Calf pain in skiers and boarders

Do your calf muscles get tight and sore after a few days on the slopes?  You're not alone. Although skiing and boarding have very different physical demands on the body, the calf complex can notoriously be a problematic area in both sports.

This blog is going to focus on aches and pains from overuse and DOMS (delayed onset muscle soreness), rather than a tear in a muscle from direct injury (contact Bonne Santé if you want more information about calf muscle tears and acute injuries).

You have two major muscles in your calf complex.  The more superficial of these is called the gastrocnemius and the deeper one is the soleus. Generally people are more aware of gastrocs muscle and how to stretch it, however the soleus is particularly key in skiers and boarders because it is a stabiliser of the lower leg when the knee is bent (which is how you spend most of the day on the hill).

The role of both of these muscles is plantar flexion, in other words they point the foot towards the ground. Any pressure through the ball of your foot is generated by the calf complex. When we are skiing and boarding we are constantly using pressure through our forefoot to control our equipment, speed and direction. Therefore the calf complex is constantly being stretched and contracted, placing the muscles under significant tension.

There are many factors that increase the risk of calf strains and pains when you are skiing / boarding.  These include but are not limited to:

• poor flexibility in both the gastrocs and soleus muscles
• weakness
• ankle joint stiffness
• inadequate recovery periods
• poor foot position and / or boot set up
• inadequate warm up and cool down
• poor balance
• inadequate rehabilitation following a previous calf injury

Ankle Mobility

Skiers and boarders are required to have good ankle flexibility to facilitate ankle flex in a rigid boot.

If you don't have good flexibility in your ankle joint and calf complex you will struggle to achieve a sufficient ankle flex pattern which will not only affect your performance but put you at increased risk of injury.  Stiff or over flexed boots will also put more strain on the calf complex, as can boots that are fastened incorrectly.  To ensure optimum set up, speak to a professional boot fitter and take your time to get a ski boot tailored to your individual needs and level of skiing.

How to increase the flexibility of the calf complex

Try the gastrocs and soleus stretches pictured below everyday for at least six weeks prior to your skiing / boarding holiday. Make sure that you are warm before you stretch and hold each of these positions for thirty seconds. Repeat three times on each leg.  You can stand in these stretch positions while you are brushing your teeth (as long as you are warm)  - that way it becomes part of your daily routine.  If you do not feel that your flexibility is improving after a few weeks of doing these stretches daily, you may need to see a physiotherapist to make sure that it is not a structural / bony restriction.

        

Signs and Symptoms of a Calf Strain

DOMS in the calf complex is most frequently felt when you begin a new exercise program, change your exercise routine, or dramatically increase the duration or intensity of your exercise routine, such as when you are on a skiing or boarding holiday.  Symptoms include:

• tightness and muscle spasm
• pain and stiffness may occur when resting, or after standing up having sat for a while.  
• sudden pain or a pulling sensation in the calf area, which increases with activity such as walking, stairs and standing on tip toe
• Pain and stiffness can be significant in the morning.  This may improve as you get going. 

Calf Muscle Strengthening

To strengthen the calf complex place the balls of your feet on the edge of a low step. You may wish to hold on to a banister for balance.  Slowly sink your heels down and pause, then rise up onto your tip toes. Make sure you go all the way up onto your tip toes, so that you are strengthening the muscle throughout the whole range of movement. Aim to repeat this 20 times (although start with as few as 5 repetitions if you find this hard and gradually build up), as to prepare for skiing and boarding we want to increase the endurance of the muscles. If this is easy aim for x 3 sets.  If this is still easy, contact us to find out how to progress this exercise further. Ideally aim to practice this 3 - 5 times a week . This exercise targets the gastrocnemius muscle.

To focus on strengthening the soleus muscle, stand in the same position. This time bend your knees into a small squat position.  Again, sink your heels, pause and then rise onto your tip toes,  Maintain the bent knee position while you do this - it is a difficult one to master and it will challenge your coordination. Repeat as above.

If you do have aches and pains in your calf muscles when you are on your skiing holiday in Val d'Isere, call us for free telephone advice.  We are likely to advise a deep tissue massage or a physiotherapy session to accelerate the healing process and get you back on the slopes painfree.

Physiotherapy may involve:

• soft tissue and myofascial release
• strapping and taping techniques
• use of a heel wedge
• ice or heat treatment
• stretches and joint mobilisation
• ultrasound therapy
• exercises and rehabilitation 
• biomechanical correction
• compression garments
• anti-inflammatory advice

Disclaimer:
Please be aware that there are other reasons that aches and pains may occur in the calf.  It is always recommended that you seek professional advice rather than trying to diagnose injuries yourself.  If you have a calf that is hot, swollen and firm to touch with pain that doesn't go away with rest then we recommend that you seek medical advise.

The purpose of this blog, is to provide general information and educational material relating to physiotherapy and injury management..  Bonne Sante physiotherapy has made every effort to provide you with correct, up-to-date information.  In using this blog, you agree that information is provided 'as is, as available, without warranty and that you use the information at your own risk.  We recommend that you seek advise from a fitness or healthcare professional if you require further advice relating to exercise or medical issues. 

LSA

       Bonne Santé          info@bonnesantephysio.com         0033 (0) 4 79 06 07 27

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Injury trends

Did you know that the weather and the snow type both affect injury trends in alpine sports?  At Bonne Santé we audit the injuries that we see.  Along with literature reviews and up to date research, this allows us to keep track of the trends that are occurring and helps us plan injury prevention strategies. Through informative seminars, biomechanical analysis and patient education we strive to use our knowledge and awareness to decrease injury risk in skiers.

When possible, it is important for us to learn how injuries occur.  It helps us to assess the likely damage, identify the primary structure affected and ascertain if there are any other structures involved.  It helps us to decide if you may also need an x-ray, a brace or further opinion.

Many ski injuries are avoidable by being fit to ski, having the correct equipment set up and avoiding fatigue, however all sports carry a risk of injury, and alpine sports especially due to the environment and equipment involved.  The aim of this blog is not to put you off skiing, but to increase your awareness of how and why injuries occur.   This blog talks about some of the injury types that we have seen recently. Our aim, when possible and safe to do so, is to accelerate the healing process and to return our clients back to the pistes as quickly as we can.

HARD PACKED, ICY SNOW

During the first few weeks of December, the snow was icy and hard packed.  Interestingly, we had a surge of people needing treatment for pre-existing niggles that had flared up on the hard, unforgiving terrain.  This was especially true in people who had pre-existing lower back pain. Typically, the bullet proof pistes were contributing to significant myofascial spasm, especially to the quadratus lumborum muscles (found in your lower back and sides) and the hip flexors.  In the majority of cases, we were able to treat these injuries and return our clients to the slopes.

Although we saw a lot of people suffering from knee pain, this was mostly due to the hard packed pistes and thigh muscles over working. Even well conditioned ski instructors reported feeling the strain on their knees.  We did not see a lot of knee ligament injuries during this time.  The handful of anterior cruciate ligament (ACL) injuries that we did see early in the season, mostly occurred in skiers that were landing from jumps (boot-induced mechanism) or through bent knee twisting injuries (the phantom foot mechanism).

The boot-induced mechanism usually occurs after going off a jump. Instinctively, the skiers legs fully extend and the tails of the skis contact the snow first on landing.  This forces the back of the ski boot against the calf, driving the tibia (shin bone) out from under the femur (thigh bone) resulting in an ACL injury.  

In the phantom foot mechanism, the skier loses balance to the rear and 'sits back' on the skis.  The hips end up below the knees and the skiers weight is shifted on to the downhill ski, which then rotates inwards on the hyper flexed knee. The downhill ski is fixed, while the rest of the body continues forward and if the bindings do not release, the ACL takes the strain.  This typically happens when a skier is attempting to get up whilst still moving after a fall or attempting to recover from an off balance position.

When the snow was hard packed we also saw more compressive meniscal injuries than usual.  The menisci are the cartilage discs that are located in the knee joint.  These act as shock absorbers. With the repetitive forces through the legs when skiing on bullet proof pistes, the meniscus start to take the strain.  The other time we see meniscal strains is when skiers are training in the bumps.  Again, the repetitive loading puts huge forces through the knee joints and as the mensici act to absorb these forces time and time again, eventually they react.  This is especially true in skiers that may not have optimum alignment and positioning through their lower limbs, such as A-frame skiers.

POWDER ON THE PISTES AND VARIABLE TERRAIN

Since the snow has come (and keeps coming), we have seen an increase in knee ligament injuries, especially to the ACL and the medial collateral ligament (MCL).  When there is powder on the pistes, skiers are a lot more likely to catch an edge and fall.  If the ski binding doesn't release, the knee ligaments usually take the strain. Commonly, this occurs through a 'valgus and internal rotation strain' as well as through the phantom foot mechanism mentioned above.  When the former occurs,  the skier falls forwards and the inner edge of their ski tip catches on the snow.  This causes an immediate abduction (outwards) and external rotation of the tibia. As the skier is carried forward by their momentum, a valgus (inwards) strain occurs at the knee.

Another huge factor that has been contributing to current injuries is the visibility, or lack of!  All the recent snow has meant cloudy days, flat light and white out conditions.  If you can't see well, it is difficult to read the terrain and the contours in the pistes.  Lumps and bumps can sneak up unawares and falls are more likely.  Having good balance and righting reactions can significantly help to reduce the chance of falling.   Practicing both static and dynamic balance drills is a good idea on the lead up to your skiing holiday, as is practicing your balance with your eyes closed. If you take away your visual stimulus, you have to rely on your other balance systems to keep you upright (your vestibular system and your proprioceptive system).  It therefore makes sense to train these off the hill, by doing balance drills with your eyes closed.  I will come onto balance drills in a future blog, in the meantime contact info@bonnesantephysio.com for further information.

Knee injuries are common in both recreational and professional skiers. If you are unfortunate enough to sustain a knee injury on your skiing holiday, you can call us for phone advice or an appointment on 00 33 (0) 4 79 06 07 27.  We are recognised by most UK insurance companies.

LSA

       Bonne Santé          info@bonnesantephysio.com         0033 (0) 4 79 06 07 27

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References:

Factors associated with self-reported failure of binding release among ACL injured male and female recreational skiers: a catalyst to change ISO binding standards?  British Journal of Sports Medicine 

January 1, 2016 50: 37-

Knee Injuries in Downhill Skiers.  A 6-year Survery Study.   Shea et al,Orthopaedic Journal of Sports MedicineJanuary 2014 vol. 2 no. 12325967113519741   40

Mechanisms of Anterior Cruciate Ligament Injury in World Cup Alpine Skiing.  A Systematic Video Analysis of 20 Cases. Bere et al.  Am J Sports Med July 2011 vol. 39 no. 7  1421-1429

Myths Concerning Alpine Skiing Injuries, Johnson et al,  Sports Health: A Multidisciplinary Approach November/December 2009 vol. 1 no. 6 

Where are they now?

Celebrating 10 years at Bonne Santé

10 years ago today I walked through the doors of Bonne Santé and began my life in Val d'Isere.  At the time, it was early in my clinical career and I was slightly apprehensive about my clinical experience. However, my clinical skills turned out to be the least of my worries.  I soon found that I had an apt for treating acute injuries and I was passionate about snow sports.  Running a business in France, however posed a whole new set of challenges.  I must say, I think my naivety worked in my favour! Had I known the journey I was about to embark on, I may have stuck to just treating patients, rather than running a small business.  However, here I am 10 years later with many people to thank for their support and loyalty.

First and foremost, I want to thank my long suffering husband!  He has been my constant source of help and support over the years. He has been my (unpaid) marketing lead, my admin assistant, my secretary, my co-orodinator and my accountant, all on top of his own full time work as well as being a loving husband and father.  I could not do what I do without him.  I also want to thank my parents and siblings, who have also supported me and guided me on this journey.  My parents were a huge help in the early years, teaching me about running a business and accounting, always at the end of the phone when I needed them.  My brother Chris is always my port of call for technical issues and social media support - thank you.

There are too many people that I am grateful to, to mention everyone individually but I must thank Holly Junak, Clare Angus and Gill Watson who have always been there for me, believed in me and constantly supported Bonne Santé.

In celebration of 10 years of running Bonne Santé, I wanted to share with you some information about previous team members.  We often get asked about therapists that have worked at Bonne Santé in the past.  I feel proud to have had and continue to have an exceptionally high calibre of physio's as part of the team.  Although many physio's have done year after year at Bonne Santé, the nature of seasonal work means that eventually they do move on to more permanent roles.

First and foremost, I must mention and express my gratitude to Sue Reed.  Sue established Bonne Santé in 1994. She nows lives in Italy with her family where as well as physiotherapy, she specialises in Craniosacral therapy and Chi Kung.  You can find out more about Sue through her website:    http://www.ilrespirodellavita.it.  Sue is an extremely inspiring practitioner and highly skilled therapist who is still greatly missed in Val d'Isere.  Thank you Sue, for handing your hard work and dedication over to me.  It has been a pleasure to continue Bonne Santé.  

The list below is not exhaustive but I have picked a handful of previous team members to update you on their professional journey's.

• Laura Penhaul:  Laura is currently lead physio for GB Paralympics.  She has worked with the GB ski team, was part of the medical team at the Vancouver 2010 Para olympics, she worked with athletes at the London 2012 Olympics and she will be going to Rio for the Paraylmpics in 2016.  Her lists of professional achievements is huge, however she is currently undertaking an enormous personal challenge.  Laura is leading an all female crew of four across the Pacific ocean in a 29ft pink rowing boat!  They are raising money for Breast Cancer Care and Walking with the Wounded.  Follow their remarkable journey at www.coxlesscrew.com

• Jane Carré (née Hawton):  Jane has worked at both the London 2012 Olympic and Paralympic games and at the British Swiming Chamionships.  She has also travelled with GB Bobsleigh.   She is currently focused on the GB swim team as she is part of their medical team selected for Rio 2016 Olympics.  

• Paul Welford:  Paul is currently studying medicine and aims to fulfil his ambition as an orthopaedic surgeon.  Although this transition will be a loss to the physio profession, anyone looking for an outstanding physio in London can still find Paul working part time at Pure Sports Medicine  www.puresportsmed.com 

• Emma Bellew:  Emma has become a fully certified APPI pilates instructor and is currently in America looking after the performers of the Cirque de Soleil.  

• Helen Saunders: Since leaving Bonne Santé, Helen has been working at Headley Court, treating complex trauma needs of injured military personnel. She has been making a huge difference to the lives of wounded British troops. 

There are many previous team members that I am extremely thankful to for their hard work and dedication.  Seasonal work is hard work but extremely rewarding.  It is a pleasure to work with the residence and holiday makers of Val d'Isere and help to return you to the slopes as quickly as possible, when safe to do so.  

I have been very lucky to meet lots of interesting people here in Val d'Isere.  I have many patients that have taught me a lot over the years (due to client confidentiality I can't mention you individually, but I hope you know who you are). Heres to the next 10 years of Bonne Santé 'keeping you fit to ski'.

LSA

      Bonne Santé

      info@bonnesantephysio.om

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