The previous Backcountry blog post discussed the process of recovering from a major knee injury and how to recover and return to the slopes after such an occurrence. Let’s take the time now to work on avoiding the whole thing from the start! While sometimes ACL injuries may be nearly unavoidable (example: if an out-of-control skier or boarder crashes into your knee), there are things you can do to prevent excessive load being consistently placed on your ACL. We are going to look at positioning, quad strength, rotational hip strength, and hip flexibility.
When you learned how to ski, you probably quickly heard that you should be leaning forward in your boots. Keeping your weight shifted forward gives you better control over your skis so you can make that quick turn when you need to avoid a rock. It also takes stress off of the ACL. When you lean backward, the pressure of your shin bone is shifted forward in comparison to your thigh. This pressure is absorbed by the ACL to keep the shin from moving any further forward. The most effective way to maintain this position is to keep your knees and your hips bent to keep the weight shifted appropriately. To be able to keep this position for long periods of time, your quad muscles are going to need to be in top shape with great endurance! This leads into the next part of the discussion….
The quads sit on the front of your thigh. There are four parts (thus the name “quadriceps”) and it all begins at your pelvis. The muscle attaches just below your knee. Therefore, the quads actually cross both your hip and your knee joint, making them involved in the actions of both joints. To stay in the optimal position for your weight placement while skiing, the quads need to be able to hold their position for an extended period. Here are some ideas on how to help make that possible.
- Squats: Stand with your feet shoulder-width apart. Drop your hips slowly back as if you were about to sit in a chair. Let your hips and knees bend. Keep your back straight. Try to get your thighs parallel to the ground. Then return to standing.
- Wall sits: This will focus a little more on the endurance portion of your training. Place your back against a wall with your knees bent and thighs parallel to the ground. Hold as long as you can. See if you can get to 1-2 minutes and beyond!
- One-legged stance: Stand on one leg with your knee bent about 30 degrees. Hold that position for as long as you can. This will again force your quads to hold you in a stationary position. Once this becomes easier, you can challenge yourself by standing on a foam pad and/or adding in arm movements.
In addition to the quads, we need to focus on muscles around the hips as well. The hips play a MAJOR role in keeping the knees in a good position. This is because the hips have so much freedom to move in different directions and control where the rest of the leg goes! I am going to cover a few exercises that will focus on a rotational component of hip movement.
- Clamshells: Lie on your side with both knees bent. Make sure your hips are stacked on top of each other and that they stay that way throughout the exercise. Do not let your hips roll to either side. Place your back against a wall if it becomes too difficult to not let your hips roll. What you will do for this exercise is keep your feet together while your knees move apart. This creates a rotation movement, and you will feel muscle activation in the area of your glutes.
- Reverse clamshells: As the name suggests, this is more or less the opposite of the clamshell. You are set up in the exact same position, but your knees stay together while your hips rotate so that your feet come apart from one another. Add a resistance band around your feet (for reverse clamshells) or knees (for clamshells) to get an added challenge!
- Tipping bird (AKA single-leg Romanian deadlift): This movement training exercise targets the hamstrings and glutes, but will also incorporate rotation strength by forcing you to keep moving in a straight line without rotating one side or the other. While standing on one leg, hinge at the hip with your back straight to reach toward the floor. The leg that is not on the ground will be reaching straight backward. Return to start position in a controlled manner. The whole time there needs to be an emphasis on keeping your hips and trunk parallel to the ground. Do not twist toward either side.
It’s not just the strength of the hips that is important, but the range of motion of the hips as well (are we getting the idea yet of how important the hips are when it comes to your knees?!?!). To put your knees in an optimal position, the hips MUST be able to move into a position that lets the knees be there. If the hips are turned in or out, the knees will not be centered and extra stress will be placed upon the ligaments! I’ve got a couple of stretches that will be able to help. In general, I often recommend 30-second holds for stretches.
- Figure 4 stretch: Lay on your back with one knee bent. Cross the other leg over it so that the foot of the other leg is at the knee of the bent leg. Place your hands around the back of the thigh on the bent leg and pull it toward you. You will feel a stretch along the buttock.
- Butterfly stretch: Sit with both knees bent and bring your feet toward your body. Let your knees drop out to the side. Place gentle pressure on the inside part of your knee pushing toward the ground.
That’s the quick rundown on how to care for your knees and lower the risk of the dreaded ACL injury. Incorporate these activities into your routine and know your limitations on the slopes. Nobody wants to miss any powder days due to an injury! Make sure it’s not happening to you! If you are unsure about anything you read in this post and want more info, email me at scott@backcountry.physio or reach out on Backcountry Physical Therapy’s social media pages. Be sure to check back on the website for more blog posts and follow us on social media for ideas on how to keep yourself pain-free!
