Preparing to Ski Webinar – Pure Sports Medicine

This is the Preparing for Ski Season webinar that I did for Pure Sports Medicine, alongside my colleagues, on 17th November 2020…

Transcript

Welcome everybody to the Pure Sports Medicine Preparing to Ski presentation webinar.

Okay, so, for those who don’t know pure us at Pure Sports Medicine, we’re a multi-disciplinary team of sports and exercise medicine professionals. We have physios, like as myself. We have S&C coaches, like Chris. We have soft tissue therapists, like Yaad, who’s going to join us in a bit and we also have doctors and chiropractors and we run a tendon clinic and Pilates and podiatry and a variety of other sports and exercise medicine professions.

So, if you have any issues with that please come down and see us.

All right, so the plan – objectives – for today: I’m going to start off. My name’s Scott Walker. I’m a physiotherapist, Specialist Musculoskeletal Physiotherapist, and I am going to talk about various causes of common ski injuries and epidemiology. I’m also going to touch on some injury prevention decisions that you can take place whilst on the slopes.

Following on from me will be Chris, who you can probably see here. He’s a strength and conditioning coach and he’s going to talk about the key performance measures to help improve your ski performance, but also transitioning into and referring back to some of the stuff I’ll be talking about in terms of rehabilitation or injury prevention.

Then Yaad is going to join us. He’s our soft tissue therapist. He’s going to talk about preparing for a snow trip. So, how to prepare your soft tissues and the role of mobility in skiing as well as the role of soft tissue therapy and what you can do to help recover from a snow trip.

And then hopefully at the end we’ll have some time for some questions and answers.

I’d like to start the presentation with Why. Why? Why are we doing this presentation?

If you are familiar with Simon Sinek’s work, he always says starts with why.

So, what’s our motivation for giving this presentation and your motivation for preparing for a ski trip, and then, as I said, Yaad and Chris are going to touch on how we can help prevent some of these injuries.

So, let’s talk about epidemiology. We’ve all become expert epidemiologists in infectious diseases over the last year or so but what you may be less aware of is ski injuries.

In terms of joints, the knee is the most susceptible and vulnerable joint in the body, accounting for around a third of all ski injuries. Topping the list is ACL – anterior cruciate ligament – injuries. They account for, of all ski injuries… less common, quite rare actually, in snowboarders – and I’ll touch on snowboarding injuries a little bit later in the presentation however, skiing injuries… account for… they’re the third most common cause of ACL injuries in Britain, after football and rugby.

Following that is other knee injuries, but similarly… as I’ve just referred to ACLs play a massive role in hospitalisations when you end up with a ski injury.

A recent study that came out in August this year found that an ACL was involved in all hospitalizations after a skiing knee injury. Two-thirds of those were ACL. Sorry, two-thirds were ACL plus other knee injuries but over a third of those were ACL of those.

And that’s a fairly recent development. U until the late 90s, MCL, so medial medial collateral ligament, injuries are most common and that’s been attributed to the more performance, shorter and shaped carving skis that came out around then.

Following on from that, head injuries. SOS, a Danish health insurance company, found that they accounted for only about five percent overall of all ski injuries however they can be quite catastrophic. Even so, they’re still a third on the list of most common, similarly females and males generally have head injuries so it’s about – split there so don’t think it’s just the males who are doing stupid things and banging their heads.

And following on from that is other lower extremity injuries and fractures so, as I touched on, why are we doing this presentation? As you can see, this is data from football, but as you can see ACL injuries account for some of the most serious

injuries

you can have and that they can lead up

to days

off from in this case it was

professional sport but

in your case it could be from work from

playing sports and doing the other

things

that you like to do similarly fractures

are quite catastrophic and as we come

down

there’s your knee injuries and these are

some of the most severe injuries you can

have

so preventing them is imperative

sos the danish i think scandinavian

health insurance company found similar

things to the research they found that

around third of injuries were knee

lower limb and then upper limb

and neck and back and pelvic injuries

only accounted for about six percent but

these tend to be some of the more

catastrophic and we’ll touch onto that

touch on that in a bit

so who gets these injuries not just what

injuries do we get

as you can see from this little graph

here it tends to be

teenagers and people in their s who

think they’re pretty good and they’ve

got it and but it also

tends to be um people in in middle age

who either think they’ve still got it or

maybe are starting to get a little bit

more deconditioned and not preparing as

well

and not as ready to to undertake a snow

trip so

i think it’s be very relevant to this

presentation

it has already alluded to there’s about

a

split between males and females

getting sports um ski injuries

okay let’s just quickly touch on

snowboarders snowboarders generally

don’t get the knee injuries they

generally get the more upper limb

injuries with uh fractures and

and wrist wrist brains however they

still

genuinely get these head injuries which

can be quite catastrophic

um in the case of snowboarders males

generally get more head injuries than

females

and then as we come down it’s more

shoulder separations and wrist and

hand injuries spinal injuries only

account

for a small percentage of injuries in

snowboarders but obviously as i’ve

already said they can be some of the

most

catastrophic trophic injuries so well

worth presenting

when you have both skiers and

snowboarders

on the slopes the injury risk

rate increases by about and this

generally

is upper limb and head injuries

including fractures

and um and shoulder separations this is

generally because

i’m not a skier or a snowboarder

particularly but anecdotally

for what i’ve heard treating patients

coming back from snow trips this is

because

snowboarders and skiers generally take

different lines down the mountain

and they generally run into each other

so similarly there’s no change in gender

when you add snowboarders to skiers so

it’s not just

males doing stupid things where you ski

or where you snowboard

plays a massive role on your chances of

getting injured so let’s have a look at

the

terrain park versus the slopes over

over a fifth of all injuries on the at

the snow uh

actually come from the terrain park

where we have these ski

these jumps and half pipes and things

like that

um so skiing and snowboarding

in the terrain park increases your risk

of both head neck back and these

more severe injuries as a result of

doing jumps and aerial move

maneuvers and or falling off these

apparatus you’re not on the ground when

you start these

falls and they increase the risk of

serious injuries

so if you are going to have a little

play at the terrain park

um it’s better i’m sorry i’ll get on to

that in a bit but

what the research does show that it’s

not just either beginners or

intermediate or experts that um

generally hurt themselves more

in the terrain park that’s pretty much

if you even split

amongst those and um percent of all

spiral injuries i do occur in the

terrain park

and these spinal injuries in one

particular study they found that

the uh in us in one snow season there

was spinal injuries

and nine of them were considered frankl

a which is essentially no motor or

century function

below the level of the lesion so that’s

essentially complete

paralysis so quite serious spinal

injuries we’re talking about here

as i’ve started to speak about if you

are going to have a little play around

in the terrain park it’s probably best

to

stick to the the quarter pipes and the

and the rails compared to say your

half pipes and your your jumps compared

to rails

um the injury in half pipe

is you can see the stats there so i’ll

get on to it in a bit but

basically in terms of safety it go in in

terms of most safe it goes from

kickers up to mushrooms jumps and then

half pipes

so i’ve already sort of spoken about

this but what are the primary causes of

these

these injuries so in novices it’s

falling over or

collisions and an experienced snow goes

it’s

generally landing from jumps another key

factor which chris will talk about

is cardiovascular fitness many injuries

many injuries occur when people are

fatigued so there’s definitely a role

for that

also when they’re either drunk or doped

so

we’ll get onto that in a bit but um the

other causes of skin injuries

are incorrectly bound skis which can

lead to predominantly

knee injuries so this can either be the

quality and condition

of the binding or the ski boot itself or

it can be the

an inadequately adjusted binding

let’s have a quick chat about head

injury so this is some

general population stats but only

uh one percent of these are

life-threatening um

and about of them uh concussion which

can last

for months and have ongoing effects

mostly

you get over your head injury and has no

last

no lasting effects however in all three

groups initially these can appear very

very similar this is why we now see

football and rugby

in other sports really really diligent

when it comes to

any kind of head injury and so

recreational skier should be just as

aware of these head injuries

make sure if they occur that people are

monitored

and that it that make sure they don’t

deteriorate very very

very quickly generally stick skies and

snowballs

get get head injuries on easy and middle

slopes if not on in the terrain park

but however snowboarders gen generally

have it

get head injuries on the occipital

region which is essentially the back of

the head so

snowboarders generally fall backwards

onto their heads whereas skies

generally fall forwards or sideways so

that’s why

we need to pay attention to this injury

prevention

we want to decrease any massive personal

suffering with these catastrophic

injuries

the most prevalent injuries that you’re

going to get skiing are the ones that

are going to

have you not doing what you want to do

for months

on on end which with it comes medical

expenses

going to be massively expensive you’re

going to be spending a lot of time with

surgeons and people like myself and the

other people at pure sports medicine

and you’re not going to be performing at

the level that you want to be in

in work life or recreation for several

months

so what can you do whilst on the trip

it’s not hard to tell from what i’ve

talked about but make sure you

warm up properly every day you wear

appropriate clothing

it has it has been found that you’re

more likely to get injured on colder

days or when you are cold

so make sure you warm up and you dress

appropriately try to

limit the apres ski so not too much

alcohol and try to stay away from the

drugs

we all know that having too much alcohol

and other drugs can lead to increased

risk taking and decreased coordination

which is going to

increase your chances of getting injured

make sure you rest up make sure you take

regular breaks you don’t just ski your

day maybe take a

a day off and make sure you get plenty

of sleep so i hate to be a party pooper

but yeah try to avoid

too much partying tonight and too much

apres ski

and wear a helmet um if you’re a

snowboarder

make sure you have some protection

around the back of your head a

snowboarding appropriate helmet

this is some anecdotal information but

apparently i

i did have a patient who was a keen

skier a snowboarder and

no jumper and he avoided wearing a gopro

because he

he claimed that quite often that gopro

if you do

hit your head can be smashed through the

helmet and i believe he said that’s

was what contributed some of um

michael schumacher’s i know what’s

negative michael

schumacher’s um head injuries not that

we know a lot about that not only from

much information has been released about

it

as i’ve alluded to make sure you’re

wearing the

correct skis and make sure they fit you

and they’re being adjusted

for you if you are in a novice or sorry

if you are going to go

on in the terrain park make sure that

you

um are very careful um if you start off

on the kickers

then if you move on to the mushrooms the

jumps and the half pipes

um if you are a novice make sure you

take some lessons

you learn proper use of equipment how to

bind your skis how to

use your equipment make sure you

increase your skill and technique

and you learn the etiquette of the

slopes uh

there’s a lot of information available

on the slopes for preparing

so make sure you read all the safety

tips around

and make sure each day and each moment

you assess the snow conditions and take

them into consideration

along with your ski level all right so

i’m going to pass over to chris now to

talk

more about performance and

rehabilitation and injury prevention

thanks for scott see as scott mentioned

my name’s chris mccann i’m a strength

and conditioning coach for pure sports

medicine

and i’m based at our st paul’s clinic

i’m going to talk mainly through the

strength and conditioning

components of skiing so the first thing

we want to look at is what does sort of

like the academic research tell us about

skiing so here we have sort of the four

key

performance measures that the academic

research tells us

are sort of key performance measures for

ski performance and injury prevention so

they are aerobic capacity muscular

strength

muscular endurance and balance and i’m

going to touch on each one of these now

and give you sort of um tips on how to

train these and the importance of each

one of these so if you can move on to

the next

slide please scott so aerobic capacity

so why is aerobic capacity important in

skiing and why would we want to train

and improve our aerobic capacity

and so when we talk about road capacity

we talk about the function of our heart

and our lungs and our general sort of

cardiovascular respiratory function

so any kind of aerobic training is going

to lead to an increase in our stroke

volume so that’s the amount of blood

that your heart pumps per beat

so with aerobic training we get a bigger

more stronger heart the heart’s like any

other muscle

it can get bigger um and more efficient

so with a heart that has a greater

stroke volume

it’s more efficient therefore it can

pump up more blood with each beat so

therefore our resting heart rate

decreases

our heart becomes more efficient to

pumping out the same amount of blood

but a lower heart rate um a more

efficient heart is going to give us

greater recovery rates

i know an overall better health so our

heart is able to

pump blood around the body better we’re

able to

remove waste products from exercise

better so

from a skiing standpoint each time you

go on a run a more efficient heart

um it’s going to help you recover from

those each time day to day as well it’s

going to help you recover better

so if you think you know a day ski and

you might spend five or six hours on the

slopes

you know that’s quite a high increase in

activity from general sort of daily life

so it’s quite a high

spike in what we would class as your

sort of daily load

a greater um more efficient aerobic

capacity a better

heart and everything it’s going to give

you a better chance of recovering on

from day to day as well as during your

runs

and then obviously like scott touched on

a lot of injuries do come as a result of

fatigue so the fitter you are

aerobically

the better you are recovering the less

chance you are of getting

tired and leading to a fatigue-related

injury at a sort of the same sort of

level of intensity

um so if you want to move on to the next

slide please scott

so how do we go about training our

aerobic capacity how do we go about

getting those adaptations that i just

mentioned

well so the main thing sort of to do it

is long slow duration activities

so that can be a run a bike or a cross

trainer

a lot of stuff these days does focus on

sort of like high intensity like short

bursts

getting a lot of um a lot of work done a

small amount of time

but the research does show that the most

effective thing at improving

our aerobic capacity is long slow

duration activities and when you look at

research

into sports such as distance running um

sort of like the very successful elite

distance runners the kenyans the

ethiopians

you know of their training is made up

through long slow duration activity

rather than high intensity so we know

this is a method that really works

so you want to look at when you go

through this kind of training

is you want your heart rate somewhere

between to beats per minute

and you want to start around minutes

time so just

gradually going for minutes

continuously there’s a good starting

point if you’re someone that’s generally

not well trained or if you’re looking

as a starting point to get yourself fit

for skiing

um so as i switched on the heart is like

any other muscle

it needs to be put into tension for a

long period of time to be able to grow

and this is essentially what this kind

of training does the heart

contracts and relaxes it works on the

strain of the exercise and

it gets bigger more efficient as i just

touched on

so as i said like minutes would be a

good place to start again with all the

sort of wearable technology you have

these days whether it’s garmin’s

or apple watches you know it’s really

easy to sort of keep an eye on your

heart rate make sure

that you’re staying within this band you

don’t want to go too high because you’ll

get tired really quickly and then your

heart rate sort of map will look

you don’t want it looking up and down

you want to stay within that window

for a really long and consistent period

of time

minutes is a good starting point and

you want to like any kind of training

program

gradually increase that work so if you

go to the next slide please scott

so here is a really simple example of

how you might want to structure

an aerobic based training program so if

you took sort of like eight weeks is a

good sort of time period where

with any kind of physical capacity eight

weeks is a good sort of time period

where you set to see any kind of

um difference really any shorter time

period

the chances of you seeing any kind of

improvements are quite slim

but eight weeks is a good starting point

obviously if you had weeks to get

ready for a skiing holiday

or some kind of skiing competition or

any kind of athletic

competition to improve a physical

capacity that like the more time the

better essentially

but if we look at this here you know if

you look at starting points of

minutes

and you just gradually increase by five

minutes each week

you get to week eight and you’re doing

more than double what you started at

and that’s basically what sort of any

kind of training program aims to

accomplish

just to gradually increase your loading

gradually increase what your norm is

and so we know that you’re fitter your

body’s able to handle more your body has

a greater capacity for work

so this can be done on the bike on the

cross trainer a run

unless you’re you know if you’re a very

experienced runner you’re running for an

hour spray might be a bit too difficult

but so that’s why we want to sort of

maybe focus more on the non-impact modes

of um training so like a stationary bike

or a pedal bike

a cross trainer in gym and you know you

might want to do something like this

i would say minimal twice a week um but

you know you have time to fit in three

or four times a week you’re gonna get

more benefit

and the key thing is just to make sure

that you stay within that heart rate

threshold of to beats per minute

nice and steady again this type of

training isn’t supposed to make you feel

um sort of dead and thrown up in a

bucket after

it’s you know you should be able to do

this kind of training

at that um heart rate window for

for you know minutes to minutes

easily and you should be able to help

hold a conversation with someone while

you do it so you know if you have a

partner

um or a friend you’re on trip with and

you want to decide to train together

you know you should be able to do this

kind of aerobic training and have a

conversation throughout

with no problem um so again it’s not

maybe the most glamorous way of training

but it is

super effective it leads to all those

adaptations that i spoke about earlier

and it’s going to make you generally

more healthy fitter

better over capacity is going to do the

world of good on the slopes so if you go

to the next slide form please scott so

now we’ll talk about

the muscular strength and endurance

component of skiing like i mentioned

earlier

so why is it important that we have

greater strength and great endurance

well from a performance standpoint the

stronger we are the more force we’re

able to produce so the more force you’re

able to produce means you’ll be able to

propel yourself forward

or upwards or whatever kind of athletic

activity it is you’re doing

so the more force you’re able to apply

in sort of ground contact time

the faster you’ll be able to be able to

travel more efficiently be able to

travel

but it’s also being able to tolerate

forces so anytime you

uh produce force you’re going to get

forced back so if we take a ground

reaction force

for every action there’s an equal laptop

so reactions every time you put force

into the ground an equal amount of force

is going to come back at you

now our muscles tendons and ligaments

will generally absorb those forces for

us but if our muscles aren’t as

um as strong as they could be it’s going

to be the tendons and ligaments that

take up those forces and that’s not what

we want

as scott mentioned earlier acl injuries

are

very prevalent in skiing and one of the

key

injury factors when we look at the

research into acl injuries is something

called ligament dominance

where it’s people’s muscles aren’t

developed enough to dissipate the forces

that they’re put under and so

um the force is then

absorbed by ligaments instead that

attendance that leads to failure that

leads to injury

so by getting our muscles stronger they

are able to dissipate these forces away

from the key structural components of

the ligaments and the tendons

and generally a making our muscles more

stronger more

um that may come what was more robust as

a whole

so you want to think of our muscles as

sort of like an elastic band

so they get they lengthen and they

shorten they lengthen and they shorten

i know you think the amount of times

that they’re lengthening shorten when

you

ski or when you run for example if you

do that to an elastic band for so long

it’s going to get worn out and it’s

going to get thin whereas a stronger

more thicker more robust elastic band

that’s not going to happen

that’s sort of like a good analogy to

think of as to why strength training

resistance training

training your muscles to handle the load

handle the forces that they’re going to

be put under

is really important and also when we

look at it from a load standpoint

if you are going from sort of you know

general population life where you might

spend

you know your day in an office you might

maybe get one to two sessions in a week

then you’re going on a skiing holiday

where you’re spending five to six hours

on the slopes moving it’s a huge spiking

your activity levels that your body’s

not used to that your body

might not necessarily be able to handle

if it hasn’t had the key preparation

with the strength training being able to

handle those forces

but it’s not used to be important so

that’s really why we want to focus on

our muscle strength and muscular

endurance alongside increasing or

aerobic capacity next slide please scott

so how do we go about training our

muscles

to get stronger and more robust

so when we look at the scientific

research into skiing and we look at the

emg studies that have been done

which an emg for those that are unaware

is sort of basically

monitors the activity level of muscles

so they stick electrodes onto your

muscles

they get you to replicate the movements

and they monitor the activity of those

muscles

so emg studies have shown that skiing is

a total body exercise there’s a lot of

activity

in the upper body as well as a lot of

activity in the lower body

so we need to make sure that we train

top and bottom

and so one of the key things that i

would say to anyone starting off a

strength training program

is the first thing you need to do is

just to make sure that you can do any

key exercises

to the squat deadlift a lunge or any

kind of upper body

pressing or pulling movements you need

to be able to do them safely and

efficiently

because the first thing that can fail

when you start adding load is your

technique and that could

be potential injury if your technique is

sound and your movement is really

efficient and smooth

you’re going to be able to push the way

you lift week on week and keep yourself

trending upwards

and improving and getting stronger so

that’s a really important

thing to start with is make sure your

technique is dead-on

before you start your program and now

move on to my next point you have to

make sure that your training program is

progressive

so there’s no point in doing the same

exercises for the same weights

for weeks and weeks months and months on

end there’s no improvement

so you need to make sure that you start

a certain point

and that you give yourself a window

opportunity each week to

jump up in the load so the weight that

you lift each week

so it’s not necessarily about going into

the gym lifting as much as you can

destroying yourself because you leave

yourself no window for

um improvement for the next week if you

go in and you fail on every exercise

because you’re just trying to lift as

much as you can

where’s the window for opportunity like

where do you improve you go that you go

the next week and you try to do the same

what if you fail again you know there’s

no improvement so sometimes you might

have to take a step back from what

you’ve been doing previously

to give yourself that little window of

opportunity to improve

but if you can make small small um

increases week on week those really add

up and i’ll show that in a graphic a

little later on

um and for me that’s one of the most

important things for anyone starting any

kind of training program

is make sure that you are thinking about

how your sessions stack up not just week

to week but month to month because what

you do today in your session

will affect what you do tomorrow and

that will then affect the following week

so as long as you give yourself plenty

of scope to keep getting those little

gains each week

you’ll go much further than just trying

to destroy yourself and lift as much as

you can

in one session and then the final point

on this slide is that you have to

monitor your load throughout

so it’s really important to make a note

of what it is you’re doing

how you’re doing it and the weight that

you’re using

because without that information when it

comes to refreshing your program

when it comes to moving on to the next

stage if you don’t have the data

to um advise you on the next step then

you’re sort of in a bit of no man’s land

um whereas when you have the data you

know what is you’ve done previously so

you know okay here’s my scope to

increase

um i know i can’t really jump too much

because i don’t want there to be a

massive spike in the loading because

that could

lead to potential injury then but when

you have the data with you you can make

really informed decisions

or if you come see a professional like

me i can monitor the data for you i then

have the data to

properly make informed decisions about

the next part of your program

and how to advance you in the most

efficient and safe steps

um so if you’re onto the next slide

please scott

so this here is an example of a really

sort of basic

um strength training program that you

would do to increase your muscular

strength and muscle insurance

really simple this could be done in a

gym this could be done at home with

quite minimal

my quite minimal equipment um and it’s

broken down into

two four week blocks so weeks one to

four and then weeks five to eight

really simple exercises that don’t take

up a lot of space don’t take up a lot of

equipment

um but you can see that they are we have

two sort of key

lower body exercises so a squat and an

rd else that’s a deadlift variation

they’re going to target the most the key

muscles involved in skin so our quads

our glutes or hamstrings

and then we have also two upper body

exercises so floor press and bent over

row

that’s going to make sure there’s an

equal distribution between the amount of

weight we’re

pressing and pulling and then some core

work so really basic side

plank and a side plank again this

program is super simple

um you know anyone who’s at any kind of

fitness level could start this at a

certain point

um and they’d be able to move on or you

know if you’re more trained you’d

obviously look at doing some more

advanced training um you know if you’re

looking to someone that’s

sort of a really keen skier and someone

that was training to really sort of push

their performance in a skiing

event you know you’d look at maybe doing

some isometrics because you spend a lot

of time in that

deep squat position things like that but

again it’s just to give you

um you know an idea of what a training

program can look like how our training

program progresses

so if you see from weeks one to four and

five to eight in those key low body

exercises

we drop a rep but we add a set so we

drop a rep which means we can it gives

us a window to increase the load to

increase the weight that we use on that

exercise

um and that’s sort of the type of things

that we do to you know to um

to keep you on improving and increasing

the load that you’re that you’re using

um

next step please scott so this

um diagram here slash chart

is just basically a chart that you would

produce based on

your weekly loading so this is a really

basic chart that i use to

illustrate to people if you add one

kilogram a week

to an exercise program that’s consisted

of four exercises

and say you did each of those exercises

for reps for four sets

this is what your loading would look

like so your loading is the kilograms

that you lifted so your total loading

for a session

is the amount of weight you lift for the

number of reps for the number of sets

and that gives us this arbitrary number

here

which is the kilograms you lifted so as

you can see

by adding one kilogram each week you go

from

kilograms to

it’s quite a significant jump in four

weeks

so you can see how those that small

window that i talked about earlier

i’ve given yourself that opportunity to

increase and you know one kilogram

increase

increasing one kilogram is each week is

a small

increase but it can lead over time to

you know

as i can illustrate here you know quite

a big jump in the load and if you sort

of

were to scale that carry on for eight

weeks you know you’d improve even more

obviously we can’t keep adding weight

every single week that’s not how

the body works obviously you have to

look at other more advanced ways

of um increasing your loading getting

you increasing the capacity of your body

as a whole

and that’s obviously like the job of

someone like myself to do for you

um but this just simply illustrates the

points i’m making about

by making sure that you monitor the

things that you’re doing in your

training session

you’re able to produce um the numbers

like this so you know

come week four you’re like oh i’ve

improved x amount

i know now that my body can handle

kilograms of load

within the week so going forward there’s

no need for me to drop that because i

don’t want to decondition my body

i want to keep slowly progressing

upwards and by monitoring what you do in

your training sessions

you give yourself the ability to do that

uh

next slide please scott

so balance why would we want to focus on

our balance training

so balance is really important in any

kind of sport really

but skiing obviously specifically so it

keeps our joints aligned it

um prevents us getting into any kind of

compromising positions so sort of

one that’s very common in skiing is

obviously the knees diving in knee

valgus

we call it um really bad position to get

in

um and so

um that’s why we would one obviously

focus on a balance engine to prevent any

kind of

compromising positions like that

controls our center of mass it makes us

more efficient at shifting our body

weight

in more efficient ways um coordinating

complex movements so

um you know anything that involves

multi-directional things with

sort of stuff going on in front of us

that we have to coordinate to you know

being able to stay on balance

and take that information in and process

it and move on

is really important and obviously our

scott um touched on a lot of skiing

injuries

um as a result of falls so obviously

the better balance we have the more we

can prevent ourselves from falling

and we want to move on to the next

likely scott

thank you so here’s how you would sort

of

a very basic easy way to go about

balance training

so it’s as simple as literally standing

on one foot

and trying to hold that for a certain

amount of time monitor that time so

note it down and then again if it’s

seconds

one week then the next week you might

want to focus on okay i want to try and

stand on one foot for

to seconds do that for a couple of

weeks then you would move on to step two

where you want to stand on one foot on

an unstable surface so something like a

yoga block

or a bosu ball a bosu board rather um

something that’s gonna um something

that’s unstable it’s gonna make you work

a bit harder than step one

so again stand on one foot for ten

seconds on the unstable surface

holding it for a certain amount of time

jot it down give yourself

room for improvement next week so go two

to three seconds more in the following

week

do that for two to three weeks then your

next step would be adding proprioceptive

work

so again with with this you’d even then

go back to step one

where you might close your eyes you

might ask someone to pass you a ball so

you’re

you’re reaching for the ball at the same

time as you’re balancing

so you can with this one step three you

could even go back to step one do that

on a stable surface then move on to

doing that on an unstable surface

then you want to go into step four we’re

adding a bit more dynamic movement so

for example

rather than time we do this now for reps

so for example you want to hop on one

leg or hop from one leg to the other

and hold it hold your balance can you

stick that landing

in a really controlled position and

again we could move this on from a

stable surface to an unstable surface

um and this is how you would go about um

going through your balance training to

make sure that you give yourself the

best possible chance

of when you’re skiing to prevent those

fours prevent those compromising

positions that might get you injured

and so that’s all from me now i’m going

to hand over to yad

who’s joining us

hi guys you’re out mate yeah

so uh thank you very much for joining in

sorry for being

slightly late to the panel i had to

finish with a patient i’m going to

discuss about the soft tissue

aspect of the ski holiday so we’re going

to talk about two

key points one of them is free so before

the ski holiday starts and we’ll talk

about the mobility the flexibility

aspect of it

and the strength which first touch

from all aspects and then we’re going to

discuss about the post

um ski holiday uh and we’ll see

basically if you can click again um

scott for me

and during opposite ski holiday

injury prevention self-care and then in

the end

the maintenance those are the most

important things that we are going to

discuss and a next slide for me thanks

um so before the holiday we have the

most important thing is

working on the strength and working on

the mobility the strength aspect

chris touched quite brilliantly and

broke it down really nicely into the

tips and things you need to do

eight weeks or so before if you can

click on the first one for me

thank you scott so the strength is

basically the ability to withstand

the long duration of the gear up

exercise we are not talking about

one go exercise is going to be a long

time if you’re going for a weekend or

for a week

basically your body needs to withstand

that long

exercise with gear up so there’s

definitely new

stuff you need to do and that’s what

chris is talking about

and the other aspect is the mobility um

chris another click thank you great so

mobility and flexibility is just

my side of the things we need to

understand if you

are able to move freely and nicely

in the movements that ski is requiring

and of course we’re doing everything

with gear up

so it’s basically complex movements with

gear

and we need to add more factors to the

situations

the factors and leaks you consider are

the weather of course we’re going to

have

cold weather wind is not a friend to our

muscles especially in cold

we’re going to have restricted gear

we’re going to have a new range of

motion that maybe the newest ones that

never tried ski before they’re going to

be required to

familiarize themselves you’re going to

have heavy gear

some people find it light but some

people might find it very heavy for them

and basically hours of muscle use so

this is an overuse and overload

on the muscles that usually we don’t use

that much

a click for me thank you very much

so before the the ski event will start

we’ll have to have a couple of sessions

at least a month before

to work on those aspects i just

discussed about

so first thing we’ll have to target

specific muscles that we know that

either going to be

injured in the ski so we’re discussing

about lower back pelvic

hands arms shoulders everything that my

knees of course everything that might

get injured in that but also muscles

that are

you suffering from problems we need to

assess the range of motion

that you have see how flexible you are

what kind of limitations you are and

identify them

and work on those limitations it’s

crucial for you to get to

the ski um as much as

freely and pain-free as possible once

we’re assessing this we’ll

we’ll start to work on more advanced

techniques one of them is called sdr

which is soft tissue release it’s

basically stretching the muscles

through a false grip and then met which

is muscle energy technique

really nice technique works on the

principle of

reciprocal inhibition really really good

one and on top of that we need to make

sure that you get to the ski event

pain free so if you have suffering any

pain or any you know

stiffness we need to get you to the

event

completely pain-free and flush out any

ways of inflammation that you have

or you carry it out through the ears and

then get to an

optimized muscle reaction next time for

me

thank you during the ski event because

there’s something called self-awareness

injury prevention

starts with self-awareness we all know

that those key events might

be either boozy or some drugs will be

involved

which is okay everyone to himself but we

need to know our limits if you know that

you are not going to push yourself too

much or you’re going to drink too much

know the next day to rest and sleep well

eat well

hydrate when i say hiking it’s mostly

water

during those long duration of sessions

and know when to stop if you feel a bit

pain if you feel

that niggle comes in and you have an

issue with that knee over that elbow

don’t push yourself too hard don’t get

to that point that you are going to

injure yourself then regret

for the rest of that ski holiday hold

back relax

and get some rest after we discussed

about the injury prevention we’ll talk

about the self-care which is

super easy to have nowadays there’s all

sorts of tools and

homemade stuff you can take with you

from foam roller to lacrosse or spiky

balls

massage guns like their guns and and

those kind of things

and peanut will i’ll show you a picture

in a second if you don’t know what a pin

it is

ice or hot packs which are really nice

to have whenever you have like a bit of

a swollen ankle or swollen

wrist so those are the pictures of the

foam roller and the peanut is those two

bowls attached together some of them are

electric which are vibrating you can use

that either on your neck

or when you want to put them it could be

glutes anywhere else

they’re really nice and they do a good

job they’re going the same

another click for me um scott so those

are crossbars or spiky balls they do a

good job

all of those are nice twigs to use uh

they will do a nice job

a temporary job but they will help you

out to carry yourself through that

stiffness or pain that you have in the

ski event

and the most important thing after we do

this prevention and self-care

is the minded another click for me thank

you

be aware of the timeline if you know

that you’re going to finish that

event within a couple of days book in

advance a couple of sessions with me

so after you come back from the ski

event we’ll come in and we’ll do

the post treatment protocol which is

just about the next thing

so the soft tissue treatment protocol

will be mostly maintenance and then

recovery unless

we have an injury if that’s if that’s an

if that’s the case then

you might target those specific areas or

injuries or strains you had during that

sessions it could be

raised this could be your ankles it

could be your knees

your lower back all of those you need to

target understand what’s going on assess

the injury or the strength

and then move on forward to um

what’s going on if we need to involve

other

people to join us like chris to join us

or a physiotherapist

or we are talking about stiff and rigid

movement once we understand the whole

picture

we can move on to the uh treatment

itself we might involve again

str and mbt in those sessions which is

definitely going to be helpful

but mostly we’re going to use much more

of a soft approach

flushing out your inflammation taking

care of the muscles that

gone through a very long exercise

period of time and of course assess your

pain pain is a

crucial element in the whole thing if

you’re coming back from

your ski holiday and then you need to go

back to work or in regular life and you

suffer from that pain

that’s going to be um debilitating and

this is going to stop you to do the

recovery that you’re

supposed to do so we need to reduce that

sensitivity of your muscles

if it’s general or if it’s slow we need

to reduce that pain

and reduce the stress elements you just

had although it’s a holiday

the ski itself is a stress factor in our

body

we need to reduce that put you back in

that previous condition that you’re

going

to sleep well and recover well and then

um release you back to your home

that was me from the softy shoot with my

approach

i hope that was covering most of the

things that you were thinking about

good thanks chad yes thank you

so thank you guys um if you’ve got any

specific questions for

either of any of us um either for myself

as a physio or

chris as an snc coach or yard from a

soft tissue

therapy point of view um you can shoot

us an email