By LAURA LEONARD
Doctor of Chiropractic
Los Alamos
The first flakes of the season are falling and visible snow caps on the mountains mean it’s time to start training for the ski season ahead. Whether you’ve been mountain biking, cycling, hiking or running all summer or overloaded at work and ready to get back at it, paying attention to your knees is critical to prevent an early exit from the ski season.
The high-speed nature of skiing along with the restrictive nature of ski boots, results in a higher chance of injuring the structures inside and around the knee joint when compared to other sports. Cartilage injury, meniscal and ligament tears are common because the knee joint is not meant to rotate or move side to side. The knee is a hinge joint which only allows us to flex and extend the lower leg without injury. Ski boots restrict the ankle joint which also increases the odds of the knee being forced to move in directions it’s not meant to go. Strengthening and balancing the quadriceps and hamstrings with conventional strength training is useful however, sports medicine research tells us this is not enough. Knee stability screening tests along with neuromuscular training to correct dysfunction significantly reduces the risk of a season ending knee injury.
Neuromuscular training works to improve stability by improving the two-way communication between positional receptors around the knee joint and the motor cortex in the brain. This is analogous to talking on cell phone with a strong 5G signal. Clear and concise conversation with no ‘Can you hear me now?’ happening. The number one sign that we have a bad connection in this system is poor balance and assessing knee stability requires assessing our ability to balance. When we train balance and stability our body and brain react more efficiently to protect our joints. When the knee is forced in directions it’s not meant to go, we are much less likely to tear something if our system is trained to correct that motion. This won’t prevent injuries where speed and force cause a big stress on the knee joint. The goal is to have a quicker recovery from major injuries and to prevent sudden injuries from gradual wear and tear.
Tests to Determine Knee Stability
Single leg balance while observing the ankle joint. A pass on this test requires being able to hold the balance for 10 seconds while keeping the ankle stable. If the ankle collapses inwards and you can’t maintain balance, ankle stability training is needed. Weak ankles create excessive wear and tear on the knee joint by causing rotational torque. This is a problem which plagues lots of people regardless of whether or not we ski in the winter.
Single-leg squat while observing the hip and knee. A pass on this test requires being able to stand up and sit down while balancing on one leg from a bench or chair. Make sure your legs are bent at a 90-degree angle throughout the test, your arms can be held up in front of you for added balance. While moving from sit to stand, make sure your non-working leg is extended out in front of you. This is a very difficult test to perform without training. If you can’t perform the test or you see a collapsing inward of the knee and lowering of the hip/pelvis, training to improve this will greatly reduce your risk of a knee injury while skiing and in other sports.
How to Improve Stability?
Training ankle stability is simple. Start with basic single leg balancing and progress to using an unstable surface like a BOSU ball or balance pad. Three reps of 10 second balance holds on each leg with hands on the waist and knees slightly bent. For single leg squat training, start by doing single leg step up repetitions onto a box jump box at the gym. These come in several heights so you can work at a level that allows you to maintain good technique. If you don’t have access to this equipment, choose a higher surface to sit and stand from or just use the chair as a guide. Do as many quality repetitions as possible, slower is better. Keep the arms out front and the non-working leg extended in front of you. When your form starts to get messy, you are done.
The beauty of these exercises is that they can be done in 5-10 minutes almost anywhere. Daily training is best. Consistency equals a more efficient brain-body communication and improved knee stability. Improved knee stability ultimately results in a higher chance of having a safe and successful ski season.
Dr. Leonard’s practice focuses on posture and performance using a combination of soft tissue release, adjustments and exercise recommendations. She also coaches patients on nutrition, self-care and body awareness so they can manage themselves in between visits. Los Alamos Chiropractic Center is in the Mary Deal Building on Trinity Drive.
