Feb 17, 2016

Interview Transcript

Interviewer: Why most ski injuries happen in the afternoon. That's next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Travis Maak is a sports medicine expert and the Head Orthopedic Team Physician for the Utah Jazz. He says a majority of ski injuries happen in the late afternoon, and unfortunately it's during that last run, that one more run. How did you find this out?

Dr. Maak: Part of it was from personal experience, to be honest with you. So I actually was a sort of volunteer ski patroller in my high school days here when I was growing up. It's something that is known to all ski patrollers, that basically . . . ski patrol is in large part about 90% boredom, and that happens from the beginning of the day where you literally just go out and ski yourself because you're so bored, because there's nothing else going on, to about 10% of terror.

That always happens at the end of the day, and sometimes right after lunch. But usually it's from about 3:30 to 5:00 is when everything happens. That's where you basically put your gear on and get ready, because you are going out. It's not an 'if', it's a matter of 'when.'

The reason that happens is it most likely it has to do with two things. One is it's starting to cool down so from a temperature perspective the snow is starting to get a bit harder. It loosened up. It warmed up. It was a little bit softer. During the afternoon it starts to cool down, so it gets a little bit rockier, a little bit skied out, so the terrain itself is more difficult. That's the first thing that is most likely contributing.

But the other contributor is a personal and modifiable factor. You can't change the weather, but you can change yourself. We all want to get in as much as we can, the most bang for our buck. We bought that pass. It may seem a little overpriced, but when you do it, it's fantastic and you want to keep going and get the most out of it.

Basically, it has to do with a muscle fatigue. The ligaments are the structures that hold our joints together. The main injury that we see typically is either a broken bone or a ligament tear. In particular in skiing it's the ACL. The ACL seems to be unfortunately the skier's injury. Generally, the reason it happens is the knee joint has two predominant stabilizers, the muscles, the tendons as one unit, and then the ligaments. Those are separate. The ligaments are literally like ropes. They connect the two bones together.

The muscles are the dynamic stabilizers, so they fire when they're working and you make your knee bend and straighten, and it allows you to do those bumps and do those turns in a perfect fashion. But when muscle fatigue happens, then the muscles aren't working correctly. They aren't firing correctly and they start to get weak and tired. As they get weak and tired, your mind may want them to go, but it's not going to happen because, frankly, you just can't put forth the energy.

So where does that energy go? It doesn't disappear. It goes to the ligaments, and so the ligaments end up taking more energy than they're supposed to and they end up failing and tearing. That's most likely why this happens, because the energy which is dissipated by the muscles can't be because they're tired and fatigued, and so it goes to the next step in the chain.

Interviewer: Do you find that people that are a little bit more muscularly in shape are less likely to have this happen, or at that point in the day is pretty much everybody susceptible?

Dr. Maak: Muscularly in shape is a question that a lot of people take to mean the body builder, giant muscles, and frankly that actually has nothing to do with it. In fact, a lot of people who have those fast-twitch, big muscles end up getting tired quicker. If you look at endurance athletes or athletes that are training for a specific sport, the muscles themselves have become accommodated to a long-term type of energy expenditure.

Skiers, for instance, they train in both strength, the quads, the hams, the lower body strength, but also endurance. Ultimately, that's what we're talking about is endurance. It's the fatigue of the muscle, not the ability to jump really high one time or run a sprint. It's the ability to stay and produce that power and energy over a long period of time, hence the last run of the day.

At the end of the day, it's fatigue. It's training. It's the ability to generate that force required to ski throughout the day. When that ability to generate that force disappears, that's when the injuries happen.

Interviewer: So probably your casual skiers don't have that kind of muscular endurance.

Dr. Maak: They don't. Interestingly, here at the University we've actually produced a skier's program to provide people with sort of an ability to produce that type of power and endurance over a period of time pre-ski season, so that by the time they hit the ski season, they are ready. Their quads are ready. Their hams are ready, and it's a completely different muscle set than happens over the summer when you're out running, you're out doing the type of endurance summer activities, rock climbing, etc. It's totally different for skiing. It's a different muscle group, and if you don't [inaudible] and educate your body to those muscles, you're not going to be able to do it.

Interviewer: So what's your final advice? I mean, you've laid it out that the injuries are happening in the late afternoon. Do you just not do that last run? Do you just slow it down a little bit? What would you tell a skier?

Dr. Maak: At the end of the day there's always one last run. That's unavoidable. So the message that we try to get out here is make that one last run a fun one, and not a potentially serious or a safety issue run. The way to do that, let your body be your guide. You can do all of the things that we've talked about already, which is prepare yourself for the run. Prepare yourself for skiing. Get yourself in tip-top shape as best you can. But also listen to your body.

After lunch, you're going to be a little fatigued. You let things set in. You may slow down the runs. Don't go hit the double black run right after lunch. Instead, maybe start on blues, ramp it back up a little bit. But once 2:30, 3:00 starts setting in, look at your watch, listen to your legs, listen to your body, and instead of going and hitting the double black as the last run, maybe take a groomer. Take a nice, little, smooth one down. Enjoy yourself. You don't have to be a hero at the end of the day. At the end of the day, if you do it that way, you'll be able to come back the day after.

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