The week you have been waiting for all year
The trip is booked, the jacket is out of the loft and the first day on the slopes is a few weeks away. For most UK skiers, that week in the Alps is the only time all year that the legs are asked to work this way: long, bent-knee runs, sudden twists, and falls at speed on a slippery surface.
The knee takes much of that strain. The good news is that knee injuries on the slopes are not only about luck. If you get fit for skiing with a few weeks of targeted preparation, and add sensible kit and some on-slope habits, you can lower the risk to your knees.
Why the knee, and why the ACL?
Knee injuries are among the most common injuries in recreational alpine skiing. Modern release bindings have greatly reduced lower leg fractures, but they do not protect the knee as well, and ligament sprains, especially of the anterior cruciate ligament (ACL) and the medial collateral ligament, have become a large part of ski injuries (Davey et al., 2019).
The ACL (anterior cruciate ligament) is a strong band in the middle of the knee. It controls the shin bone sliding forward and rotating under the thigh bone. In skiing, it is usually injured in two typical ways, identified from video analysis of hundreds of injuries (Ettlinger et al., 1995):
- The backward twisting fall: the skier falls back, the hips drop below the knees, the uphill arm trails behind, and the inside edge of the downhill ski tail catches. The ski acts like a lever and twists the knee.
- The landing from a jump: the skier lands back on the tails with the legs straight; the stiff boot pushes the shin forward under the thigh.
Both happen in a split second. That is why preparation focuses on strength, control and reactions, not only on fitness.
Does preparation actually reduce injury?
In team sports, the answer is clearly yes. A summary of eight meta-analyses found that structured injury-reduction programmes reduced the risk of all ACL injuries by about 50%, and of non-contact ACL injuries in female athletes by about two thirds (Webster and Hewett, 2018). A US clinical practice guideline (Arundale et al., 2023) recommends exercise-based programmes that combine strength, landing and jumping technique, balance and trunk control for people taking part in sports that load the knee.
There is less trial data specific to recreational skiers. Still, the risk factors described in ski racing, such as fatigue, reduced strength, and poor control when the body is pushed back, are the same ones these programmes target (Jordan et al., 2017).
Awareness training has also been tested directly on the slopes. When ski patrollers and instructors were shown videos of how ACL injuries happen and taught how to avoid the high-risk positions, serious knee sprains fell by 62% compared with previous seasons, while there was no change in a group without the training (Ettlinger et al., 1995).
How to get fit for skiing: a six-week plan
Aim for two or three sessions a week, starting at least six weeks before the trip. Each session takes 30 to 40 minutes.
Strength (the base)
- Squats to a comfortable depth, building to 3 sets of 8 to 12.
- Split squats or reverse lunges, 3 sets of 8 on each leg.
- Romanian deadlifts or hip hinges (bending at the hips with a flat back), for the hamstrings, which help protect the ACL.
- Wall sits, building to 60 seconds, to prepare for long bent-knee runs.
- Calf raises, single leg if you can.
Control and landing
- Step-downs from a low step, keeping the knee in line with the second toe.
- Small jumps and hops with soft, quiet landings, knees bent and hips back.
- Side to side jumps from one foot to the other, holding each landing for two seconds.
Balance and trunk
- Single leg balance, progressing to an unstable surface or eyes closed.
- Side planks and front planks, building to 30 to 45 seconds.
Fatigue increases risk, so include some endurance: cycling or a rowing machine for 20 minutes helps your legs last through the afternoon, when many injuries happen.
Habits on the slopes
- Have your bindings checked by a qualified ski technician for your weight, height, age and ability, especially with rented kit.
- Warm up with a few easy runs before the steeper ones.
- Stop before you are exhausted. The last run of the day is a cliché for a reason.
- When you fall, let it happen. Keep your arms forward and hands over the skis, do not try to get up while you are still sliding, and avoid sitting back with the hips below the knees.
- Land jumps on both skis, with knees bent and weight centred, not on the tails.
- Respect conditions. Flat light, icy pistes and heavy snow late in the day call for slower skiing.
If you have had a knee injury before
A previous ACL injury or reconstruction, a meniscus problem or an old sprain that never quite felt the same are all reasons to have your knee assessed before the trip. The aim is to check strength on both sides, control on landing and confidence, and to adjust your plan if something is missing.
After a fall on holiday, if you heard a pop, the knee swells quickly within a few hours, or it feels unstable or gives way, stop skiing for the day. Rest it, use ice and have the knee checked by a doctor at the resort or when you are home. Do not go back up the slope "to test it". These can be signs of a ligament injury and should be properly looked at.
Frequently asked questions
How far ahead should I start getting fit for skiing? Six weeks is a good minimum. Strength takes several weeks to build, so starting earlier gives you more margin.
Is the gym bike or running enough? They help your stamina, which matters for the afternoon runs. They do not replace strength, landing and balance work for the knees.
I had knee surgery years ago. Can I still ski? Many people do. It is worth checking that both legs are similarly strong and that you land and balance with confidence before the trip.
The bottom line
Skiing is a fantastic sport, and most knee injuries are not inevitable. Six weeks of strength, landing and balance work, good bindings and a few smart habits on the slopes can lower the risk to your knees.
If you would like a pre-ski programme tailored to your knees, or you are returning to the slopes after an injury, create an account at bpr.clinic and book an assessment with our therapists. At the assessment we listen to your history, look at how your knees move, land and balance, and give you a six-week plan you can follow before the trip.
References
- Davey A, Endres NK, Johnson RJ, Shealy JE. Alpine skiing injuries. Sports Health. 2019;11(1):18-26. https://doi.org/10.1177/1941738118813051
- Ettlinger CF, Johnson RJ, Shealy JE. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. American Journal of Sports Medicine. 1995;23(5):531-537. https://doi.org/10.1177/036354659502300503
- Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of Orthopaedic Research. 2018;36(10):2696-2708. https://doi.org/10.1002/jor.24043
- Arundale AJH, Bizzini M, Dix C, et al. Exercise-based knee and anterior cruciate ligament injury prevention: clinical practice guideline. Journal of Orthopaedic and Sports Physical Therapy. 2023;53(1):CPG1-CPG34. https://doi.org/10.2519/jospt.2023.0301
- Jordan MJ, Aagaard P, Herzog W. Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review. Open Access Journal of Sports Medicine. 2017;8:71-83. https://doi.org/10.2147/OAJSM.S106699
