I had an interesting conversation with one of my Cert 3 candidates the other day. The subject was alignment subsequent to re-habilitation of an injury. Before anyone suggests this subject might belong in another thread, I want to say most of what we discussed that day centered around the very natural re-educating and modification of our body movements to compensate for the injury. Once established, these new default movement patterns can signifigantly affect our technique. But is that the end of the story?
What moves do you use?
One of the things my fitter did also was to give me a bit more heel lift on the left side then the right, just to help me get a little forward on that side compared to the other.
The plan is to remove the heel lift after I'm fully recovered (knock on wood).
So anyway, I guess I'm just sharing my own similar experience, but I'm not sure what question you meant to ask or discussion you wanted to have specifically.
The discussion I had involved a lot of re-balancing of muscles and re educating the body to create better body alignment. The idea was offered that many of the body's asymmeries can be eliminated and if true, this also means our equipment would need to be adjusted several times during this process. That was as far as we went with that idea though. My question is after an injury and recovery just how many people still use the compensatory movements we needed during re-hab. When do you feel confident enough to go back to movements you used prior to the injury? How hard is it to eliminate those habitual movements we learned before reaching full recovery? As instructors how do we help a student overcome these habitual movement patterns that negatively limit their technique?
Each injury will be different. A guy that has knee surgery should probably just stay off the skis until fully recovered then will probably have totally normal function after normal physical therapy. If someone has had an injury that was less pronounced, but which went on and on for a long time.... Stuff that exists for a long time can create long term body symmetry issues which can possible be worked out or possibly not, and if so, may take years to do it. I would say the skier recovering from knee surgery, for example, probably does not need a special setup in his skis. He just needs to do rehab and get back on his normal setup only when his knee is ready. A skier with a more long lived problem may have to always have compensatory aids in his boots or would have to ween himself. Hey some people tweak with their boots every year, even without any injury or rehab. Its not that big of a deal to do it and they should.
Regarding technique, that's an interesting discussion and I'll have to think about it before I say too much.
I will say with my own case, that in order to go out skiing and have fun, I had to accept that I couldn't do certain things that I normally would like to do, such as hit the bumps zipper line, etc. Also, making an aggressive big edge angle turn on the left was generally just not a good idea. I did them anyway, with more-than-I-should banking and yes I slid onto my side a lot last year because of that.
In my case I basically stayed off the hill at all until I knew I was more or less rehabbed enough to not get injured again. After that, its a matter of finding the muscles that are weaker and then focusing on them while doing your movements in order to try to strengthen them or get more ROM. That was MUCH easier for me to do because I kind of know what I'm doing or what I'm supposed to be doing so I knew what to spot.
If you're working with a student I think you'd need to try to spot some of the ways they aren't moving the way they are supposed to be moving and then try to identify whether that movements is related to their injury or just bad technique. Once you've identified both a movement and the muscles used, then talk with them about the muscles, they will probably be rather versant by then about various muscles because of their PT activities. If you find that their injury is not related, then teach them normally. If you find their injury is related, then try to find out if its just a matter of atrophy that needs to get strong again, in which case give them some drills that will focus on strengthening that particular movement. If its not an atrophy issue but more like a torn or weathered-out tendon or ligament or something like that...then I'd say they may be dealing with a long term and permanent alteration to their skiing that may look funky to some, but will keep them skiing.
One friend of mind has extremely limited ROM in his hips. I didn't believe him until we were at a party one time and I asked him to do some ROM exercises in the hallway. REALLY limited. Actually there are certain ski movements he is just never going to be able to do. He has to find a way to adapt and always ski that way. He'll never be on the WC, but he can still have fun. Myself I deal with limited dorsiflexion and there are many work arounds for that.
I guess every case is different. Sometimes these work arounds will have to be permanent and sometimes they can slowly rehab their way out of it, with constant attention to their boot setup over years while they do it. Most recreational skiers don't have the dedication to do that though.
I noticed something in my skiing as well thanks to a shoulder injury and subsequent surgery. I found myself using that arm differently and even though the shoulder doesn't show any sign of weakness I still have some favoring issues that creep into my skiing every fall. The weird part is since my clavicles are not the same length It isn't quite natural to keep my shoulders symmetrical.
I agree that it shouldn't matter much. Although it does require a small compensation. Which was my only point. It does bring up an interesting question about how the top end racers who use one of those compensatory movements. How often does that move get studied because it worked so well?
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The issue is; What is the recovered body going to look like vs the body before the injury. You can retrain muscles to work in a different manor, but trying to compensate for a change in your now "normal" body position (as in broken and healed bones) may be a whole different deal.
I regularly see a Chiropractor. My "leg length" changes from time to time. When I say "leg length", it isn't the actual length of my leg that changes but how far my feet are relative to my head as a result of pelvic tilt. (You'll just have to accept the concept here....that's just what the Chiros call this). My new normal is to have one leg be a quarter of an inch longer than the other. I can be off as much as 3/4 of an inch.
What happens with me is that my spine constantly tries to readjust to compensate for the curve left in the L2-4 area after fully healed. After an adjustment I am usually right back to 1/4 inch out.
I'm sure you can all imagine what effect this has on my skiing. I'll never be symmetrical again like BTS mentioned above and can live with that, but...my boots are adjusted (cant and lift) to compensate for 1/4 inch leg length difference. You can imagine what things feel like when my actual length is 3/4 different. The cant changes by about 2 degrees. In my case it's 2 degrees more edge angle. I have no idea what I would do if it were less edge angle, or if that's even possible, but I guess I'd need to adjust my boots on a daily basis if that were the case.
Summing up......My boot adjustment compensates for what my body looks like when my leg length is only 1/4 inch different. In theory that adjustment brings me back to pre-accident body position as far as how the skis are in contact with the snow. Other times I need to change my skiing a bit. I can feel the difference on right and left turns on firm groomed terrain when my spine is considerably out of whack and just have to back off the edge a bit on one side (or drive a little harder on the other). I suspect some of the constant problem with my left hand dropping is related to this. That I can change because there is no damage there, it's just that as my CM changes ever so slightly from turn to turn because of the leg length, in theory something would have to change in the upper body to maintain the same feeling of balance. So now the question is.....while I can't correct my stance when my spine is out of whack (short of correcting boots or going in to get adjusted) SHOULD I correct the left hand drop to compensate for "today's" stance?
As you can see the most accurate comment in the tread so far is in post 8 where BTS says "It would be very interesting to dive in a little more deeply......"
On another level, how does this affect how our students ski during a lesson? Would it make any sense to do some sort of warm up activities based on this phenomenon? Some schools try to address equipment adjustments but most don't try to address alignment issues. So IMO the idea of warm up exercises would be even less likely to be part of lesson planning in these schools. Hopefully as I explore this idea further some reasonable set of warm up activities will emerge. Any and all ideas you guys have are certainly welcome...
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Further to the points here - in my opinion post-injury compensation is a big problem. For three reasons:
- physical therapy often gets a person healthy enough for daily activities but not necessarily healthy/strong enough for sports
- rehab goals are typically to return a person to "pre-injury" strength/mobility. The thing is many injuries happen because a person was weak or asymmetrical, so this still doesn't mean they are fit to ski
- one of the biggest risks of injury in athletics is previous injury. Another is muscular asymmetries.
- as noted above, often during injury we develop new asymmetries/compensations. These can later lead to new problems.
To me, what that means is that most people returning from an injury are not ready to ski - or at least they are at risk of re-injury, and they are likely to suffer from performance issues related to asymmetries.
The idea of a good warmup is a sound one - warmup should be looking to get some movement in the ankles, hips and thoracic spine and work at activating muscles in the glutes and core to get them primed for the job ahead.
I do think there is a lot of room for correcting on-snow deficits via off-snow exercises. We all see people who have trouble with a phase of their turn in one direction but not the other. To me that's a clear sign of an imbalance. It could be structural which would be a good indicator that equipment adjustments are in order, but odds are it's a functional issue in which case you really want to re-train the appropriate movement pattern.
When I see athletes in the sports therapy clinic (I am a strength and conditioning consultant), I do a functional movement screen (FMS - many imbalances and movement compensations can be seen here), a single-leg squat to chair test (for glute strength) , an eyes closed walking test (for pelvic rotation), sometimes I do back and core endurance tests (how long can someone hold flexion, extension, and side-planks), and in some cases I also do a Hop and Leap test (http://www.athletebydesign.com/Research/HopStop/tabid/217/Default.aspx).
Virtually everyone has issues, and I can improve a lot of them with corrective exercises. Addressing these asymmetries and compensations is relevant for reducing injury risk in general, but in skiing I think it also will have a big impact on ability to perform.
I'm starting to think that I might try to create an on-hill functional movement screen type test including corrective exercise suggestions that ski instructors can use if they have clients who are showing signs of asymmetrical skiing. As instructors I think we should continue to try to fix the movement on snow, but if you can send someone home with 2 or 3 simple exercises they should do daily the improvements are going to come much faster. If after a few weeks you don't see any improvement, then I think that would be the time to send them to the bootfitter.
I hope I'm not sounding like the carpenter who suggests every problem can be solved with a saw! I'm just very excited as I'm seeing that merging my two jobs and my two passions can result in helping improve peoples skiing. :)
Does this sound reasonable?