Ski school after injury - all experiences please....

A snowHead

I'm writing an article about coaching after injury and would welcome all your stories on this - negative as well as positive. I have helped a few people back to sliding afeter injury; I figure it's a rather neglected area, but would value all experiences.....do pile in....

A snowHead

@valais2, not much of a story - I had a TPF, meniscus damage and stretched MCL (not skiing). Happened on 1st April 2013, went to Hemel for Jonathan Bell's Return to Ski day with a Warren Smith instructor around 16th November, went skiing at the end of November and had 3 x 2hr private lessons with Steve Angus (TDC & snowhead) to work on technique so as not to stress my knee. It was absolutely the right thing to do - in hindsight my knee really wasn't strong enough but I got away with it enough to ski all week, including reds, although I could hardly walk by the end of the week (dancing may have contributed Embarassed

). I skied a few weeks that season and I've continued with physio and gym since the injury and still have lessons at the start of every season.

Well, the person's real but it's just a made up name, see?

I'd have thought it's mainly head games. If someone had found a way for me to crash n burn at some speed first day back it would have probably greatly facilitated a strong comeback.

Experience: 2 returns to skiing following a menisectomy and Acl recon. I same season return following tibial plateau feature. No specific instruction taken or indeed sought. My feeling of comfort or otherwise dictated the pace not what a 3rd party who couldn't feel what I was feeling thought would be helpful.

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Thanks both - my own experience is that knowledge of biomechanics can help significantly with skiing after injury - essentially by:

1 reducing recovery time - strengthening after muscle loss
2 avoiding stresses which set you back or incite recurrence
3 avoiding compensatory action which creates long term issues eg skiing preferentially on one leg
4 corrects problems which might have contributed to injury in the first place

DOM I share your 'just get on with it' sentiment since climbing often involves injury which you just have to put up with at the time - including for me a big hit on the head last year, when some rock piles collapsed above Arolla. But I've come to realise that careful training and coaching after injury can really improve things in skiing - with such value on snowtime and pre-arranged weekends, I want to make the most of sliding time. Any more stories anyone?

Anyway, snowHeads is much more fun if you do.

I am afraid that I'm with DotMs.

Presuming (!) you are otherwise fit, get back on the horse.

Having done so after 1. a thankfully end of season and thankfully without many sequelae double vertebral fracture (hubris and stupidity of youth) about 25 years ago and 2. A surprisingly shattered hand after a totally innocuous fall (well, innocuous at the time) ...

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@Dave of the Marmottes, @under a new name, I think the difference here is you are both...from what I glean...highly competent skiers who are fit and strong. I came back stronger and a better skier for going back to lessons. The injury did me a favour in many ways

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@holidayloverxx, personally I think those are two different questions. I don't think injury should change anything as I feel one should be getting coached all the time anyway, even if informally.

After all it is free

@under a new name, yes they probably are.

@holidayloverxx, ...thanks for this; interesting point - I assume from this that your injury encouraged you to get some tuition - was there discussion of the injury with the instructor? I am interested in what she/he said and what they then recommended for you. In which country was the post-injury lesson?

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@valais2, because I had an injury I wanted to improve my technique to be able to continue to ski. We discussed the injury but more in terms of how strong my knee was and how much skiing I could cope with so we agreed 2 hour sessions instead of the usual 3 that the ski school.operated. it was TDC in val disere

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I think they are 2 separate things too. The coaching will always be valuable and if you have technique defects which put you in more danger of e.g. a backwards twisting fall then it is of course helpful prophylacticly.

But after any surgery what you are most concerned about is reinjuring yourself and a lot of it is mental ( assuming you have worked your socks off in the gym etc for rehab). Of course if you aren't "good enough" physically then there is a role for gentle build up but I believe that this can be done more cost effectively ( for those of us that don't live in resort) in the gym.

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@holidayloverxx, thanks for the detail - interesting that you went to TDC.

@Dave of the Marmottes, I agree - prep is extremely important. Cycling seems to be a universal physio after ACL and seems to have good cross-over to skiing.

You know it makes sense.

@valais2, I always got to TDC in Tignes or Val d'Isere - why is that interesting?

@Dave of the Marmottes, I certainly did the work in the gym (5 times a week as soon as I was fully weight bearing) hence skiing 8 months after a big TPF, and continue to do so (leg press 140kg, squatting 40kg etc - 56 year old woman . When I think about being "good enough" I mean I'm only an OK skier so I agree that coaching will always be valuable for me both to improve and reduce the chances of injury

Otherwise you'll just go on seeing the one name:

@holidayloverxx, ...interesting since all the people I have spoken to regarding good post-injury tuition have been to small independent schools, while the negative experiences have all been related to official schools...but would be interested in any stories which confound this trend...

A snowHead

@valais2, I see the TDC boys....and girls .. as independent, within their business model.

A snowHead

When I book Steve Angus or gavin Lewis I am booking them as individuals.. they just happen to be part of TDC

Well, the person's real but it's just a made up name, see?

Done it several times, back to teaching after injury. As long as rehab properly, build your strength around the injured part and work with your surgoe(if you've undergone surgery) what's the problem. I've since retired but still do the odd hour or so if asked.

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@Samerberg Sue, ...agree entirely with working with medics - but also note variability of medics' approaches and the physios' - some interested only in return to normal life, not to a level of functionning consistent with specific sports. This of course is not true of all but I am aware of great variability in the goals of different medics and centres.

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i didnt go back to ski school but on the first day back skiing after breaking a collar bone and hand the previous year, I had a private half day lesson just in case of any confidence issues- I was still as daft as ever

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@philwig, thanks for this ... I think quite a few people are agreeing with your view that '...if you're strong in the sport you'll just get on with it...' - and I have done that myself in the past - ACL twice, broken back (wedge fracture L3, stable), grade 3 shoulder separation - I've pushed through all of these. Back at work within two days and on the snow six weeks later with both the back and the shoulder. I refused point blank to stop skiing after a rotator cuff injury (suspected fracture but just topped up on horse pill painkillers and anti-inflammatories) - an injury sustained after an idiot had taken me out from behind.

'Just get on with it' has always been my approach too....but I was brought up short last season with a repeat of last years' huge inflammation (and I mean huge) in one knee (very compromised ACL) which took away a lot of the pleasure of being on the hill and simply hurt a lot. After some very focussed coaching it was clear that I was trying to compensate for the injury and this was really establishing some bad technique on both sides. It took some excellent coaching to get rid of it, and - impressively - the inflammation was very much reduced. This made me think a lot about biometrics - and I suggested to a close friend who could only ski for a couple of hours before also having horrible inflammation (tibial plateau problems, ACL issues) that he also should have some specific coaching. This had exactly the same immediate, beneficial effect. He has been struggling for around five years with this problem, and the coaching stopped him loading up the ligaments in that knee, and enabled him for the first time in years to ski all day. The difference for both of us was startling.

After all it is free

@valais2, interesting re coaching and the improvement.

Managed to break my tib & fib and get a nice big rod down my leg, happened in October and i went straight to the sports injuries clinic at the university where they have people who deal with real athletes at national level, they pretty much pushed it as far and as fast as they could to allow me to go skiing for 2 weeks in Feb which somehow we achieved.
Their view was the sooner i started rehab on it the better and it worked but it was a bit of an effort.

As for tuition after it i have been on a few basi courses and some GS training and a couple of free ride events, as has been said if you are keen then it wont stop you much.

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@valais2, Ok that's interesting but I'd probably classify the results you describe with coaching as management of chronic conditions rather than return after injury. Further I'm not sure I'd have confidence that the majority of ski instructors (picking at random) would be able to achieve such results - for some people it means completely rebuilding their skiing and if they are carrying a chronic injury as well that could well be difficult.

One thing I have concluded after knee injuries is that I flat out refuse to do one footed drills - the risk of causing damage due to pivot on a dab far exceeds the utility of the drill IMV.

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@Dave of the Marmottes, ...I thknk that's right - it was not rehabilitation immediately after injury to get back function (that should be left to the medics and related, I think), but it certainly was technique-based training to resolve persistent issues deriving from injury.

I think the picking at random is a very key issue - I am exploring where people should go who might benefit from such provision, when quite a few have had bad experiences with 'run of the mill' instruction which does not contain any genuine background knowledge of biometrics or a sympathetic coaching model.

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Interesting topic. I have a few thoughts (for what its worth I am an academic researching biomechanics and rehabilitation).

Following an acute injury (e.g. crash or fall) the majority of people should be able to make a full recovery. If a doctor or physio is willing to give you the all clear there is no reason you can't ski as before. I guess coaching may improve your technique reducing risk of future falls and injury, however this would be true regardless of previous injury. There is no reason the coaching need be any different than it would be to someone that never had an injury. Of course this is from a purely physiological perspective. Some people may have some anxiety about reinjury or a loss in confidence, the right coaching could improve this. While I'm sure many coach's have experience of anxious or low confidence students I don't know if any receive training or have qualifications for this. I imagine that more experienced sliders are less likely to suffer this, or it goes away after a few hours back on the slopes.

Inflammation is more of a chronic (overuse) injury. Often linked to dyskinesis (faulty movement). Obviously poor skiing technique may cause this by putting extra stress on joints or muscles. So for some people coaching may be able to fix this. For others the dyskinesis is created due to poor posture, inflexibility, lack of strength, muscle imbalances, fatigue etc which can't be fixed on the hill.

I am often alarmed by how poorly conditioned a lot of people going to ski/snowboard are. A week of skiing is very demanding compared to most peoples fairly sedentary lives. I would be interested to know the rates of injuries throughout the days and weeks as imagine a lot of late afternoon and end of week injuries happen due to fatigue. The idea of prehabilitation is now very common in elite athletes. The idea is to stop the injury occurring in the first place. This includes strengthening the muscles, which can help protect and stabilise the joint (with decent muscle strength its possible to ski without an acl!).

I can't recommend getting a full physio screening enough. In one hour a decent physio should be able to identify any issues. Combined with a decent prehab program this will likely improve your skiing and almost certainly reduce the risk of injury.

Welcome to snowHeads @boarder2020

You know it makes sense.

@boarder2020, the most important part about returning, particularly after knee injuries is to work with highly experienced physio son propriorception. This is awareness of where your knee and what it is doing. Reconstructive surety destroys this initially because the neurofeedback system is "fooked" to begin with

Otherwise you'll just go on seeing the one name:

@Samerberg Sue, interesting idea.

I wonder if it applies to other injuries too (non-reconstructive)? After all, the neurofeeback system was disrupted just the same during the injury. There's no guarantee it's re-established after healing.

A snowHead

I've broken one or two (at a conservative estimate Embarassed

) things skiing, and have found that rather than having physical issues the next time on skis, it's mainly been a headspace issue.

Do the fitness/physio/muscle strengthening stuff as routine, adjusting my gym routine as necessary, dependent on what bit is hurting.

I find that a lesson or two on the thing I'm nervous about makes a huge difference - I currently have an "issue" with breakable crust…. Even if it is just on techniques that will help when I next encounter that scenario. Without this I get quite nervous and find I am skiing very hesitantly and nervously, and will shy away from more difficult stuff. But it does have to be quite focussed for it to work for me - 1:1 for a couple of hours.

Or I just try to keep up with @admin for an afternoon….. NehNeh

A snowHead

Oh, and welcome @boarder2020, snowHead

Well, the person's real but it's just a made up name, see?

Yes the loss of proprioception can be an issue following ligament injuries. But, this is something any good physio should address in the rehabilitation process. The fact that so many elite athletes tear acls and return to playing sport at the highest level demonstrates just how effective surgery and physiotherapy are today. If you make a full recovery and are signed off by a doctor or physio there is no reason why coaching should be different to before from a physiological point of view. I think the psychological aspect is more important as loss of confidence or fear of reinjury would probably affect the type of coaching required.

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@boarder2020, yes.....but I am going to say 'but'....some peoples' technique places a heavy strain on ligaments - muscling through turns etc - which can be tolerated pre-injury (ie a typical intermediate who has plateaued and thinks they are no longer in need of improvement) but is a real danger re re-injuring a damaged ACL. It's in this kind of context that I would suggest sensitive coaching becomes all-important.

Anyway, snowHeads is much more fun if you do.

I am referring to full recovery (function restored to that of pre-injury). Obviously if someone has a compromised joint this is a different story; I wouldn't expect a doctor/physio to sign them off and its likely their insurance would be invalid. I'm not sure how many coaches would be willing to take them on with the potential risk of being sued should an injury happen.

The most common sign of stress on the knee ligaments is a high q-angle (knees caving inside). The cause of this is usually at the feet and/or hips. The solutions are foot orthotics and strengthening of hip muscles. A coach can not fix this on the hill. Hence the importance of getting a physio screening and fixing these things prior to injury.

Personally my expectations of a coach is to simply coach the movements in a patient and understanding manner. I wouldn't expect them to have detailed medical knowledge/training or an understanding of injury biomechanics. It would be interesting to get a coaches view on this. If they consider these things to be part of their job and if they feel qualified to address them.

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@boarder2020, it's really good to have your take on these issues. The following is a real scenario:

Male, mid-40's, reasonable intermediate, could do with working on technique but hasn't had coaching in years. Falls in 2010, breaks three ribs, punctures lung, breaks hip in three places. French surgeon severs peroneal nerve, resulting in permanent 'dropped foot'. After physio and return to normal living, I encourage him to do a weekend's skiing. Insurance is fine. I expect to have one terrible run and then spend the rest of the weekend in the bar. In fact the ski boot supports the bad leg perfectly and he can ski. Coaching sympathetic to his underlying limitations was essential to get good technique re-established.

What's your reaction to this kind of rehabilitation?

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I think this is a great example of what can be accomplished. A few points:

-His dropped foot was unlikely to cause further injury (except maybe increased risk of fall due to less ski control?). So I would consider this very different to someone skiing with an instable joint who is at a higher risk of reinjury. I think this is perhaps the insurance companies thinking too.

-The body has incredible redundancy (can accomplish the same task in many different ways). The classic example we use is touching your nose with your index finger. There are almost infinite combinations of joint angles and rotations that could produce this position. This redundancy is also true for controlling your centre of mass and centre of pressure which are both vital for skiing. So it is not surprising that someone with paralysis can produce a suitable movement to ski.

-Often we select movement patterns based on efficiency. People with paralysis don't have this luxury and have to adapt their movements based on their limitations. For this reason they are often moving inefficiently and using more energy. Fatigue due to this may be something for coaches to consider. Did your mate suffer from fatigue?

-There is a role for medical devices. In this case the boot helped support the leg. Knee braces are a potential device that can help stabilise the knee. Although sometimes overuse can slow rehabilitation as the muscles are not having to work as much.

-We all have some limitations and I think a good coach should be able to work around these as much as possible. At these times patience and flexibility are probably important from the coach. If somebody has to use "non-correct" technique to get down the slopes in a controlled way is this a problem? Less efficient and effective - probably, but IMO a good coach should be able to work with what he's got. I guess client goals come into this.

Credit to the coach and your mate for the success! Bit of an unfair question but do you think the coaches knowledge of the limitations was more important or was it his flexibility trying different things as the day went on that had more influence on the positive outcome?

After all it is free

What a fascinating thread. Welcome to snowHeads, @boarder2020.

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Ski school after injury - all experiences please....

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