Low Back and Knee Ski Injuries
How to Reduce Risk, Build Resilience, and Stay on the Slopes
Robert Inesta
9/18/20268 min read
Skiing is a great way to stay active and enjoy the winter months in the Berkshires, but it also places unique demands on the body. Between speed, changing terrain, snow and ice conditions, fatigue, and the unpredictable nature of the sport, there is no way to completely prevent skiing injuries.
What we can do is prepare the body to better tolerate the forces and repetitive stresses that come with skiing.
In other words, we can build resilience and adaptability.
Two areas that commonly take a significant amount of stress while skiing are the knees and lower back. Although traumatic injuries such as knee ligament tears can happen suddenly during a fall or awkward turn, both the knees and lower back can also become painful from repetitive loading over the course of a day, or an entire ski season.
Fortunately, there are steps we can take before and during ski season to help reduce unnecessary stress on these areas.
Why Skiing Can Be Hard on the Knees and Lower Back
Skiing requires the body to repeatedly absorb, control, and redirect forces while traveling downhill.
Unlike walking or running on a relatively predictable surface, skiing involves constantly adapting to changes in terrain, snow conditions, speed, direction, and balance. Although this unpredictability comes with obvious risks, continually adapting to the terrain is also a great exercise in focus, attention, and body awareness.
The knees remain flexed for significant periods while the hips and legs absorb force. At the same time, the trunk must remain stable while responding to rotation, side-to-side movement, and changes in the position of the lower body.
Research examining alpine skiing has demonstrated substantial loading of the spine while the trunk undergoes flexion, side bending, and rotation.
The legs also act somewhat like shock absorbers, repeatedly controlling forces as the skier moves downhill.
This makes mobility, strength, stability, coordination, and endurance particularly important.
The knee is also vulnerable to acute injury during a fall or twisting event. Ligament injuries, including injuries to the ACL (anterior cruciate ligament), are among the more serious knee injuries associated with alpine skiing. While physical preparation cannot eliminate the risk of these injuries, strength, neuromuscular control, balance, and good skiing habits can help prepare the body for the demands of the sport.
And, as with many athletic injuries, the location where you feel the pain is not necessarily the only area we need to think about.
Don't Forget About the Hips
If you've read some of my other articles on sports injuries, you've probably noticed a recurring theme:
The hips sit between the knees and lower back and play a major role in transferring and absorbing forces through the body.
Ideally, the hips provide a combination of mobility, strength, and stability.
When hip mobility is restricted, the body still has to find the movement required to ski. Some of that movement may instead come from the knees or lower back.
Likewise, if the muscles surrounding the hips aren't adequately controlling the pelvis and legs, the knees and spine may have to manage forces differently.
This doesn't mean that every sore knee or painful back is caused by a hip problem. Pain and injuries are rarely that simple. But it does mean that when evaluating knee or lower-back problems, particularly repetitive ones, it makes sense to look beyond the painful area itself.
Core Stability Helps Connect the Upper and Lower Body
The same principle applies to the trunk or "core."
Core stability doesn't simply mean having strong abdominal muscles or being able to hold a plank for several minutes. The trunk needs to provide a stable platform while the hips and legs move underneath it.
Think of trying to fire a cannon from a canoe versus firing it from solid ground. The stronger and more stable the platform, the more efficiently force can be transferred.
While skiing, your legs are continually responding to the terrain while your trunk helps control your body's position. If the trunk doesn't provide adequate stability, other tissues may have to work harder to maintain control.
Research in competitive alpine skiing has identified insufficient or imbalanced core strength as one potential injury risk factor. Although recreational skiing and ski racing are obviously not the same thing, the underlying concept reinforces the importance of looking at the body as an interconnected system.
Prepare Before You Hit the Slopes
One of the best times to prepare for ski season is before ski season begins. You don't need to train like an Olympic skier. But going directly from relatively little activity to spending six hours skiing places a large and unfamiliar demand on the body.
A good preseason program should develop several qualities:
1. Lower-Body Strength
Squats, lunges, step-ups, split squats, and similar exercises can help strengthen the quadriceps, hamstrings, gluteal muscles, and other muscles responsible for controlling the hips and knees.
Rather than focusing exclusively on how much weight you can lift, consider the different ways muscles work while skiing.
One of these is eccentric strength.
Eccentric muscle contractions occur as a muscle lengthens under load. Think about slowly lowering yourself during a squat rather than simply dropping downward.
While skiing, your legs repeatedly perform this type of work as they help absorb forces from the terrain.
Slow, controlled lowering during squats, lunges, and step-downs can therefore be useful additions to ski preparation.
2. Single-Leg Strength and Control
Although both skis remain on the snow much of the time, skiing involves continually shifting forces and weight from one leg to the other. That's why I like incorporating single-leg exercises into athletic training.
Examples include:
Single-leg squats
Split squats
Step-ups and step-downs
Single-leg deadlifts
Forward, backward, and lateral lunges
Multidirectional lunges are particularly useful because sports rarely occur entirely in a straight line.
These exercises challenge not only strength, but also balance, coordination, and control of the hip, knee, ankle, and foot.
3. Core Stability
Planks and side planks are simple places to begin, but eventually the goal should be to maintain trunk stability while the arms and legs are moving.
Exercises involving anti-rotation, controlled rotation, carries, chops, and different plank variations can help train the trunk to manage forces coming from multiple directions.
Remember, the purpose isn't simply to make your abdominal muscles tired. It's to teach your trunk to provide a stable foundation for movement.
4. Balance and Proprioception
Balance isn't just standing on one foot without falling over.
Your nervous system is constantly gathering information about where your body is in space and making rapid corrections. This is referred to as proprioception.
Skiing challenges this system continuously.
Simple single-leg balance exercises can be progressed by adding movement, reaching in different directions, changing surfaces, or incorporating sport-specific movements.
The goal is to improve your body's ability to sense, react, and adapt.
5. Mobility
Strength without adequate movement can create its own problems. Pay particular attention to mobility through the:
Hips
Ankles
Thoracic spine (mid and upper back)
If these areas don't move adequately, the body may compensate elsewhere. For example, restricted hip or thoracic mobility may contribute to additional movement and stress through the lumbar spine.
The goal isn't to become as flexible as possible. More mobility isn't always better.
The goal is to have enough mobility in the right places, combined with the stability to control it.
Don't Ignore Movement Quality
How you perform an exercise matters.
A person may be strong enough to squat a considerable amount of weight but still demonstrate poor control during a single-leg squat or step-down.
Watch what happens to the pelvis, hip, knee, and foot. Some examples of patterns to look for are:
The knee repeatedly collapsing inward
The pelvis rotating or dropping
One side behaving very differently from the other
Difficulty maintaining control as you become fatigued
These movement patterns don't guarantee that an injury will occur. Human biomechanics are far too complex for that. But they can provide useful information about how the body is managing movement and load.
This is one reason I believe preseason training should include not just strength, but also movement quality and neuromuscular control.
Working with a knowledgeable fitness or strength professional is always a good idea to develop a plan specific to your body and your needs.
Fatigue Changes Everything
You may move beautifully during your first few runs of the morning. That doesn't necessarily mean you'll move the same way at 3:30 in the afternoon.
As muscles fatigue, our ability to absorb force, stabilize joints, maintain posture, and react quickly may decrease. This is where endurance becomes important.
It's also where common sense becomes important.
If your legs are exhausted, your back is tightening up, or your knee has started hurting, consider what your body is telling you. There is no prize for squeezing in one final run when you're exhausted.
Knowing when to stop may be one of the simplest injury-reduction strategies available.
Don't Forget the Basics
Physical preparation is only part of reducing ski injury risk. Some of the most important strategies are also the simplest:
Use properly fitted and maintained equipment. Boots and bindings should be appropriate for you and properly adjusted.
Know the terrain and conditions. Ice, heavy snow, poor visibility, moguls, and rapidly changing conditions can significantly alter the demands placed on your body.
Ski within your ability. Progress gradually rather than allowing enthusiasm to exceed your current skill or conditioning.
Warm up. Give your body some time to move before immediately asking it for maximum performance.
Stay hydrated and fueled. Skiing can be physically demanding, and cold temperatures may make you less aware of fluid loss.
Get adequate sleep and recovery. Physical and mental fatigue can both affect performance.
And most importantly:
Listen to your body. Pain and fatigue are information. They don't always mean something is injured, but they shouldn't automatically be ignored either.
What If Your Knee or Lower Back Is Already Hurting?
Not every ache after skiing means you've suffered an injury. Muscle soreness and stiffness can occur simply because your body has been exposed to an activity it hasn't performed for months.
Persistent or worsening pain, though, deserves attention.
If the problem is primarily related to repetitive strain, it can be helpful to determine why a particular area may be getting overloaded.
The right questions can help identify contributing factors and ultimately determine the appropriate course of action.
Is hip mobility restricted? Is there excessive muscular or fascial tension? Are certain joints not moving well? Is trunk stability inadequate? Are there significant strength or movement asymmetries? Has training volume increased too quickly? Is skiing technique contributing? Is there an old injury affecting the way you're moving?
This is where treatment should ideally go beyond simply chasing the location of pain.
Myofascial therapy can be used to identify and address soft-tissue restrictions that may be affecting movement. Chiropractic adjustments can help address joint restrictions and mobility. Acupuncture and dry needling may be useful for reducing pain and muscular tension.
These treatments can then be combined with appropriate mobility, stability, strengthening, and movement exercises to help address the larger picture.
The goal isn't simply to make the painful area feel better. It's to help the entire system function better.
When You Should Get an Injury Evaluated
There is an important difference between soreness from a long day on the mountain and an acute injury.
A significant fall or twisting injury followed by substantial pain, swelling, inability to bear weight, joint instability, locking, significant loss of motion, numbness, or weakness should be appropriately evaluated rather than simply "worked through."
Similarly, persistent or progressively worsening back or knee pain should be assessed to determine what may be contributing to it.
The appropriate treatment depends on the nature and severity of the injury or condition.
Build a More Resilient Skier
We cannot completely prevent skiing injuries since there are simply too many variables we can't control.
But that doesn't mean we are powerless. As I always say, when we control what we CAN control, we can better handle what we can't control.
And there's a lot we can do, such as:
Improve mobility.
Build strength and endurance.
Train balance and proprioception.
Improve trunk stability and hip function.
Address restrictions before they become bigger problems.
And we can make intelligent decisions about terrain, equipment, fatigue, recovery, and when it's time to call it a day.
Think of injury prevention less as creating an injury-proof body and more as building a resilient and adaptable body, one with the capacity to absorb, adapt to, and recover from the demands placed upon it.
That won't eliminate the inherent risks of skiing. But it may give your body a better chance of handling them, and help keep you enjoying the slopes throughout the season.
Want to Build Better Stability and Movement?
My free 10-Day Basics of Functional Stability & Posture Series teaches simple exercises and movement concepts designed to help improve stability, posture, balance, and body awareness.
Dealing With Knee or Low Back Pain?
If pain or restricted movement is keeping you from skiing or doing the activities you enjoy, a comprehensive evaluation can help identify factors that may be contributing to the problem.
At Berkshire Functional Chiropractic & Acupuncture in Great Barrington, treatment may combine myofascial therapy, chiropractic care, acupuncture/dry needling, and individualized movement recommendations based on your needs.
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