11/25/2025
🎿 How to Dodge KNEE INJURIES this Ski Season ⛷️
- written by Adam Yu, our Masters of Physiotherapy student
Ski season is just around the corner, which means that many of us will soon be dusting off our skis and hitting the slopes. Skiing and snowboarding is a great way to enjoy the outdoors and improve cardiovascular health, especially for older adults. However, as we age, our bodies experience changes that can increase the risk of injury, particularly to the knees. One of the most common knee injuries from skiing is an anterior cruciate ligament (ACL) tear. Understanding some basic knee anatomy, how ACL tears can happen, and some strategies to protect your knees can help you safely enjoy the upcoming winter season.
Basic Knee Anatomy: 🩻
The knee is a complex hinge joint that connects the thigh bone (femur) to the shin bone (tibia). Between these two bones sits a shock-absorbing piece of cartilage called the meniscus. The kneecap (patella) sits at the front of the joint to help facilitate knee bending (flexion) and straightening (extension). Ligaments are tough fibrous bands of tissue that connect the femur and tibia and stabilize the knee. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) run diagonally through the middle of the knee and provide stability when stopping suddenly or rotating. The medial collateral ligament (MCL) sits on the inside side of the knee and provides side-to-side stability. The lateral collateral ligament (LCL) serves the same purpose on the outside of the knee.
As we age, these ligaments can lose some of their elasticity and strength, making them more susceptible to injury. While we think of an ACL tear, we usually picture a complete rupture of the ligament, but tears can also be partial. Ligament injuries are graded from 1 to 3; a grade 1 tear is one in which the ligament has stretched and has one or more small tears. A grade 2 injury is a partial tear, and a grade 3 injury is a complete rupture.
Almost all partial tears will heal, but complete tears require a lengthy rehabilitation period. In most cases, surgery is required to repair a complete tear but some individuals don’t receive surgery and still recover extremely well with only physical therapy. While ACL repair surgeries are extremely common and successful, tearing an ACL drastically increases the chance of developing knee osteoarthritis later in life, regardless of whether the knee is operated on or not.
What Contributes to an ACL Tear? 🤔
The ACL is the most commonly injured ligament in the knee and can tear when stretched beyond its limits or put under excessive force. Skiing, with its dynamic movements and high-impact nature, is a sport where ACL injuries are unfortunately common, especially for older adults. Other sports that commonly see ACL tears include soccer, basketball, and football.
Sudden twisting movements or abrupt changes in direction place rotational strain on the knee. At high speeds, these movements can be challenging to control, and can cause the knee to twist in a way it wasn’t designed to handle, tearing the ACL. This can happen in skiing or snowboarding when you “catch an edge.”
Falling is an unfortunate part of skiing that can also cause ACL tears, especially if you fall on your leg when it is completely bent (hyperflexed). Conversely, falling on a completely straight (hyperextended) knee can also cause ACL tears.
As we age, our muscle mass tends to decrease, especially in the large muscle groups around the knee like the quadriceps and hamstrings. Because these muscles play such an important role in stabilizing the joint, having weak muscles can result in poor knee control and increase the risk of injury. Additionally, having “imbalanced muscles” in which the strength of the quads greatly exceeds the strength of the hamstrings can also contribute to poor knee function.
People who have torn their ACLs describe their injuries very similarly. Usually, they report a “pop” at the time of injury, which was initially painful, but soon subsides. There is usually quite a bit of swelling in the hours following the injury. After the pain and swelling subside, the leading complaint is usually instability and reports of the knee “giving out.”
If you suspect that you have torn your ACL, it is important that you get your knee assessed by a healthcare professional like a physiotherapist or doctor. A physical exam is often sufficient to diagnose an ACL tear, but oftentimes other parts of the knee such as the meniscus or MCL are injured at the same time and these injuries may warrant further medical imaging (such as an X-ray or MRI scan).
Protecting Your Knees While Skiing: 🎿
Although skiing carries some inherent risks, there are several strategies you can adopt to reduce the likelihood of injuring your knees!
1️⃣ Warming up – Before beginning your ski day, it is essential to properly warm up your muscles and joints. Focus on dynamic stretches that target your lower body, such as leg swings, hip rotations, and squats. These dynamic stretches should take your joints through their entire range of motion. Warming up prepares your joints for the demands and impacts of skiing. It is also wise to begin with a few easier runs before tackling your biggest runs of the day, just to prime your body and brain for the physical and cognitive demands of these trickier runs.
2️⃣ Strengthening – Maintaining strong muscles around the knee joint is the best way to protect the ACL. Training that focuses on all main muscles off the knee (hamstrings, quadriceps, glutes, and calves) can improve strength, balance, and proprioception (the ability to sense where your body is in space) which all help prevent falls.
3️⃣ Training should begin in the off-season and continue throughout the season. Remember, it takes time to build and maintain muscle, so start early and progress the weight of any exercises slowly to avoid injuries from training. Exercises like lunges, squats, Romanian deadlifts, and calf raises target these main muscle groups. The best exercises are specific and mimic the actions you do during skiing.
4️⃣ Wear properly fitted equipment – Ski boots and bindings should be appropriately fitted to ensure optimal performance and safety. Ill-fitting boots can lead to improper alignment of your knees, increasing the risk of injury. The boots should be snug but not painfully tight, and the bindings should release properly in case of a fall to prevent excessive strain on the knees.
5️⃣ Take breaks and know your limits – It's important to listen to your body and take breaks when needed. Skiing can be physically demanding, and fatigue can impair your coordination and reaction times. Overexertion increases the risk of accidents, so rest frequently and stay hydrated. If you start feeling tired, it’s better to take a break than to push through the fatigue, which can lead to poor form and increase the likelihood of a knee injury. In fact, a large proportion of ski injuries happen during the last run of the day as the fatigued muscles aren’t able to protect the knee as easily.
Ready For Ski Season:💪🏼
Be sure to strengthen your legs and listen to your body to see if you’re ready for winter sports. Also be sure to maintain your fitness throughout the winter – exercise is protective not only for knee injuries, but for many chronic health conditions! If you notice that your joints are sore, be sure to take a break and know that you can always seek help from a therapist who can help address your pain and injuries. We hope that you have a safe ski and snowboard season this year! 🙌🏼
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