SKI TOURING AND NORDIC SKIING INJURIES AND PREVENTION

PRESENTED BY KEVIN MACOMBER, PT, CERT MDT

1/5/2023

ABOUT ME…

• Practicing PT for 27 years. Graduated from Daemen College in Buffalo, NY
• I specialize in Orthopedics, Sports Medicine and The Mckenzie Method.
• Owner of Above It All PT, founded in 2009, Highlands Ranch, CO
• Added 2nd clinic location @ Dove Valley, CO in 2020.
• NSP member since 1987! 35 years! Bridget Johnson and I started together at Bristol Mt, NY, and have stayed together since…Berthoud Pass and BMNSP.
• I am a member of the Winter Park Bike Patrol.

ABOUT ME…

• I’m an avid skier- alpine, touring, nordic.
• I’m a mountaineer, both alpine and ski.
• My climbing resume includes 43 CO 14ers, more than 30 named 13ers, Mt Rainier, Mt Hood, Mt Adams, Mt St. Helens, Pico de Orizaba, MX.
• I’m a skimo racer- competed in Audi Power of Two, Copper Mountain Uphill Series, Aspen American Uphill, Grand Traverse, Winter Park Uphill Mountain Battle.

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• TRAUMA- WE KNOW THIS FROM OUR OEC TRAINING- SPRAINS, STRAINS, CONTUSIONS, LACERATIONS, FXs, CONCUSSIONS, NEUROLOGIC
• REPETITIVE INJURIES- COMMON TO BOTH FORMS OF SKIING

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• REPETIVE TRAUMA=OVERUSE SYNDROME
• MICRO-TEARS IN SOFT TISSUE
• AN INFLAMMATORY RESPONSE OCCURS
• THE REPAIR BEGINS!

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• PHASES OF HEALING
• ACUTE- TIME OF ONSET—>2 WEEKS
• SUBACUTE- 2-4 WEEKS
• CHRONIC/REMODEL- 4-6 WEEKS+

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• REPETIVE STRESS RELATED PATHOLOGY
• TENDINITIS, TENOSYNIVITIS, BURSITIS, TENDINOSIS
• LABRUM/MENISCUS
• ARTICULAR (JOINT)

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• REPETITIVE INJURIES- UNDERSTANDING THE MECHANICS IS IMPORTANT
• NORDIC SKATING VS. CLASSIC VS. TOURING

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• NORDIC SKATING
• REQUIRES FORWARD, BACKWARD AND LATERAL MOVEMENTS.
• THE MECHANICS STRESS:
1. PRIMARY SOFT TISSUE MUSCLES: UE- WRIST/FOREARM, ELBOW EXTENSORS>FLEXORS, SHOULDER FLEXORS AND EXTENSORS; BACK EXTENSORS, LE- GLUTES, TFL/IT BAND, VASTUS LATERALIS, GASTROCNEMIUS/SOLEUS, PERONEALS, ANTERIOR TIBIALIS.
2. JOINTS: UE- WRIST, ELBOW, SHOULDER; SPINE, LE- HIP, KNEE, ANKLE

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• NORDIC SKATING COMMON REPETITIVE INJURIES:
1. RADIAL WRIST PAIN (THUMB SIDE)- DEQUERVAIN’S TENOSYNIVITIS
2. OLECRONON TENDINITIS (TRICEPS INSERTION AT THE POSTERIOR ELBOW)
3. SHOULDER PAIN- DERANGEMENT OF CARTILAGE, TENDINITIS- USUALLY POSTERIOR PAIN.
4. HIP PAIN- GREATER TROCHANTERIC BURSITIS, DERANGEMENT- LABRAL DISRUPTION
5. KNEE PAIN- PATELLOFEMORAL- LATERAL TRACKING, IT BAND SYNDROME/SNAPPING IT BAND.
6. LOWER LEG/ANKLE- PERONEAL TENDINITIS/TENOSYNIVITIS, ACHILLES TENDINITIS, CALF STRAIN, SHIN SPLINTS/COMPARTENT SYNDROME.

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• CLASSIC NORDIC
• REQUIRES FORWARD AND BACKWARD MOVEMENT THE MECHANICS STRESS:
1. PRIMARY SOFT TISSUE MUSCLES: UE- WRIST/FOREARM, ELBOW EXTENSORS>FLEXIORS, SHOULDER FLEXORS AND EXTENSORS; BACK EXTENSORS, LE- HIP FLEXORS, GLUTES, QUADRICEPS, GASTROCNEMIUS/SOLEUS, ANTERIOR TIBIALIS.
2. JOINTS: UE- WRIST, ELBOW, SHOULDER; SPINE, LE- HIP, KNEE, ANKLE

UNDERSTANDING INJURIES RELATED TO NORDIC SKIING AND ALPINE TOURING

• CLASSIC NORDIC COMMON REPETITIVE INJURIES:
• RADIAL WRIST PAIN (THUMB SIDE)- DEQUERVAIN’S TENOSYNIVITIS
• OLECRONON TENDINITIS (TRICEPS INSERTION AT THE POSTERIOR ELBOW)
• SHOULDER PAIN- DERANGEMENT OF CARTILAGE, TENDINITIS- USUALLY POSTERIOR PAIN.
• HIP PAIN- HIP FLEXOR TENDINITIS, DERANGEMENT- LABRAL DISRUPTION
• KNEE PAIN- PATELLOFEMORAL, PATELLAR TENDINITIS, QUADRICEPS STRAIN.
• LOWER LEG/ANKLE- ACHILLES TENDINITIS, CALF STRAIN, SHIN SPLINTS/COMPARTENT SYNDROME.

ALPINE SKI TOUR INJURIES

• IN TOUR MODE THE MECHANICS AND INJURIES ARE SIMILAR TO THOSE OF CLASSIC NORDIC SKIING. TOURING EQUIPMENT IS HEAVIER THAN NORDIC SO THERE IS MORE STRESS ON THE BODY. EXCEPTION- SOFT TISSUE REPETITIVE INJURIES TO THE ANKLE/LOWER LEG (TENDINITIS) ISN’T SEEN DUE TO THE IMMOBILIZATION OF THE HARD TOURING BOOT.
• IN ALPINE MODE INJURIES ARE THOSE RELATED TO ALPINE SKIING- HIGH VELOCITY/IMPACT MOI. KNEE LIGAMENT INJURIES AND EXTREMITY FXS ARE LIKELY.

PREVENTING SKI TOURING AND NORDIC SKIING INJURIES-7 PILLARS TO HELP PREVENT INJURIES:

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1. STRETCH AND MAINTAIN NORMAL RANGE OF MOTION
• TO BE DONE DAILY AND AFTER ACTIVITY
2. MOBILIZE SOFT TISSUE
• MASSAGE
• FOAM ROLL
• THERAGUN
• THERACANE
3. PERFORM DYNAMIC WARM UP PRIOR TO ACTIVITY
• WRIST ROLLS
• ARM SWINGS/CIRCLES
• LEG SWINGS/CIRCLES
• AIR SQUATS WITH OVERHEAD PRESS
• WALKING LUNGES- FORWARD/BACKWARD/LATERAL

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PREVENTING SKI TOURING AND NORDIC SKIING INJURIES-7 PILLARS TO HELP PREVENT INJURIES:

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5. BALANCE

• PERFORM DAILY, 3 DAYS MINIMUM PER WEEK.

6. STENGTH

• FOCUS ON SPECIFIC MUSCLES AND FUNCTIONAL MOVEMENTS USED IN SKIING
• PERFORM 3 DAY PER WEEK

7. CROSS TRAIN IN THE OFF SEASON- HIKING, CYCLING/MTB, SUP/KAYAK, SWIMMING, RUNNING, GYM CARDIO MACHINES

• STUDIES SHOW STRONG EVIDENCE THAT THOSE WHO DO NOT VARY THEIR ACTIVITY OR TAKE AT LEAST A MONTH OFF OF THE SAME ACTIVITY, ARE AT A GREATER RISK OF INJURY.
• TRAINING FOR THE UPHILL ATHLETE- BY STEVE HOUSE, SCOTT JOHNSON, KILLIAN JORNET

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SPECIFIC FOAM ROLL MOBILIZATION

STRETCHES

SKI BALANCE

SKI STRENGTH

THAT’S ALL FOLKS. THANKS FOR LISTENING!