Skiing on ice - top tips from Val d'Isere instructors

We've had some beautiful sunny days in Val d'Isere over the last few weeks.  The Val d'Isere commune have done a fantastic job in keeping the pistes in good condition, especially when you see pictures of other resorts around Europe looking very green!  We are extremely lucky. However, due to the unseasonably warm temperatures, the pistes are now starting to get icy.

When the pistes are hard packed and icy, they can be very unforgiving.  Your leg muscles work a lot harder and there is a high chance that you may aggravate any pre-existing injury. If your legs are felling particularly tired stick to easier pistes, take regular breaks and come and have a massage to help with recovery.

In terms of current injury patterns, we are seeing a lot less knee ligament injuries than we usually do at this time of year.  These type of injuries are particularly prevalent after a heavy snow fall, when the powder influences the mechanism of injury. Whilst this is good news, the hard icy pistes present their own pattern of injuries.  When its icy, we see more impact injuries that can affect the pelvis, back and shoulders.  We also see an exacerbation in knee problems, such as tendionpathy's and patella-femoral dysfunctions.  These are usually easily treatable and we can help help you understand and manage your injury or pain.

Skiing on icy snow can be scary.  It requires skill and precision.  We've asked some of Val d'Isere's fantastic ski instructors for their top tips on skiing on the ice?

Gavin Paley
http://www.tdcski.com/val_disere/about_tdc_valdisere/
Stay balanced over the middle of your feet, with a slightly wider stance than normal.  Look ahead and make the middle of your turn through the softer snow that has been scraped aside by other skiers. Turn your feet slowly and avoid harsh movements.

Elaine Bunyan
https://m.facebook.com/ElainesEliteCoaching
Don't panic and keep your speed to a minimum.  Stay over the downhill ski (don't lean into the hill) so your hips are down the hill.  Don't try to ski but rather slide over it until you find a piece of softer snow to break.  Turn on the softer snow, slide and survive! If its too icy avoid that piste and stay within your limits.  Drink lots of hot chocolate.

Wayne Watson

http://www.alpineexperience.com/guides/

On ice use a controlled side slip with feet well apart. Over edging and fighting is a recipe for disaster. 

Caroline Barley

http://ultimatesnowsports.com/about-us-ski-instructors/

On an icy slope go with it, stay balanced, twist and slide.  Don't try to force the ski to grip because it won't - go with it.  Be on top of the ski.

Lara De Agostini
http://www.platinumskischool.com
Use your body as a spring and bend the three main joints evenly (hips, ankles and knees).

Rich Murray
http://www.skinewgen.com/instructors/rich-murray/
Relax and understand the limitations of your equipment. A lot of ski's will not grip on ice, so relax and go with it and be ready to grip when they will. Racers make their ski's much sharper, a tourist ski isn't designed to grip them same way.

Alan Okrafo-Smart
http://mountain-masters.com/team_alan_okrafo_smart.asp
When skiing on hard packed, icy snow keep the turns small so you don't pick up too much speed. Try to blend the turning of the skis, the edging of the skis and the weight transfer as smoothly and progressively as possible form turn to turn.

Steve Ricketts
http://www.bass-skischools.com/about-us/bass-instructors/
Stand centrally on your ski's to survive the ice.  Face downhill to keep your weight on the lower ski to travel with the ski.  If you are on your uphill ski you are more likely to have your feet swept from beneath you.

Liam Luke
http://www.leadingedgeski.com/team/liam-luke
Go with it, stay balanced and turn in the soft stuff.

Max Kratter
https://oxygene-ski.com/en/instructor-profile-max/
Move your body facing down the hill and keep your weight on the downhill ski.  Let it go!

Thank you to everyone that has let me pick their brains.  There are some very useful tips which will hopefully help to prevent injuries occurring.

LSA

www.bonnesantephysio.com

info@bonnesantephysio.com

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Q and A - your first physiotherapy appointment

We are often asked questions regarding the initial physiotherapy consultation.  I hope the information below gives you a few answers, however please do not hesitate to get in touch if you would like any further details.

Some people feel slightly nervous or apprehensive prior to their first physio appointment.  We will help you to feel at ease, keep you comfortable and give you details about your injury so that you learn how to manage it and how long it is likely to take to get better.

Q. I have hurt myself on the slopes?  Do I need to see a physio or a doctor? 
A. If you are not sure, then please give us a call for free advice over the phone.  Usually, physio is your first port of call for injuries.  However, there are a few exceptions when you may need to see a doctor first including:

• if an x-ray is required to rule out bony injury.  We can advise on this if you are not sure.
• when painkillers and / or anti inflammatories are needed
• for insurance purposes
• for onward referral, e.g for an MRI scan or surgical opinion

Q.  How long is a physiotherapy session?
We usually allow 45 to 60 minutes for your first session.  This is often longer than sessions will be in the UK, however we use the extra time to perform a comprehensive assessment and understand your goals, as well as getting stuck into treatment straight away.  Most people are keen to get back on to the slopes as soon as possible and when safe to do so, we will do what we can to accelerate the healing process and keep you 'fit to ski'.  Follow up sessions are usually 30 minutes long.

Q. What will happen at my first appointment? 
A. You will be asked to complete a registration form, then your therapist will run through a series of questions relating to your current complaint, including medical history, details of your work, hobbies and your goals / aims of treatment.  A physical examination will be completed, then your therapist will discuss their findings and formulate a treatment plan.  Treatment will then be started which is likely to include manual therapy and a home exercise programme.

Q.  How many treatments will I have? 
A.  There is no fixed course of treatment.  Your needs will be assessed and discussed with you during your initial visit.

Q. Do you just treat ski and snowboard injuries? 
A. No.  Although alpine injuries are the most common presentation, we can treat all sorts of injuries, whether recently acquired or long standing.  We often see people with injuries that have occurred before arriving in resort or injuries that have occurred in transit, for example back injuries from lifting heavy suitcases.

Q. What should I wear?
A. Please wear comfortable, easily removable clothing as your physiotherapist will need to examine the affected area.  Shorts are useful for lower limb problems and vest tops if you have hurt your shoulder or neck. Your modesty will be respected at all times.

Q.  Will I always see the same physiotherapist? 
A. It is our aim that you will always see the same person.  However, there are occasions (such as the therapists day off) when it becomes necessary for you to see someone else.  In this instance, we make sure that a full handover is made to ensure continuity of care.

Q. What payment do you accept?
A.  Cash, cheques in euros and all credit and debit cards, except American Express.

Q. Do I need a doctor's referral?
Not necessarily.  You can refer yourself directly to us, however if you are going through your insurance, it is recommended that you contact them to find out what your policy says with regards to physiotherapy treatment.  Sometimes, insurance companies will request that you see a doctor first to have physio authorised.  In this situation, we can point you in the right direction for the doctors in resort.

Q.  Should I bring my X-rays and MRI scans with me? 
A. Yes, please bring all the relevant information relating to your condition.  It all assists your therapist at your initial assessment.

Q. How long will I have to wait for my first appointment? 
A. We aim to see you on the day that you book, however if this is not possible, an appointment will be arranged for the very next day. We are committed to getting you pain free as soon as possible.

Q.  I work in resort and I do not want my employer to know that I am having treatment.  Do you have to tell them?
A.  No. We cannot discuss any aspect of your treatment with anyone, other than yourself without your prior consent.  The only times we may ask your permission to do this, is if your injury affects your job and we can offer advice and modifications in the workplace to make your life easier, however usually we would advise you directly.

Q.  I am training to be a ski instructor.  Can you liaise with my coach about my injury as it is a affecting my performance? 
A.  Absolutely, as long as we have your full consent to do this.  We can help advise on training load and recovery, plus advise on any drills that should be avoided or limited while you are having treatment.

Q. Can I be seen at home / in my chalet? 
A. Yes, especially if you are having difficulty walking.  We prefer to carry out physiotherapy treatment in the clinic (65, Residence Les Andes) in the centre of town, where we have a wide range of equipment to facilitate your recovery. However we are happy to come to you when this is difficult or not possible.

Q. What if I need physiotherapy when I return to the UK?
A. We have links with some top UK practices, so we can often recommend where you can continue your treatment on return home.  Will can provide a detailed handover to facilitate our ongoing treatment.

Q. Do you offer any treatments other than physiotherapy?
A. Yes, we offer a range of massages including the following:

• sports / deep tissue
• pregnancy
• relaxation / bien etre
• hot stone
• indian head
• stretch and relax
• thai and swedish techniques

We also offer ski injury prevention screening, biomechanical assessments for performance enhancement and pilates.  

      LSA 

      Bonne Santé

      info@bonnesantephysio.om

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DOMS and Recovery - Top tips

DOMS = Delayed Onset Muscle Soreness

We all get it from time to time.  When we start a new exercise regime, over do it or ask new demands from our muscles, pain and stiffness can set in.  This can be after a few hours after exercise, the next morning or up to two days later.  DOMs can last from 24 - 72 hours.  In skiers, it most commonly occurs in our quadriceps muscles and our calf muscles.  There are not many sports where we keep going for up to seven hours a day and it is very difficult to prepare our muscles for this.  

Overuse can cause inflammation and small tears in our muscle fibres and connective tissue.  So, what can you do to reduce DOMs?  Follow our top 12 tips below to reduce achy legs and limit fatigue.

1 - Prepare 

Get fit for your skiing holiday.  Ideally, start training up to six weeks before you hit the slopes.  I will talk more about ski fit training in a future blog, but as a guide you should work on you leg strength and endurance, cardiovasuclar stamina, core and upper body strength, balance and flexibility.


Gradually ease yourself into skiing and take regular rest breaks.  Ski with people of a similar standard to yourself and don't try and keep up with more advance skiers as this can end in disaster!

2 -  Hydrate

At altitude, the air is very dry.  This is often most noticeable first thing in the morning, especially if our rooms are very warm.  We lose a lot of moisture through breathing and through exercise.  Even when its very cold, you are still likely to be sweating on the slopes. 

Good levels of hydration are essential to reduce fatigue and to help our muscles repair.  When dehydrated, DOMS are likely to be greater.  Everyone requires different amounts of water but by monitoring the colour of your urine, you will be able to tell if you have drunk enough.  Apart from first thing in the morning, your wee should be clear - light straw coloured.  If it remains dark yellow during the day, you need to increase your fluid intake. 

3 - Eat a balance of protein and carbohydrates

Ensure that you are having enough protein and carbohydrates at meal times. Protein is what your muscles use to replenish, repair and recover.  Carbohydrates help provide energy and transport proteins to your muscles.  Foods high in protein include: eggs, cheese, nuts, yoghurt, meat and lentils.

4 - Eat at the right time


Having something to eat around half an hour after you have come off the slopes can aid recovery, as the timing can be key to replenishing your muscles.  Think about incorporating a mix of protein and carbohydrates as a snack or for afternoon tea.  Regular snacks on the slopes also help, so think about keeping a handful of dried fruit and nuts in your pocket.


5 - Antioxidants and anti-inflammatories.

Although more research is needed to support this, there are many health professionals who strongly recommend certain foods with antioxidant and anti-inflammatory properties to aid recovery.


Examples are:

•               Vitamin C is a powerful antioxidant which is important for growth and repair of tissues.  It boosts the production of collagen and therefore can help with wound healing.  Sources include citrus fruit, leafy green vegetables, sweet potatoes and peppers. 

•               Vitamin D not only aids the absorption of calcium to help build strong muscles and bones, but it also can help decrease inflammation and regulate the immune system.  We gain a large proportion of our Vitamin D through sunlight, but other sources include oily fish, liver oils, fortified milk products, fortified cereals, meat and eggs

•               Vitamin E has antioxidant properties and also increases blood circulation and can help rid the body of the build up of waste products associated with exercise. Foods containing vitamin E include sunflower seeds, almonds, fortified cereals, avocados and and olives.

•               B vitamins have been shown to influence would healing and collagen synthesis.   Vitamins B6, B12 and folic acid are said to help reduce inflammation.  B6 is found in bananas, beans, sunflower seeds and chicken breasts.  B12 is found in oysters, liver, fish, beef, lamb, cheese and eggs.   

•               Omega 3's which are found in cod and salmon are said to have anti-inflammatory properties.

•               Certain herbs and spices may help reduce inflammation such as tumeric, ginger, cinnamon, garlic and cloves

8 - Keep Recovery Active

Always aim to keep moving after your workout. Walk around, do bodyweight squats, arm circles, stretch to the ceiling or get out for a walk. Active recovery is great - as much as you want to collapse on the sofa, it will not help and you'll end up feeling a lot stiffer.

9 - Have a massage


Call Bonne Santé on 0033 (0)4 79 06 07 27 to make an appointment.  You can come to our clinic in the centre of town or we can come to your chalet.

10 - Elevate your legs


Lie on your back with your legs up against the wall for a few minutes after you've had a good stretch.  This may sound silly but it is a popular technique with cyclists. Elevating your legs helps drain waste products and improve circulation. 


11 - Pool Session


If you have a chance to get in the pool after a hard day on the slopes, this is great for the recovery.  The pressure of the water has a pumping effect on the tissues, thus helping to remove lactic acid and waste products.  You don't need to do a hard swim.  Stretching, walking, pedalling and jogging in the water are all great ways of facilitating recovery.  Make sure you drink plenty of water to rehydrate afterwards.


12 - Sleep

Sleep is essential for repair and recovery.  However, good quality sleep can be challenging when at altitude.  See my previous blog on 'Why can't I sleep at altitude' for more information on sleep http://bonnesantephysio.blogspot.fr/2015/11/why-cant-i-sleep-at-altitude.html

LSA

www.bonnesantephysio.com

info@bonnesantephysio.com

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        References: 

        Prolonged vitamin C supplementation and recovery from demanding exercise.    Int J Sport Nutr Exerc Metab. 2001 Dec;11(4):466-81. Thompson D¹, Williams C, McGregor SJ, Nicholas CW, McArdle F, Jackson MJ, Powell JR.

        http://www.healthline.com/health/osteoarthritis/turmeric-and-anti-inflammatory-herbs#Clove9
        http://www.advancedtissue.com/vitamins-b-c-wound-healing/

First Week of the Season

Val d'Isère is looking beautiful this week.  The lifts opened on Saturday and since then, the therapists at Bonne Santé have been busy making sure that everything is running smoothly for the season ahead. After snow for the opening weekend, we have been having a gloriously sunny week. Here is a run down of what we get up to at the beginning of the season:

On Saturday, we had team induction and orientation.  This was a heavy day, going through policies and procedures, company goals and objectives and service delivery.  Admin and personnel is never fun,  but essential all the same.  We have fantastic team dynamics, good banter and a great range of skills to work with this season.

On Sunday morning, we had the first ski of the season.  Although the light wasn't great at times, the sun tried to break through the clouds on the Solaise ski area and the effect was stunning.  The pistes were beautifully groomed and the slopes were quiet.

We checked out the new magic carpets at the top of Solaise. These are part of a huge redevelopment project which is taking place over the next two years. The project has been designed to minimise environmental impact, with many new trees being planted and noise pollution reduced. The magic carpets have replaced the rope pull and drag on the top of the ski area, with double carpets (slow and fast) replacing the short lac chair lift that brings you back to the summit.  

On Sunday afternoon, we had our first team training session. We have these every week of the season, to allow us to skill share, brainstrom and improve our techniques.  On Sunday we had massage training. Although we are all already trained and highly skilled in a variety of massage techniques, we spent three hours going through our skills and practicing on each other.  Needless to say, by the end of the session we were all very relaxed and ready for a nap! 

Monday was my beautiful little girls second birthday.  She spent the morning with her friends in Crèche and then celebrated in the afternoon.  She was particularly excited by her present from her Grandparents......her very first pair of ski's! 

The rest of this week has been busy with patients, meetings and social time in the evenings.  Thank you to the chalet companies that have invited us to drinks and dinners this past week.  We have been giving presentations and talks to chalet staff and ski instructors, with more lined up next week. We have been delivering presentations on injury prevention during a ski season, covering topics such as strength and fitness, nutrition, hydration and fatigue.  Fatigue is probably the largest contributor to injuries occurring.  It is all too easy to burn the candle at both ends during a ski season, and getting a work-life balance is essential to staying fit and healthy.  

My team have been making the most of this quieter time by getting up the hill most days.  They have already had ski lessons and are enjoying great conditions on the pistes.  Fingers crossed for more snow this weekend. 

LSA

www.bonnesantephysio.com

info@bonnesantephysio.com

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