1. Preventing Winter Injuries Castro Valley Ski Club 01/21/2009 Darrell S. Lavin, DC Lavin Chiropractic 20995 Redwood Road Castro Valley, CA 94546 510-727-0660doclavin@sbcglobal.net

2. Darrell S. Lavin, DC, QME, CGFI  Doctor of Chiropractic (20 years)  Qualified Medical Examiner  Certified Chiropractic Sports Practitioner  Certified Golf Fitness Instructor (Titleist Performance Institute)  Yada, yada, yada

7. Some Numbers  133,585 injuries from snow skiing  127,643 injuries from snow boarding  55,666 injuries from ice skating  55,311 injuries from ice hockey  38,395 injuries from sledding and tobogganing  20,390 injuries from snowmobiling Source: 2006, the U.S. Consumer Product Safety Commission

8. Types of Injuries  Sprains and strains  Dislocations  Fractures  Typically at the end of the day.  Overexertion and fatigue.  “One last run before the day's end.” (Hometown Buffet Syndrome)  Easily prevented with preparation, good physical conditioning, staying alert and stopping when tired or in pain.

9. Preventing Injuries  Maintain your fitness level during the off-season, then continue during the season since deconditioned bodies are pre-disposed to injuries.  Promptly address any injuries to avoid secondary injuries.  3-4 months to prepare for winter sports; more intense sports up to 6 months.  Pre-season training should include aerobic work and core strength training.

10. Important Muscles  Hamstrings are major protectors of the Anterior Cruciate Ligament (ACL).  Skiing, snowboarding and snowshoeing are quadriceps and gluteus dominant activities.  Cross-country skiing and skating have more lateral push.  Core stabilizes the lumbar spine (low back).  Dysfunction of these muscles can result in injury.  Lower Crossed Syndrome

11. Lower Crossed Syndrome  Hours of sitting with hips flexed.  Adaptive shortening of hip flexors.  Brain thinks the hip flexors are working.  Opposite muscles (glutes) are inhibited.  With major pelvic stabilizers (glutes) shut down muscles above (lower back) and below (hamstrings) tighten.  Opposite muscles (abs/quads) shut down.  Now prone to injury since primary muscles used for skiing are shut down with LCS.

12. Primary Skiing Muscles = tight = weak

13. Stretch and Strengthen  Stretch –Deep Hip Flexors  Hip Flexor Stretch – Half-Kneeling  Long Turns with Pole – Half-Kneeling  Strengthen –Glutes and Quads  Lunges  Lunges with Arm Pulls  Endurance  HIIT

14. Hip Flexor Stretch – Half-Kneeling  Start in the half-kneeling position with your right knee down and your left foot forward.  Start in the half-kneeling position with your right knee down and your left foot forward.  Take both hands and place them on your right hip.  Take both hands and place them on your right hip.  Keeping your spine neutral and using your hands to prevent any rotation of the pelvis, slowly lunge forward until you feel a big stretch in the hip flexors.  Keeping your spine neutral and using your hands to prevent any rotation of the pelvis, slowly lunge forward until you feel a big stretch in the hip flexors.  Try to stay tall throughout the exercise.  Make it a little tougher by putting your palms together and reaching your arms straight overhead to the ceiling.

15. Long Turns with Pole – Half-Kneeling  Start by getting into a half kneeling position with your front foot placed directly in front of your down knee.  Start by getting into a half kneeling position with your front foot placed directly in front of your down knee.  Sit as tall as possible.  Sit as tall as possible.  Raise a ski pole up over your head and continue to try and sit as tall as possible.  Raise a ski pole up over your head and continue to try and sit as tall as possible.  Slowly begin to rotate your trunk and the pole as far as possible in both directions.  Slowly begin to rotate your trunk and the pole as far as possible in both directions.  Repeat this movement 15 times to each side.  Repeat this movement 15 times to each side.  Go slow enough to maintain a good posture and good balance.

16. Lunges  From a standing position start by taking a large step forward with your right foot.  From a standing position start by taking a large step forward with your right foot.  Pretend like you are standing on a balance beam (narrow your base) and lower your torso and pelvis down keeping your posture upright.  Pretend like you are standing on a balance beam (narrow your base) and lower your torso and pelvis down keeping your posture upright.  Allow your back heel to come off the ground and make sure your front knee stays over your front ankle (Don't let your front knee go forward past your ankle!!!).  Allow your back heel to come off the ground and make sure your front knee stays over your front ankle (Don't let your front knee go forward past your ankle!!!).  Repeat on the other side.

17. Lunge with Arm Pulls  Start by attaching a resistance band at waist height.  Start by attaching a resistance band at waist height.  Facing the door, grab both handles and back away from the door.  Facing the door, grab both handles and back away from the door.  Now perform a lunge towards the door and simultaneously pull your arms down and back keeping your arms straight.  An alternative to pulling both arms down at the same time is to alternate each arm one at a time.  An alternative to pulling both arms down at the same time is to alternate each arm one at a time.  This forces your core to stabilize a rotational force and adds an additional level of difficulty to this exercise.

18. Endurance – HIIT (High Intensity Interval Training)  Downhill skiing is done in intervals.  30 second workout is the ideal place to start with Interval training.  Make sure that you stretch, warm up and warm down properly for every workout.  Go fast enough to feel that the last few seconds feel almost impossible to keep running.  Don’t save yourself for later, give it all up front. Make sure you consult with your physician prior to starting any exercise program!

19. AAOS Recommendations  Never participate alone in a winter sport.  Keep in shape and condition muscles before participating in winter activities.  Warm up thoroughly before playing. Cold muscles, tendons and ligaments are vulnerable to injury.  Wear appropriate protective gear, including goggles, helmets, gloves and padding.  Check that equipment is in good working order and used properly.  Wear several layers of light, loose and water- and wind-resistant clothing for warmth and protection. Layering allows you to accommodate your body's constantly changing temperature.  Wear proper footwear that provides warmth and dryness, as well as ample ankle support.

20. AAOS Recommendations  Know and abide by all rules of the sport in which you are participating.  Take a lesson (or several) from a qualified instructor, especially in sports like skiing and snow boarding. Learning how to fall correctly and safely can reduce the risk of injury.  Pay attention to warnings about upcoming storms and severe drops in temperature to ensure safety.  Seek shelter and medical attention immediately if you, or anyone with you, is experiencing hypothermia or frostbite. Make sure everyone is aware of proper procedures for getting help, if injuries occur.  Drink plenty of water before, during and after activities.  Avoid participating in sports when you are in pain or exhausted.

21. THANK YOU!