FITNESS AND INJURY PREVENTION MANAGING THE MALALIGNED SKIER By Carl Petersen BPE, BSc (PT)

Symmetrical strength and flexibility of the legs and lower torso are necessary for opti- mum agility, mobility, speed and on hill deceleration control. If your hips and pelvis are malaligned the changes can lead to asymmetries of muscle tension, strength and joint range of motion leading to poor performance, dysfunction, pain and injury (Fig.1). The flexed posture assumed when skiingand travelling to and from the slopes and up lifts, further adds to this potential imbalance. The muscles most commonly shortened are the hip flex- ors, hamstrings and pectoral muscles.

WHAT DOES MALALIGNMENT MEAN?

Do you ever feel like your body is crooked or twisted and one foot seems to be scuff- ing the ground more than the other? Do you have particular trouble making a turn in one direction? If this is accompanied by pain or stiffness in the lower back, groin or into the buttocks, this could be a symptom of having a malaligned pelvis. Although there are many areas of abnormal biome- chanics, a common one, sometimes over- looked, is the pelvis and hips. Abnormal pelvic motion during skiing or training for skiing can put undue strain on a variety of structures that lead to overuse problems.

In the healthy body, the pelvis is able to withstand repeated gravitational and rota- tional strains but if the repeated strains are largely asymmetrical, as in skiing, the pelvic ring can become malaligned. Unequal muscle pull on each side of the pelvis can result in the ring becoming dis- torted. If the pelvic ring is distorted for a period of time your body’s ability to adapt is overwhelmed and pain is usually the result (Fig.2).

CAUSES A common cause involves bending forward while twisting the trunk either to the right or the left side eg. picking up your skis or

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The aim of this article is to create an awareness of the malalignment issues skiers, boarders and other athletes present with and to learn what can be done to prevent, treat and minimise its impact on active individuals. Sports like skiing are asymmet- rical in nature and can torque the body’s muscle and fascial systems leading to an imbalance in the length and strength of muscles and tendons. Few skiers make it through an entire season without experiencing some form of malalignment of the pelvis, spine and extremities, which can be an unrecognised cause of back and leg pain (1). In skiing and boarding the soft tissues around the spine are always work- ing dynamically in three dimensions (3D) to protect from the forces of gravity and rotation.

when hitting a mogul, creating a combined action of forward flexion with side-bending and rotation. The onset of pain is usually immediate, often felt on trying to get back to the upright position. It can, however, come on more gradually over the next few hours or even days, as inflammation in the supporting ligaments occurs (2).

Figure 1: Skiier Julien Couisineau

WHO IS AFFECTED? Skiers and athletes of all different levels are vulnerable to this syndrome. Here are some common risk factors: ■ Landing on one leg repetitively like skiing or playing volleyball

■ Playing asymmetrical sports that require a lunging and rotation action eg. golf, tennis and other racquet sports

■ Training on a camber (sloped surface, like the side of the road)

■ Inadequate 3-dimensional core strength and endurance

Figure 2: Most common form of malalignment

■ Inadequate hip flexibility especially hip flexors.

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