Knee Injuries in Skiing: Risk Factors and Prevention
The knee is the most commonly injured body part in skiing: according to a clinical review of skiing injuries, 27–41% of all injuries affect the knee. The most common knee injuries are sprains of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL); in an 18-season study in the US state of Vermont, the ACL was the single most common injury among skiers (17.2%). There are two typical mechanisms: phantom foot (falling backwards off balance so that your weight goes onto the tail of the downhill ski) and boot-induced injury (landing a jump with a straight leg). For prevention, the right binding setting, stopping when you are tired, not sitting back and not fighting a fall all matter; an awareness training programme given to ski staff reduced serious knee sprains by 62%.
1. Phantom foot: The skier loses balance and falls backwards, the hips drop below the level of the knees and the weight goes onto the inside edge of the tail of the downhill ski. The tail of the ski acts like a lever, twisting the knee inwards and straining the anterior cruciate ligament. This position occurs especially when you are trying to avoid falling.
2. Boot-induced injury: After a jump or a bump, you land with a fully straight leg and your weight back; the stiff boot pushes the shinbone forwards and the anterior cruciate ligament can tear.
In a survey study of skiers, about a third of ACL injuries occurred in falls where the knee collapsed inwards and twisted outwards (valgus–external rotation), 22.5% in phantom foot and 7% were boot-induced.
Why does the binding setting matter?
Ski bindings are designed to release the boot in a fall, limiting the force on your leg. According to the clinical review, more than 75% of the equipment involved in lower-leg injuries did not comply with ISO standards. Under international standards (ISO 11088 for your own equipment, ISO 13993 for short-term rental), a technician sets the binding according to your weight, height, age, boot sole length and skier type. But the review also gives an important warning: the anterior cruciate ligament can tear even if a correctly working binding does not release; the binding alone does not prevent knee injuries. A study on rental equipment showed that ACL injuries were more common among skiers using rental skis, but that this was also linked to lack of experience; for details, see our guide Rent or Buy Skis and Snowboards?
Awareness training
At 20 ski resorts in the US state of Vermont, ski patrollers and instructors were given training that used videos to show how serious knee injuries happen; serious knee sprains among the trained staff fell by 62% compared with the previous two seasons, while there was no reduction in the control group (American Journal of Sports Medicine, 1995). The study was not randomised and the participants were ski staff; but it shows that recognising dangerous positions works.
6 tips to protect your knees
Get your binding set correctly: Give your correct weight, height, age and level.
Do not sit back: Knees and ankles bent, weight over the middle of your feet; throwing your hips back out of fear leads to the phantom foot position.
Do not fight a fall: If a fall is unavoidable, fall in a controlled way; do not try to get up before you have come to a complete stop. The correct falling and getting up technique is taught in your first lesson.
Take care on jumps: If your level is not ready, avoid bumps and jumps; bend your knees when you land.
Stop when you are tired: Many injuries happen at the end of the day, along with fatigue.
A knee injury often comes with a “pop” sound or sensation, sudden pain, swelling and the knee “giving way” (a feeling of instability). If this happens, do not keep skiing, alert the ski patrol and have your knee assessed by a health professional. For what to do at the scene of an accident on the slopes, see our guide What to Do If There Is an Accident on the Slopes.
Starting right with an instructor
Many knee injuries are linked to mistakes common among beginners, such as sitting back and falling without control. On an activity holiday, your instructor teaches you the correct stance and falling technique from day one, and your equipment is set up for your level at the rental shop. On Doğadayız Erciyes basic course packages, lessons with instructors affiliated with the Turkish Ski Federation (TKF) and protective gear including knee pads are included. Learning with a group turns the programme into a social adventure holiday.
Doğadayız Packages
Doğadayız packages for your level
Winter activity holidays with accommodation, ski pass and equipment included, shared with a group.
The easiest way to learn to ski: a winter activity holiday
An activity holiday puts a sport at the heart of your trip: transport, accommodation and meals are planned, so you can focus on learning on the slopes. On Doğadayız winter activity holidays, accommodation, ski pass and ski or snowboard equipment are included in every package; course packages include basic lessons with instructors affiliated with the Turkish Ski Federation, while experience packages let you practise on the slopes at your own level.
What makes the programme different is the group: sharing the slopes with people at a similar level, dinners and nights out together, and a group leader by your side at all times. Solo travellers become part of this social adventure holiday from day one. That is why we describe our programmes as a social adventure holiday.
The knee. According to a clinical review of skiing injuries, 27–41% of all injuries affect the knee; the most common knee injuries are sprains of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL).
What is phantom foot?
It is the position in which the skier loses balance backwards, the hips drop below the level of the knees and the weight goes onto the inside edge of the tail of the downhill ski. The tail of the ski twists the knee inwards and strains the anterior cruciate ligament.
Does the binding setting prevent knee injuries?
The right setting reduces the risk but does not prevent injury on its own. According to a review of skiing injuries, the anterior cruciate ligament can tear even if a correctly working binding does not release. Correct stance, not fighting a fall and stopping when you are tired also matter.
I heard a pop in my knee. What should I do?
Do not keep skiing, alert the ski patrol and have your knee assessed by a health professional. A pop, sudden pain, swelling and the knee giving way can be signs of a ligament injury.
Physical preparation for skiing and snowboarding gives you two things: less fatigue in the first few days and keeping control at the end of the day. The American Academy of Orthopaedic Surgeons (AAOS) recommends arriving in good condition, stopping when you get tired, and warming up for 3–5 minutes before skiing and starting with a few slow runs; many skiing injuries happen at the end of the day. To be honest, though, according to a systematic review there is not enough evidence that fitness training reduces injuries in recreational skiers; the evidence is strongest for knee injury awareness training and, in snowboarding, for wrist guards.
The pattern of injuries in snowboarding is different from skiing: in skiing the knee comes first, in snowboarding the wrist. In an 18-season study in the US state of Vermont, wrist injuries made up 27.6% of all snowboarding injuries but only 2.8% of skiing injuries; shoulder and collarbone injuries and concussions were also more common among snowboarders. The good news is that the most common injury is also the easiest one to prevent: according to a systematic review pooling 6 studies, wrist guards cut the risk of wrist injury to roughly a quarter. Among helmet wearers, the likelihood of a head injury is about 35% lower. Because beginners are injured more often, wearing protection in the first days and learning how to fall properly matters.
For a beginner, skis should be short and easy to turn. Manufacturers' rules differ slightly: Atomic recommends a length at about chin height for beginners; Salomon says to choose skis 10–15 cm shorter than your height, and 15 cm shorter for complete beginners; Head points to between the chin and the nose. If you are light and inexperienced, choose the shorter end; if you are heavy or sporty, the longer end. A short turn radius (about 12–15 m) and a little rocker make turning easier. In your first season, renting rather than buying is the easiest way to try out the right length.
