Knee Injuries & Tele Skiing

 

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Knee Injuries and Tele Skiing: More Research Is Needed

September, 2002-- There has been much discussion on the Telemark Talk Forum in recent years concerning the nature of telemark knee injuries and the relative merits of releasable freeheel bindings. At first glance it would seem to be a no brainer: alpine skiers have been using continuously refined release bindings for years, and everyone knows that alpine skiing has become safer as a result. Wouldn't it follow that reliable freeheel release bindings would do the same for telemark skiing?

The answer is that indeed they might, but more research is needed to determine the extent to which releasables can contribute to a reduced rate of knee injuries among freeheel skiers. Here's why:

One would also reasonably expect medial collateral ligament injuries to be rare among freeheel skiers, and by most accounts they are. In this kind of fall having the heel free is a big advantage. Boots and bindings that allow the foot to twist some during a crash will help too.

 By far the most common knee injury in alpine (some reports put it as high as 30% of total injuries of all types) is the medial collateral ligament sprain. The injury mechanism is usually a forward fall by beginners in a snowplow. A forward fall after crossing ones tips is also a pretty efficient way to experience this kind of injury. As one would expect, the victim of this most common knee problem is almost always a beginner or low intermediate, usually with poorly maintained and adjusted bindings (especially the heel piece).

 

is still weight on the foot when there is not, tries to pull himself back up. With only the ski tail to brace against, this move puts even more injury causing strain onto the knee. The boot top levers the tibia forward, further straining, tearing or rupturing the ACL.

So far we haven't seen any bindings, alpine or freeheel, that have successfully demonstrated an ability to consistently release before an ACL injury can occur. All of the alpine binding innovations and refinements over the past 25 years have not reduced the number of ACL injuries, in fact the rate of this type of injury has been rising steadily.

The second most common skiing knee injury is the anterior cruciate ligament strain or tear. ACL problems account for 10 to 15% of all injuries at the resorts. Extensive video analysis of thousands of ACL mishaps reveals that, by far, the most common mechanism of injury is a backwards twisting fall where the skier's own weight and the tail of the ski act in conjunction with the back of the boot to lever a dangerous combination of forces onto the knee joint. Often the situation is exacerbated by the skier who, thinking there

 

Line's new "Twin Pivot" alpine binding, hitting the market this year, is the first to promise an increase in knee safety during both twisting forward falls that stress the medial collateral ligament and the backwards, twisting, ACL-tearing fall. Looking at the literature, Line's approach does indeed look promising.

The third most common skiing knee problem is an injury to the meniscus, accounting for around 5% of all injuries while skiing. Meniscal damage most often occurs during big, forward-twisting crashes, usually after catching an edge. In this type of fall it's commonly the lateral meniscus of the weight bearing knee that gets tweaked.

Rotational meniscal injuries might be far more common in alpine if it were not for the many improvements in fixed-heel release bindings. One need only look at the declining statistics for tib/fib and spiral leg fractures to see that forward rotational stress type injuries have been reduced as alpine bindings have improved. This type of injury may also be the most preventable kind of knee injury though the use of releasable freeheel bindings. And that brings us to the point of this article: more research is needed in the area of releasable tele bindings and the prevention or reduction of knee injuries.

In this rapidly evolving sport, gear, technique and the level of aggression have changed considerably in recent years. To definitively determine the usefulness of releasable freeheel bindings a scientific study addressing knee injuries sustained by tele skiers using modern plastic boots, the latest generation of bindings, and wide shaped skis would be extremely useful.

Such a study would have many benefits to both the freeheel skiers themselves and the tele industry as a whole. It's no secret that a major obstacle to converting more riders to telemark is that the gear is often viewed as antiquated and unsafe. Parents are reluctant to gear-up their kids for freeheel skiing on bindings that don't appear to be as safe as alpine bindings. Many of us suspect that this is a false perception, even in the case of non-releasable freeheel bindings, but complete data to back up that idea is simply not available.

A thorough and scientifically valid research study into the nature, causes and prevention of freeheel skiing knee injuries could serve to aid in the development of telemark bindings that help reduce the rate of injury. Or perhaps such a study would show that the nature of freeheel skiing i such that release bindings aren't necessary and that tele is as safe or safer than the other snowsport disciplines. The point is that finding out would be one more step we could take to move the sport forward and establish telemark skiing as a progressive and serious alternative ride in the world of snow sports.

So the question is this: who's going to step up and do the heavy lifting? Who is going to financially support those who would commit the time and effort necessary to conduct such a study? Will it be one of the trade groups? Perhaps a consortium of manufacturers like the one currently working on a new telemark norm? Maybe a national club such as the United States Telemark Skiing Association? Or is there some other way to get the ball rolling? How can we take this interest in the subject, so often expressed on the Telemark Talk Forum, and leverage it into a meaningful study of long-lasting benefit to freeheel skiers and the telemark industry worldwide?

For more information on steps you can take to reduce the possibility of skiing knee injuries visit the following sites:

Ski-Injury.com

SkiHealth.com

Bob's ACL WWWBoard & this Specific Discussion

Knee-Friendly Advice from vermontskisafety.com

Illustrations courtesy LINE SKIS

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