By Dev K. Mishra, M.D.,?President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
Key Points:
- Lack of binding release is correlated with knee injury in most age groups
- Bindings must be professionally adjusted at the minimum at the start of the ski season, and more often if you are a high-frequency skier
- Get yourself in good skiing condition prior to the start of your ski season
In Northern California mountains it is snowing, ski resorts are open for business, and this week we started seeing the first real flow of patients with skiing related injuries in the office. We revisit an important topic today: skiers, check your bindings for proper release to reduce your knee injury risk.?
Skis, boots, and bindings have changed dramatically over the last 40 years. It was believed that the main injury risk for skiers were fractures of the leg or ankle, and over time the design of skis, boots, and bindings has evolved to significantly reduce the risk of equipment related fractures. But an interesting thing then happened: as the risk of fractures went down the risk of knee ligament injuries went up. ACL tears in particular are estimated to occur in 70,000 skiers per year. There are several factors that lead up to the ?why? but I would anecdotally say that in the clinic I do hear some common themes in the injured patient. It was an end of day run with less than ideal conditions, and the patient?s legs were fatigued. And from the equipment standpoint we often hear that the bindings didn?t release.
Like most medical issues, the exact causes for knee injury in skiers is not black and white. For the scientifically inclined amongst you I would recommend you have a look at this excellent review study in the open source Orthopedic Journal of Sports Medicine. You can view the full text here. There are a few nice take-aways from the article. Younger skiers (less than 20 years old) reported that their binding did release at time of injury in 53.7% of the injuries but across all age groups the bindings released in only about 24.6% of all injuries. This study along with several others does not prove that the lack of binding release caused the knee injury but certainly it suggests a correlation. Furthermore, the lack of binding release seems to be more dangerous in some injury mechanisms like the ?phantom foot? (happens when the skier falls backwards).
The experience from our orthopedic sports medicine clinic might be a bit different in other parts of the country but at least from what we are seeing I can suggest some simple tactics to reduce your chance of injuries this ski season.
- Get yourself into good skiing shape! My bias especially for young athletes is to avoid heavy weights and focus on power, core strength, and coordination. Click here for a simple set of exercises that utilizes body weight activities and can be done indoors or out. These are good for all age groups up to adults.
- Absolutely make sure your bindings are professionally adjusted, for novice skiers at the start of the ski season and for high-frequency skiers at a minimum a monthly check. You might also consider the Knee Binding, a new type of binding that allows for a binding release prior to the theoretic strain point leading to ACL tears.
- Finally, know your conditions! Resist the temptation to ski in bad snow, especially slush. You?re just asking for trouble.
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