Skiing in Japan or South Korea? Here are expert tips to prevent and recover from skiing’s injuries

As ski resorts in Japan and South Korea start opening for the winter season, many of us are eager to hit the slopes. There’s fresh, fluffy powder on the mountains, new ski garb ready for use and there is a mix of fun and adrenaline rush when it comes to experiencing the sport.

However, whether you’re a beginner or expert on the slick ski slopes, there comes the risk of injuries - with knee injuries ranking as the top winter sports injuries for skiers. 

To help you get prepared for your ski trip, we asked Dr. Mizan Marican, an experienced orthopaedic surgeon with clinics at Mount Elizabeth Medical Centre and Katong, for his advice on what to do if you sustain them.

Before ski trip, take these simple but effective preventive measures

Preparation is key

Many skiers prepare for their ski trip a few months before by doing specific strengthening and stamina exercises. These include high intensity interval training (HIIT), weights at the gym and simple 5km runs. These exercises certainly help to elevate the general strength and stamina of your body so that you can withstand the stresses of skiing during your year-end holidays! With better muscle strength and conditioning, skiers have better control of your posture and joints. This helps them maintain their balance and prevent falls. 

Checking ski equipment

With any sport that requires equipment and training, it is important to inform the professionals at the ski rental shop the level of your skiing abilities (beginner, intermediate, professional). For beginners who are more likely to fall while skiing and who have not formed protective mechanisms when they fall, the fitters may adjust how tight your skis attach to your ski boots and make it slightly looser. 

This allows the skis to disengage from the boots when you fall so that the high torque or twisting forces are not translated to your knee to cause those ligament injuries. The drawback of this is that each time you fall and your skis disengage, you will have to walk down the slopes in your chunky ski boots to pick up your skis!

Professional skiers on the other hand will want a very tight attachment between their ski boots and their skis to prevent any disengagement as they are travelling downhill at high speeds and carve the mountain at high torques! They will NOT want their skis to disengage!

Beginner or intermediate skiers should also undergo some training with a certified coach to learn the basics of skiing downhill safely to prevent serious injuries. This is especially for skiers who ski only once a season. The focus will be about coming down the slopes making comfortable turns and controlling your downhill speed. Do not depend on your ski poles to reduce speed as this may lead to elbow injuries and dislocations. 

Bringing food and keeping hydrated

It is always important to keep well hydrated and have some breakfast before you start skiing. Dehydration can lead to muscle pain, spasm and a build up of lactic acid. This causes a burning pain in your thighs as you come down a steep slope. It is also good to keep some snacks in your backpack or pockets so you are not too hungry as you sit on the ski lift towards your next mountain top. 

Heat packs are also important accessories you should bring to keep your core and peripheries (hand and feet) comfortably warm as you enjoy the mountain tops and slopes. There are small heat stickers that you can place under your clothes, gloves and socks when you get ready to ski and can be disposed of at the end of each day. Do bring enough for yourself and family members, taking into account the number of days you’re spending in the snow!

Skiers commonly experience mild injuries like muscle aches and sprains to severe injuries like ligament ruptures

It takes quite a lot of strength and endurance to be in a half squat position as you ski down the slopes. The steeper the slopes are example, black runs, the more stress you place on our thighs and knee joint. When we spend six hours on the slope per day for a week, it will surely take a toll on our bodies. Many of us experience a severe burning sensation in our thighs as we are skiing due to the build-up of lactic acid in our muscles.

Why do knee injuries happen so frequently among skiers?

Knee injuries such as simple strains and sprains to more severe ligament injuries are rather common amongst skiers. Falling over is a rather common occurrence when it comes to skiing. Let’s face it, we’re mostly beginners or intermediate skiers and ski perhaps only once or twice a year. 

Some of us ski once every few years and only picked up the sport when we are adults. This infrequency makes it difficult for us to master the art of skiing and our body loses its muscle memory when it comes to carving and shifting our weight about. We may also not be familiar with the types of snow, undulations (moguls) and other terrain challenges that we face.

Ligaments around the knee allow us to move in a stable manner. We have four main ligaments around the knee. The two cruciate ligaments, the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are situated in the middle of our knees connecting our femur and tibia bones together. The Medial and lateral collateral ligaments (MCL, LCL) are situated on either side of our knee. 

The ACL provides stability to our knee when we twist and pivot during daily activities and strenuous sports. The ACL itself is an extremely strong structure but can still tear or rupture if excessive force is applied to it! This commonly happens in skiing due to the sudden change of direction at speeds while the foot and knee move in different directions. 

Ligament injuries are very common in skiers. It was reported that ACL and MCL injuries make up about 25% to 30% of all skiing injuries. This includes both amateur and professional skiers. So why is it so common? Unlike snowboarders, skiers’ feet are independently attached to two separate skis through their rigid ski boots. 

How to keep safe while skiing on slopes

While skiing at high speeds and torque, skiers may lose control of their feet and both feet may move uncontrollable in very separate directions. One knee may twist hard while the skier’s body tumbles down the side of the mountain. If the twisting force is more than what the ACL can tolerate, the ACL will rupture and the skier will experience immediate pain in the knee.

 The other mechanism in which skiers may rupture their ACL is through the ‘anterior drawer’ method. As they land off balance and their buttock hits the slope, their lower leg in the boot continues to move forwards. This pulls the ACL forward to the point of rupture. 

The most important tip is to do warm-ups before you start hitting the slopes. Stretch muscle groups like your hamstrings, thigh muscles, calf and hip muscles before and after the sport. Another important tip is to hydrate. Despite being in the cold, you will certainly perspire as you carve your way down the mountain side. Do bring along a small bottle of water in your backpack or ensure you have enough to drink during your lunch break!

What happens if you’ve had a bad fall

You know you’ve had a bad fall or knee injury if you experience severe pain and are unable to move your knee freely. 

First, try and wave for help to someone nearby and inform them you have a serious injury. This might be a friend, family members or just a fellow skier. They might be able to shield you from oncoming skiers and prevent a further collision. If you’ve lost your skis or poles, they will help you retrieve them while you sit in one spot. 

While you are sitting, try moving your toes, ankle and knee. If any specific part hurts, just rest a while before trying again. If the pain is persistent, worsening or unbearable, or if you are not able to put on your skis or stand on your own, you or your assistant may call the ski patrol to bring you down the mountain slope for further assessment and treatment. They may pull you along in a rescue taboggan behind their snowmobile. It is good to have their emergency contact number for these sorts of things. 

If the knee injury is not too bad and you can make your way down the mountain yourself, it is best to apply some ice and compression to your knee to help with its recovery. If the symptoms worsen the following day, it’s best not to ski the following day and have a medical professional take a look at your injury. They may have an x-ray machine to ensure that there are no fractures around the knee. They may also be able to provide a knee brace and some medication for your pain and swelling.