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The Sports Medicine Doctor: Leg and Knee Injury in Downhill Skiers

By Andrew W. Gottschalk, M.D., Director of Sports Medicine

Champion Orthopedics & Sports Medicine at Cole Memorial Hospital

When I was 14 years old, I was downhill skiing with my older brother on a blustery day in northern Michigan. He was stronger and faster, and I raced to catch up. I lowered my center of gravity, hit a tight clump of snow exactly the wrong way, and my right leg twisted out and under me as I collapsed. I had just broken my shinbone.

The leg and the knee are two of the most commonly injured body parts in this very popular sport. Each year, downhill skiing is enjoyed by around 200,000,000 people worldwide. There is only about a 0.35 percent chance of being significantly injured when a skier hits the slopes, which doesn’t sound like much. But with so many people participating in the sport, even this small percent results in a large number of people hurt each year.

As my 14-year-old self can attest, when a skier breaks a leg bone it is usually the shinbone (the tibia). The thin support bone next to the shinbone (the fibula) is also broken by skiers, though less often. The thighbone (the femur) may be broken when skiing, though this is fortunately very rare. The thighbone is strong, thick, and the longest bone in the human body. Breaking this bone takes significant forces from a more serious fall or collision.

Several years ago, leg fractures used to be much more common than they are today. We can thank improvements in ski equipment for this change. Ski boots have improved as stiffer materials have been developed. Also, rapid release bindings now snap a boot from the ski before torsional forces rise high enough to fracture through bone.

The falling rate of broken legs is good news. However, now ski-related knee problems are being seen more and more often. Knee injuries usually involve hurting a ligament, a thick rubber band-like structure that connects one bone to another. There are four main ligaments that hold the knee together, one on the inside of the knee, one on the outside of the knee, and two deep within the knee. These injuries are common!

Almost one in five skiing injuries involve the inside knee ligament (the medial collateral ligament) or one of the deep knee ligaments (the anterior cruciate ligament). Some ligament problems heal with rest, some need good physical therapy and rehabilitation, and some require surgery. It is important to have a doctor who knows which is which. Never be afraid to ask for help.

Breaking a leg is a traumatic event, so you might think I would have thought twice about more skiing. But I had a great medical team, and I met a wonderful doctor that day who was smart and kind. That doctor saw that I was well healed and — just as importantly — well educated as to the risks of skiing and how to be safe on the slopes. The next winter I was again enjoying snowy days with my brother on the Michigan hills and enjoying the feeling of the snow beneath my skis and the wind against my cheeks as I charged after him.

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