Skiing on an aging knee 

click to enlarge Warming up the joints and limbs for older skiers can be a preventative measure toward avoiding injury.
  • Warming up the joints and limbs for older skiers can be a preventative measure toward avoiding injury.

Aging knees can be rejuvenated with skiing. Just ask any 80-year-old skier. Many wouldn't dream of just rocking a chair. Here are some of their secrets:

To ski, we must bend the knees. Even the new flat-cambered rocker skis that seem to turn effortlessly with just the motion of the ankle require knee bending, especially when the hill gets steep. Since the knee bone is connected to the hipbone, which is connected to the backbone and so on (and all controlled by the brain), we must start at the top and work our way down to comfortable, effective and fun skiing.

The head controls not just our body, but our attitude towards all physical activity. Mentally getting ready to ski starts in the summer with thinking about the upcoming season, planning great ski trips that are matched to your skills and committing yourself to a total program of ski readiness. Buying gear, hiring a trainer or adjusting work out programs to be ready for the first snowfall all build the confidence necessary to have a full ski season. As the season starts, you can plan your ski day with the most time on the hill during the best snow conditions, getting back to the lodge for food when it is time to quit. The best older skiers I know pick runs according to the migration of the sun during the day, showing up on top of each run just at the moment the sun has softened the snow to the perfect consistency. They move around the mountain as the sundial does, quitting when the snow gets hard again.

Before skiing, stretching in a warm bath, hot tub or shower improves flexibility. The pictures of people lounging in the hot spa after skiing, with a drink in hand, miss the point for the older skier. Use the tub before you ski (save the alcohol for later). The point of stretching is not just to loosen the tissues, but also to focus the mind on the sport ahead and lose the distractions of work life. Mentally being in the moment of skiing decreases the injury rate more than any safety gear can.

The fitness programs in the off-season focus on strength, flexibility, balance and coordination for the total body. The aging knee needs special attention. As you lose motion from stiffness or arthritis, pressure is put on smaller areas of the bearing surfaces of the knee. This reduction in area causes a dramatic increase in wear. So improving joint range of motion is one of the key steps to decreasing joint pain and wear, and improving skiing enjoyment. It turns out with the new skis and techniques, knees with loss of motion can still ski gracefully. Every great older skier I know minimizes his or her knee motion reflexively, probably remembering Warren Miller's words: "There are only so many moguls in any given knee."

And moguls are not prohibited for the aging knee, just modified. While I always give my patients a prescription that says, "Must ski powder," the piste and the moguls are everywhere and can be negotiated by rhythmic use of the hips and ankles, squeezing each degree of motion out of the knee possible. The best use of the ubiquitous cellphones is to have someone record your skiing on the hill and watch it with a ski pro or an instructor. Small adjustments make huge differences in skiing ability.

Supplements such as glucosamine and joint injections of hyaluronic acid have been shown to relieve pain and stiffness for many people. These are probably safer than using anti-inflammatory medications. However, an occasional Advil or aspirin before skiing helps millions of winter athletes too. Injections of heated blood products (Regenokine), growth factors (platelet-rich plasma) and stem cells are new and do change the biochemical environment of the knee. We are testing these to see which patients gain the most relief.

If the knees just won't perform, then the newer techniques of meniscus cartilage replacement and robotic partial knee replacement have returned people to skiing without limitations in a wide range of ages. Even our patients with total knee replacements ski without restrictions. Fortunately, however, with the advanced techniques, we have been able to keep more and more people from having a complete replacement. The care and feeding of the aging ski knee is all about empowering people to enjoy the freedom of movement. It starts with desire and ends in ski heaven.

About The Author

Dr. Kevin R. Stone

Bio:
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco. He pioneers advanced orthopedic surgical and rehabilitation techniques to repair, regenerate and replace damaged cartilage and ligaments.
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