Injuries and Rehabilitation in Cross Country Skiing Objectives ...

Injuries and Rehabilitation in
Cross Country Skiing
Marian Delaney PT/ATC, SCS
Melissa Shirriff PT, OCS
Disclosure Information
Twin Cities Sports Medicine
Conference
• Marian Delaney, PT/ATC, SCS
– I have no financial relationships to disclose. I will
not discuss off label use and/or investigational use
in my presentation.
• Melissa Shirriff, PT OCS
– I have no financial relationships to disclose. I will
not discuss off label use and/or investigational use
in my presentation.
Objectives
• Review studies of XC ski injuries
• Understand the different XC ski techniques:
classic and skate
• Review equipment used for XC skiing
• Recognize common XC ski injuries, both
traumatic and overuse
• Understand rehabilitation techniques to
utilize for skiers with injuries
Literature Review
• Most studies report the injury rate for XC
skiers in terms of the number of injuries per
1000 consecutive skier days in a given
geographic region.
• Studies vary in rates from .49 to 5.63.
• J Sports Med Phys Fitness 2005
Study Designs
• Most studies quote statistics from the 1970’s,
a few from 1980 –2010
• Self Report: Descriptive self administered
survey from the 1996 American Birkebeiner
• Injury rates were higher than previously
reported in the literature
• Clinical Journal of Sports Medicine, 1998
Study Designs
• Many studies are retrospective
studies looking at reported
injuries over a period of time.
• Data gathered:
– USA and European ski venues
– Norwegian XC ski high
schools
– Australia
• Scand J Med Sci Sports 1996
• Sports Med March, 1996

Ski Technique
• Classic or diagonal stride
– Historically the predominant technique
– Noted to be used by Norwegian Birkebeiners in
the 1200’s
• Skate
– Developed in the mid 1980’s
Classic
• Both skis are pointed straight ahead
• Skis in a track
• Poling technique
– Single stick
– Double pole
Skate
• Legs are alternately pushed out to the side in
a skating technique
– V1, V2, and V2 alternate describe different skating
technique
• Poling technique differs
– Poles are used in different
planes
Equipment
• Classic skis
– Longer skis
– Kick box for kick wax
– Wax less skis don’t require kick wax
• Poles
– Shorter, to the top of the
of the shoulder
• Skate Skis
– Shorter
– no kick box
– Waxed for glide only
• Poles
– Longer, to the bottom
of the chin
Equipment
• Traumatic
– Lower Extremity
• Medial Collateral
Ligament Sprains
• ACL and meniscal
injuries
• Ankle inversion
injuries
• Fractures
Injuries

Injuries
• Traumatic
– Upper Extremity
• Fractures of the shoulder, wrist and thumb
• Skier’s thumb: sprain of the ulnar collateral
ligament
• AC sprains
• Shoulder dislocations
Speeds with skating techniques on a downhill can
reach up to 50 mph.
Injuries
The repetitive nature of XC
techniques makes skiers
susceptible to overuse injuries
– Low back
– Patellafemoral
– Shoulder
Low Back Pain
• Contributing Factors
– Classic skiing techniques induces back pain to a
greater degree than skating.
• Static load on the erector spinae
• Double poling induced twice as much pain in females
than males
• May be caused by greater trunk muscular weakness in
females
• Hip weakness
‐Trendelenberg
‐Gluteal
strengthening
Low Back Rehab
Scand J Med Sci Sports 1996
Normal Strength
Trendelenberg

Gluteal Strengthening
• Bridging
• Side lying abduction
• Step downs
• Band walks
Exercise Frequency
• Repetitions and frequency of performing the
exercises is dependent on the severity of the
injury or if the exercises are being performed for
prevention.
• 3 sets of 15 reps to fatigue performed 2X a week
is recommended in the building phase of training.
• One session a week is recommended for
maintenance during the season.
Bridging
Side Lying Abduction
Step Downs
Band Walks

Core Issues
• Abdominal strength
• Back Extensor endurance
• Planks
– Prone
– Side lying
Trunk Strengthening
• Hip Flexor length
Trunk Strengthening
Abdominal Strengthening
Back Extension
Back Extension

Hip Flexor Stretch
Technique
Patellafemoral Pain
• Knee valgus position
– Poor tracking of patella
– Weakness of the hips
– Foot and ankle
influences
– Technique
Patellafemoral Pain
• Hip strengthening
– Exercises from LBP
– Side lying ER
• Clams
– Dynamic control
• Lunge variations
• Single leg dead lifts
Hip strength
Lunges
ER strength
Clams

Single leg dead lifts
Technique
• Knee valgus
• Poor weight shift
• Foot/Ankle position
Valgus Knee ‐ Classic
Good Alignment ‐ Skate
Valgus Knee ‐ Skate
Shoulder Pain
• Postural influences
– Forward head
– Rounded shoulders
– Thoracic kyphosis

Good Position
Poor Position
Poor Position
Shoulder Pain
• Impingements
– Rotator cuff weakness
– Scapular dysfunction
– Technique
• Skating poling off one side
predominantly
• Lack of trunk compression
– Equipment
• Pole length
Strengthening
External Rotation
Include cuff and scapular exercises
• External Rotators
• Scaption
• Rowing
• Horizontal Abduction
• Extension

Scaption
Rowing
Horizontal Abduction
Extension
Flexibility
Pectoral Stretch
• Thoracic
extension
• Pectoralis
stretch

Prevention and Safety
• Off season training
• Proper warm up
• Ski instruction and coaching
• Snow conditions and terrain
– www.skinnyski.com
– Three Rivers Park District ski hotline: 763‐559‐6778
• Professional advice when choosing equipment
• Proper eye protection
• Clothing
In Summary
• Utilize information about technique to help
understand a skier’s injury history
• Select the appropriate exercises
• Work with coaches on proper technique
The End