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Skiing and ACL Injuries - Part 2
What to do if you suspect you have injured your ACL
This is PART 2 of a three part series about skiing and your ACL
In this article, we are going to cover:
What to do if you think you have an ACL injury
How do I know I have an ACL injury?
Do I need surgery to fix my ACL?
Will I have knee pain forever after hurting my ACL?
Can I still ski after I tear my ACL?
You missed Part 1? Learn about the fundamentals of ACL injuries here
In part 3, we will cover training and injury prevention.
How do I know if I have an ACL injury?
If you suspect you might have an ACL injury, I highly recommend getting assessed. Proper assessment and rehab is essential for preserving your ability to use your knee long term.
In the case of ski-related ACL injuries though, most skiers know when they had a major ACL injury. This is usually because they couldn’t make it off the mountain on their own and had to be towed out on a stretched or sat on the back of a sled.
If you are NOT sure though, here are a couple of things that I look for as a Chiropractor in Vernon, BC when I get a skier with knee pain who I suspect might have an ACL surgery:
First, I ask a series of questions looking for some common signs and symptoms of ACL sprains:
Knee pain following trauma
“Pop’ or ‘snap’ sensation at the time of the injury
Pain and/or rapid swelling in the knee at the time of the injury and ever since the injury
Catching or locking while walking
A subjective feeling of instability or ‘giving way’ when weight bearing
Then I look and test for:
Swelling or bruising around the knee joint
Structural integrity of the ligaments in the knee (checking for instability)
Ability to weight-bear and/or walk
Ultimately, if you suspect you have an ACL injury from skiing, I highly recommend you get an assessment. The clock may be ticking on your rehab protocol. Whether that is from us at Base Camp Sport and Spine, another chiropractor in Vernon, a physiotherapist in Vernon, a physiatrist or someone else doesn’t matter (but I do recommend a clinician with experience working with skiers or sports injuries).
PRO TIP: if you can’t find someone in your area that often works with skiers, working with someone experienced with soccer players is also a great option because of the prevalence of soccer-related ACL injuries.
What should I do if I injure my ACL?
The first thing I recommend doing if you think you have injured your ACL is getting an assessment by someone who knows what they are doing. A good physiotherapist, sports medicine provider, or sports chiropractor will be able to help start you on the right path.
One of the first things we need to decide after you get assessed following an injury is whether or not you are interested in surgery.
Do I need surgery to fix my ACL?
Let me be clear: even a FULL ACL rupture does not automatically mean you need to have surgery. ACLs can heal, but they heal slowly and only heal in a small percentage of people. Conservative care (i.e. a proper rehabilitation program) can get a lot of people back to their activity WITHOUT surgery (even if their ACL doesn’t fully heal). The caveat is that sports that require high amounts of cutting and twisting (like soccer, tennis, skiing, etc) put you at higher risk for meniscus injury later on if you do not have an ACL.
Whether or not you decide to have surgery is a personal decision that you need to make in conjunction with your provider and your surgeon. There are costs and benefits to either decision, so you need to understand them before jumping into one decision or another.
If you decide that you want to go down the surgical route, one of the first steps is getting a consult with a good orthopaedic surgeon and getting an MRI (the best way to see the ACL). Hot Tip: if your doc tells you your ACL is ruptured because they saw it on an X-ray, get a new doctor. X-rays only show us the hard stuff (bones) and will not show your ligaments or tendons).
Will I have knee pain forever after tearing my ACL?
Not necessarily. With a proper progressive rehab plan and a focus on your overall health, you can be pain-free even after a full ACL tear.
Something to keep in mind is that following an ACL tear and ACL surgery, there IS a higher incidence of osteoarthritis (OA), but thankfully OA does not automatically mean you will have pain. It does mean that staying on top of your nutrition, sleep, and stress management are important to better manage your inflammation.
Can I ski after injuring my ACL?
Yup!
Not immediately, but most skiers who injure their ACL can get back to skiing after an ACL injury. Depending on the severity of the injury though, an ACL injury often means that you are out for the season.
Whether you decided to have surgery or not, the ACL rehab process is lengthy in order to avoid reinjury. Most of my patients who are rehabbing an ACL injury can expect at least 9 months before returning to full activity, and many as long as a full year.
Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.
Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.
Contact: drmurdoch@basecampclinic.com
Instagram: Base.Camp.Doc
Disclaimer: This blog is intended for general informational purposes only and is not intended for the delivery of medical advice. No doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog and website is not intended to be a substitute for medical advice.
Skiing and ACL Injuries - part 1
ACL Injuries are the most common injury that put alpine skiers in the hospital. They can be life-changing, they’re brutal to rehab and can truly be a depressing and career-ending injury.
In this article, we are going to cover:
What is an ACL injury?
How do ACL injuries happen?
How do I know if I have an ACL injury?
Why are they so common in downhill skiing?
In Part 2, we will cover:
What to do if you think you have an ACL injury
How do I know I have an ACL injury?
Do I need surgery to fix my ACL?
Will I have knee pain forever after hurting my ACL?
Can I still ski after I tear my ACL?
In part 3, we will cover:
How to prevent alpine skiing ACL injuries
Training in preparation for the ski season
Training during the ski season
What is an ACL, anyways?
The ACL is shorthand for the Anterior Cruciate Ligament. Ligaments attach bones to each other and limit unwanted movement. The ACL is one of the most important ligaments that stabilize your knee, attaching your shin bone (tibia) to your thigh bone (femur). The primary job of the ACL is to prevent anterior translation of the tibia on the femur. (Huh?) In other words, it keeps your shin bone from moving forward underneath your thigh bone. (Fun fact: ligaments also help us with our ‘joint position sense’, also known as proprioception).
The ligaments are what are known as ‘passive stabilizers’ of your joints. They don’t actively contract or control movement like your muscles do. Instead, they pretty much work just by being there and waiting until they’re needed (at least when it comes to joint stability).
Most of the time, our ligaments are some of the most reliable structures in the body. They save us from ourselves all the time and keep us moving!
When they are injured though, they like to let us know about it.
What does it mean if the ACL is injured?
Ligament injuries are known as SPRAINS and come in levels, known as ‘GRADES’, each more severe than the one before.
GRADE 1 SPRAIN: some mild stress on the ligament causing irritation.
This level of injury is almost never diagnosed in the ACL. This is because the ACL is so strong that most of the time it can handle the twists and stresses we through at it.
The most common ligament to be sprained is the ATFL (anterior talofibular ligament) aka an Ankle Sprain
Not usually associated with swelling or bruising
Despite the lack of ligament damage, this injury can be extremely painful and still requires proper rehab
GRADE 2 SprAIN: some stretching and possible tearing of the ligament
ACL injuries usually fall somewhere between Grade 2 and 3. This is because Grade 2 is very broad, and covers everything from mild tearing up to just shy of complete tearing
Often extremely painful
Associated with joint swelling, bruising and range of motion limitations
GRADE 3 SPRAIN: complete tearing/rupturing of the ligament.
ACL ruptures are the most common reason a skier will end up in the hospital
Grade 3 Sprains are often accompanied by severe swelling and bruising
Surprisingly, a full ACL tear is not always associated with extreme pain, at least not immediately. This is because the nerves that sense pain are also ruptured, so the knee can no longer send the pain messages back to the brain. The pain usually takes anywhere from minutes to hours to develop, and in some cases, never truly comes.
Complications: it is important to note that a severe ACL injury is often accompanied by damage to other structures in the knee. The most common grouping is known as the ‘terrible triad’ and includes the ACL, MCL (medial collateral ligament), and the medial meniscus.
How do ACL injuries happen?
Injuries happen when the forces applied exceed the body’s ability to resist them. In the case of a ligament, those injuries typically have specific patterns. We typically see ACL injuries with either a straight leg landing (for example landing a jump with stiff knees while in the backseat on your skis) or with a paired twisting and forward force (like trying to get up on your skis, but catching the tail end and torquing your knee).
Here is an example of pro skier Landon Gardner (Team USA) tearing his ACL landing a freestyle jump in 2009: https://www.youtube.com/watch?v=XguonAtk3C8&ab_channel=LandonGardner (while this is not a graphic video, it might not be the most pleasant to watch).
For skiing specifically, there are two primary injury mechanisms:
The Phantom Foot mechanism
The Boot-induced mechanism
1) The Phanton Foot mechanism happens when a skier is either trying to get up from a seated position, or they are off-balanced and fall backwards. Often the skier will place all of their weight on a single leg with weight on the inside edge of their downhill leg. The other ski basically either floats in the air or (worse) catches the ground, but the downhill leg keeps going. The ACL is unable to manage the force and snaps under the tension.
2) The Boot-induced mechanism happens when a skier is again off balance when landing with their legs straight. The landing forces the shinbone up and forward relative to the thigh bone and again overloads the ACL.
Ski-Knee.com has some great graphics on these mechanisms:
Why are ACL injuries so common with skiing?
There are many reasons why injuries happen.
In the case of skiing, the forces, the gear, and the terrain are have a large impact on the nature of the injury.
THE GEAR:
Most gear advancements have decreased skiing injuries. Improvements in ski, boot, and helmet technology have all decreased injury rates since skiing inception. However, better gear also means fast skiers and faster skiers means higher forces… which we already know is a risk for more serious injury.
Skis themselves also change the way our legs function. They limit our rotational movement through the hips (because your can’t exactly twist your skis in any direction without consequences) and essentially eliminate motion in the ankle. When we cannot perform rotation in the hips, and can’t use our ankles in rull range of motion, the only joint left to take responsibility is the knee. The knee is what is known as a hinge joint. It is great at bending forward and back. It is not so great at rotation or side bending (the two primary forces involved in ACL tears).
THE FORCES:
Any time we add in a tool, we increase the amount of force we dealing with. Try throwing a hockey puck as hard as you can slap shot it. Not going to happen. Any time we add in a form of transportation that lets us move faster than we can run (skis, bikes, skates, cars) we start exposing ourselves to forces and speeds that are much more dangerous than we can typically produce with our own power.
This is one of the reasons why skiing injuries can be so devastating. When you are moving at higher speeds, even a small mistake can lead to some pretty frustrating consequences.
THE TERRAIN:
Skiers encounter all sorts of terrain and snow conditions. The nature of the sport takes advantage of gravity while sliding along on a slippery surface. Gravity tends not to care if you are ready for it or not, so often ACL injuries involve unprepared landing or falls.
Snow conditions can also be a fracture, when one ski hits a patch of wet and heavy snow, causing it to trail behind, and putting some crazy forces through the knee.
At the end of the day, the last thing I want you to be thinking about is your ACL. Instead, I want you to be recounting the best stories from the day with your buddy over a beer or a good whiskey. The last thing I want is for you to be scrambling to make an appointment with me on Monday morning. If you DO think you have an ACL injury… well that is what Part 2 is for. (Stay tuned).
Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.
Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.
Contact: drmurdoch@basecampclinic.com
Instagram: Base.Camp.Doc
Disclaimer: This blog is intended for general informational purposes only and is not intended for the delivery of medical advice. No doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog and website is not intended to be a substitute for medical advice.
How is trail running different than road running?
How trail running is different than road running
As a Chiropractor in Vernon, I see a lot of runners. I am sure this is the same for most Vernon Chiropractors, but this is something that is often over looked. In this article, Dr Alex Hueston shares his experience transitioning form road running in his training to a trail race.
Written by Dr. Alex Hueston. Chiropractor at Young Health Management in Duncan, BC (Vancouver Island). www.younghealthmgmt.com
Hey Team!
We are back from running the Thetis Lake 20 KM Relay Race last week, on Remembrance Day. To honour those that have served for our country I felt it was appropriate to refrain from any social media. Running with Ceevacs has been a blast and running with a 4-person relay team in a distance race was a first for me. The race itself was structured with each member running a 4-5km loop around upper and lower Thetis Lake to combine for an overall 20 KM long race total. One of the cool parts of the race was that you were able to have multiple teammates run at once, which became very helpful for me without ever having run the route.
The track itself was quite challenging with a high degree of focus needed for your footing. With a lot of navigating needed with rock sections and high root areas, speed on the downhills was limited to your ability to quickly navigate the technical sections. On top of that, it was some of the heaviest rain I have been in for quite a while so definitely a type-2 fun kind of day.
Leading up to the race with my 80/20 running it had been challenging with weather and scheduling to get out and run everyday. With that I supplemented in a lot more cross-training using many concepts implemented in Ben Patrick’s ATG principles. More on that in the future!
I also ran a V02 max test on myself to get a baseline of my current level of fitness that I will go into more detail on in future posts. What I gathered from my fitness testing and cross-training was more information on how I can perform at close to a max effort which is important when you are usually running at 90%+ of your capacity in a 5 KM race. My runs gave me the confidence that my cardiovascular system was in a good position and my strength training gave me the confidence that my legs would hold up on some more extreme slope sections if they should show up in the race.
How did it go?
Looking at my data on Strava my time over my ~4 KM loop was 21:38 with an average 5:19/KM pace, 178 avg. HR (peak HR of 189!) and 178 avg. cadence.
Key Take-Aways:
Trail time and road time can not be compared over the same distance. Trail running is all about how quickly you can adapt and recover from different running conditions. Forget the consistency that can be present in road running and learn to accept and even love the variability trail running can bring.
When on trail, run by feel first, metrics second. Through this race my heart rate went as high as 189 which is close to my theoretical max of 191 and pace was anywhere between 3:00-7:30/km pace! What was consistent was that I felt like I was in control of my breath, I felt strong and that I could maintain my perceived exertion for the length of the race.
Extreme slopes means extreme changes in speed. With this track the downhills were paramount to making up time and needing to push hard on the climbs. This is where the hill training/speed work pays off.
Running with an experienced person is invaluable. When looking to perform in a scenario with a lot of unknowns a simple solution is to run with somebody who has experience with those unknowns, whether that is pacing, running approach, equipment choice, route knowledge. It makes a race as simple as trusting if you can stay with that person you are going to get a good outcome.
Big thank you for all the support from all the people who came out cheering us on, for all the volunteers that made it possible and for Ceevacs Roadrunners giving us propane fires and cover to keep us warm and dry. Lastly, a personal thanks to my teammate Rob Grant for leading the way for me and giving me the confidence to push at the finish.
If you have a pain or condition that is holding you back from engaging in activity, book an appointment, book a free discover call today: www.basecampclinic.janeapp.com
If you are looking for community weekly runs, running clinics and coaching, or even triathlon training be sure to go check out:
Bush Babes and Bros Trail Running for training
Starting Block Vernon for weekly group runs (all levels)
Be sure to keep an eye on the registration for the Thetis Lake Relay (link here) next year. I’ll see you there!
Author:
Dr. Alex Hueston is a Chiropractor in Duncan, BC at the Young Health Management clinic. www.younghealthmgmt.com
You Are Not Fragile
You are not fragile. Our bodies are designed to keep us moving forward and that is basically a super power.
Good news! Most injuries do not have to become lifelong struggles. Our bones rebuild, our cells regrow, our neurons learn new pathways. Human bodies are designed to be highly adaptable.
Our softness is sometimes purely mental. Driven by the fear of re-injury, an internal dialogue we tell ourselves plays on repeat based on our Dr. Google searches or incomplete conversations with our doctors.
Repeat after me: I am not a chocolate souffle’. You have order, structure and the ability to move forward. This is why it’s important to have a conversation with your doctor about your injury and the healing process.
We all have our dings and dents.
We are surrounded by stories of strength and adaptivity. A man jumped over the Great Wall of China on a skateboard with two broken ankles. A woman runs ultra marathons after being told she had arthritic knees and should restrict herself to walking. A man moved a 1000 pounds off the ground after a disc injury to his back years before. Ask any person who has been pregnant and given birth about adaptivity and they will no doubt have a good chuckle.
How do injuries happen?
Injuries are the body's response to overload. There are 2 types of overload: acute and chronic.
Acute load is when you take a tumble on your skis and reach out to break the fall, thus breaking your wrist. It’s a quick insult to the tissues that pushes past the threshold of structural integrity rebuilding.
Chronic load is when you spend 8 hours a day sitting like a banana in your desk chair. This is multiple insults to the tissue that will eventually cause pain because the body can’t keep up.
What does healing tissue look like?
Healing time is based on 4 main things:
Age
Degree of injury
Amount of load to tissues
Overall health of person
Younger people tend to heal faster. The degree or grade of injury may require more time to heal. For example: An athlete with a Grade 1 (ligament irritation) ankle sprain will take less time to heal than a person of similar age and lifestyle who has a Grade 3 (full ligament rupture) ankle sprain.
Ligamentous injuries like sprained ankles take as little as 6 weeks to heal. Muscular injuries like groin strains take as little as 3 weeks to heal. Bone injuries like stress fractures take approximately 6 to 12 weeks to heal. Neuromuscular injuries like disc herniations take approximately 12 weeks to heal.
But my doctor said my scoliosis will always give me back pain.
Injuries are not the only thing that can make us feel fragile. Sometimes we are told that our anatomy or structure predisposes us to further injury down the line. Many people are told that things like scoliosis, spinal alignment and osteoarthritis may make life more difficult for them down the road. This is not often the case. Structure does not dictate function. I plant my flag firmly in this ground.
One study of 230 knees on 115 pain-free adults (mean age of 44 years old) showed abnormalities (meniscus tearing, cartilage damage or bone marrow legions) in at least one knee in every patient.
It’s important to have a conversion with your doctor or chiropractor or physiotherapist about your concerns around your injury.
Things to ask your doc:
How long will it take for this injury to fully heal?
What can I do to ensure this process doesn’t take longer?
Is there any reason I should believe this may be a long term struggle for me in my activities I enjoy doing?
How do I build strength around this injury?
Bottom line: You are not merely a meat bag moving in three planes. Your injury should not make you feel fragile. We all get ego checks but it shouldn’t keep us from doing what we love. Have a conversation with your doc today about how you can feel stronger around your injuries.
Author: Dr Sam Krieg, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.
Contact: drkrieg@basecampclinic.com
Disclaimer: This blog is intended for general informational purposes only and is not intended for the delivery of medical advice. No doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog and website is not intended to be a substitute for medical advice.
References:
Horga LM, Hirschmann AC, Henckel J, Fotiadou A, Di Laura A, Torlasco C, D'Silva A, Sharma S, Moon JC, Hart AJ. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020 Jul;49(7):1099-1107. doi: 10.1007/s00256-020-03394-z. Epub 2020 Feb 14. PMID: 32060622; PMCID: PMC7237395.
Written by: Sam Krieg DC in Vernon, British Columbia at Base Camp Sport and Spine
How do you treat a concussion?
Here is how concussions are treated by chiropractors
Think you might have a concussion? Check out Part 1 of our Concussion Series: Do I have a concussion?
This post is all about how concussions are treated.
The content in this post is intended for educational purposes only. No information in this post is to be interpreted as medical advice, recommendations, or prescription. If you think you have a concussion, are concerned about your symptoms, or have further questions, make an appointment here, give us a call here, or contact your medical provider.
Picture this…
A few days ago you went over your handlebars at the end of a day of hitting the single tracks on your bike. At first, you felt ok. Some mild neck stiffness, and maybe a mild headache. Since then though, you have been EXHAUSTED. Your neck is still stiff, but the headache is pretty much gone.
You are pretty sure you had a concussion. Should you feel better by now? Is there anything that can make you feel better?
Let’s talk about what to do if you think you have a concussion…
What this article covers:
When to start when treating a concussion
Your different treatment options
Expected recovery time
Not sure if you have a concussion? Check out Part 1 of our Concussion Series: Do I have a concussion?
When should you start treating a concussion?
your options to treat a concussion
Recovery time after a Concussion
How long does it take to recover from a Concussion?
The good news about concussions is that most people fully recover from them completely and in a relatively short amount of time. The tricky part of concussions though, is that you will typically feel better before your brain has healed, which puts you at risk of a second injury with more serious consequences. Every person who experiences a concussion recovers somewhat differently, however, there are a few rules we can use to predict recovery. (2)
Concussion symptoms usually last 7-14 days following the injury
Symptoms often get worse 24-72 hours following a concussion
Those with less severe concussion symptoms are more likely to recover quickly
Symptoms resolve before the brain has recovered
When can I get back to doing what I love?
Despite feeling better within a relatively short amount of time, returning to the activity that caused the concussion in the first place is dangerous. The brain heals slowly and takes about 30 days to recover to baseline for most concussions. (2) As long as your symptoms do not persist or return, in general, you can return to your activity at about 30 days after a concussion without increased risk or permanent or lasting damage. It is, however, recommended that you return to your activity gradually, rather than back to 100% on day one (I am looking at you single track riders).
Will I have symptoms forever?
Most people who experience a concussion fully recover with no residual injuries. If you are experiencing symptoms that last longer than 2 weeks then you need to get a thorough evaluation by someone who knows what they are doing. If you receive proper treatment then most people who have persistent symptoms still experience a full recovery. A portion of patients have persistent symptoms that do not resolve. These people can still experience significant relief with treatment.
When should I go see someone if I think I have a concussion?
So… you went over your handlebars. What now? When should you see someone if you think you have a concussion? I recommend seeing a qualified clinician as soon as possible following an injury if you think you have a concussion. Not only will this help you rule out anything more severe, it will also help you recover FASTER because early interventions with concussions are the key to fast and effective recovery. The ideal timeframe for an evaluation happens within 72 hours of injury.
If you think you have a concussion or someone you know and care about has a concussion, contact me ASAP and we can get you on the road to recovery.
NOTE: If you have severe symptoms (loss of consciousness, vomiting, sustained double vision, passing out) then you need to go to the emergency room as soon as possible.
Summary
Here is the bullet point summary:
Concussions are very common and, while they should be taken seriously, most people completely recover within a short time.
Most common symptoms include headache, neck pain, and dizziness, but anyone who has an injury involving the head and neck should get evaluated
Concussions are diagnosed by a history and a physical exam, in which the primary goal is ruling out a more serious injury
A timely exam and treatment can enhance healing and recovery. Guidance can help decrease the chance of re-injury or persistent symptoms.
Have a question about concussions? Shoot me an email: drmurdoch@basecampclinic.com
For a great video on concussions, check this video from TED: https://www.youtube.com/watch?v=xvjK-4NXRsM
Author: Dr. Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.
Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.
Contact: drmurdoch@basecampclinic.com
Instagram: Base.Camp.Doc
References:
Jackson, W. T., & Starling, A. J (2018) Concussion Evaluation and Management. The Medical Clinics of North America.
Vagnozzi et al., 2010.
SCAT 5
How running injuries happen