If you were to ask any physical therapist about the safest sports for any particular joint there’d likely be a consensus opinion on many of them. Baseball players will eventually suffer from some shoulder or elbow pain. Basketball players struggle with knee and back pain from time to time while golfers might complain of elbow, hip or back pain.
Now that the winter Olympics are wrapping up and everyone is coming off the mountain, we are feeling the aches. The funny thing about skiing and snowboarding isn’t the frequency with which we see catastrophic knee injuries but the astounding number of ankle or foot injuries we treat in these individuals: NONE!!! There is no sport that protects a joint so well as to literally be able to do the activity on an almost completely unstable joint. The trick is the equipment. Ski and snowboard boots (more so ski boots) do such an unbelievable job of locking down the movement of the foot and ankle that you hardly need to have any intact ligaments to do it.
When people ask us, “So what sports can I do and not be concerned about injury?” I almost have to bring up the winter sports. That said, the reasons that we see so many knee injuries may cancel out the benefit of protecting your feet and ankles. When you take what should be a mobile portion of your leg and freeze it in place with a boot and/or binding, the next link in the movement economy chain will/does take over a more important job. That’s the knee my friends, and if it’s trying to control forces in more than one plane at a time, you’d better have a good sports rehab team on call. The numbers of knee injuries in skiers is staggering, accounting for up to 30% of all skiing related injuries.
If you paid any attention to the Sochi Olympics, this time around you’d have been hard pressed to find a skier or snowboarder that has his/her original equipment inside of their knees. For these athletes, it’s simply a job hazard and they do what they must to continue training and competing. For those of us not on that level, our ACLs are very important. Not only for skiing but also for taking part in a lot of the other activities that make exercise fun year round.
Here are some helpful tips for keeping your knees healthy, ready for the slopes and whatever else you want to throw at them:
1. GOT GLUTES?
- The knee is the middle child of the leg: it does everything that the hip and foot demand of it. That said, there aren’t “muscles of the knee” per se.
- While we know of several muscles that cross the knee, the most powerful ones t
hat have a role in knee mechanics are up at the hips (specifically your glute max, med/min and several other smaller but powerful muscles). That is, the muscles that can prevent excessive twisting of the knee are NOT your quads and hamstrings.
- I’ve heard many a casual acquaintance mention to me that they were assigned some quads exercises for their “knee pain” (usually torn menisci, patellar compression issues or collateral ligament strains
- ) that are completely missing the mark.
- Test that persons’ hip abduction and extension strength and try not to gasp when you see how weak they are even if their quads and hamstrings are perfectly strong.
2. STOP with the “PT” exercises
- “PT” exercises, like quad sets and glute sets, are fine but we aren’t helping anyone
- get back to higher level activity with these.
- Learn more advanced strength and conditioning. Progressions. Ways to make functional exercise appropriate, safe and engaging. If you can hand a patient off/if you’re being handed off to a therapy “aide” or “tech”, your patient/you ARE DONE at that clinic. Neuroreeducation and/or therapeutic exercise should NEED to be intensely supervised by a professional. If it is not, then that patient/you can do it on your own.
- Unfortunately in our industry Physical Therapists are typically far less equipped to teach higher level movement skills/progressions than our far-less-trained personal fitness colleagues. This may sound like a slight but I mean it more toward my rehab pro colleagues.
- While some of us regard therapeutic, progressive, intense and functional exercise as an extremely important part of the therapeutic process, other don’t: we call those “good enough” physical therapists. Don’t be one, don’t be treated by one.
3. Single Leg Stability (SLS)
- Once the pieces of the strength and endurance puzzle have been identified and worked out on their own, it is IMPERATIVE to put those puzzle pieces back together to create fluid and balanced movement. I don’t care how strong your glutes are if they’ve never been “taught” how to work in conjunction with your foot and ankle. There are lots of people walking around who are “strong” in the truest sense of the word but they are complete movement midgets. It’s as if they have no idea where they are in space. THIS is where advanced training in neuromuscular reeducation comes in so valuable.
- It’s an ability to challenge an entire system while adding and removing difficulty to achieve the desired outcome.
- There are a few very good resources out there for Single Leg Stability drills. One such resource includes Dr. Christopher Johnson, currently out of Seattle, and his over 200 exercise demonstration videos. Click here to check out some of his work. His work is primarily with runners but his SLS drills are right on point.
Be sure to keep an eye on our blog at www.SPARKphysio.com/SPARK-Live and specifically our newest addition, SPARK University at www.SPARKphysio.com/SPARK-U. Here we are building a comprehensive resource of vetted, relevant and professionally digested peer reviewed/expert level material for all things sports, rehab and athletic development. Such material will include peer reviewed articles digested for both our professional colleagues and the health-info-seeking public, blog posts from our professional network across the country and around the world, videos and video blog posts and of course the occasional fun exercise video from right here at SPARK Physio in Alexandria, VA.