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Mr Parag Jaiswal is a lower limb orthopaedic surgeon who specialises in complex lower limb trauma. In this Q&A he shares his top tips for going skiing.
What are some common skiing injuries you see?
There’s a real spectrum, some which will need surgical treatment, and some which can be treated conservatively with pain management, physiotherapy and rest.
Knee injuries are by far the most common, such as ligament sprains. These also vary from less severe (Grade 1), such as an ACL sprain, to complex multiple sprains of all four knee ligaments. The type and extent of the injury will determine whether a person needs surgery or not. I do also see hip injuries, and more infrequently ankle injuries – these tend to be more common with snowboarders.
Are there any differences between skiing and snowboarding injuries?
Broadly speaking, I’d say ankle injuries are more common in snowboarders and knee injuries in skiers.
I have seen snowboarders with broken bones round the ankle and some with really bad ankle sprains. This usually happens when the snowboard twists and the bindings don’t release, causing the ankle to twist along with the board.
If someone has been injured, what could the recovery journey look like?
First of all, it’s important to make a diagnosis. When the injury is acute, it can be difficult to determine what’s going on, as the person will be in a lot of pain. In this situation, I would put them in a brace which prevents sideways movement in the knee, helps with pain, and also reassures the patient. Probably, they will already have had some scans, either abroad or at another hospital upon their return to the UK, but I would request further MRIs and X –rays, so I have the latest information about their condition to hand.
If a person has been injured in Switzerland, they will often operate then and there, or for those that don’t need surgery, give them a brace that keeps the knee straight. I can’t say that I agree with this approach. A brace that immobilises the knee can actually do more damage in the long run. What you need is a brace that allows for certain movements of the knee. This will ensure a better recovery and return to optimal function.
If it turns out the person has a torn ligament, I wouldn’t want to rush into surgery. In this scenario, I would wait for 4 to 6 weeks after the injury, then decide if surgery is needed. This is because the body has the remarkable ability of healing itself, and in this time the body may have done the job for me! I’ve treated a few people with ACL injuries in this way, with a programme of pain management, injections and physio instead of surgery.
The treatment journey itself really depends on the extent of the injury and the levels of activity that particular person wants to get back to. Many people can return to running and certainly cycling. If someone wants to play a lot of football following a severe knee injury, this could be more challenging though, is it’s a sport that requires a lot of pivoting motion in the leg. That’s why I treat everyone in their own unique way, which depends on the type and extent of injury as well as the lifestyle they want to return to.
What would your advice be to someone going skiing this winter?
I learned to ski for the first time in Canada, when I was out there for a fellowship. I learned in the Rockies, which was phenomenal! However, learning at the age of 37 was quite daunting – especially as Canadians seem to start skiing before they even start walking! From my experience, I learned to:
Take it easy and ease into the day with some gentle green runs. This is particularly important for those that are new to skiing
Get an instructor or take group lessons. They can provide a path for you, show you some good techniques and get you acquainted with the mountain before you venture off. I would also follow a fitness and strengthening programme beforehand, so that you’re more able to deal with the physically challenging days
Listen to your body. When you go on a winter sports holiday, you’ll be exercising for many hours, and by the end of the day you’ll be very fatigued. I definitely noticed my form was nowhere near as good later on in the afternoon.
Try not to ski for too long and don’t forget to use the hot tub at the end of the day!
Mr Parag Jaiswal is a lower limb orthopaedic surgeon who specialises in complex lower limb trauma. Last year (2022) he also won the title of Orthopaedic Surgeon of the Year at the London and South East Prestige Awards.
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