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Journal, injury prevention, 6 minute read

Your knees and skiing: what the research says

The knee is the joint skiers injure most. Here is what studies of recreational skiers show about the risks, and what you can do before your trip.

Jean-Marie Delaunay carving a turn on a groomed piste

The numbers

The knee accounts for about one third of all injuries in recreational alpine skiers. When a knee injury needs hospital care, the anterior cruciate ligament, or ACL, is the structure most often damaged.1

Where and when it happens

An Austrian study compared 392 skiers who had injured an ACL with 392 uninjured skiers of the same sex and skiing level.2 Snow conditions mattered, and icy slopes showed the strongest link with injury. Risk also rose with age, by about five percent for each year.

One result surprises most people. ACL injuries were more likely on easy blue runs than on black runs. The study does not say why. My reading as an instructor is that easy terrain is where skiers relax, stand tall and stop paying attention.

Equipment counts

A second study from the same group looked at the equipment of 1,817 recreational skiers.3 Worn boot soles at the toe were linked with ACL injury in every group studied. The standing height of the binding, front compared with rear, also differed between injured and uninjured skiers. For more skilled skiers, rented or borrowed skis were also a risk factor.

The practical lesson is simple. Have your bindings set and tested by a ski shop every season, and replace boots when the soles are worn.

Where fitness fits

In a prospective study of 117 recreational skiers, those with average or good balance scores had at least four times lower odds of injury than those with poor scores. Slow agility scores pointed the same way.4

Fatigue is the other piece. Four hours of skiing reduced eccentric strength in the thighs of fit recreational skiers for at least 24 hours.5 The quadriceps and hamstrings are the muscles that control the knee, so legs that are still tired from the day before give it less support.

The evidence has limits. No study has yet proved that a fitness programme prevents ski injuries, and a systematic review found no exercise-based recommendation in the research on recreational skiers.6 Training improves the qualities linked with fewer injuries. It is not a guarantee.

What to do before your trip

  • Train balance and agility. Single-leg exercises and quick footwork, twice a week.
  • Build braking strength. Squats and split squats lowered slowly, so your thighs cope with long days.
  • Include the hamstrings. Bridges, hip hinges and slow curls. They work with the quadriceps to stabilise the knee.
  • Check your equipment. Bindings tested by a shop, boots with sound soles.
  • Stay alert on easy runs. Keep an athletic stance on the way back to the lift too.
  • Respect fatigue. Plan an easier day in the middle of the week, and stop when your legs stop answering.

This article is general information, not medical advice. If you have had a knee injury, ask your doctor or physiotherapist before starting a programme.

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References

  1. Posch M, Schranz A, Lener M, Tecklenburg K, Burtscher M, Ruedl G. In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation. Knee Surgery, Sports Traumatology, Arthroscopy. 2021;29(6):1790. doi:10.1007/s00167-020-06221-z
  2. Posch M, Ruedl G, Greier K, Faulhaber M, Tecklenburg K, Schranz A, Schliernzauer B, Burtscher M. Impact of environmental factors on the ACL injury risk in recreational alpine skiing. International Journal of Sports Medicine. 2023;44(13):1003-1008. doi:10.1055/a-2134-3908
  3. Ruedl G, Posch M, Tecklenburg K, Schranz A, Faulhaber M, Burtscher M. Skill-specific differences in equipment-related risk factors for ACL injury in male and female recreational skiers. Orthopaedic Journal of Sports Medicine. 2023;11(3). doi:10.1177/23259671231155841
  4. Wang Z, Cai Y, Wu J, Xie S, Jiao W. Relationship between lower extremity fitness levels and injury risk among recreational alpine skiers: a prospective cohort study. International Journal of Environmental Research and Public Health. 2022;19(16):10430. doi:10.3390/ijerph191610430
  5. Koller A, Fuchs B, Leichtfried V, Schobersberger W. Decrease in eccentric quadriceps and hamstring strength in recreational alpine skiers after prolonged skiing. BMJ Open Sport & Exercise Medicine. 2015;1:e000028. doi:10.1136/bmjsem-2015-000028
  6. Hébert-Losier K, Holmberg HC. What are the exercise-based injury prevention recommendations for recreational alpine skiing and snowboarding? A systematic review. Sports Medicine. 2013;43(5):355-366. doi:10.1007/s40279-013-0032-2