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Being Proactive instead of Reactive with your Knees

post #1 of 28
Thread Starter 

The title of this forum area is 

Fitness, Injury and Recover, right? 

This leads me to wonder how much a proactive Fitness lifestyle can help us so that we're not dealing with Injury and Recover quite so much. 

 

Knee injury seems to be a primary thing we see on this site, so lets talk about being proactive about strengthening our knees and maintaining that knee health for ski season. 

 

Go!

popcorn.gif

post #2 of 28

Best possible in house knee specific training you can do is a slow squat - starting with standing straight with your feet shoulders apart, slowly begin to squat until your butt touches your heels. If you never done it before it could be tricky to keep your balance. "Tuck" position helps to maintain the balance though. Once you touched your heels, slowly stand up. When moving down or up, move your torso in sync with the butt - do not lift the butt and then torso, do it simultaneously. Try to avoid "shaking", if it is too tough - move up or down faster. Once you can do this squat with 1min down and 1min up 2 or 3 times - you are good to go ;-)

 

Another variation of this is to start with your feet a bit wider than shoulders width with you feet pointing 45deg outward. Same thing - slowly sit down all the way and stand up. This one exercises lower part of the hamstring.

 

Safe skiing!

 

cfr

post #3 of 28

Don't neglect the strengthening of the gluteus intermedius and associated muscles and the flexibility of the aforementioned glutes, piriformis and TFL.

post #4 of 28

Just my non medical education opinion -

 

Know what you have and work with it appropriately.

 

My knees aren't the best.  Even before my two acl tears, one knee was already not the best from a previous injury when I was a mere 19 y/o.  Neither of my meniscus's are pristine. When I do any high impact exercises (jumping, running etc.), my knees swell quite a bit.  Don't hurt but swell and get tight.  I view this as a sign that I shouldn't do things like that and instead work my legs/knees using low impact exercises.  This has been going on since 2008.

 

What I've been doing lately and have found it to not hurt (surprisingly) my knees, is to run up stairs taking them two at a time.  I believe the reason for it not hurting is there isn't an "impact" on my knees.  Running on flat ground means I have to land and all my weight for a moment in time is directed at my heel and absorbed up my leg, causing my knees to feel the impact.  When I run upstairs I don't land.  I'm constantly pushing off, or only extending while weighted and while flexing they leg is unweighted.  Since I work in a rather large building, I get to do this several times a day.

 

The down side is that the muscles aren't worked as well in the opposite direction but if you know this ahead of time, you can make sure to include something like the squats mentioned above to add balance.

 

Ken

post #5 of 28

Some related discussion in this thread started by someone who had ACLr surgery about a year ago.  Note the comments about the importance of balance (neuromuscular) exercises.  The next category that is emphasized in ACLr injury PREVENTION programs is plyometrics, as in controlled jumping with SOFT landings in the proper position with each knee over second toe.  Especially important for women and girls for a variety of reasons based on anatomy.

 

http://www.epicski.com/t/113900/had-acl-surgery-10-11-ski-trip-booked-for-1-13-asking-for-recs-as-to-top-2-exercises-to-get-ready

post #6 of 28

I think one of the reasons skiers have ACL injuries is being a hero.  By this I mean that instead of falling, the skier goes for the recovery (I've been strength training) and bingo knee injury.  Let me give an example.

 

Having just switch from straights to shaped last year, I was amazed at how the skis held an edge (luckily reading in this group about ACL, phantom foot and so on) I actually discovered what this meant.

 

In the middle of a high speed transition (also lighting change) I missed seeing the compression and before I knew it I sitting back and hooked the inside rear edge.  As I started to power through it I felt the knee start to seriously load (and had flashes of EPIC threads re ACL go before my eyes).  Luckily I relaxed and sat down bruising my butt on the bindings, taking several bumps at high speed further adding to the pain in the butt and was able to stand up after about 75m when the ski un hooked without major injury. (I must clarify I was the only one hill or I would have been playing at these speeds in the first place, luckily this gave me the option of letting them run uncontrolled until things settled down).

 

Had I been younger (more bravado than brains), less educated (thank you epic), not quick enough (not to old yet wink.gif), conditions permitting (no other skiers to run into) and reacted to completely pull out of the fall from the start the ACL would not have survived.

 

The point is do we injure the knees because we think we can hold it together, when we should actually take the fall first in some circumstances instead of directly causing the injury that we were trying to avoid.  Tough call, I think luck has a big portion of it.

 

In part with the discussion, does part of this training give us a false sense of heroism instead of realism and common sense? eek.gif  I think the training is good, just don't forget what causes the injury in the first place.

post #7 of 28

Knees are the worst engineered mechanical device ever!  Intelligent design my @$$! 

 

I have been saying it for years - a neoprene sleeve for the knees give warmth, stability, vibration reduction, and a lil more stamina over the course of a long day.

 

I wear neoprene braces with jointed aluminum stays.  Keeps the creaky knees tight and healthy (er) over the course of a long season!  You can find these on sale for $20-$30 a piece at your fav sporting good store.

post #8 of 28
Quote:
Originally Posted by pat View Post

Knees are the worst engineered mechanical device ever!  Intelligent design my @$$! 

 

I have been saying it for years - a neoprene sleeve for the knees give warmth, stability, vibration reduction, and a lil more stamina over the course of a long day.

 

I wear neoprene braces with jointed aluminum stays.  Keeps the creaky knees tight and healthy (er) over the course of a long season!  You can find these on sale for $20-$30 a piece at your fav sporting good store.

Ha, that reminds me of an article last week in the Denver Post about ski conditioning ... one of the trainers said "I don't even know why we have knees. .... They just wind up getting hurt, especially in the winter." Article was pretty good ... too long to copy entirely, but I'll post the link and the knee part

 

 

Get in shape for ski season: Local trainers share exercises, best tips

POSTED:   10/09/2012 12:01:00 AM MDT
UPDATED:   10/17/2012 03:07:08 PM MDT
By Kyle Wagner
The Denver Post
 

After the first run, your ankles feel as though they're caught between a Mack truck and a telephone pole. Three hours later, your quads start to shimmy like they're shaking a can of paint. By the end of the morning, the question is, do you need new knees?

You know what we're talking about here. Day One on the slopes, and despite your best intentions, you aren't ready. Again.

It doesn't have to be that way. You can start off the season in shape this year: muscles toned, core strengthened, body balanced, breathing easy.

<lots snipped>

 

Healthy knees are happy knees

"I don't even know why we have knees," says Strandjord. "They just wind up getting hurt, especially in the winter." To keep that from happening, all of the trainers said the same thing:Strengthen the muscles around the knees.

Scott Harwood says he likesadductor and abductor exercisesthat help the lower body maintain balance. "If you get those strong and then work your way down the legs, you'll notice a huge improvement in how your knees react," he says.

Dana Fullington agrees, adding thattraining your body to react to any situationis one of the primary objectives for a good workout. "One of the things I see people neglecting islateral movement,' Fullington says. "They get out there and one lateral slip, and that's it, they're injured for life." In addition tolateral lunges, she suggests a combination ofcompound exercises(squats, leg presses, lunges, step-ups) andisolation ones(single-leg extensions, ham curls) for the lower body to maximize results.

Tanenholtz says she believes thevastus medialis oblique(also known as the VMO), one of the four muscles on the front of the thigh, is the "single most important muscle to address" in keeping the knee healthy and stabilized. "Look forexercises that hit all four muscles of the quad," Tanenholtz says. Options includesquats against a wall with a Swiss ball and quad extensions.

Stretch, a lot

Keeping your muscles pliable and injury-free comes down tostretching when you're warm, as often as possible. "Warm up by doingjumping jacks or light lunges," Harwood says. "Stretch a few times while you're out on the slopes."

Strandjord says that how you stretch is just as important as how often. "Make sure you're doingdynamic stretching," she says. "That means when you're nice and warm, stretch the muscle in a movement, in pulses. Don't just stretch and hold it.Gently pulsingwill allow you to push the stretch further."

Overall fitness is the key to success

Strandjord and Christopher Flower are fans ofplyometrics— exercises that focus on explosive, quick movements to generate muscle power and speed — to improve on-slope speed and performance. "Plyometrics will help with mogul runs a lot," Strandjord says. "Look atside-to-side hurdle jumps and squat jumps."

Flower likessquat and box jumps. "Just jump right up onto a box or something stable," Flower says. "You'll be amazed at how quickly that gets your heart rate up."

Several of the trainers also mentionedyogaas a top way to improve flexibility, stability and coordination. "I don't teach it but I do it," Flower says. "It really took my own training and fitness to the next level."

Flower also endorses regularlyeating wellandgetting a good night's sleep. "General wellness can't be over-emphasized," he says. "I had a day last season where my thighs were burning out, I just was terrible out there, and I had been up late the night before. I wasdehydrated. I should have gotten more sleep. The same goes for when you're training. You can't expect your body to do well if you're not putting good stuff in it."

 



Read more:Get in shape for ski season: Local trainers share exercises, best tips - The Denver Posthttp://www.denverpost.com/outwest/ci_21726892/get-shape-ski-season-local-trainers-share-exercises?source=pkg#ixzz29kl4SKfl
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

post #9 of 28
Quote:
Originally Posted by oldschoolskier View Post

I think one of the reasons skiers have ACL injuries is being a hero.  By this I mean that instead of falling, the skier goes for the recovery (I've been strength training) and bingo knee injury.  Let me give an example.

 

. . .

In part with the discussion, does part of this training give us a false sense of heroism instead of realism and common sense? eek.gif  I think the training is good, just don't forget what causes the injury in the first place.

Vermont Ski Safety put together a injury prevention program that directly addresses how to avoid bad situations on snow.  Well worth reading the Tips for Knee-Friendly Skiing.  One major point is that it's important to PRACTICE the skills so that the actions are more likely to happen when a bad situation happens.

 

http://www.vermontskisafety.com/kneefriendly.php

post #10 of 28
Quote:
Originally Posted by marznc View Post

Vermont Ski Safety put together a injury prevention program that directly addresses how to avoid bad situations on snow.  Well worth reading the Tips for Knee-Friendly Skiing.  One major point is that it's important to PRACTICE the skills so that the actions are more likely to happen when a bad situation happens.

 

http://www.vermontskisafety.com/kneefriendly.php

icon14.gif I agree, luckily I read it before the experience (mind you I didn't practice nonono2.gif, as up till then I wasn't that concerned about it).

post #11 of 28

A key point that I learned while rehabbing a knee in the last few months is that knee injury prevention exercises are not so much about increasing strength.  Enhancing flexibility, balance, and practicing correct form when landing are more important in some ways.  There are relatively easy exercises that can be done with no special equipment that can make a big difference if done 2-3 times a week.  Here is an example from Australia.

 

post #12 of 28

A collection of exercises focused on maintaining a knee after ACL reconstruction surgery.  Work just as well for enhancing proprioception by doing balance exercises with the BOSU.

post #13 of 28

In the Denver article, one trainer noted that there are lots of ways to accomplish the same goal.

 

"The great thing about working out is that there are so many approaches to choose from to get to the same place," says Samantha Tanenholtz, a Pilates instructor at the JCC Sports & Fitness Center in Denver. "You can experiment to find out what works for you, what you're comfortable with. And within each discipline there are always ways to take it down or up a notch, so it's important to be aware of how your body is reacting and adjust the exercises to make sure your form is where it should be and that you're doing things properly."


Read more:Get in shape for ski season: Local trainers share exercises, best tips - The Denver Posthttp://www.denverpost.com/outwest/ci_21726892/get-shape-ski-season-local-trainers-share-exercises?source=pkg#ixzz29nL6JGyz
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse

 

post #14 of 28

Everything seems to concentrate on the obvious exercises and completely valid they are of course but from my recent reading there is a definite move awy from focusing on the quads and in particular VMO, hamstrings etc. The glutes have an absolutely critical and much overlooked function in the stability and therefore protection of the knee.

 

Having suffered with knee problems for a number of years, I was interested when my bootfitter sent me some exercises that concentrated on the glutes and piriformis both to strengthen and stretch these areas. This includes stretching the TFL which is responsible for the tension of the ITB, the source of much knee pain. Since I've been doing these exercises in my training, I have significantly reduced knee pain. I've also passed them to a number of people with knee problems with good results.

 

I'm sure there was a thread on here not long ago that refered to this as means of improving the integrity and strength of the knee and thus reducing the likelihood of injury. Coupled with lots of the exercises above should help.

 

Examples of some of the beneficial strengthening exercises:

 

Lying clam with band resistance

Resistance band sidewalking (The crab)

Lying on your side on a raised surface, draw the the upper foot along the lower leg, drop the knee as low as possible maintaing foot contact, abduct the upper leg fully by raising the upper, still maintaining foot contact, now fully extend the uppr leg with the foot uppermost then lower the leg to the ground using maximum hip flexion and return slowly to the starting position (very complicated but a great exercise)

On all fours abduct the left leg maintaing knee flex. Kick the leg into full extension to the side and slowly return to starting position.

Standing band resistance abduction

Standing resistance adduction

On all fours extend left leg and right arm simultaneously

 

There are more!

post #15 of 28

Go to the gym and Squat.

Learn and practice Back,Front,Overhead,single leg Squats

Deadlift,Walking Lunges

On your off days ride a bike or go for a hike or some running.

post #16 of 28
Quote:
Originally Posted by Adie View Post

Examples of some of the beneficial strengthening exercises:

 

Lying clam with band resistance

Resistance band sidewalking (The crab)

Lying on your side on a raised surface, draw the the upper foot along the lower leg, drop the knee as low as possible maintaing foot contact, abduct the upper leg fully by raising the upper, still maintaining foot contact, now fully extend the uppr leg with the foot uppermost then lower the leg to the ground using maximum hip flexion and return slowly to the starting position (very complicated but a great exercise)

On all fours abduct the left leg maintaing knee flex. Kick the leg into full extension to the side and slowly return to starting position.

Standing band resistance abduction

Standing resistance adduction

On all fours extend left leg and right arm simultaneously

My PT had me doing hip adduction and abduction exercises from the very beginning when rehabbing my knee.  Even before it was confirmed that the ACL was gone.  Did straight leg lifts while lying on my side (no added weight, no impact).  Progressed from there to ankle weights at home and relevant exercise machine at the gym.

 

For complex exercises, probably better to learn proper form from someone.  In some cases, doing them wrong is bad for a weak knee.

 

The last exercise mentioned is included in the ski conditioning exercises put together by Bumps for Boomers.  That's a company in Aspen that focuses on folks born in 1945-64 who want to ski more than groomers well into their 70's and beyond.  I'm using the full set of Phase I (lower body, core, upper body) as a general workout.  They are easy to do at home.  They provide progression to Phase 2 and Phase 3. (I have no connection to Bumps for Boomers.)

 

Basic Ski Fitness - Free Online Video Skiing Exercises by Bumps for Boomers

http://www.bumpsforboomers.com/basic-ski-fitness-free-online-video-skiing-exercises

 

 

By the way, I do not have pain in the knee with no ACL. Never did.  Only had a bit with lateral movement (easily avoided) when the MCL strain was healing, which took until about Week 8.  Finished formal PT in Month 4 when he approved running and jumping exercises.  Meniscus tear the type that could heal on its own.  Not planning ACLr surgery, with agreement from my surgeon.  Did a lot of online research before making the decision.  Still finding useful stuff.

 

It's fair to say that being in better condition overall is good for knees.  Less fatigue at the end of the day means more likelihood of doing things right and avoiding a high risk situation.  That's the main reason that I started working with a personal trainer as I did less formal PT.

post #17 of 28

Came across this series of exercises.  Haven't looked at the videos but the exercise names are pretty familiar.  The second set are for ACL injury prevention.

 

http://ptsportswellness.wordpress.com/exercises/lower-body-strength/

post #18 of 28

A couple of short videos with ski conditioning exercises that I find handy with an ACL-less knee.  I find that doing a variety of different types of exercises keeps me from getting bored.  So more likely to do it more often.  Plus these are easy to do at home.

 

BOSU stuff presented at some conference related to skiing in Fall 2011.

 

 

 

Pilates mat work

post #19 of 28

Thanks for the reply and threads underneith-Vermont ski saftey good too.
 

post #20 of 28

Here's a book that could be useful for learning a lot more about how to improve balance in relation to sports.  It's called "Athletic Body in Balance."  Adie mentioned Grey Cook in another thread.

 

http://www.amazon.com/Athletic-Body-Balance-Gray-Cook/dp/0736042288

post #21 of 28
Quote:
Originally Posted by Adie View Post

Everything seems to concentrate on the obvious exercises and completely valid they are of course but from my recent reading there is a definite move awy from focusing on the quads and in particular VMO, hamstrings etc. The glutes have an absolutely critical and much overlooked function in the stability and therefore protection of the knee.

 

Having suffered with knee problems for a number of years, I was interested when my bootfitter sent me some exercises that concentrated on the glutes and piriformis both to strengthen and stretch these areas. This includes stretching the TFL which is responsible for the tension of the ITB, the source of much knee pain. Since I've been doing these exercises in my training, I have significantly reduced knee pain. I've also passed them to a number of people with knee problems with good results.

 

I'm sure there was a thread on here not long ago that refered to this as means of improving the integrity and strength of the knee and thus reducing the likelihood of injury. Coupled with lots of the exercises above should help.

 

Examples of some of the beneficial strengthening exercises:

 

Lying clam with band resistance

Resistance band sidewalking (The crab)

Lying on your side on a raised surface, draw the the upper foot along the lower leg, drop the knee as low as possible maintaing foot contact, abduct the upper leg fully by raising the upper, still maintaining foot contact, now fully extend the uppr leg with the foot uppermost then lower the leg to the ground using maximum hip flexion and return slowly to the starting position (very complicated but a great exercise)

On all fours abduct the left leg maintaing knee flex. Kick the leg into full extension to the side and slowly return to starting position.

Standing band resistance abduction

Standing resistance adduction

On all fours extend left leg and right arm simultaneously

 

There are more!

 

I can attest to the impact the glutes have on the knees. After much PT to fix mis-tracking patellas (including two subluxations on the left one) and pretty severe IT band pain, I found a routine that works well for me which includes some of the above, PLUS one-legged dead lifts with added weight at slow speeds and about 125 lunges per leg off a step, of varying speed. I've always had very strong quads. Too strong in relation to my glutes/adductors. Working those muscle groups has also helped my biking and equestrian endeavors.

post #22 of 28

this is timely.  I ended up with issues with glute and illiopsoas issues and my pt had me doing all these ^ that Adie posted to strengthen this muscle group. 

post #23 of 28

I don’t go to the gym for several reasons.  I do walk 30 minutes a day though.

 

Two seasons ago my knees hurt for the entire season.  Every step I climbed on the stairways was painful.  I believe the reason was that I started charging on my GS turns too hard and too early in the season.  At the time I also considered the possibility that my 40 year old body was showing signs of aging.  I took it easy after the ski season, and the pain eventually disappeared.

 

Last year was much better.  No pain at all.  While I did not train before the beginning of the season, I just took it easy on the first few weeks before gradually increasing the intensity of my skiing.  Taking it easy was no problem as we only had a WROD to ski on for the first weeks, so there was no incentive to go super fast or to ski aggressively on those runs.

 

This year I climbed the mountain by foot with friends once or twice a week during the fall season.  As a result, my body didn’t ache after the first days of skiing, I am quickly getting up to optimal shape for the type of aggressive skiing I like.  I know, this is not very scientific in terms of exercise, but climbing a mountain, on uneven terrain, seems to be a great workout for me, both for strengthening my muscles and joints, but also for working on balance.

 

As others have mentioned, the types of knee injuries we see on our mountain are mostly either beginners twisting their knees in a relatively slow fall and the bindings not releasing, or accomplished, overtrained skiers who were overly aggressive on a bombing run and pushed their body beyond its capacity.  So I guess knowing your body and its limitations, and ensuring the bindings are set appropriately for your skills, body and type of skiing goes a long way to prevent injuries.

post #24 of 28
Lots of good workout advice. All I will add is to stay in shape all year.
post #25 of 28

Squats and kettlebells works for me.  My problem is more hip than knee but the leg is a kinetic chain starting at your foot.  

 

My trainer and I do Z-Health for mobility, assessment by squat, overhead reach, toe touch.  Test, retest.

 

Foam rolling recently too, the stick, a tennis ball.  These type of self-release tools are important.

 

Then kettlebell turkish get ups.

 

Kettlebell snatches.

 

Swings.

 

Stretch, recovery, rest, repeat.

post #26 of 28
Quote:
Originally Posted by marznc View Post

A key point that I learned while rehabbing a knee in the last few months is that knee injury prevention exercises are not so much about increasing strength.  Enhancing flexibility, balance, and practicing correct form when landing are more important in some ways.  There are relatively easy exercises that can be done with no special equipment that can make a big difference if done 2-3 times a week.  Here is an example from Australia.

 

 

 

in light of my sportive backround over 25 years; I can say that video is very helpful, useful and easy daily short work-out for the knees for everyone interesting ski and snow sports...and if you do   #5, #4 and #3 excersises without shoes, you will see quick improvement of your balance...smile.gif

post #27 of 28
Quote:
Originally Posted by Adie View Post

Everything seems to concentrate on the obvious exercises and completely valid they are of course but from my recent reading there is a definite move awy from focusing on the quads and in particular VMO, hamstrings etc. The glutes have an absolutely critical and much overlooked function in the stability and therefore protection of the knee.

 

 

 

Bingo! 

 

There's a great expression that goes something like this: "Knees are stupid; they only do what the hips and ankles tell them to do." Work on hip and ankle mobility, and calf and glute strength, and your knees will be happy. Ideally you do that as part of a balanced full body program, not instead of. 

 

Elsbeth

post #28 of 28

I got the SkiA Sweetspot balance trainer a couple months ago.  I like it.  Being able to practice balance exercises and edging in ski boots well before getting on the slopes did a lot for building confidence.  Especially since there was no snow at my local hill in Virginia until after Christmas.  I had no issues for my first ski days without an ACL last weekend.

 

What's not obvious until you see them in person is that the "balance blocks" on the Sweetspot are not flat on the bottom.  That's one reason it's reasonable to practice edging.  Plus the blocks are held in place at the right fore-aft balance point.

 

I'm glad I have the Sweetspot and a BOSU available at home for quick balance training sessions.

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