 Poster: A snowHead
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Hi guys.
I had ACL surgery in August, and am hoping to get a bit of indoor skiing in late next week as my physio has signed me off and my knee feels good. I am getting some new Marker Griffons fitted to my Line Blend freestyle ski's. Is there anything that I should change to the DIN settings on my bindings to minimise the chances of recurring injury in my acl? I don't want to crash and re-do my ACL! If i should lower the DIN setting, how much should I do it by, and should i do it in both ski's for balance or just the right ski where I previously injured it?
Thanks
Harry
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Others with greater knowledge than me will I am sure come on, but pay a few bob for a professional setting from someone with the latest charts for your make of binding. I do my own, but from such a chart.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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hazamadcow, I set mine quite low (4 I think from 7), low enough to step out quite easily while doing a little drill. Unless you've done the training I'd get them set 'professionally' (was going to say shop.....) to ensure the forward pressure is correct. I did go back to the charts as a guide, looking towards the OAP setting
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You need to Login to know who's really who.
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Injury down 1, over 50 down 1, beginner down 1, 10 and under down 1, over 25 down 1, competant up 1, so only people on the normal setting is between 10 and 25 competant, just find your normal setting on a chart near you.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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My reading of the literature is that it's not the fall that causes acl injury as much as the binding that did not release. I think this is based on superslowmo film of fis skiers acl injuries; basically what they are saying is that under stress the acl ruptures, this then leads to lack of stability of the knee joint and the skier falls. That certainly sounds like what happened to me ( not that I am a fis level skier)
Set it a point lower and don't worry about prerelease causing rerupture. Ps how do you know which is your left and which is right ski?
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You'll need to Register first of course.
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You might want to start by considering a different pair of skis. The blends are quite wide and so will require more work to get edge to edge., not really necessary either in a fridge.
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Thanks for the help AndAnotherThing.., I will get the shop to do it!
As for PP, I can tell which is left and right by the graphics on the skis. I am aware how the ACL ruptures, as I went through it! However the ease at which the binding realeases during a crash can be a factor when returning to ski's after an ACL injury!
albinomountainbadger, I am aware that my blends aren't necessary in a 'fridge', but that isn't the only place i ski!
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hazamadcow, You need to get a pro/shop to suggest, go too light you can have skis falling off on chair take off if you are heavy and flexing the ski around. Ignore end bit just read OP
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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I have to admit to being a bit 'demure with my DIN'. Age, injury and experience have taught me that it's better to seek for a ski than seek for a stretcher. Staying on your skis is a matter of your skill in the vast majority of conditions we ski in. My chart DIN is 9 for age/weight/experience . . . the day I wind it past 6 is the day I've been taken to where I'm being taught in an environment that needs it and to gain the skills to wind it back down again. If I'm going to eat snow I'd rather do it without having an additional encumbrance.
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hazamadcow, think you missed the more important part of my message. Supposedly you will put more strain on your knee Rolling a fat ski edge to edge. I have no basis for this other than every person I spoke to telling me so when I was ready to ski post-op.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Thanks for the advice Masque, wise words!
albinomountainbadger, I see your point, thanks. I agree they are unecessarily wide for an indoor slope. With regards to putting more strain on my knee by going edge to edge, that hopefully isn't a problem, as my knee should be able to cope with strain pretty well now, im just more worried about what happens if i crash. Id rather get comfortable on my own ski's and start as i mean to carry on! But i agree with you they will be a little tricker to carve on!
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Modern ski bindings' design do not allow release to prevent ACL type injuries except a fairly new design marketed under the name "The Kneebinding".
For useful info on how to identify dangerous situations leading up to ACL injuries and on how to prevent them see here:
http://www.vermontskisafety.com/kneefriendly.php
It is largely dependent on how you fall and your immediate movements after the event.
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knocked mine down from 8 to 6 post ACL. But then I did lose weight during physio and after so it's probably about right. Had no problem with pre-release in Vald a couple of weeks ago.
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You know it makes sense.
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snowman, That binding has been knocking around since I lost first ACL in 1989. It creates interest then disappears, then gets tweaked by someone, then disappears again. Still not mainstream, which makes me ask why if it is as good as they say it is.
Correctly maintained and serviced bindings that are not cranked up beyond your ability are the best protection. But nothing can protect you if your accident takes place like mine did, when I was standing still and my ski was trapped under the binding of an out of control skier! These things happen, if you are worried about it, then go play tiddlely-winks, then you only need to worry about broken nails or black eyes maybe
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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hazamadcow,
Google AFNOR which gives settings for male and female.
This gives a tailored setting that is more sophisticated than just giving them your weight.
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Poster: A snowHead
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What's the view on ACLs and fat ski's ?
My gut feeling is that my fat skis were a contributing factor to my initial injury and I'm slightly weary about jumping on my new pair, 8 months post op.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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AndAnotherThing.. I'd be tempted to view this season as part of your rehab and choose weapons and conditions (and self control) more in keeping with easier use/skiing.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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AndAnotherThing.., i find skiing fat skis on hardpack can be a bit uncomfortable for my bad knee after a while. as Masque says, I'd ease yourself in. if you get a powder day and want to use your fat skis, I don't think that will put any particular pressure on your knees. in fact, when my knee was giving me grief last season, skiing powder was the nicest thing - no nasy bumps etc
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You need to Login to know who's really who.
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Arno, Masque, Good advice I think. 'All rounders' it is then 
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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Bit confused here, had a pair of Atomic D2 VC 170 cms, with a din setting of 6 for my weight / height/ability and they seemed just fine. My New BBRs 8.9, 176 cms, from same supplier, same technician but were set at 8? Would this seem correct for same weight/height/ability ? I have checked various tables on the Net with conflicting options / settings, so I have reduced them by 1 to setting of 7.
Any thoughts suggestions gratefully accepted.
Regards Andy.
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AJQ, stay on 6 and if you pre-release too easily go to 6.5 then 7 . . . the better you ski the less you drop your skis . . . I was happy on 5 for a long time till I started bouncing off the side of the piste and into moguls so I lifted to 6 with no problems . . . my chart is 8/9.
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I don't tend to fall over too often these days but do take the odd tumble now and then, also these skis are a wee bit different too, may just crank them down another notch then and see how it goes. Thanks for the Info.
Andy 
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AndAnotherThing..,
ACL ruptures in skiers occur in a number of ways
A fall backwards( especially if you try to resist). You end up on the tail which carves the ski aggressively and twists the knee at the same time that the quad contract with huge force pulling the tibia( shinbone ) forwards. The twist and the tibia coming forwards strain then rupture ACL. This mechanism is sometimes referred to as phantom foot.
A fall forwards over stretching the back of the knee into hyper extension. It usually also cause minor injury to the medial collateral ligament( MCL ) and lateral collateral ligament( LCL), the inner and outer ligaments respectively.
Both of above can, and often do, occur at relatively slow speeds which is why bindings don't release. A classic example,which I see numerous of times a season, is when some else falls, or skiis, across another's skis in a queue, getting off lift or skiing slowly on the piste
Higher energy falls where the knee is very rapidly forced into a twisted and knock knee position. This often ruptures both ACL and MCL. This quite often seems to happen at higher speed in variable snow/terrain but not infrequently through in attention on the flattest part of a run at the end where it is easy to catch an edge in ruts.
All these can happen on any ski.
Powder skiing done badly or in wet heavy snow can put huge,dangerous, forces through the knee. Skiing quality powder with good technique on fat skiis shouldnt really be as dangerous to your knee as the chopped up variable the day after.
8 months is about earliest you should ski assuming the ACL is fine.
Ask yourself the following:-
Are you sure you are fully rehabbed and upto full strength?
How good is your technique?
Have you done an end stage, ski specific, strengthening and conditioning programme?
Are you comfortable in your head or fearful?
If answers to those all good ski on the skis you know best.
Don't ski when tired.
Don't drink alcohol when skiing.
Pick you conditions , if not perfect ease back a bit.
Have a quiet day on day three( max fatigue of the week on this day)
Get your binding setup properly.
Get the lift home at end of day to avoid out of control numpties.
Sorry that's a bit of an essay hope it helps.
Jonathan Bell
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Jonathan Bell, out of pure nosiness, as a skiing knee guru, do you always follow your own advice and how's your knee health?
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Another one to worry about is, it's not just when you've got your skis on that you need to be careful, last night I slipped forward on the heel of my good leg leaving the inside toe of my bad leg twisted outwards behind! Bloody shiny floors, hurt like hell for a few moments, and I hadn't even got my skis on, another place to take it easy.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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gatecrasher, yes, might be wise to leave your heels in the wardrobe and switch to a pair of sensible flats until your knee is better. 
Hope it's ok!
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| miranda wrote: |
| Jonathan Bell, out of pure nosiness, as a skiing knee guru, do you always follow your own advice and how's your knee health? |
I don't mind you asking. I wouldn't give advice that I didn't follow myself.
I run a ski injury clinic so see large numbers of ACL ruptures each winter from skiing so i see what causes them.
I see all levels of skier with quite a number of elite skiers . All levels are prone to rupture but some things seem to increase risk. I try to minimise the risk where possible.
My knee health fine - so far. Ankle and back less good but if I'm fit they seem to be less trouble.
I don't crank my bindings up in case the ski comes off in a couloir.
I do get the lift home, especially in Argentiere . Although tongue in cheek the Pierre Ric was voted in a ski mag as the most dangerous run in the world.
I ski quite a lot ,so happy to have lunch or easy day occasionally .
I view skiing as a sport and my wife is a physio so to think I could get away without loads of conditioning would be a big mistake
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You know it makes sense.
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| Jonathan Bell wrote: |
AndAnotherThing..,
Ask yourself the following:-
Are you sure you are fully rehabbed and upto full strength?
How good is your technique?
Have you done an end stage, ski specific, strengthening and conditioning programme? .
Are you comfortable in your head or fearful?
Jonathan Bell |
To answer your questions:
I reckon.
Adequate.
Yes.
Coping.
Full details of the rehab here: http://snowheads.com/ski-forum/viewtopic.php?t=88075&highlight=
But, yes my Summer was sent working with the Professional Footballer Associations physio's at their rehab center. My physio OK'd me for skiing for my first trip back in early December and I took it pretty easy, finishing early most days. I'm in Chamonix at the moment for my 3rd week skiing, enjoying the powder in Felegere and all seems fine, touch wood. I'll check back with the physio guys back at fhe end of the season just as a check.
>>Sorry that's a bit of an essay hope it helps.
All sensible advice in your post. For sure if I'd stuck with the free NHS physio I wouldn't be skiing at the moment.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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In the end I left the fat ski's at home and I'm on my cheat GS jobs.
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Poster: A snowHead
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Jonathan Bell,
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| 8 months is about earliest you should ski assuming the ACL is fine. |
When I wrote my answer above I didn't realise you were a Surgeon(?).
One of the things I've been asking about and trying to understand how the healing process evolves after the operation and the chances of accidentally damaging the graft. Given your statement above could you tell me more ?
Looks like I've survived to 10 months so far and I'm looking forward to seeing the surgeon again in a couple of weeks.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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| AndAnotherThing.. wrote: |
Jonathan Bell,
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| 8 months is about earliest you should ski assuming the ACL is fine. |
When I wrote my answer above I didn't realise you were a Surgeon(?).
One of the things I've been asking about and trying to understand how the healing process evolves after the operation and the chances of accidentally damaging the graft. Given your statement above could you tell me more ?
Looks like I've survived to 10 months so far and I'm looking forward to seeing the surgeon again in a couple of weeks. |
I am a knee surgeon.
Here are some thoughts.
The graft ( the new ACL) goes into its new tunnels as a stripped hamstring tendon( or similar). Studies have looked at the changes in the graft. T he appearance under a microscope changes from something that looks like a tendon to something more ligament like. It takes eighteen months. However a process of similar length occurs when a broken bone or a skin wound heals. So it follows that you don't need to wait until full" maturation " of the graft has taken place in the same way that a broken wrist is not off limits for 18 months. It heal adequately long before that.
At the opposite extreme there have been some disasters in trying to get patients back to sports in much under six months with re rupture. ( overall re rupture rates post ACL reconstruction are around 5 to 10 % even in the best hands).
ACL ruptures occurs relatively easily if you fall in a certain way but by rehabbing all components adequately you should minimise your risk of injury to the graft. That takes a least six months and many studies shave shown in some it can take 12 to reach that point. A pro athlete will probably take around 9 months. If you are physically recovered at 8 to 10 months then the last remaining factor is your head. If you are scared, fearful or tentative your injury risk rises. So I try to persuade my ACL patients to work with our sports psychologist to bring the mental recovery up to match the physical. In the same vein I have taken my own patients back skiing with Warren Smith in Verbier and have used his instructors to reintroduce the more tentative back to snow.
So if you are fit,strong and have done a ski specific programme to a good standard that may be enough, as long as the surgeon is happy with the graft and your head is ready.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Very interesting thread, mostly because my wife partially tore her cruciate last week 
Jonathan Bell, the scenario fits your pattern exactly - :
A low speed version of this where the bindings didn't release.
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A fall backwards( especially if you try to resist). You end up on the tail which carves the ski aggressively and twists the knee at the same time that the quad contract with huge force pulling the tibia( shinbone ) forwards. The twist and the tibia coming forwards strain then rupture ACL.
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plus being wiped out by some ignorant git who ski'd off when she was no more than 100 m from the Chalet at the end of the day
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Get the lift home at end of day to avoid out of control numpties.
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Sage counsel.
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You need to Login to know who's really who.
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Jonathan Bell, I'm an Instructor and Coach, have strong technical skills and have tried to manage my return to skiing with some care. Luckily my head is OK although my first week back, particularly on piste, did seem to involve 'learning to ski' again with the resulting gain in confidence and speed. were it not for my training it may have been much harder and would have involved more risk.
The 18 month time scale for full maturity is interesting. Presumably from a monitoring point of view it's quite hard to study without being invasive.
When you say that there is a 5 to 10% re-rupture rate is that over a given time scale post op, or an over all re-rupture rate irrespective of the age of the graft ? Either way it seems a reasonably high number although I guess it would be interesting to categorise them based on the back ground.
From my own NHS experience the surgery element appears to be compromised by the quality of the physio available. My hospital physio discharged me at around 12 weeks which seemed to me to be the point at where I probably needed the most help in terms of rebuilding strength and a managed return to physical sport & activity. If my experience is normal then perhaps the 5 to 10% rupture rate isn't so bad.
I was lucky as we have a National Sports Centre on our door step with a rehab organisation specialising in professional footballers recovering from ACL reconstructions and involved them from the start with the specific goal of skiing this season.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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| AndAnotherThing.. wrote: |
Jonathan Bell,
When you say that there is a 5 to 10% re-rupture rate is that over a given time scale post op, or an over all re-rupture rate irrespective of the age of the graft ? |
Re-rupture tends to occur within first two years. The quoted figure of 5 to 10% would fit with many published studies, including from some highly respected centres. The best known surgeons in the world should be quoting this sort of rate.
We don't know exactly why but we know there is a genetic ( inherited) component and the new ligament has no nerve supply. It is not a perfect substitute for the uninjured ligament. Ligaments without injury, or replacements , provide detailed information to the brain on the loads they are experiencing. This information helps the brain control movement, muscle control and protective muscle contraction. This cannot be restored in an " artificial ligament " . There are , of course some who don't do he rehab and course some ops may not have worked aswell.
Having said that a significant number are very happy with the knee so don't only look at the downside, they are in the vast ,majority of cases better off with the ligament reconstructed.
Three months of physio is, to my mind, wasting the huge cost invested in carrying out the operation in first place. It's not the NHS physio' s fault but a fault of the system. Great that you have had the insight to take it beyond.
I'm not a huge fan of braces , as the literature is full of studies sponsored by the manufacturers and therefore difficult to interpret, but if you have nagging doubts you could get a Donjoy or CTI. If you do get it fitted properly.
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You'll need to Register first of course.
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Crell,
Sorry to hear about your wife, there is little you can do about out of control skiers.
If you have questions post in ACL injury forum or pm me.
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Jonathan Bell, Do you have a link tot he forum please as I cnnot find it?
Many thanks
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Jivebaby,
I pm' d you
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Jonathan Bell,
I hope you don't mind answering, but my wife suffered a tibial spine fracture 3 weeks ago plus grade 3 MCL and minor posterolateral ligament damage ( about 5hrs earlier than L Vonn's fall so she was in good company ). The tibial spine has been reattached and the knee is limited to 10degrees range by the brace.
Longer term, given that she will be very good at following the rehab physio regime, was fit pre-injury, mid 40's, would you think a ski trip in December would be a possibility?
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| Scottish Scrutineer wrote: |
Jonathan Bell,
I hope you don't mind answering, but my wife suffered a tibial spine fracture 3 weeks ago plus grade 3 MCL and minor posterolateral ligament damage ( about 5hrs earlier than L Vonn's fall so she was in good company ). The tibial spine has been reattached and the knee is limited to 10degrees range by the brace.
Longer term, given that she will be very good at following the rehab physio regime, was fit pre-injury, mid 40's, would you think a ski trip in December would be a possibility? |
Had she ruptured the ACL and other ligaments, rather than fractured I wold be fairly confident she could.
I find the tibial spine fractures much less predictable than a reconstruction. Reattaching them( which I hasten to add is standard treatment) requires a slower post op recovery of range of movement than if the AcL reconstructed, it is done acutely which mean she knee is more inflamed at time of surgery and it is usually more difficult to regain full straightening which is crucial to a good outcome. If she is able to get the knee moving( surgeon will dictate that) early then that will help but I do find that if it has to go slowly then it will be less predictable.
The key will be if she can regain early full movement. I would ask the surgeon to let her know when she can try and achieve movement and work on that as quickly as allowed. If all goes well then it may well be possible to ski next season.
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FAQ
