Knees, Skiing and the Phantom Boot

Sandeep Chauhan

Winter sports are now so popular that there are an estimated 200 million skiers and 70 million boarders worldwide, some of whom live in Sussex! The Ski Team at Spring Orthopaedics, who ski regularly, have been treating winter sport-related injuries for many years.

As Christmas passes I know I am not the only one dreaming of mountains and crisp white snow. And thoughts of speeding down the Vallée Blanche or the back bowls of Vail may even spur me into some extra gym sessions!

The ski season is a busy time of year for the medical staff at Spring as we see large numbers of injured people returning from their holidays. This might sound somewhat alarming but in reality only 1-2% of individuals each year suffer significant injuries.

Looking back on our last four years of data on knee injuries sustained while skiing, we noted that almost three-quarters (70%) were due to low-energy causes (getting off ski lifts, losing control at slow speed and trying to get up from a seated position). Of the 30% of high-energy injuries, the vast majority were due to individuals being hit by another skier. The skiers of Sussex are clearly a careful bunch as only two injuries occurred through reckless skiing.

Here are some steps that you can take to lower the odds of injuring yourself.

1. Preparation

The vast majority of skiers do so only once a year. While you may be physically fit, the demands placed on your body during a week of unaccustomed exercise at altitude are very different and you need to prepare. Going to the gym and doing your normal routine with additional exercises to strengthen your quadriceps (thigh muscles) will help, but consider enrolling in a specialist ski fitness class. As well as getting you very fit so that you can ski longer and harder, these classes have been shown to significantly reduce the incidence of injuries.

Once out on the slopes, don’t forget all about your preparation with the excitement of being on holiday. Before you put on your skis, do your warm-up stretching routine and at the end of the day consider doing a warm-down (that’s exercise not the Gluhwein!)

2. Equipment

Did you know that people who borrow equipment from friends, especially boots and skis, have a 700% higher incidence of injury then normal skiers? Those of you with your own equipment need to have it checked each year. For those renting at resorts, make sure your equipment is right for you and that it fits well. The staff should spend time with you, particularly if you are inexperienced, and if they do not take your height, weight and ability level into consideration, problems are likely to occur.

Poor fitting ski boots are the biggest cause of significant knee injuries. A boot that doesn’t fit properly can cause your heel to lift up, giving you the sensation of leaning too far forward. You naturally compensate by leaning backwards thus putting more pressure on the tails of the skis. This can cause you to lose control and fall, often twisting your knee in the process. Carl Ettlinger, a ski safety expert and President of Vermont Safety Research, coined the term “phantom boot” to describe this scenario after examining the boots and bindings of 10,000 injured skiers. He identified the phantom boot as a common culprit for ruptured anterior cruciate ligament (ACL) which accounted for 70% of the serious knee injuries in his study.

More injuries occur immediately after lunch and on the last run of the day

3. Take extra care after lunch

More injuries occur immediately after lunch and on the last run of the day than at any other point of a holiday, so be aware! Take extra time and care after lunch and even consider taking the lift down at the end of the day.

What should you do if you have a bad fall and hurt your knee? Firstly stay calm. Take a moment to assess yourself to see if you have any significant pain before trying to get up. If your skis are crossed over at odd directions, try to shuffle so you are facing across the mountain and then unbuckle one of your skis - usually the uninjured side is best so you can control how you get up. Many significant ligament injuries are caused by a second fall while trying to get up which is why this is so important. If you cannot get up, then wait for help to arrive.

Once on your feet your knee may feel painful, in which case gently get to the next station if you can and seek help. A knee that feels wobbly like jelly usually signifies a significant injury in which case wait for assistance to be taken off the mountain. If your knee becomes very swollen when compared with the other, it could be an indication of a more serious injury. Swelling can take 24 hours to develop.

If you think you have a significant injury then get it assessed sooner rather than later. If your knee is swollen then rest, elevation and ice are a good idea. You may need a knee support or even crutches.

On your return to Sussex, go and see your GP to get assessed. If you are referred to a specialist knee clinic you will be seen, examined and diagnosed. This may involve an MRI scan as x-rays do not pick up these injuries. Treatment could involve physiotherapy or an operation may be needed. If this is the case, don’t panic, as the success rates are very good.

That said it’s always better to stay injury-free, so remember your preparation, check your kit, always stop in a safe place, look up the mountain and have fun.