Cross country skiing – also known as Nordic skiing – is enjoyed by a growing demographic of all levels in the US. The Nordic experience provides a vigorous athletic workout, and access to winter landscapes and unique vistas for recreational participants to Olympic competitors. Injury prevention is essential to keep cross country skiers enjoying a full season. Here is what you need to know.

Common Injuries Seen in Cross Country Skiers

Good news. Cross country skiers are in the minority when it comes to ski injuries. Only 2 out of 10 ski injuries occur in the cross country world. Knowing the common causes can keep you safe. Injury risk occurs with:

• Inadequate preparation
• Overuse
• Trauma, most often a fall

Inadequate Preparation and Cross Country Ski Injury

Cross country skiing is a rigorous, and cardio intense sport. Skiers must be equipped for the full range of demands required to negotiate the terrain. A safe cross country skier will:

• Use professionally recommended, well-fitted, appropriate equipment
• Select terrain and conditions matched to capabilities
• Align balance, agility, stamina and technical skill with the course.
• Avoid terrain that exceeds training level
• Account for distance, duration, weather, elevation changes, and current conditions of the ski tracks
• Avoid fatigue
• Protect against frostbite and hypothermia
• Recognize personal limits and plan accordingly

Proper preparation is key to preventing a wide range of Nordic skiing injuries.

Overuse Injury in Cross Country Skiers

Overuse injuries in cross country skiers are the most common. Repetition of the various lower and upper body propulsion and glide techniques can lead to overuse injury. Ligament and joint strains and sprains are frequently the result of repetitive motion and overuse. This can occur in all joints of the body, as cross country is a demanding, full body sport.

However, the knee is the most frequently injured joint in cross country skiers. Sprain or strain Injury to the knee’s medial cruciate ligament (MCL) is the most common overuse injury. In addition, skier’s knee, also known as patellofemoral syndrome, occurs at a high rate. The repetitive bending and straightening of the knee creates friction and inflammation, resulting in severe pain. The kneecap is affected with symptoms such as:

• Pain, ranging from dull to shooting, surrounding the kneecap
• Limited knee movement
• More motion equals more pain
• Pain increases with pressure or flexing
• Noisy knee, such as snapping, cracking and popping sounds
• Up and down stairs and hills, running, squats and prolonged sitting activates pain
• Degeneration over time

The shoulder complex, along with the upper and lower back are also subject to overuse injury in Nordic skiers. The particular technique used for cross country skiing can place excess demand on these joints and muscle complexes. Shoulder impingement may also occur when overuse is coupled with inadequate strength in muscles of the shoulder complex. Pinching of the rotator cuff can result. Strength training, proper form, and avoiding overuse help prevent this injury.

Trauma Injury in Cross Country Skiers

Falls can occur in cross country skiing. The great majority of falls are simple, low risk events. However, falls are also the most frequent cause of acute cross country injuries. The design of the cross country ski contributes to the fall rate. Cross country ski boots attach only at the toe. The freedom of the heel can allow motions which can cause a fall. Unnatural positioning of the foot, twisting of the knee and landing in a risky position can result in a fall injury. Tangling up with skis and poles, or landing on a dangerous part of terrain can cause a blow to the head, torn tendons and ligament in the shoulder or knee, sprains and strains of other joints, and fractures to a bone.

The most common fall injuries are to the knee. Richard Cunningham, MD, is a board certified orthopedic and sports medicine specialist with a practice focusing on the knee and shoulder. Dr. Cunningham and his talented care team help diagnose and treat cross country skier injuries. The common types of injuries to the knee include:

• Sprain – can occur through overuse, but more often from a hard fall impacting the knee. Swelling, pain and limited movement are the initial symptoms. Medical treatment is recommended, and treatments range from home care to medical interventions.
• Meniscus tear – when a fall causes a twisting injury to the knee, this rubbery cartilage cushion of the knee may tear. The degree of tear will determine the symptoms. Home care may address the initial injury, but medical care is indicated if the injury does not improve, or worsens.
• Tendon tear – An awkward fall, blow to the front of the knee or even a minor twist may result in a tear to a tendon. The knee is supported by the quadriceps and patellar tendons. Tears of one of these tendons causes pain, swelling, and weakness. Orthopedic evaluation is indicated with these injuries.
• Torn ligament – the four ligaments of the knee may be injured by a fall impacting the front or side of the knee. A tear to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) will typically require surgical repair to ensure a full recovery.
• Shoulder dislocation – a hard fall on an outstretched hand may cause the shoulder to dislocate. A first time dislocation is often treated non-surgically, but a recurrent dislocation often requires surgery to prevent further shoulder damage.

Preventing Injuries in Cross Country Skiers

Cross country skiers prevent injury by being prepared. The key areas of prevention are safety and technique. Take a closer look.

Safety, ahead of time:

• Pre-season training for core, flexibility, strength, balance, stamina and aerobic conditioning
• Acquisition and maintenance of the appropriate gear, equipment and clothing
• A comprehensive understanding of the demands of the sport with an eye on personal limitations
• Gather items for light day pack, including hydration, nutrition, first aid and emergency items
• Proper skin and eye protection

Safety, day of:

• Check for safe weather conditions
• A group of 3 is optimal
• Inform others of your expected time, location and duration
• Review the conditions of the trail; speak with other skiers
• Make a note of icy conditions, ruts, tracks and sharp bends
• Be mindful of proper handling of poles and straps
• Observe trail safety and courtesy norms
• Take regular rest and refueling breaks
• Pay attention to fatigue and modify accordingly

If you have suffered from a cross country skiing injury, contact Dr. Cunningham and his team today.