Returning to skiing after an ACL injury can be daunting. After a full year of rehab, pain, and endless doctors appointments, the last thing you want to do is retear your ACL. Returning to the slopes following a major surgery can be physically and emotionally challenging. Here is what to expect following an ACL injury and a few tips on how to prevent the injury in the first place.
The ACL is an important ligament in your knee. It prevents your tibia from shifting forward on your femur, and it prevents rotation of the tibia on the femur. This ligament is most commonly injured when a skier falls without the binding releasing causing excessive rotation of the knee in a fully flexed or fully extended position. An ACL injury can also happen when a skier jumps and lands with their weight behind them causing their skis to run out underneath them. When the ACL is damaged, your tibia is able to move excessively on the femur causing pain and instability in the knee. A physical therapist can help to diagnose an ACL tear and start your rehab process. Oftentimes, a complete tear of the ACL requires surgery to stabilize the knee, but may not be necessary depending on the extent of the tear and the level of skiing you wish to return to.
Following surgery, the best outcomes result from compliance with your physician and the physical therapy plan of care. Immediately after surgery, Your knee will be painful, difficult to bend and straighten, and feel weak. A physical therapist can guide you in exercises to do immediately after surgery to speed your recovery. Return to recreational sports varies based on a patient's individual rehab progress, however, this can usually happen between 4-6 months. Due to the stresses placed on the knee while skiing, it is usually around 9-12 months before returning to skiing can happen. But how do you know when you’re ready to return to sport? How do you know if your knee is strong enough to withhold the stress of skiing?
Your physical therapist can help you with this. They will run you through a series of tests and measures that assess your strength and endurance, movement patterns, and balance. If there is any deficit in these areas, the therapist will prescribe exercises that help to mediate potential risk factors for retearing the ACL. The therapist will also go over assessments that judge your readiness to return to sport. Some activities that the therapist might have you do include squats, lunges, resisted running, plyometric exercises, and balance exercises. When you are doing this, the therapist is looking to ensure you have the correct form even when fatigued.
This section will talk about how to avoid the ACL injury before it happens
Skiing with good form: Good ski form is hard to master. It may be worth your while to have a ski lesson or two in order to ensure proper technique. Generally speaking, you want your feet to be hip distance apart, knees and hips should be maintained in a deep squat, and your knees should not collapse inwards. Your torso should be pointing down the slope as this will give you more control from the hips when turning. The majority of your weight should be on the downhill ski, and you should be digging the edges of your skis into the slope.
General Fitness: The stronger your legs are, the less likely you will fatigue, which means, the less likely you are to make mistakes and injure yourself. Here are some exercises you can work on to build your strength:
Squats (pulses, holds, jumps)
Lunges and lateral lunges
Running or cycling program
Single leg balance exercises
Jumping activities
Stretching is another important activity to prevent injuries. The major muscle groups you should stretch are listed below:
Hamstring stretch
Quad stretch
Piriformis stretch
Lower back muscles
Hip flexors
It is always best to consult a professional prior to starting these exercises in order to assess your form and ensure safety when completing a new exercise program.
We may have done everything in our power to avoid an injury, however no one is safe from a serious injury. In the unfortunate event that you have torn your ACL, here is a list of additional factors that can contribute to your rehab and return to the slopes. This article is not designed to replace the advice from medical professionals due to the variability between people and injuries.
Patience
You just had your ACL repaired and are ready to hit the slopes, but you have to remember what your knee just went through. You don’t want to stress the knee too much too soon. Start on easy slopes to warm up your body. Listen to your body, are you having pain? Is there any instability in the knee? Is there any difficulty with the easy slopes? Does your form feel correct? If the answer to any of these questions is no, then you should stay on the easy slopes. Don’t expect to ski first to last chair, since your endurance may not be up to par. If you feel tired, you should take a break since you are more at risk for retear when your muscles are fatigued.
Time Frame
Bracing
Higher Level Strength Training
Endurance
Equipment
Warm Up
Confidence
Imagery and Relaxation Techniques
Overall Fitness
Each person is different and so is their ACL rehab. Time frames between surgery and return to sport vary based on age, gender, prior level of function, level of activity an individual is returning to ( recreational skiing vs. competitive skiing), graft type (autograft vs. allograft), previous injuries, comorbidities, co-injuries, current strength, success with rehab, and presence of any adverse movement patterns. Since everyone is different, it is best to take your return to skiing one step at a time as you feel comfortable. With diligent work and focus, it is possible to return to the sport you love. If you are hesitant about skiing, still having pain, or want to work to prevent injury to your knees contact your local physical therapist for advice in these areas.
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