Hitting the Slopes? Prevent ACL Injury with These Expert Tips

Neal B. Goldenberg, MD, MA, an orthopaedic surgeon and chair of sports medicine at Dartmouth Health’s Cheshire Medical Center, displays a model of the bones and tendons of the knee.

The whole point of a prevention program is that it's easy for anybody to do. Typically, the program doesn't need to last more than 20 minutes and only needs to be done two to three times a week.

Neal B. Goldenberg, MD, MA

Most K-12 students in New Hampshire will have their winter break from February 26-March 1 this year, and many Granite State families will use that time to hit the slopes. Skiing and snowboarding is a great way to get outside and enjoy the season here in northern New England, but like any sport, it comes with risk of physical injury, especially if you don’t prepare your body ahead of time.

One common—and also painful and debilitating—injury caused by skiing and snowboarding is tearing of the anterior cruciate ligament, or ACL. “What happens is the tibia, or the shin bone, moves forward in relation to the femur, tearing the ACL,” said Neal B. Goldenberg, MD, MA, an orthopaedic surgeon and chair of sports medicine at Dartmouth Health’s Cheshire Medical Center. “Often, this happens when the knee is no longer directly above the toes. So, if you think about the position of someone cutting, and they're more kind of ‘knock-kneed’ at that time, they’re at higher risk for an ACL injury.”

By working on strength, balance, plyometrics and body awareness, people can guard against possible ACL tears, Goldenberg said. Starting these exercises a week or two before a planned ski trip is ideal, but starting even a few days ahead has benefits. Here are some exercises to consider, courtesy of the Multicenter Orthopaedic Outcomes Network Knee Group, with modifications available to best suit your level of fitness:

Strength:

  • Plank (push-ups)
    • Level 1: Both legs
    • Level 2: Alternate legs
    • Level 3: One leg lift
  • Side plank
    • Level 1: Static
    • Level 2: Dynamic
    • Level 3: With leg lift

Balance:

  • Single-leg balance
    • Level 1: Hold the ball
    • Level 2: Throwing ball with partner
    • Level 3: Test your partner
    • Level 4: Throwing ball with partner on wobble-board
    • Level 5: Test your partner on the wobble-board

Plyometrics:

  • Squats
    • Level 1: With toe raise
    • Level 2: Walking lunges
    • Level 3: One-leg squats
    • Level 4: Squats with toe raise on wobble-board
    • Level 5: One-leg squats on wobble-board

Jumping:

  • Level 1: Vertical jumps
  • Level 2: Lateral jumps
  • Level 3: Box jumps
  • Level 4: One-legged jumping sequence
  • Level 5: Box jumps with partner

Running exercises:

  • Running over a field – If you’re rehabbing after ACL surgery, you’ll begin walking on smooth surfaces before advancing to jogging and running and then on grass or other uneven surfaces.
  • Bounding run (basically high knee skipping)
  • Running and cutting
  • Running through a course
    • Hip out
    • Hip in
    • Circling
    • Running and jumping
    • Quick run

“It doesn’t need to be a very long or intensive routine,” Goldenberg said. “The whole point of a prevention program is that it's easy for anybody to do. Typically, the program doesn't need to last more than 20 minutes and only needs to be done two to three times a week.”