Injuries Jonathan Bell consultant surgeon

There’s always loads of advice about getting fit for skiing and doing excercises, but I have been doing a season in the Alps and my knees hurt. Not an uncommon problem amoung people who ski a lot! They are not really bad or anything but is there anything I can do? Will it get worse? I cycle a lot in the summer, is this something I should cut back on as I’d rather ski than cycle? Hope you can help. Thanks.

There are a number of considerations.

If you are getting pain from your knees your are overloading them.

If you knees are arthritic they will tolerate alot less and you may need to reduce the skiing and pace the amount you do more evenly.

Assuming that you knees are normal you then need to establish whether the amount, and intensity, of skiing reasonable given your condition? If you want to do a sport to a high level of intensity you will need to prepare the body with appropriate strength and conditioning. Most full season skiers i know just rely on skiing to keep them in shape. That will not work and gradually the loading proves to be excessive and you effectively reach a point where you are overtraining.

In summary you need to prepare in the close season. Cycling alone is not enough. You need a diverse programmme that targets different aspects of your strength and condition. Try a good personal trainer for advice.

During the season don't rely on skiing to maintain your condition. Again talk to a trainer. If you are injured you should talk to a good physiotherapist. If that fails a knee specialist.

Do you think people should wear a helmet when skiing? Susanne.

Most injuries that occur in skiers and boarders are not serious and can be patched up. Serious Head injuries are thankfully comparatively rare but are a significant cause of death and severe long term disability. There is good evidence that even moderate head injuries can lead to some permanent disability.

Children are more susceptible to head injury. For that reason I think that they should all wear helmets.

In adults it is unlikely that a helmet will protect from high speed trauma which may still result in serious injury.

A helmet will protect against moderate injury by absorbing some of the impact and spreading the load. Thus possibly reducing the severity of injury.

Finally a helmet provides excellent protection from laceration to the scalp (they don't half bleed!) or a bash on the head from a ski, pole or even a small branch when skiing in the trees.

Since knocking myself out whilst skiing a few years ago I now use a helmet all the time and don't regret the switch - it is also easier to get my daughter to wear one if I do.

What other sport, that takes place at such speeds, is carried out without a helmet?

"I had my ACL repaired a few years ago and it has been fine but is now beginning to ache after skiing and it's getting worse. Should I just ignore it and hope it goes away or see a specialist?" Thanks. Jim.

A successful ACL reconstruction will have stabilised the knee. If the knee remains stable it is probably not an ACL  graft problem.

There are a diverse number of possiblities for your pain though it's impossible to advise on a course of treatment without a diagnosis. This should be your priority and as such requires an assessment.

You may wish to see a knee surgeon or sports physician but if the problem is mild you may get away seeing a physiotherapist.
If you can access a sports physician that's where I would start.

One final point is that many people arrange to have an MRI scan to get a diagnosis. A scan is just one piece of evidence when making a diagnosis and therefore on its own can be misleading.

Hope that helps.