Spectators of the 2022 Beijing Winter Olympic Games enjoyed watching additional freestyle skiing events. Freestyle skiing formerly included Aerials, Halfpipe, Moguls and Ski Cross. However, starting in 2018, the International Olympic Committee added Big Air and Slopestyle, and now there are a total of 13 events for the sport. These additions are an acknowledgment of the growing interest in freestyle skiing. Higher speeds, bigger jumps, more complicated aerial tricks, blind landings, and expanding showmanship, all while on skis, have led to a higher level of risk and injury to the freestyle skiing athlete.

Richard Cunningham, MD, a Board Certified Orthopedic Surgeon, Sports Medicine Specialist and US Ski Team Physician, as well as an avid high country skier, outlines the top 4 most common freestyle skiing injuries. Dr. Cunningham and his exceptional sports medicine care team, have the experience and expertise to diagnose and treat the injured freestyle skier.

Risks

Practice and balanced training regimens can sometimes prevent injury, strain, and impacts to knees, shoulders, hips and the spine. However, given the high speeds, difficult terrain, adoption of more difficult tricks, potential for awkward landings, crashes, collisions, injuries often occur.

Knees and shoulders are at particular risk, second only to a head injury. Damage to joints and ligaments, fractures, and bone bruises to the knee and shoulder are common. Knee injuries most often involve a rupture to the anterior cruciate ligament (ACL) of the knee usually in combination with an MCL tear. Shoulder injuries typically involve shoulder dislocation and labral tears. Each event in freestyle skiing contribute distinct risk factors:

• Aerials – aerial height and maneuvers can result in high impact falls
• Halfpipe – elevated heights leading to high risk falls
• Moguls – repetitive impacts to the knee with possible wear and tear changes
• Ski cross – possible collisions after landing jumps, taking rollers and banks
• Big Air – skiing on rails, doing tricks off jumps has a high injury risk
• Slopestyle – skiing with obstacles, rails, and varying terrain poses risks

Freestyle skiing injuries tend to be more severe than other ski injuries. Athletes often find they are missing more than 28 days with their injuries. Here are the four most common types of freestyle skiing injuries.

1. Knee Ligament ( ACL and MCL) Injury

ACL (anterior cruciate ligament) and MCL (medical cruciate ligament) tears are the most common type of acute knee injuries in freestyle skiing. The most commonly reported injury events are:

• Landing in the back seat
• Having your knee move inward suddenly
• Direct impact to the knee

ACL’s tear when the knee suddenly shifts out of place. Most ACL tears are complete but their are the occasional partial tears. Other structures in the knee may be damaged at the same time. For instance, the medial and/or lateral meniscus commonly tear when the anterior cruciate ligament tears.

A torn ACL causes immediate symptoms. If symptoms are not immediate, there is a notable change in a patient’s condition within the first 24 hours. Most commonly, symptoms include:

• An initial popping sound, similar to a rubber band snapping
• Swelling
• Pain, usually intense and often coupled with a burning sensation
• Progressive limitation in normal knee range of motion
• Significant reduction in the weight bearing capacity of the knee
• Developing tenderness to the touch around the knee
• Sensation of looseness and instability in the knee joint
• Warm to the touch due to joint inflammation
• Change in appearance of the knee as compared to healthy knee

A torn MCL is always due to a traumatic event, such as a hard fall or an injury while playing sports. As the knee angles inward, the MCL is stretched until its fibers tear to varying degrees. An audible popping sound may occur upon injury. This popping is the sound of the ligament tearing. Patients often report hearing a pop and then having severe pain along the inside of the knee. The knee can feel unstable when walking following an MCL tear. Additional symptoms may include:

• Difficulty straightening and bending the knee
• Stiffness and tightness in the knee
• Swelling and pain localized to the inside of the knee
• Difficulty going up and down stairs or getting up from a seated position
• Sensation of the knee giving way, especially when turning on the knee

MCL tears are often isolated injuries. However, in freestyle skiing, it is not uncommon to tear other ligaments in the knee at the same time, most frequently the ACL. Freestyle Skiers with injury to the ligaments of the knee usually require surgery for the ACL and in some cases the MCL. Knee surgery, including ACL and MCL surgery are the most common surgeries performed for freestyle ski athletes. Many patients report a full return to activities after ACL surgery. Dr. Cunningham is a knee specialist at Vail Summit Orthopaedics. He is an expert at diagnosing and treating ACL tears for patients in Vail, Summit County, Aspen, and Denver, CO.

2. Knee Meniscal Tears

With an acute freestyle skiing injury resulting in a meniscus tear, a skier typically experiences:

• A sudden, severe injury often with feeling a pop in the knee
• Immediate and severe pain
• Swelling and stiffness of the knee
• Weakness and limited range of motion
• A sensation of catching or locking in the knee during knee movement
• Often other associated ligament tears causing knee instability and further pain

Freestyle skiers with acute meniscus tears are best treated surgically to allow for preservation of the entire meniscus. Without surgery, the meniscus will not typically heal, and if a patient waits too long the tear can progress, and the tissue then becomes completely torn until it is no longer amenable to repair and instead has to eventually be removed.

The outer third of the meniscus is called “the red zone.” This area has blood supply and the meniscus can heal in this area if sutured together. The inner two thirds of the meniscus is called “the white zone.” This area has no blood supply and will not heal, even if sutured together. For tears in the red zone of the meniscus, Dr. Cunningham always recommends meniscus repair, so that the entire meniscus can be preserved with no meniscus being removed as it is such an important shock absorber. Removing a significant portion of the meniscus in a young person will predispose the patient to developing early arthritis in the knee.

Dr. Cunningham performs meniscus repairs arthroscopically. Several small incisions are made around the knee and an arthroscope is introduced. Specialized instruments are used to place sutures across the meniscus in order to hold the tissue together so the meniscus can heal. Following surgery, patients go home the same day. They are placed in a knee brace and for most repairs, they are allowed to fully weight bear on the knee as long as the knee is held straight in a brace. Full recovery following meniscus repair surgery can take 3 – 4 months. Dr. Cunningham is a knee specialist at Vail Summit Orthopaedics and Neurosurgery. He is an expert at diagnosing and treating meniscus tears for patients in Vail, Summit County, Aspen, and Denver, CO.

Shoulder injuries are second in frequency to knee injuries in Freestyle Skiers. These injuries are also more likely to be severe, with a greater than 28 day time loss from the sport. The most common shoulder injury is:

3. Shoulder Dislocation

The hard falls associated with freestyle skiing in which one extends their arm to break their fall can result in dislocation or subluxation of the shoulder. As a shoulder specialist, Dr. Cunningham offers expert information for freestyle skiers with shoulder dislocations.

Shoulders dislocations are usually anterior. In these cases, the humeral head comes out of the shoulder socket toward the front of the shoulder. The initial symptoms include:

• Intense pain
• Knowing that the shoulder is out of place
• Near inability to move the shoulder
• Shoulder weakness
• Numbness and tingling down the arm
• Swelling

Accessing emergency medical care is recommended. In an emergency room, an xray will be obtained to assess the direction of the dislocation and to rule out any associated fractures that would prevent a reduction attempt in the ER. If there is no associated fracture and just a dislocation, the ER physician will utilize one of several reduction maneuvers to get the ball back in the socket. The upper extremity is then placed in a shoulder sling to immobilize the shoulder joint and protect it.

After the ball is put back into the socket and the joint properly aligned, patients commonly experience the following symptoms:

• Significant reduction in pain
• Apprehension when moving the shoulder away from the body
• Numbness and Tingling down the arm
• Swelling
• Popping and clicking sensations when moving the shoulder

Icing the shoulder after a dislocated shoulder is encouraged. Over the counter pain medications can be used if needed for pain. One can also slip out of the sling to do limited shoulder range of motion exercises or to take a shower. A return to freestyle skiing should be overseen by your physician and physical therapist. Dr. Cunningham and his team are experts in guiding your return to activity.

Freestyle Ski Injury Prevention

Regular and guided training, properly fitted equipment, and safety protocols can allow for enjoyment of this sport and limit injury risk. It is most often the unpredictable element that leads to injury. Falls, collisions and technical error are the leading causes of injury. Freestyle skiers should be mindful of these risks. Dr. Cunningham recommends prevention best practices:

• Warm-up and stretch before and after
• Evaluate the ever-changing weather and terrain
• Pay attention to fatigue
• Respect personal limits
• Monitor condition and fit of equipment
• Commit to overall conditioning
• Maintain healthy nutrition, hydration and sleep habits

Dr. Cunningham, a sports medicine specialist, and his team have the expertise to treat freestyle ski injury, as well as work with athletes to protect themselves from injury with overall freestyle skiing fitness and proper body mechanics. Contact his team today: 970-476-7220.