Sally John – Physiotherapy
Registered physiotherapist
Clinic; 1 Buckingham Blvd,
Collingwood, Ont
L9Y 3Y9
Tel; 446-1616
Ski & Snow-board Injuries
Due to the nature of this sport, many people may experience profound disability due to injury from fractures, ligament strains or ruptures. When experiencing shock, it is always advisable to visit Ski Patrol, or go to your nearest physician or emergency for a correct assessment & diagnosis. Treatment by a medical specialist, should be given, especially if you notice deformity or loss of strength from the fall or injury, or the inability to walk.
Below are listed a brief description of some selected less severe injuries, which advises you on their immediate care, which occur with Downhill skiing or snowboarding.
When ice is mentioned; it should be applied through a damp terry towel. The ice should be in a plastic bag and should be applied for 10-15 minutes every hour.
Most injuries, if carefully cared for, should take 4-6 weeks to improve.
Should injuries be taking more than 4-6 weeks to improve, other anatomical structures should be evaluated. Please see your physician or a physiotherapist for advice on these.
Please note that the below mentioned treatment guides are just that. If the injury does not improve, you should contact your therapist.
Foot injuries
Achilles tendinitis
Symptoms
· Pain at the back of the heel – always on the inside edge of the heel – sore upon palpation.. Usually occurs due to over-pronating or increased level of ankle bending as in toe edging in snow boarding.
· Worse in the morning getting out of bed
· Heel raising; causes pain at the heel and there is reduced strength
· Can be caused by shoes pressing on the back of the heel
Treatment
Place a 1cm foam heel raise under heel in ski boot or board boot. ( can obtain from sports specialist or well equipped drug store)
Ice heel. 10mins every hour when out of your boots! Use of 90 degree night splint. Double heel raising and then go to single as heel pain dissipates. Every hour do 10x and increase number of repetitions to 40X
Reduce intensity of skiing or boarding. Avoid jumping.
Tendinitis of tibialis posterior / partial rupture
Symptoms
· Pain at the mid arch of the foot, which can go up the inside of the lower leg from behind the ankle bone. This is made worse upon foot strike (may have felt a pull after landing a jump
· – tender to touch at the navicular. (inside foot bone on top part of arch)
· Aggravated by heel raise and especially painful with heel lowering
Treatment
Ice foot 10 mins every hour
Tape muscle to reduce strain on the muscle.
Strengthen with heel raises not increasing pain as for achilles tendonitis.
Metatarsalgia – caused by curling up toes in ski/board boot.
Symptoms
Pain at the ball of the foot usually at the base of the 2nd toe. Pain increases with push off when walking or running or at gait start in racing. Pain is worse in the morning.
Treatment
Ice pack under toes if tolerated.
Use metatarsal pad ( made of foam) Eg; Spenco and tape to foot just behind the metatarsal heads.
Mobilisations to your toes and foot by your friendly therapist
Assessment of walking or running pattern
Lower Leg Injuries;
Knee
Patellofemoral syndrome( anterior knee pain)
Symptoms
Pain at the front of the knee cap which can radiate down the shin. Aggravated when the knee is bent to 90 degrees when sitting for long periods of time. (“movie goers knee”)
Aggravated by climbing hills or stairs and with squatting when skiing. Knee can give way and can be confused with Meniscus problems (see below)
Problem – Knee cap is not in its correct track and may be positioned incorrectly at the start of the movement ( incorrect Q angle).
Treatment
1) Reduce pain with ice if particularly tender
2) Correct tracking with mobilisations and taping (see a therapist who knows Jenny McConnell’s techniques)
3) Check walking squatting patterns to see if there is problems above or below. Hip/back or foot.
4) Check shoe wear – If there is a need for orthotics in ski boots?
5) Vastus medialis rehab – Check with a therapist who knows (J.McConnell’s work)
Patellotendinitis
Symptoms
Acute pain at the front of the knee-cap but is below the knee cap. Usually caused by jumping
Treatment
1) Ultrasound or massage may help as might acupuncture to reduce tenderness. Also ice for short periods.
2) Use of Cho-pat (available at Pharmacies) or taping.
3) Isometrics to Quads and then gradual strengthening exercises. (See your friendly physiotherapist.)
Popliteus syndrome
Symptoms
Point tenderness at the outer part of the knee – above the knee – not to be mistaken for iliotibial band tendonitis which is pain below the knee joint on the outer side.
This is aggravated by running downhill, or downstairs as
the muscle acts as a check-rein to the knee or at the gait start with racing.
Treatment
1) Ice over area with ice cube or pack for about 5-10mins every hour
2) Work with co-contractions to hamstrings and quads to get activation of popliteus with help of muscle stimulation ( contact your local therapy unit for this)
3) Manual therapy
Torn Medial or lateral meniscus of knee
Symptoms
Pseudo-locking of knee or locks and has to be unlocked. Knee gives way.
Aggravated by duck walking, or squatting.
Treatment
This depends on the depth & side of the tear. Tears may go to arthroscopic surgery if constant locking. However, if pseudo locking and this could be the lateral meniscus, this meniscus has a great blood supply and can heal.
See a therapist of physician for confirmation.
1) manual manipulation of the meniscus to relocate is possible, but does not always stay in place and heal.
2) Isometric strengthening to increase blood supply for healing with the assistance of an EMS. (electrical muscle stimulator.) at different positions of knee bend without pain
3) When improved graduated weight bearing exercises which avoid twist, until later in the therapy.
Torn medial collateral ligament or Anterior cruciate ligament of the knee
Symptoms
from twisting the knee. The latter from stressing the lower leg forwards, when the boot does not release.
The inside of the knee hurts from the injury with the former and the whole knee is painful from the latter.
There is swelling.
The knee does not lock.
There is limited movement of knee bend and straighten.
Treatment
1) Reduce swelling with ice and elevation.
2) Isometric quads/hamstrings muscle strengthening - Progressed to squats
3) Movement exercises, - bend & stretch. Use of the bike forward/backwards when able and then go fully around. ( see a physiotherapist to guide you through the protocol).
Hip Injuries
Piriformis Syndrome
Symptoms
Pain at the buttock, which can cause sciatic type pain as the muscle can compress the nerve. Aggravated, when the leg is turned when standing and turned out when the hip is above 90 degrees movement when squatting below 90 degrees. Follows the line of the muscle; piriformis. A line which is tender from the tail bone to the hip joint line.
This pain can be mistaken for low back pain from a facet joint problem. There is no back pain with this syndrome.
Leg is usually turned out for comfort and leading with the leg upstairs or uphill increases the pain.
Treatment
It is best to see a therapist who will also check your back and treat this condition. Correct heel strike and swing through stage of gait as soon as possible
Symptoms
There is extreme tenderness over the hip joint either at the front of the thigh or else at the outside of the hip. The pain is made worse with climbing stairs or running/walking uphill, the latter is worse with walking downhill or downstairs.
Treatment
1. Check walking/running pattern
2. Stabilization of the hip by re-training the glutei muscles. (see your therapist)
3. Check hip flexors for increased tone and reduce tone and stretch hip joint.
4. Check need for orthotics different running/walking shoes.
5. Break bad standing habits and avoid prelonged sitting or standing.
Quads or Hamstrings muscle tear
Symptoms
Injury occurs either at the muscle over the front of the leg called the quadriceps muscle, often just above the inside part of the knee for the former injury or at the back of the leg, for the latter. These injuries usually occur after quick lunges or poorly when muscles are poorly warmed.
There is usually a sharp pain, which ends in some amount of disability and the inability to continue to lunge.
Treatment
Immediate:
· Ice the area immediately post injury with 10-15 minutes on & off with ice in a dampened terry cloth.
· While icing – co-contract muscles and move ankle up and down to promote circulation and fast heal
· Pressure bandage over the injury, which will develop into some degree of haematoma, which will keep the swelling down.
· Gentle knee bending without increasing pain
· Reduce weight bearing if necessary – use of a cane. Weight bear as tolerated. (no increase in pain)
Next day
· Repeat as above
· Gentle massage around the haematoma
· Isometric co-contractions of hamstrings and quads with the assistance of muscle stimulation, not enough to increase pain.
· See a therapist for further treatment advice who will put you on a graded exercise program. Recovery should be 4-6 weeks.
Iliopsoas Tendinitis
Symptoms
Pain at the hip into the groin especially with weight bearing, walking up hill or upstairs.
(cause often because the glutei muscles are not been correctly used and the hip flexor- iliopsoas catches on the pectineal eminence of the pelvic ring due to the angle of the pull in their attempt to stabilize the hip.
Treatment
1. Check walking(increased lumbar lordosis and therefore increased tone in hip flexors.
2. Reduce tone in iliopsoas by using the opposite muscle group; the hip extensors - glutei
3. Strengthen glutei in side lying and standing to functional positions (see you therapist for help)
4. Check ski/board boot position , assess the daily need for orthotics
5. Break bad standing habits.
6. Check training methods (as above)
Upper body injuries
Fall on the shoulder, hand or thumb or ribs. If in severe pain and shock has been experienced it is advisable to get an Xray or see your medical specialist.
Shoulder contusion
Often a direct fall onto the shoulder or hand or elbow may cause a fracture and needs further investigations. However, if the client is able to move the arm with not much pain, then early therapy is recommended.
1. Ice as initial advise (with a damp terry towel) every 2 hours for 10 minutes.
2. Pendular swinging. Dangling the arm by leaning forwards and letting the arm swing forwards and backwards and across body
3. Try lifting your arm up with the other hand clasped around your wrist or if able take a ski pole and lift the arm up with the use of the other arm.
4. Consult your physiotherapist for stabilisation exercises, to retrain muscle strength around the shoulder joint.
Shoulder rotator cuff injury, shoulder impingement injury or bursitis or finally frozen shoulder.
All of these injuries are often a result of a fall on the shoulder, where there has not been adequate treatment. Now treatment is very important as frozen shoulder syndrome may result.
Treatment advise
It is really best, at this point, to see a physiotherapist or sports medicine specialist who can best advise you in the rehabilatation needed.
Hydrocortisone injection may be needed, especially, if pain at night.
Hand & wrist injuries
Again, anywhere that there is sever pain or shock from the injury and obvious deformity, should be taken as a severe injury and should be seen immediately by a physician for advise on splinting or surgery.
If you are able to move the wrist, or hand then there may be a strain of the joint.
Common injuries are;
Skiier’s thumb – where the ski pole gets caught in the thumb by the strap and hence causes stress on the ulnar ligament.
Treatment
1. Splinting the thumb with a special made thumb splint, made by occupational therapist or sports therapist for 4-6 weeks so that the ligament can heal. During that time, it is important to remove the splint regularly for movement. However, whenever, there is any chance of re-injury, a splint should be worn.
2. Mobilisation to the other joints of the thumb may be necessary.
3. Strengthening to the injured thumb joint
Lumbar or cervical injuries. ( Back & neck injuries)
These usually require specialised from a therapist who specialises in this care.
Generally lack of movement with pain, could be related to muscle injury,
subluxed vertebra, or discogenic derangement. Please be thoroughly assessed as soon as possible to prevent compensation.
These are just some of the common injuries which are seen. For information or these and other information, please call Sally John or Email at Sallyjphysio@rogers.com
Or visit my web-site at www.sallyjohnphysio.com.