Skiing After ACL Injury
Let me make one thing clear. It doesn’t have to be impossible to get back to skiing after ACL injury. I have had ACL reconstruction on both my knees. Both my ACL injuries happened when I was competing on the world cup in moguls skiing – 5 years apart. The first was more than 15 years ago but I still go out skiing every year.
It does require specific, goal oriented training though. In the following you can read a little about what happens after an ACL injury.
Usually, when you tear an ACL, your balance on that leg gets poorer. That’s because the ACL contains little receptors that tell your brain what position your knee is in. And what you need to do to correct for balance. The connection to these receptors are broken when the ACL is torn. To get good balance reflexes again, you need a lot of balance training, or proprioceptive training as it also called.
The good news is that balance improves quickly, once you start training it – as long as you keep your training challenging.
It is also important to work the absolute strength in your legs. If you don’t, the strength of that leg will decline significantly after an ACL injury. As a result, you will start compensating and likely cause other problems. It is very important to keep an eye on the VMO ( the little muscle just above your knee to the inside). You don’t want this muscle to weaken too much. It has an important role keeping the knee cap in place and making sure it is not pulled laterally by the other thigh muscles.
It is better to work your legs in closed kinetic chain exercises. This means, do exercises where your foot is against some kind of support. Squats and step-ups fx. are closed chain exercises.
Seated knee extension is an example of an open chain: You kick out in the open. I usually don’t recommend that exercise, but it can be okay for muscle re-activation purposes (i.e. reconnecting with those muscles again after the injury). If you choose to do this exercise, don’t work with very heavy resistance. It may cause you knee pain because of the sheer forces. As you get stronger it is better to replace it with the reverse step-up exercise (closed chain). In this exercise the foot is locked against the step and it is easier to control knee stabilization. Besides, the movement is more functional and you can do it anywhere there is a step.
It is also very important to strengthen the hamstring muscles (on the back of the thigh). They assist the ACL in holding the tibia under the femur, thus stabilizing anteriorly. If, for instance, you get in the back seat while skiing and you want to pull yourself up, then you would contract your quadriceps muscles to avoid bending your knees further and you hip extensors (hamstrings and glutes) to move the hips forward again. If your hamstrings are strong, they will assist by co-contracting. This in turn helps decrease the load on the ACL. If the hastrings are weak, they will not contribute as much and the ACL will be under relatively more stress.
If your ACL is partly or completely torn and you didn’t have an ACL
reconstruction then obviously, the hamstring strength becomes even more important. Otherwise you knee will be very unstable and you run a great risk of doing even more damage to your knee. In this case, you will want to make sure that your hamstrings are not only – but also that they are not too fatigued when you go skiing.
For skiing, strength training should preferably be performed with single legged exercises. With double-sided exercises such as regular squats, it is very easy to compensate unconsciously and let the stronger leg take more loading. In fact, it is very hard to avoid even if you are conscious about it.
Most people don’t notice that they are compensating, but the problem with that is obviously that your strong leg then will get stronger and stronger and your weak leg will get weaker and weaker. Another problem is that these imbalances might soon translate to other parts of the body causing other injuries or pains.
A bonus to single leg exercises is that it has balance training incorporated.
Finally, you need to train the agility of your legs. The communication path to your leg muscles will most likely have gotten a little rusty after your injury and you might not find it all that easy to make quick shifts in direction or absorbing a shock or a landing. Through agility training you can recover those quick reactions and useful movement patterns. A good place to start, is by simply sitting on a chair, tapping your foot as fast as possible and making small patterns with your foot such as triangles and squares with fast, little movements.
Train progressively. Get your 2-progression ski workout video here
When you get better contact with your foot and your leg is getting stronger, you can progress to landing or bouncing on a softer surface like a BOSU ball. First on two feet and the on one foot with focus on absorbing the landing. When this is easy, you can add jumping off the BOSU again. Keep progressing this way by gently til your knee feels more stable and secure.
Taking the above factors into your training is a good path for regaining knee stability and getting back on snow to enjoy skiing after ACL injury.