16 Jul 2010
What to Do When a Skater is Injured: Part Two
Lauren Downes MSPT
This is part two of a series of articles that will discuss various figure skating injuries and recommendations for a skaters’ activity level while injured. Please note that these are general guidelines, as each skater’s injury may affect him or her differently than another skater. Many injuries require a consultation with a physician and/or a physical therapist. After reading this article, you will have increased awareness of how to limit your skater’s activity level and how to avoid further injury.
1) ACL Tear: An ACL tear is an injury that requires a great amount of rehabilitation. The ACL is a ligament which connects the two major lower leg bones, the femur and the tibia. It is one of the most important structures that stabilizes the knee. Without an ACL, your knee is more likely to buckle underneath you. An ACL tear is very common in female soccer, lacrosse, and basketball players, yet a figure skater can easily tear it by landing and causing a twisting motion at the knee. A younger athlete will need surgery to reconstruct the knee, and rehabilitation may take up to six months. A new ACL is constructed from either part of the patellar tendon or the hamstring tendon, or from a cadaver graft. The first few months are devoted to restoring range of motion (bending and straightening) and basic strengthening exercises. A skater would be on crutches and in a full leg brace for a month. After the initial phase of recovery, physical therapy will continue to work on lower extremity strengthening and stabilization exercises, flexibility, swelling reduction, and balance. The quadriceps muscle automatically ‘shuts off’ when the ACL tears, and re-building strength is a lengthy process. It is very important to listen to the physician’s and physical therapist’s recommendations regarding a return to the ice. If a skater returns too soon, before full strength is achieved, he or she will not be able to perform jumps effectively, and may develop knee pain or other lower extremity issues in the future. If your skater tears the ACL, be prepared for him or her to be out of the sport for at least 6 months.
2) Groin Pull/Strain: A groin pull is the layman’s term for a psoas or adductor muscle strain. The psoas muscle attaches to the hip and pelvis anteriorly, and the adductor muscle group attaches more towards the inner part of the hip and pelvis. A pull can occur because a skater is not properly warmed up or the muscle becomes overloaded. A skater with sufficient strength can injure the muscle; he or she may torque it at the wrong angle and overstrain it. Rehabilitation should start right away and involve icing, deep tissue massage, ultrasound, and electric stimulation. Once the initial pain subsides, a skater can begin strengthening and stretching. It is important to avoid over-stretching at first, as the muscle fibers need time to heal.
As with other injuries, it is important to gradually return to jumping and completing certain spins. Once back on the ice, a skater should only stroke and do moves in the field the first day, to test the muscle’s capabilities. Next, the skater should perform spins, yet avoid performance of the sit spin. Sit spins require a great amount of force production from the adductor and psoas, and should be avoided for the first week or so. Also, the action of swinging the free leg through for momentum requires strength from these muscles, and should be done gingerly at first. If a skater has pain with this motion, he or she is not ready to return to the ice. A return to jumping should be monitored with a jump chart. Once the skater has performed a few sessions of only single jumps, double jumps can be performed on a limit basis. Set the number of jumps at a low number for the first few days, then gradually increase that number as a skater feels more comfortable. Pay attention to the skater’s complaints of pain and discomfort. A groin injury is a pesky condition; returning too soon can lead to months of pain and further breakdown of the muscle.
3) Wrist Ligament Sprain: The wrist is a complicated structure made up of your ulna and radius bones in the lower arm, and many small bones called ‘carpals.’ Ligaments hold these bones together and control the wrist’s mobility. A sprain of one or several of these ligaments is very common in the sport of figure skating, caused by repetitive falling on the wrist. The ligaments become overstretched and inflamed. There are several grades of a sprain, with grade 1 being minor and grade 3-4 being severe. The grade is determined by the amount of stretch or tearing in the ligament. A physician may prescribe a wrist splint or brace for a certain amount of time, with the duration of wear depending on the severity of the injury. In the case of a grade 1 sprain, a skater should be able to skate his or her normal routine while wearing a brace. However, if the pain persists or worsens, a week or two rest from jumping may be recommended. All other skating moves can be performed, with the exception of any move that involves grabbing the blade (and we all know how common that is nowadays.) A grade 2 sprain may need a week or two rest from jumping to allow for healing, as even a fall while wearing a brace may cause aggravation of the ligament. A significant sprain needs time to heal, and scar tissue may develop if it does not heal properly. A grade 3 sprain will most likely require time off from the ice completely, as a physician may not want a skater to risk falling on any type of skating move. The rest period should be at the discretion of the physician, and in some cases, a certified hand therapist. During this time, a skater should be involved in an off-ice strength and conditioning routine to avoid loss in stamina and strength.
4) SI (Sacroiliac) Dysfunction: A very common diagnosis for figure skaters, SI dysfunction involves inflammation of the sacroiliac joint, the joint which connects part of your pelvis to your tailbone. SI dysfunction can be a whole separate topic by itself, yet we will touch upon the most important points for this discussion. Repetitive falling on the tailbone and pelvis may cause an instability in the SI joint, leading to increased movement and an increase in friction at the joint. The instability can either evolve over time or be caused by one hard fall. In some cases, the pelvis becomes displaced, and the result can be very painful for a skater. It is important to immediately complete a course of physical therapy. In therapy, the skater will learn a pelvis and lumbar stabilization exercise program, among several other treatment methods. These exercises will help stabilize the joint and prevent further injury occurrence. During this time, a skater is typically instructed to avoid skating, and the duration of time varies between skaters. Recovery can take several weeks or a few months, depending on the severity of injury. It is important to avoid an early return to the ice, as an additional fall on the inflamed joint may set a skater back to square one. As with other injuries, a skater should begin stroking and edgework in the first few sessions, and perform light single jumping in the following days. It is important to introduce a gradual return to double jumps to determine if the joint is ready to withstand the forces of taking off and landing. Slowly increase the number of jumps performed only if the skater is pain free. Any sign of pain should not be ignored, as it may indicate that a skater is not ready to return to jumping. In some cases, a skater may be given a protective brace to wear, yet I believe if a skater is still wearing a brace, she or she is not stable enough to jump. Natural stability should occur from strengthening of the muscles and ligaments around the joints.