or numbness - ER evaluation
  • ●Cannot be awakened - BRAIN EMERGENCY, call 911
  • ●Very drowsy, cannot stay awake - ER evaluation

When to Seek Professional Care

  • →Any danger signs
  • →Any loss of consciousness
  • →Symptoms not improving after 1-2 weeks
  • →Multiple prior concussions
  • →Before returning to skiing (medical clearance required)

General Principles

  • •When in doubt, sit them out
  • •No same-day return to skiing after a concussion
  • •Brain needs rest to heal - cognitive and physical
  • •Helmets help but don't prevent all concussions
  • •Second impact syndrome (second concussion before first heals) can be fatal

Contraindicated Movements

All skiing until fully clearedAny activity risking another head injuryStrenuous exercise during recoveryScreen time (may worsen symptoms initially)

Recommended Exercises

Light walking (when cleared)

sets × reps

Gentle activity as symptoms allow

Balance exercises (later stages)

3 sets × reps

Restore vestibular function if affected

Gradual aerobic progression

sets × reps

Structured return to exercise capacity

Mcl Sprain

MCL (medial collateral ligament) sprains are common in skiing, often occurring when the ski tip catches and forces the knee into a valgus (knock-knee) position. Unlike ACL tears, most MCL sprains heal well without surgery. The MCL stabilizes the inside of the knee against forces pushing the knee inward. Ski bindings don't protect well against rotational forces that injure the MCL.

Warning Signs

  • ⚠Knee giving way
  • ⚠Swelling increasing
  • ⚠Pain not improving with rest
  • ⚠Instability with activity

Red Flags - Seek Immediate Care

  • ●Significant swelling immediately after injury - may indicate multiple ligament injury
  • ●Unable to bear weight - evaluate for fracture or severe injury
  • ●Knee locking or catching - possible meniscus injury
  • ●Gross instability in multiple directions - multi-ligament injury, seek urgent evaluation

When to Seek Professional Care

  • →Any knee injury with significant swelling
  • →Unable to bear weight
  • →Feeling of knee giving way
  • →No improvement after 2 weeks of conservative treatment
  • →Any red flag symptoms

General Principles

  • •MCL sprains usually heal without surgery (good blood supply)
  • •Bracing protects the MCL during healing
  • •Must evaluate for associated ACL, meniscus injury
  • •Isolated MCL sprains have excellent prognosis
  • •Return to skiing requires full stability and strength

Contraindicated Movements

All skiing until clearedActivities that stress inside of kneePivoting or twisting movementsHeavy squatting in early stages

Recommended Exercises

Quad sets

3 sets × 20 reps

Maintain quad activation early

Straight leg raises

3 sets × 15 reps

Quad strengthening without knee bending

Hamstring curls

3 sets × 15 reps

Restore hamstring strength

Mini squats (progress to full)

3 sets × 15 reps

Functional strengthening as healing allows

Lateral band walks

3 sets × 15 reps

Hip strengthening reduces knee stress

Balance exercises

3 sets × reps

Proprioception for ski-specific control

Shoulder Injury

Shoulder injuries in skiing typically occur from falls, especially when catching yourself with an outstretched arm. Common injuries include AC joint separations, shoulder dislocations, clavicle fractures, and rotator cuff injuries. Pole planting can also cause repetitive shoulder issues in more experienced skiers.

Warning Signs

  • ⚠Shoulder slipping or feeling unstable
  • ⚠Weakness not improving
  • ⚠Night pain
  • ⚠Unable to sleep on affected side
  • ⚠Clicking or catching

Red Flags - Seek Immediate Care

  • ●Shoulder looks deformed or squared off - POSSIBLE DISLOCATION, seek immediate care
  • ●Obvious bump/step at collarbone - possible fracture or severe AC separation
  • ●Unable to move arm at all - significant injury, needs evaluation
  • ●Numbness or tingling down arm - nerve involvement
  • ●Arm appears pale or cold - vascular concern
  • ●Severe pain not controlled with ice/OTC medication

When to Seek Professional Care

  • →Any suspected dislocation or fracture
  • →Visible deformity
  • →Unable to move arm
  • →Significant weakness
  • →Numbness or tingling
  • →Pain not improving after 1-2 weeks

General Principles

  • •Always rule out fracture with significant shoulder injuries
  • •Dislocated shoulders need prompt reduction
  • •AC separations often heal without surgery (grades 1-2)
  • •Rotator cuff tears may need surgical repair depending on severity
  • •Don't ski with a shoulder injury that affects arm control

Contraindicated Movements

All skiing until shoulder functionalPole planting with injured armOverhead movementsCatching yourself with injured arm if you fall

Recommended Exercises

Pendulum exercises (early stage)

3 sets × reps

Gentle ROM without active muscle use

Isometric rotator cuff (when cleared)

3 sets × reps

Begin activating cuff safely

Scapular exercises

3 sets × 15 reps

Restore scapular control and stability

Progressive rotator cuff strengthening

3 sets × 15 reps

Build cuff strength for future protection

Skiers Thumb

Skier's thumb is an injury to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint. It's named for skiing because it commonly occurs when a skier falls while holding a pole. The pole acts as a lever, forcing the thumb away from the hand and stressing or tearing the UCL. This is also called "gamekeeper's thumb" when chronic. A complete UCL tear may require surgery for proper healing and to restore grip strength and pinch function.

Warning Signs

  • ⚠Ongoing instability despite treatment
  • ⚠Weakness not improving
  • ⚠Pain with pinching activities
  • ⚠Thumb 'giving way'

Red Flags - Seek Immediate Care

  • ●Significant instability on exam - may need surgery, seek hand specialist
  • ●Palpable lump at thumb base (Stener lesion) - surgery likely needed
  • ●Numbness in thumb - nerve involvement
  • ●Open wound over thumb - open injury needs urgent care
  • ●Obvious deformity - possible fracture-dislocation

When to Seek Professional Care

  • →Any significant thumb injury while skiing
  • →Unable to grip or pinch
  • →Thumb feels unstable
  • →Swelling and bruising
  • →Any red flag symptoms

General Principles

  • •Complete tears often need surgery for best outcomes
  • •Stener lesion is a surgical indication
  • •Partial tears usually heal with immobilization
  • •Good pinch strength is important for grip function
  • •Chronic instability affects daily function significantly

Contraindicated Movements

Gripping activities with injured thumbSkiing (falls could worsen injury)Forceful pinchingThumb stress in any direction

Recommended Exercises

Finger ROM (unaffected fingers)

3 sets × 10 reps

Prevent stiffness in other fingers

Wrist ROM

3 sets × 10 reps

Maintain wrist mobility during thumb immobilization

Thumb ROM (when cleared)

3 sets × 10 reps

Restore motion after healing

Pinch strengthening (late stage)

3 sets × 15 reps

Restore functional pinch strength

Grip strengthening

3 sets × 15 reps

Overall hand strength after healing