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Preventive measures for skiing with weak knee/ankle

post #1 of 17
Thread Starter 
I play a lot of tennis and as a result have a few injuries. I got tendinitis in my left knee a few years ago, and twisted my left ankle a few months ago. Both are healed but I can still feel some weakness and pain sometimes and I don't trust them 100%.

I wear a cheap neoprene brace on my knee (the kind with a hole for the kneecap), and sometimes one for my ankle as well. I've been lazy and haven't hit the gym as much as I shoul have.

Are there any specific things I should do/not do to make sure I don't get injured further. I know technique/luck/not pushing it is a big part of this but any additional tips would be welcome. I'll be using Tyrolia HD14 bindings which are said to be safer.
post #2 of 17
muscle strength is your friend, defcon. training for power and stamina helps. dynamic training that includes balance (like plyometrics) helps a lot too.

I've been told by various orthopods and PT folks that the neoprene sleeve on the knee really can't provide any structural support. it's okay to wear for warmth & padding, but don't fool yourself into thinking it's going to help a debilitated knee be more structurally sound.

and of course,

stop skiing when you're fatigued.
post #3 of 17
For structural support, there generally needs to be some metal hinges going on in a knee brace. Even then the jury is out on whether they really provide structural support or whether they just prompt you to keep you knee in a more correct position. My feelings after wearing a brace for 15 years now (am I that old?) is that it's more the latter: the brace prompts you to keep your knee in better positions, but it doesn't actually provide "real" support.

Best suggestion: get a brace with some hinges sewn into the neoprene (about $40 to $60 at most sporting goods stores) AND stop skiing when you're fatigued. Most ski injuries happen in the last few hours of the day when folks are tired from skiing all day: there's a lesson in that bit of information for those wise enough to learn it.

J
post #4 of 17
I have a trick knee (I don't know what the condition is really called -- an old running injury that comes back to bite me every now and then).

I've taken to wearing neoprene knee braces with the metal hinged rods on either side. For me, the braces make a very real difference, both in my skiing performance, and in how I feel afterward.

I am not lying when I tell you that with the braces, I'm on the snow from open to close, sometime for multiple days. Without, I was off the snow early, popping pain relievers, and walking on a weak knee for days afterwards.

At this point, I am not brave enough to give up the knee braces, even as just a one-day experiment to see if perhaps things have either healed or strengthened adequately. If they're a placebo, I'll happily live out my life wearing the sweaty buggers whenever I hit the slopes.
post #5 of 17
Glucosamine-Chondroitin-MSM is your friend if you have any arthritic component.
post #6 of 17
I'm with you speede, almost word for word. I ran cross-country / long distance track in high school and college - my right knee started giving me problems in hs. I skied in a neoprene with the metal hinged rods for years, last season went to a full blown donjoy armor. I still don't *know* that it isn't a placebo, but what I do know is that I can ski all day and the next, and still walk the day after. At the tail end of years using the neoprene with metal, I started getting a little sore the next day, which is what prompted the move up in brace - the knee has been pain-free (at least from skiing) ever since.

I still *think* that the brace doesn't really provide support, but merely feedback to keep the knee in a correct position; but I *know* that whatever it is, it works for me. I've been trempted to try skiing without it to see how I feel the next day, but then I think better of it and go with "don't change anything if it works."

To Defcon: try it out, it may help, it may not. As always, ymmv. I probably would have had to give up skiing 7 or 8 years ago without a brace, now there's no end in sight .

J
post #7 of 17
jake,

have you tried aggressive PT?

I have had both ACLs rebuilt, the right in 1985 and the left in 1999. I have arthritic developments in both knees.

when I returned to skiing in 2000 after a 12-year hiatus, I wore a Townsend brace (circa 1987) on the right knee, and a BREG brace (circa 2000) on the left knee.

my orthopod urged me to use the braces if necessary psychologically, but urged even stronger that I should learn to NOT depend on them, and instead develop the leg strength to ski without them.

it is quite possible to do so. there are quite a few skiers here at EpicSki who can attest to this.

not saying you have to do what I'm suggesting. just saying that your options are broader than you've outlined so far.
post #8 of 17
Uncle Crud, I haven't tried really aggressive PT as an "adult." When I was running competitively I had several trainers work with me on strengthening my knees - it never produced pain-free running or skiing. What I mean by "as an adult" is that I graduated HS at 17, my college elligibility was used up by 21, and we all know that male's skelatal/muscular systems don't stop developing until 20-25, depending on the boy. So, the answer is a qualified "no, I haven't tried aggessive PT." Basically, I understand that "it didn't work then" does not necessarily mean that "it won't work now."

I actually have an app't with the doc to talk about my knee this week, and I'm betting we're going to start a PT regimen shortly thereafter. The reason for the doc appt is kind of strange: something happened in the knee on the moguls at Keystone on Sat. I fell, and I could tell that something happened in the joint (it felt like something "released"), but no pain at all. I picked myself up carefully, expecting pain at any moment, or not being to put weight on it, or something bad, but nothing: skied out the rest of the run, that day and the next with no problems. The LCL was a little sore that night, but what was weird (and is prompting the doc visit) is that there is a little clump of some sort of tissue in the back, top (almost above the joint) outside portion of the knee - and I have no clue what it is... And I haven't had even a twinge of pain, discomfort or weakness in the joint since. Weird enough for me to make an app't with the doc though.

We'll see what happens, keep fingers crossed that it isn't a big deal and won't kill the rest of this season...

J
post #9 of 17
do you use any MSM, glucosamine or chondroitin? I started using them early Fall '05 and my whole body feels 20 years younger, at least where the formerly achy knees and elbows and wrists and shoulders are concerned. last season I had pretty nasty pain in both knees for the first few hours after skiing a full day. this season I am skiing more aggressively than ever, but I have no knee pain at the end of the day. some of that is from my technique improvements thanks to ESA '04 and '05 and my work with master yoda at Club LT, but the Triple Threat MSM/Glucosamine/Chondroitin I'm taking definitely is helping. (thanks Kneale!)
post #10 of 17
Thread Starter 
Thanks for all the replies, I've been a bit late in checking back.

Didn't know about braces with metal rods, I'm not sure I've seen them in Sportmart/Riteaid etc, I'll have to go back for a closer look. Or order online. I've already decided to start taking glucosamine supplement tablets, but they will take about a month before any effects are felt, so they may not help much this season.

And I still wear my knee brace when playing tennis, even though it may not be required, precisely because of what you guys said - it may be a placebo, but the risk of not using it is not worth it.

The reason I got injured in the first place is I was an idiot and ignored what my body was telling me.
post #11 of 17
Was skiing with a surgeon once, he worked on knees. Said he felt a bit guilty that other peoples mishaps on the slopes paid for his time on the slopes . He also said that a lot of accidents happen when people aren't paying attention, are tired at the end of the day etc. Often people catch an edge, get off balance etc and don't realize at first that there is a problem then the body realizes too late and tries to recover from a difficult position that puts the knee under great stress then something breaks. He said that the neoprene type supports help a skier to realize sooner that all is not right, the feedback from the tighter fitting fabric on the knee to the skier is better than an uncovered knee. Sort of improves the body's injury warning system, or so he said
post #12 of 17
interesting DB. I've had at least 4 orthopods give the big "MEH! placebo!" at the mention of anything other than typical neoprene sleeve function... the point repeatedly made is that there is no structural support offered.

as a matter of fact, even the custom rigid skeletal hinged braces aren't really intended to offer structural support beyond positive stop to prevent hyperextension. the original Lenox-Hill hospital lab brace designed for late '60s early 70s NY Jets QB Joe Namath and later supplied to others for a fee was billed as a "derotation brace" but orthopods who paid attention to the results of bracing realized that rotation really couldn't be stopped, only hyperextension. apparently the skeleton of the brace is needed to make firm enough contact for the positive stop to actually work.

no doubt neoprene can keep a sensitive area warm

no doubt that compression can aid slightly in biofeedback as DB's MD said
post #13 of 17
Jake, just curious if you bike and/or hike much?

Out on the mountain bike, I can ride all day and then some with no external knee support -- unless I'm pushing a tall gear for too long, and then I'll get that funny feeling for a few days, nowhere near as bad as skiing though.

Hiking is another story. Walking down steep hills for long stretches, even with no gear, really does a number on me. I haven't tried with with a brace, and in fact, just prefer to avoid the activity altogether.
post #14 of 17
Defcon, you also asked about ankles.

Last season, I re-injured a previous, somewhat severe, sprain. A couple of flat landings on skis is all it took.

The doc says my ankle is as healed as it's going to get. I've got occassional discomfort walking on it, can bike on it just fine, and ski & board boots have been ok with slight discomfort.

But early this season the new footbeds I had made up for my ski boots made a pretty big difference compared to the old ones (which have been retired to my snowboard boots).

Based on some advice from forum members, last week I took delivery of a Dyna Disc and Dyna Board from Exertools. It's basically a piece of wood on a heavy-duty whoopie cushion, and pretty much does the same thing as any other balance board.

I've only spent a couple of hours on the contraption in front of the television, so obviously I'm not ready to tell you it's made a difference (or even that I can feel a difference). I'll monitor for any improvements as the season wears on...
post #15 of 17
Quote:
Originally Posted by speede541
Based on some advice from forum members, last week I took delivery of a Dyna Disc and Dyna Board from Exertools. It's basically a piece of wood on a heavy-duty whoopie cushion, and pretty much does the same thing as any other balance board.

I've only spent a couple of hours on the contraption in front of the television, so obviously I'm not ready to tell you it's made a difference (or even that I can feel a difference). I'll monitor for any improvements as the season wears on...
please let us know, speede. my right ankle is a chronic sprain ankle, always instable. I'd like to use those things if they seem to work.
post #16 of 17
Speede, good luck with the Dyna Disc! I used to have chronic ankle sprains which which stopped happening after using the discs!

Every time you sprain an ankle, you lose proprioception, which is why you sprain the same ankle again. Proprioception exercises help.
post #17 of 17
Some ski techniques put a rotational force on the knee and some put much less. Any turn where you steer the ski puts a rotational force on the knee, and the knee isn't made to rotate. Also, a wide stance and deep flex of the knees puts a rotational force on the knees*.

So, learn how to carve your skis instead of steering and skidding. Narrow your stance.

*Try this in a chair...upper legs straight out & parallel, feet are also parallel. Spread your upper legs into a moderate V and the feet also V out. Make your feet parallel, and you've put a rotation into your knees. Knees don't like to rotate; that puts a stress on the ligaments.


Ken
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