Skiing versus knee health? Issues, prevention, treatment

Hey folks,

Skiing is tons of fun! However, in the past three years my knees have gotten progressively more sore after every ski day. While a doctor visit may be in my future for actual knee issues, I'm curious about long-term effects on the knee from skiing. Do any ski professionals have info on the causes of knee pain related to skiing, and what specifically you can do to prevent, resolve or correct these issues? I'm curious from perspectives of:

• technique (what kind of "bad" technique hurts? what kind of "good" technique helps? Are any good techniques incompatible with carving?)
• conditioning (maybe some exercises can help? squats? maybe warming up and cooling down?)
• terrain (for me, I'm in way more pain after doing some jumps or tons of moguls. is icy terrain worse? crud?)
• duration (for me, one day a week doesn't result in much pain. four days in a row is killer. should duration matter?)
• equipment (springs in your boots? )
• physiological (skeletal alignment maybe? damage to tissues, cartilege, ligaments? using tools like icing or heating compresses?)
• diet (I've heard lots of talk about glucosamine with chondroitin, but minimal conclusive study results in healthy individuals... are there "knee foods"?)

Also, if you have an expert credential of some sort, that'd be great to hear too! Lastly, of course "see a doctor" if you find yourself in pain. Now that that disclaimer's out of the way... any thoughts?

Knee pain is generally related to a couple things and I can't tell you which you might be experiencing. One is discomfort from tendons, such as patellar tendinitis. This is more likely to be a result of an acute injury than just time taking its toll. The other is the lack of or damage to your meniscus. This can be from constant wear and use (abuse) or from acute injuries. meniscus damage nearly always accompanies ligament damage.

The tracking of the knee joint affects how much your knee will hurt. Improper tracking is likely to hurt more than proper tracking. Tracking is affected by muscular strength in the leg as well as laxity of the ligaments of the knee. A strong leg can counteract some laxity. Andy Mill could move his lower leg over an inch out of 'alignment' in his prime, yet without a brace he could race WC DH because he was strong and knew how to overcome the laxity.

Neoprene knee braces generally have little affect on tracking, although they can adjust the way the patella moves over the tibial plateau. They provide warmth that generally results in more comfortable feeling joint. Orthopedic braces (DonJoy, CTI, etc.), the kinds with steel, metal and/or composite frames and mechanical hinges are designed to control the knee's tracking. These can help to overcome laxity and often make the difference between pain and no pain. I was ACL deficient (no ACL at all) in my left knee for about 15 years. I used a brace and experienced little to no discomfort. If I forgot the brace, my knee ached. Eventually the discomfort entered my daily life so I opted for an ACL reconstruction. I used a brace as insurance during the recovery but soon returned to aggresive skiing without a brace and without discomfort in the joint.

Glucosamine, chondroitin and MSM work for many people to alleviate the discomfort associated with meniscus damage. It won't affect ligament pain, to my knowledge. I don't know of any other 'knee foods' other than a good overall diet. These supplements aren't immediate and need to be used regularly. You may not notice a difference for weeks. You'll also have to try to maintain a regular routine to actully be able to coorelate the supplements affects against your activities.

Flexibility is very important. Warming up and stretching can help. Icing after activity generally helps as it reduces inflamation and numbs the pain. Your orthopedic surgeon can give you advice as can your physical therapist. If you have had surgeries, perhaps you know what the weaknesses in your knee are. Knowing what is wrong, ligament vs. meniscus vs. ???, is key to addressing treatments and solutions.

Regardless of what your condition is, you want to ski smoothly and well balanced to reduce the stresses on the knee joint. The terrain is less of the culprit than how you deal with it. Even moguls would be ok if you weren't doing them competition style (straight and fast) but rather slipping and sloshing through the troughs. Jumping is about as bad as it gets as landing requires you to absorb with your legs, running your knees through virtually the entire range of motion, not to mention impact. Jump turns in steep chutes would be one extreme and to be avoided, arcing easy 20m turns on gentle, groomed terrain would be at the other end of the spectrum.

As I mentioned balance is key as you want to allow your skeleton to support your body, not your musclature (muscles). Any time your rely on your muscles (as being in the back seat) to support your weight, you are effectively pulling your knee out of alignment and causing it to 'rub the wrong way'. Your knee was designed to work best in a small range of its possible motion, roughly from nearly straight to halfway between straight and sitting. These are rough guides, but totally upright is bad as you have no flexibility and causes compression of the meniscus. A sitting posture and beyond is really bad when you are in motion as your joint is being misaligned while accepting huge strains.

FWIW, I've had about a dozen knee surgeries including 2 ACL reconstructions and numerous meniscus repairs and removals. I deal with masters racers that are in the same boat as me. This topic comes up a lot. SL is the hardest on the knees. DH (as long as you keep the slippery side down) is probably the easiest on the knees. Quick, forceful direction changes, regardless of overall speed, are harder on the knees than long, progressive turns.

Be strong, be limber, take it easy and increase your skiing intensity progressively to your threshold of discomfort. Keep track of what you did when it hurts, and what you did when it doesn't. Obviously avoid the former once you identify what it is. Ice and elevate after skiing as needed. Supplements may help.

I am not a doctor and I don't play one ever. I offer this advise as personal experience and encourage you to meet with a sports doctor and/or PT to evaluate your own circumstances.

Best of luck. While slowing down and taking it easy may not seem like a fun solution, it beats not being able to ski at all.

MR

Edited because this reply was meant to be in another thread


Edited by Ghost - 10/24/09 at 9:30am

How old are you?  I started skiing as a boy. Normal wear and tear started to cause knee pain from skiing and jogging for me around age 50.  So I took up frequent biking.  It makes my legs strong and somehow strangely seems to reduce inflammation in my knees caused by other activities (such as skiing).  Go figure?

After my ACL reconstruction 11 months ago, my ortho said that building up the muscles would likely reduce the swelling I was experiencing.  He described the muscles as a shock absorber (and they also provide stability.  This seems to have worked for the most part.  Good luck...

Find a good bootfitter and get aligned.  Proper alignment from the soles of your boots up to your hips will keep the load on your knees and other joints straight, and that will be a help.  This might mean that your boot soles get planed at an angle, or other canting, and/or you get custom footbeds for alignment, or maybe you're OK as you stand...the bootfitter can show you.

I avoid both twisting with my knee and holding a load on it with the knee partly flexed.  Carving with retraction turns is my technique.  I never flex down in the latter half of the turn, nor push up at the end of the turn.  I never twist the knee to steer or guide the ski in the turn.  Turning sharper than the sidecut of the ski is designed for or scrubbing off speed is no problem.  Load the tip and allow the wide tip to pull the ski around while is brushes somewhat sideways.

Learn retraction turns.  You keep the outside leg near-straight.  You increase your angulation and as the turn progresses to be able to handle the building forces (and counter to the max early in the turn).  The inner leg is flexed to keep it light on the snow.  To release from this turn and start the next, just rapidly relax the old outside leg and allow that force to propel you into the next turn.  Allow the new outside leg to lengthen while you shorten the new inside leg.  These are the turns the experts use in bumps, and they work very well everywhere on all kinds of snow.  To impel your body to the inside of the turn, invert the inside foot...tip the foot so the inside edge of the ski is elevated...tip so your arch is raised.  Allow your inside knee to drop toward the snow.  When I say allow, I mean don't force it.  The effort is in the ankle.  It works and saves my knees.

Glucosamine sulfate probably helps knee cartilage and does no harm except the cost.  If you try it, use plenty.

Technique:  as noted by SSG, avoid any techniques w/ place a big emphasis on twisting, period.  The ski has a sidecut and flex for a reason.  The wide stance, "two-footed" weighting, and "twist and shout" emphasis of a lot of ski instruction has knee issues written all over it.  Conversely, go to a well-regarded race camp with a program for recreational adults, and the technique you get there (or, at a specialty mogul camp such as Mogul Logic) will be pretty knee-friendly.

Conditioning: being in better shape helps with some issues, but for major knee injuries can't prevent them.

Terrain:  for jumps, the key is managing your landing.  Some people hurt themselves frequently jumping/in the park, some virtually never do.  Firm snow/crud etc.:   see the good technique point.  There are some types of snow like breakable crust which heighten all kinds of injury risk of course.

Duration does matter.

Equipment:  the wider and/or stiffer and more energetic your ski, the more likely you'll hav eknee issues.  So carving on 120 powder boards or on slalom skis will both be harder on your knees. 

Physiological:  yep, makes a diff.  But, the other variables trump this for most people.  I will say it's remarkable how many people are misfit for their boots, which gives negative feedback into technique.  Wear only one pair of thin socks, and find a good bootfitter.

Diet:  every time I've hurt a knee, whether cartilage or ACL/MCL, etc., there've been some foods I've craved, liked chicken wings, etc.  Anecdotally I've heard similar stories from others, and obviously some rave about supplements... and statistically there seems to be zero evidence any type of diet or supplement helps. 

For me, anecdotally "hot" yoga (Bikram, etc.) has specifically helped my subjective experience of knee pain, even though there are some postures they generally teach which to my mind clearly are not great for knees.  Probably chalk one up for placebos, although there's a chance that sweating buckets helps lessen joint pain, or some such. 

I have found a great exercise for anyone having knee problems.  Using a tred mill exercise machine, elevate the machine to its maximun hight and have in run around 2 miles per hr.  Next alternate walking both forward and backward (thats right backward) one hundred steps each way.  Work up to 2 hundred steps and in both cases go 5 or more reps or each direction.
     In doing this you place yourself in the forward stance above the balls of your feet simulating the action of actually skiing which increases those skiing muscles.  You are most importantly strengthing the inner and outer knee muscles and ligaments which will protect your knees later while skiing.  This is a safe and painless way of protecting your knees and getting ready for the ski season.

TIm