As an avid skier who has experienced both the icy slopes of the East Coast and the powdery trails out West, one thing remains constant: knee injuries are a leading concern in skiing and snowboarding accidents. In 2024, these injuries accounted for 27-41% of incidents at ski resorts, commonly involving ACL or MCL sprains. Unfortunately, following ACL repair surgery, the risk of re-injury—either at the repair site or the opposite knee—increases due to natural compensations.
To address this, physical therapists have developed detailed return-to-sport protocols aimed at reducing re-injury rates and restoring athletes to their prior skill level. However, re-injury remains prevalent, particularly among competitive alpine skiers, with rates as high as 19-46.7%.
Incorporating Perceptual-Motor-Cognitive Training
Emerging research, such as a study by Smith et al. (2024), highlights the importance of integrating perceptual-motor-cognitive (PMC) components into rehabilitation to enhance safe return-to-sport outcomes. PMC training focuses on maintaining joint stability under variable challenges, such as environmental factors or cognitive distractions. This is particularly relevant in skiing, where rapidly changing conditions, equipment adjustments, and visual distractions contribute to injury risks.
Although replicating on-slope environments in the clinic is challenging, PMC skills can be progressively developed using specific exercises:
- Visual Challenges: LED lights, visual cue cards, eyes closed
- Proprioceptive Challenges: Single-leg stances, unstable surfaces like foam pads or Bosu balls
- Reaction Time/Anticipation: Perturbations, virtual reality, or reacting to unexpected cues
Once patients demonstrate consistent, high-quality movements (no more than 10% quality disparity between injured and non-injured sides), they can transition to outdoor training using ski gear.
On-Slope PMC Progressions
PMC training should continue on the slopes with gradually increasing difficulty. Examples include:
- Visual: Skiing day/night, using tinted goggles, tracking trail signs, or performing head turns
- Proprioceptive: Wedge turns, single-leg maneuvers, varying ski/boot types, or skiing without poles
- Reaction Time/Anticipation: Skiing with distractions (music, podcasts), varying speeds, or navigating moguls and wooded areas
- Environmental: Adapting to icy conditions, powder, fog, or moguls
By systematically progressing these challenges, athletes improve their dual-task ability and environmental awareness, reducing the likelihood of mistakes that lead to re-injury.
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Are you recovering from a ski injury or preparing to hit the slopes this season? FX Physical Therapy’s expert team is here to guide you through every step of your recovery and get you back to doing what you love. Schedule your personalized consultation today and experience the FX difference!
Citation
Smith, C., Grooms, D. R., & Bradley, H. (2024). Enhancing Return to Alpine Skiing: Integrating Perceptual-Motor-Cognitive Considerations in Testing and Progressions: A Clinical Commentary. International Journal of Sports Physical Therapy, 19(7), 923.
