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Powder days can be tough on skiers’ knees

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By Dr. Jeff Daniels EBS Medical Columnist

Recently, we received a burst of snow that brought many skiers out to enjoy the fresh powder. Some of those who were not used to powder skiing found out that it isn’t as easy as Warren Miller makes it look.

What I hear from patients when they describe their injuries—be it a torn anterior cruciate ligament (ACL), broken shoulder or fractured wrist—is that one ski didn’t want to follow the other as a turn was being made through the powder. I’m sure there are lots of reasons for that, ranging from inexperience to using the wrong type of ski. I’ve also noticed that snowboarders fare a lot better on powder days than skiers. I imagine that’s because a person’s legs can’t move in opposite directions when tethered to a snowboard.

Twisting injuries to the knee do predominate on powder days. In my experience, the ACL is the part of the knee that’s most vulnerable to injury resulting from strain on the downhill knee. Most people who injure their ACL while skiing will either hear or feel a pop. Pain ranges from mild and short-lived to excruciating, which raises the possibility of a fracture in the knee. If one is daring enough to stand up and try to ski, the injured knee will invariably feel unstable and often collapses, which can produce further injuries.

Over the years, I’ve watched the Big Sky Ski Patrol take many people with knee injuries down the hill in a toboggan. Most will come in for an evaluation. A few bypass the Medical Clinic to seek care elsewhere, or because they’re in denial mode. On occasion, they immediately return to the Medical Clinic when their knee buckles as they try to get into their car.

There are some very unusual reasons why patients with knee injuries don’t want us to evaluate them immediately. I still remember a woman who was brought in by the Ski Patrol many years ago with an immobilizer around each knee. She waited for her family, who carried her out and back to their hotel room.

The next day, they carried her back in to see me for an evaluation, and the first thing I asked was why she hadn’t let me check her knees the day before. My jaw dropped when she said, “But Doctor, I hadn’t shaved my legs!”

This year, we’ve seen some unusual injuries where our suspicions have been borne out by getting a CT scan or an MRI on the same day of the injury, or very shortly thereafter. That’s because of the availability of CT and MRI at the Big Sky Medical Center. In most major cities, getting scans like that could take days or weeks, but for now, Big Sky’s new hospital allows for quick access to these incredible ways of imaging many injured parts of the body.

Since many of my patients have sent me MRI results, I know that I’m very accurate at diagnosing torn ACLs. I’m also amazed at how many significant ankle and foot fractures we see where the X-rays don’t reveal an injury. Clinically, we know something is wrong, and we’re now relying on a CT scan of the ankle and forefoot to confirm the diagnosis.

On another note, while watching the opening of “Saturday Night Live” on March 4, I was struck by a line delivered by Kate McKinnon, who was portraying Attorney General Jeff Sessions as Forrest Gump. When it was revealed that he lied to Congress, his attorney admonished him to “Run, Jeffrey, Run!”

Well, taking that to another dimension, I’ve decided to begin seriously training to run another marathon. You never know how current events might affect you!

Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.

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