OCR Text |
Show The Park Record B-8 Subscribe today! Anatomy of an ACL injury A deeper look into a popular injury in winter sports PHIL LINDEMAN Summit Daily F E E R $50 Egyptian Theatre Gift Card Offer for new, in-county, print, two-year subscribers. Available until April 30, 2017 and while supplies last! While supplies last! Sign up for a new two-year, in Summit County, print subscription and receive a $50 Egyptian Theatre gift card! Please call The Park Record at 435-649-9014 and ask for our circulation department for more details. Serial Sarah and Julie Main2.pdf 5 3/20/2017 3:55:35 PM Wed/Thurs/Fri, March 22-24, 2017 “See ya later MCL!” reads the caption with Keri Herman’s Instagram video from March 13. “At least I went out grabbin’. Who wants to go to the beach?” In the video, the Breckenridge pro skier — the same 32-yearold Minnesota native who has claimed 16 medals at X Games, Dew Tour and the Grand Prix over the past decade — is going for a hard-way 270 off a shooter rail at her home mountain. She spins, she grabs, and then she lands just a touch short of the full 270, wrenching her left knee under her body at an angle anyone would describe as wrong. Hours later, she had the diagnoses: a blown MCL and the end of her ski season. This year’s MCL tear is just the latest in a long line of injuries for Herman. She’s missed full nearcomplete seasons due to concussions and past knee injuries, and she’s hardly alone. Knee ligament tears — otherwise known as blowing out a knee — are the No. 1 injuries for skiers, said Rick Cunningham, an orthopedic surgeon with Vail Summit Orthopedics. In more than a decade with the office, Cunningham has repaired hundreds of ACLs, MCLs and other ligaments that hold the knee together and make sports like skiing, basketball, baseball and tennis possible. Those kind of kinetic, fastmoving sports are the most dangerous for knee joints, and it all comes down to the twisting, jerking, high-impact movements that even novices have to endure. Some injuries, like Herman’s MCL, will heal naturally with enough downtime and a strict physical therapy regimen. Others, like an ACL tear, require surgery to fully heal, especially if a skier or snowboarder ever wants to ride again. Meet your ACL But an ACL tear isn’t as simple as rest and relaxation. The ACL sits inside the knee behind the kneecap. It holds the tibia in your lower leg to the femur in your upper leg and prevents one from jutting out in front of the other. Like all knee injuries, ACL injuries come in three levels, agreed Cunningham and local physical therapy offices. Grade I trauma is relatively minor and is often referred to as a sprain. Grade II injury is more serious and includes partial tearing to the ACL fibers, which makes it weaker and more prone to injury. Grade III is the end all, be all, when a ligament is fully torn in half. “In other parts of the U.S., where you have a patient who does little more than walk or ride their bike, they might not need surgery,” Cunningham said of ACL injuries. “Maybe they just need to protect the knee and avoid impact sports. You only need surgery absolutely if you’re doing cutting and pivoting sports that expose your knee to those movements.” The winter sports connection Why, then, are ACL and MCL injuries so common with skiers and snowboarders, while other knee ligament tears are rare? It comes down to the natural movements of both sports. Skiers are more prone to knee injuries — they’re wearing two enormous sticks, or levers, and barreling down hills, after all — while snowboarders are more prone to upper-body injuries, including broken wrists and dislocated shoulders. A 2012 study in the American Journal of Sports Medicine found that 28 percent of snowboard injuries involve the wrist, while 17 percent of skiing injuries involve the ACL. “People fall in lift lines and tear their ACLs all the time,” said Paula Ashbaugh, a physical therapist with Avalanche Physical Therapy who works part-time at the Breckenridge Medical Center on Peak 9. The ACL is the weaker of two ligaments inside the knee, and Ashbaugh said it’s often ruptured when the knee twists out of alignment in relation to the thigh. Because snowboarders have two feet attached to one piece of equipment, their knees are more protected against the buckling and bowing motion of skiing — even if they’re more likely to fall completely off-balance. If skiers are more prone to knee injuries simply because of their equipment, then how do snowboarders blow a knee? Simple: flat landings and strong quads. A 2009 study in another medical journal compared knee injuries for snowboarding and alpine skiing, showing that all 35 of the included snowboard injuries came from landing flat after a jump. Of those 35, 31 injuries were to the front leg. Researchers found that these snowboarder’s quad muscles were strong enough to rip the ACL after a hard, flat landing. Over time, researchers and doctors have found that ACL injuries (and other knee ligament tears) also tend to be more prevalent with women. It comes down to anatomy: Women’s hips grow wider than men’s during puberty, which leads to a natural bowing of the legs at the knee. This puts some women’s knees under pressure long before they even step into a pair of ski boots. Roads to recovery Surgery or not, knee recovery is vital for anyone who lives an active life, or even simply wants to walk stairs comfortably years from now. Ashbaugh and Eric Dube, a physical therapist with Howard Head Sports Medicine, recommend three things immediately after injury: manage the swelling, return to a normal range of motion and work your quad. “It’s all about stability: What can you do to stabilize the knee?” Ashbaugh said. “And it starts with the quad. It’s going to help you walk better, it’s going to help you keep you range of motion and it’s going to help you walk when you get done.” Physical therapists and doctors suggest rehab after any knee injury or surgery, and the trick is to continue strengthening the muscles and joints long after you’re back to normal. It isn’t guaranteed to ward off another injury, but it can help. “That’s like saying if you’re a totally fit athlete and train properly, you won’t tear your ACL,” Ashbaugh said. “But what about Lindsey Vonn and Bode Miller? We see professional, world-class skiers tearing their ACLs. It might help you ski longer and last longer.” |