Safety on the snow: A surgeon’s guide to skiing and snowboarding without injury

If you’re heading to the slopes this year, there are ways to ski and snowboard safely. We asked Mr Mazin Ibrahim, Consultant Orthopaedic Surgeon, for advice on winter sports. A specialist in knee injuries at The Princess Grace Hospital, part of HCA Healthcare UK, Mr Ibrahim sees many patients who have returned from snow sport holidays with knee injuries.

Here’s what he told us:

What are the most common knee injuries among skiers and snowboarders?

The two snow sports are very different and cause different injuries. Skiers tend to have more knee injuries, while snowboarders probably get more head and shoulder injuries.

Why is that?

Because skiers have their feet well planted and twist at high speed, they have more pivoting injuries. There may be tears to the main stabilising ligament, the ACL (anterior cruciate ligament), the PCL (posterior cruciate ligament) which is the connecting ligament at the back of the knee, or the meniscus (knee cartilage). Other injuries, such as collisions, can cause very painful MCL (medial collateral ligament) tears and even bone fractures.

Snowboarders are often tempted to try more tricks, jumps and stunts, so riders can fall onto their hands, shoulders or head. It is rare but sometimes they’ll injure their knee, typically if they collide with someone or fall directly onto it, in a tumble.

Who’s most at risk?

Beginners for sure, as well as people who don’t exercise regularly or make a habit of stretching before and after exercise. Experience makes a big difference – it’s not a good idea to try something without preparation. And with snow sports, it’s all about warming up. The trouble is beginners aren’t usually aware of the best warm up routines.

In terms of age, I see people of all ages, who just want to get straight back on the slopes. There is also some evidence that women are more liable to ACL injury than men in general.

If you injure yourself on a skiing trip, what should you do in terms of first line treatment?

Most resorts have a minor injuries clinic with doctors on site who can X-ray any minor injuries, including knee twists, to exclude fractures. Usually, they can offer a brace and crutches and advise the patient on how to elevate, rest, and ice the injuries. And, if you need to be referred to an orthopaedics specialist or transferred to hospital, it’s usually covered by winter sport travel insurance.

When should you see a specialist on your return? What are the signs that a knee injury isn't healing?

If you’ve come back and, one week down the line, you still have bruising, swelling, pain or instability, maybe with some clicking or locking, you really need to get it checked out. You can ask your GP for an urgent referral or just go direct to an orthopaedic surgeon for a specialist clinical assessment as soon as possible.

What does a specialist assessment look like?

It's a hands-on, clinical examination of the knee and the area surrounding the joint. If the knee feels very swollen and tender and you can’t put weight on it, I will usually do an X-ray to exclude a fracture. An MRI is best to diagnose any soft tissue damage like an ACL rear or an MCL tear.

Basically, going direct to an orthopaedic surgeon fast tracks your diagnosis. If conservative or non-surgical treatment is best, I will always refer on to a physiotherapist or sports physician according to the patient’s lifestyle or goals. If surgical treatment is required, I usually schedule the operation at the earliest opportunity.

What’s the treatment for a mild injury?

A mild ACL or MCL strain doesn’t need much intervention. It will heal on its own with ice, rest and anti-inflammatory painkillers. It can still be a good idea to see a physiotherapist to help build up muscle strength around the knee.

What about more serious injuries?

Usually it’s the complex, multiple ligament injuries that need urgent treatment. With injuries to the ACL, MCL and meniscus, often the patient can’t straighten their knee, let alone weight bear. These ‘locked knee’ injuries need urgent surgical intervention followed by a programme of carefully managed rehabilitation.

Other problems, however, can arise from simple orthopaedics injuries that got missed on the X-ray. That’s why it’s a good idea to see a consultant first. Some ACL injuries require what we call ‘prehab’ – a series of conditioning exercises before surgery to improve swelling, mobility and weight bearing – followed by rehab afterwards. This can help improve outcomes by maximising the condition of the joint before surgery. Afterwards, we may need to restrict their movement with braces, to promote healing, before they go back to sports and activities.

At The Princess Grace Hospital, we all get together – surgeons, physiotherapists, sports physicians and radiologists – to discuss complex cases, especially multi-ligament injuries, and manage referrals accordingly. It's always a collaboration.