Prevention, Management, and Exercises for Common Lower Limb Skiing Injuries
Skiing is a thrilling winter sport, but it places high demands on the lower limbs, and requires a unique combination of strength, balance, and technique, which makes skiers and snowboarders particularly susceptible to injury.
In this article we discuss in-depth, six of the most common lower limb injuries that people sustained on the slopes, including their anatomical basis, mechanisms of injury, and symptoms.
Six Common Lower Limb Skiing Injuries
1. Anterior Cruciate Ligament (ACL) Tear
ACL injuries are among the most frequent skiing injuries due to the twisting forces on the knee during falls or sudden stops. Symptoms include a popping sound at the time of injury, instability, and swelling.
Anatomy of Knee Ligaments
- Anatomy of the knee: The ACL is one of the four major ligaments in the knee, connecting the femur (thighbone) to the tibia (shinbone). It provides stability by preventing excessive forward movement and rotational forces of the femur on the tibia.
- Action: The ACL works with the hamstrings and quadriceps to stabilise the knee during activities that requiring quick changes in direction or deceleration.
- Cause – ACL tears often occur due to:
- Sudden deceleration combined with a change in direction.
- Twisting forces when skis catch or during a fall.
- Hyperextension of the knee, especially during jumps.
- Symptoms:
- A popping sensation at the time of injury.
- Rapid knee swelling due to bleeding into the joint (hemarthrosis).
- Difficulty bearing weight or a feeling of knee instability.
- At Risk: Skiers who fail to release their bindings during falls or who more novice skiers who have a poor technique are at higher risk.
- Management: This type of injury often requires surgical intervention. However, it is not a medical emergency, and you do not need to rush to have surgery while you are away.
You should try and see a medical professional; a Sports Doctor or a Physiotherapist who will give you some advice on immediate injury management (issuing you a knee brace and crutches etc). Once you are home It’s important that you seek further medical advice; you may require an MRI to assess the extent of the ligament damage and then a treatment plan will be put in place.
2. Medial Collateral Ligament (MCL) Sprain
The MCL, located on the inside of the knee, is often sprained when the knee collapses inward during a fall. Symptoms include pain, swelling, and tenderness along the inside of the knee.
- Anatomy: The MCL is a thick band of tissue on the inner side of the knee, connecting the femur to the tibia. It resists valgus forces (inward angulation of the knee).
- Action: The MCL stabilises the knee against an inward bending movement of the knee.
- Cause:
- Valgus stress, such as during a snowplough turn.
- Direct trauma to the outer side of the knee.
- Twisting injuries during a fall with inward knee collapse.
- Symptoms:
- Pain and tenderness along the inner knee.
- Swelling and sometimes bruising.
- A feeling of instability, especially when the knee is loaded laterally.
- Grades of Injury: The severity of the injury is graded 1-3. Depending on the level of injury will determine your potential treatment and outcome.
- Grade 1: Mild sprain with minimal pain and swelling.
- Grade 2: Partial tear, significant pain, and swelling.
- Grade 3: Complete rupture with severe instability.
3. Tibial Plateau Fracture
High-energy falls can cause fractures at the top of the shinbone, affecting the knee joint. This injury often requires surgical intervention and prolonged recovery.
- Anatomy: The tibial plateau is the upper surface of the tibia that forms the lower half of the knee joint. It bears significant weight and articulates with the femur.
- Action: Acts as a weight-bearing surface and stabilizer for the knee joint.
- Cause:
- High-energy trauma such as falling at speed or landing awkwardly after a jump.
- Direct impact or twisting forces.
- Symptoms:
- Severe pain in the knee and inability to bear weight.
- Visible deformity in severe cases.
- Swelling, often with bruising.
- Difficulty straightening or bending the knee due to joint damage.
- Management: This type of injury often requires surgical intervention (open reduction and internal fixation) to restore the joint surface and function. It’s important that you seek professional medical attention if you suspect you have sustained this injury.
4. Hip Labral Tears
The repetitive rotational forces of skiing can lead to tears in the hip labrum, causing groin pain, clicking, and limited hip movement.
- Anatomy: The labrum is a ring of cartilage that lines the socket of the hip joint (acetabulum). It provides stability and facilitates smooth joint movement.
- Action: Assists in deep flexion, rotation, and weight transfer in the hip joint.
- Cause:
- Repetitive twisting and rotational forces during skiing.
- Deep hip flexion while turning at speed.
- Falls that cause a sudden, forceful movement of the hip.
- Symptoms:
- Groin pain, which may worsen during twisting or squatting.
- Clicking or catching sensation in the hip.
- Reduced range of motion and stiffness.
- Pain that radiates to the thigh or buttocks.
- Management: Depending on the severity of this injury, you may well be able to continue skiing after a few days rest. It does not usually require urgent medical attention but be guided by your symptoms, and touch base with a sports doctor when you get back to the UK; the likelihood is that you will require some rehabilitation to manage your injury and strengthen the hip.
5. Ankle Sprains and Fractures
These types of injuries frequently occur when walking around the resort, rather than while on the slopes. Poorly fitting ski boots or awkward landings can also lead to significant ankle injuries. Symptoms include swelling, bruising, and difficulty bearing weight.
- Anatomy: The ankle is composed of the tibia, fibula, and talus bones, which are supported by ligaments including the lateral and medial (deltoid) ligament complex, as well as stabilising tendons and muscles.
- Action: The ankle ligaments and tendons stabilises the foot during weight-bearing and movement.
- Cause:
- Twisting injuries from an awkward landing or fall.
- Overstretching or tearing of the ligaments.
- Ski boots that are too loose or improperly adjusted.
- Symptoms:
- Pain, swelling, and bruising around the ankle joint.
- Difficulty bearing weight or walking.
- Visible deformity in cases of fracture.
- Types of Sprains:
- Inversion Sprain: Damage to the lateral ligaments – this is by far the most common type of sprain.
- Eversion Sprain: Damage to the medial deltoid ligament, less common but can be more severe.
- Management: If you suspect that you’ve sustained an ankle fracture (broken bone) then you need to seek immediate medical care. The fracture will need to be stabilised in a cast, or in more severe cases may require surgery.
Ankle sprains can be incredibly painful, and it is unlikely that you’ll make it back on the slopes (depending on the severity). You will need to rest and ice it, and will likely require an ankle support and crutches to get around the resort safely.
6. Achilles Tendon Tears and/or Rupture
This is a rare but quite severe injury seen on the slopes, this injury occurs when the tendon is overstretched, often during high-energy movements. Symptoms include a sudden sharp pain and an inability to push off the foot.
- Anatomy: The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone). It is the strongest tendon in the body.
- Action: Facilitates push-off during walking, running, or jumping.
- Cause:
- Sudden forceful dorsiflexion of the ankle, such as landing awkwardly or losing balance.
- Overstretching of the tendon during aggressive manoeuvres.
- Symptoms:
- A sudden snapping or popping sound at the back of the ankle.
- Severe pain and swelling around the Achilles tendon.
- Difficulty or inability to weight bear or push off the affected foot.
- Palpable gap in the length of the tendon.
- Management: An Achilles rupture need to be seen and managed quickly. It can often be missed, especially if your pain and symptoms are less severe. If you think that you may have injured your Achilles, then you should go to the medical centre straight away. It is often an injury that is managed with surgery, but this will need to be discussed with an experienced medical professional.
Why Pre-Season Training Is Essential
Skiing demands strength, stability, and endurance. Pre-season training helps:
- Enhance muscle strength and joint stability.
- Improve flexibility to reduce the risk of strains and sprains.
- Boost balance and coordination to handle variable terrain.
- Condition your cardiovascular system to sustain energy during long runs.
Six Best Lower Limb Exercises for Skiers
1. Squats
- Why: Strengthens quads, hamstrings, and glutes.
- How: Perform with proper form; progress to single-leg squats for an added challenge.
2. Lateral Lunges
- Why: Improves side-to-side stability essential for turning.
- How: Step laterally, bending one knee while keeping the other leg straight.
3. Bulgarian Split Squats
- Why: Builds unilateral leg strength and mimics skiing posture.
- How: Place one foot on a bench behind you and lower into a split squat.
4. Deadlifts
- Why: Strengthens the posterior chain, reducing the risk of back and knee injuries.
- How: Use a barbell or dumbbells; focus on form to avoid injury.
5. Calf Raises
- Why: Strengthens the calves and Achilles tendon.
- How: Perform standing or on a step for a greater range of motion.
6. Single-Leg Balance Drills
- Why: Improves proprioception and ankle stability.
- How: Practice balancing on one leg; add a wobble board for progression.
Immediate Injury Management on the Slopes
There is often excellent medical care on the mountains, where you require help on the slopes or at the medical centre in resort. There will usually be GPs, Sports Doctors and Physiotherapists in a lot of the bigger resorts, and emergency hospital care further down the mountain in the towns or cities.
Make sure that you are covered on your holiday insurance for a high level of medical care. The last thing that you want when you are being rushed to hospital is to worry about any financial repercussions.
If you do sustain an injury, here are a few simple steps you can take during the acute injury phase:
- Protect: Immobilise the affected area to prevent any further harm – this might be a bandage or brace, and/or crutches.
- Off Load: Stop skiing straight away to reduce stress on the injury. It might only mean you miss a few hours or a day or two of being on the slopes, but it’s worth just giving yourself a bit of time to recover and see if symptoms improve.
- Ice and Compressions: Apply a cold pack for 15-20 minutes to help reduce any swelling. Using a bandage or Tubi grip can also help to control swelling and give you support.
- Elevate: Try and raise the limb above heart level, again to help minimise swelling.
Red Flags Requiring Specialist Assessment
If you suspect a fracture or have any of the below symptoms, then you need to seek more urgent medical attention:
- Inability to bear weight or severe pain that gets worse.
- Visible deformity or unnatural limb positioning.
- Persistent swelling or bruising that gets worse.
- Numbness, tingling, or loss of movement in your limbs.
- A popping sound at the time of injury with sever instability, pain and swelling.
- Signs of infection (redness, warmth, fever), especially if the skin is broken.
Conclusion
Skiing is an exhilarating sport, but preparation and awareness are key to minimising injury risks. Pre-season training is key to reducing your risk of injury so now is the time to get into the gym or seek some support from a Physio or personal trainer to ensure you stay injury free in the slopes.
If you do sustain a lower limb injury while you’re away, please don’t hesitate to get in touch with us at London Bridge Sports Medicine, and we can help guide your management and recovery whether that be virtually, or in person when you’re back home.
Stay safe and enjoy the slopes!
