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Monique

bounceswoosh
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It's 18 months post-surgery with patellar tendon autograft ACL reconstruction and minor meniscus repair. I still have knee pain, particularly skiing. I'm working on it, making inroads, but it's slow going. I don't think the manmade hardpack is doing my knee any favors.

FWIW, I don't think it's the surgery per se that's the issue - it's muscles either not doing their jobs, or tightening excessively when doing their jobs.

In particular, after a few hours of skiing, I get swelling just above the knee on the right side of the quad. Where the "lump" should be when you flex your quads. My muscles also progressively tighten, resulting in my kneecap being held too close to my knee - I have to do stretches all week to get it back to where it was before I skied on the weekend.

I'm skiing half a day in lessons, then bailing at lunch.

I've been skiing my Blizzard Viva 80s - my skinniest ski in years.

As of this weekend, I'll finally have my Armada ARV 96s, which skied wonderfully - on a day with fresh snow, although there was also hardpack under the snow.

I'm trying to decide if it makes any sense at all to pull out the ARVs. Obviously, I can just try and see, but I'm wondering. The ARV is a twin tip, which several people have suggested is why it's easier on my knee - the release is easy. Compare that to the more traditionally shaped Vivas with just a smidge of tip and tail rocker and a flat tail.

But it's fatter, obviously.

I don't carve, really, even when I try to, and I'm a dirty heel pusher, too. I'm working on that - whole foot skiing and pivoting at the mid foot and all that - but it's not yet automatic, especially with people flying around me and behind me on the crowded slopes right now. I'm positive that eliminating the heel push would put less strain on my knee.

My left quad is also considerably more built than my (post-surgery) right quad, and I definitely favor one side. When I'm skiing this season, I feel my left quad clenching, which was never an issue in past seasons.

Anyway - I definitely do not want recommendations of "if you only had X ski." I'm wondering, given the givens, if I should try out the ARV 96s, or if that's just on its face a terrible idea.

Before the injury and surgery, I would ski 113 waists every day, and I'd likely be on something wider than 100 even with the current conditions. But things change, and I'm not sure how relevant that is anyway - I just want to make the point that historically, I've been very comfortable on wide skis.
 

martyg

Making fresh tracks
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My sense, and research indicates, that narrower is better.

Check out Anne Healzer. She's a PT in the Seattle area and a PSIA L3. I've worked with her when we lived in Seattle and she has been known to consult via Skype.

If I were in your shoes I'd go to a good source of The Truth - someone like Anne - who REALLY understands the forces at play and have her prescribe the tool kit for you.

Enjoy!
 

Josh Matta

Skiing the powder
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really depends on how you ski.....

but for me a 80mm ski would be easier on my knees(on packed snow) than anything 90 or wider.....I am even a fat ski proponent and think many fat skis hold an edge really well on packed and even "hard" snow.

My wife was a dirty heel pusher and basically told her to only ski on her Viva X7 till she quit doing it, even in soft snow conditions because skis like that will punish heel pushing. your experience isnt wrong, I am guessing on flatter edge angle with heel pushing that a mid 90 underfoot ski will feel better on the body than a 80mm carving ski.
 

PTskier

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Couple of thoughts...
...The wider the ski the more work required to keep it edged. Take both pair out for a day. Ski on the 80s until your quad is talking to you, then put on the 96s. You'll immediately know if that's a good idea or not.
...How tall do you stand while skiing? Can you stand taller to take load off your quads? Have someone take a side photo and spot if you're sitting back. Try standing taller and staying up on the balls of your feet. Don't squat down as the turn progresses. Handle the increased forces by more angulation & counter to increase the skis' angle on the snow. To release the turn just relax both legs, let the skis come flat on the snow, then edge them the other way.
...For carving you must not pivot. Put the skis on edge and have the patience to let the turn come to you.
...The alternative to heel push is to engage the ski tips and let them pull you around the turn. More tip pressure to start, edge them, control the turn radius very early in the turn by the amount of tip pressure and the amount you edge the skis. You get the tip pressure by pulling your feet behind you, sometimes it feels like they're way behind you. Pull your feet way back, edge the skis, and let the tips pull you around. Legs walking-width apart, almost all your weight on the outside ski.
 

Large Squirrel

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apache

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Skinny is relative. The PMTS crowd considers 80mm as "fat". Do your bindings have a lot elevation? Is there another binding that would get your feet closer to the ski? Are you boots/bindings canted for alignment purposes?

I have suffered from PFPS over the last three years and quit doing tris as a result. I can sympathize with you for sure. Do you stretch your quads, psoas, etc? Have you tried eccentric stretching using a slant board? Have you tried a cho-pat strap?
 
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cantunamunch

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Out of curiosity, what bindings do you have on your Vivas? Would they allow you to shift 5 -10 mm back?

If yes, that could get you much of that tail playfulness you thought you gave up when you left the ARVs home.

I have suffered from PFPS over the last three years and quit doing tris as a result. I can sympathize with you for sure. Do you stretch your quads, psoas, etc? Have you tried eccentric stretching using a slant board? Have you tried a cho-pat strap?

Good points. Even K-T tape might be marginally beneficial.
 
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AmyPJ

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Are you skiing with a brace to help stabilize that knee at all? I'm sorry your knee still hurts. I can relate. Thankfully, mine doesn't bother me after the fact, and I don't notice it very much during skiing, but, subconsciously, it does affect me. Good on you for being aware of it. My first thought is to take some of the load off of that knee with a good stabilizing brace. (I am having to wait WEEKS for mine. :() And also, as was mentioned above, stand taller to try to take the load off of your quads. You and I are working on a lot of the same stuff, it seems. This early season lack of snow is forcing me to focus extra hard on my technique, and I'm actually OK with that. A silver lining to this crappy start to the season.
 
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Monique

Monique

bounceswoosh
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My sense, and research indicates, that narrower is better.

Check out Anne Healzer. She's a PT in the Seattle area and a PSIA L3. I've worked with her when we lived in Seattle and she has been known to consult via Skype.

If I were in your shoes I'd go to a good source of The Truth - someone like Anne - who REALLY understands the forces at play and have her prescribe the tool kit for you.

Enjoy!

I don't want a toolkit - I just want to make a choice between which ski to use this weekend. The idea of a PSIA trained PT is intriguing. If she were in Boulder, that would be interesting, but I can't see spending money to talk to a PT over Skype.

I don't know, or have any data, but this makes a LOT of sense to me.

Yeah, I agree that the twin tip having an easier turn release makes sense. The question is whether it overcomes a 16mm waist difference :)

really depends on how you ski.....

but for me a 80mm ski would be easier on my knees(on packed snow) than anything 90 or wider.....I am even a fat ski proponent and think many fat skis hold an edge really well on packed and even "hard" snow.

My wife was a dirty heel pusher and basically told her to only ski on her Viva X7 till she quit doing it, even in soft snow conditions because skis like that will punish heel pushing. your experience isnt wrong, I am guessing on flatter edge angle with heel pushing that a mid 90 underfoot ski will feel better on the body than a 80mm carving ski.

Yeah, it's a tough question to answer (without actually trying it, LOL). I agree that the Viva will punish heel pushing, but I'm not into extra punishment right now ... and I definitely don't flash a lot of base when I turn. I do sometimes have an instructor skiing behind me, yelling at me to stop pushing my heels ;-) . It sometimes even works!

...The wider the ski the more work required to keep it edged. Take both pair out for a day. Ski on the 80s until your quad is talking to you, then put on the 96s. You'll immediately know if that's a good idea or not.

That's a good idea - but practically speaking, it's too much carrying around of skis (especially because my shoulders are a mess right now, too ... sigh).

I just realized that since I'm skiing half days anyway, I could wait to pick them up till Saturday afternoon, after having skied Saturday on the skinny skis. And then ski the ARVs Sunday (not having had to get up 20 minutes early to pick up the skis) and have sort of an elongated version of your suggestion. Excellent!

...How tall do you stand while skiing? Can you stand taller to take load off your quads? Have someone take a side photo and spot if you're sitting back. Try standing taller and staying up on the balls of your feet. Don't squat down as the turn progresses. Handle the increased forces by more angulation & counter to increase the skis' angle on the snow. To release the turn just relax both legs, let the skis come flat on the snow, then edge them the other way.

I stand way too tall, and I do not sit back. I also suck at angulation, as you and others pointed out in my MA thread. I've been working on angulation. My MAT guy found some stuff going on in my upper body and we've been figuring that out - there's definitely some physical restriction, especially on the recovering side. It also messes with my deadlifts, so they're off the table for now. It's interesting to ski with my shadow in front of me, think I'm angulating like crazy, and see barely any in the shadow. Shadows don't lie!

...For carving you must not pivot. Put the skis on edge and have the patience to let the turn come to you.

...The alternative to heel push is to engage the ski tips and let them pull you around the turn. More tip pressure to start, edge them, control the turn radius very early in the turn by the amount of tip pressure and the amount you edge the skis. You get the tip pressure by pulling your feet behind you, sometimes it feels like they're way behind you. Pull your feet way back, edge the skis, and let the tips pull you around. Legs walking-width apart, almost all your weight on the outside ski.

I know you mean the best, but I already have tons of access to instruction. I just want some input on which of two pairs of skis I should use this weekend. I already understand carving and not-heel-pushing intellectually, but that doesn't instantly translate to consistent results on the slopes.

even if you don't carve, a narrower ski on hardpack will exert less lateral force on your knees. don't be afraid to check out skis in the upper 70's in width. here are a couple of articles with data on affects of ski width on knees on hardpack snow. (perhaps you've already seen these? idk). I hope you find something that works for you!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541126/
http://www.montanakaimin.com/news/y...cle_b73f0f3a-b0ba-11e4-9f66-fb3b2e4b192c.html

Yeah, I've seen them, but I'm not sure to what extent a twin tip's easy release might counteract that data in this particular case. Ie, maybe a twin-tip 80mm ski would be a better choice, but I don't have that (and don't want more skis right now).

Also - my knees didn't mind fat skis on hardpack before the injury, despite pre-existing arthritis. While I believe these studies, I don't know if they're relevant to the specific issues I'm experiencing. After the surgery, in which the surgeon "cleaned up" in the area while he was there, I no longer have some of the knee pain I *used* to have (like driving for more than an hour used to make my knee very angry).

Skinny is relative. The PMTS crowd considers 80mm as "fat". Do your bindings have a lot elevation? Is there another binding that would get your feet closer to the ski? Are you boots/bindings canted for alignment purposes?

I have suffered from PFPS over the last three years and quit doing tris as a result. I can sympathize with you for sure. Do you stretch your quads, psoas, etc? Have you tried eccentric stretching using a slant board? Have you tried a cho-pat strap?

Attack 13s on both pairs, not high IMO. I went through canting evaluation as part of my boot fit last year. I do find that my right ("affected") leg is lazier than the left when it's the inside leg - feels like a boat coming around to change edges - but that was the case before the injury, too, and canting has only been part of it. One of my instructors said that often women have a bigger Q Angle on one side than the other, and thus it's harder to switch edges, and that in her case she just has to focus more on that side.

OMG so much stretching. My quad is so stretched that my yoga instructor can't even force a stretch there anymore. I do daily PNF hip flexor stretches (that immediately provide relief, at least in the short term). I do kneecap mobilization exercises (push to one side and hold for a minute; then the other). I roll, so much. Foam roller doesn't do much for me anymore, so I use variously sized and shaped PT balls and a lacrosse ball to dig into tender places, which at this point is mostly just one spot on my quad that won't stop forming a muscle knot. I've had dry needling on that knot, but it just comes back. I also have biweekly massages with someone I've seen for a decade now, I do two hot yoga sessions a week (my knee almost always feels better after), and I'm seeing the MAT guy for another modality (he gave me the PNF stretches as well as a "pin and flex" approach to foam rolling that is helpful).

Tell me about eccentric stretching on a slant board? I think that's a thing I tried and rejected - where you try to increase stress on your knees and force inflammation so that it'll heal itself? That was a thing my PT had me trying, but it hurt too much (ie, I couldn't ski AND do those exercises).

Not sure about psoas stretches. Quick googling suggests I'm getting it as part of yoga, but I'm not sure. Bridges are pretty comfortable/nice for me.

Funny - I tried what is apparently a cho-pat strap (for below the knee) - except I tried it above the knee, to put pressure on the area that is swelling. I'd been thinking about trying it below the knee as well - you know, the way it's intended to be used. I'm having relatively little of *that* pain anymore thanks to all the stretching. It's migrated to new and exciting different forms of pain.

Out of curiosity, what bindings do you have on your Vivas? Would they allow you to shift 5 -10 mm back?

If yes, that could get you much of that tail playfulness you thought you gave up when you left the ARVs home.



Good points. Even K-T tape might be marginally beneficial.

Probably I could shift a bit back. I don't think that's exactly the same type of thing, though, as the rear portion of a twin tip ...

There are one million K-Tape applications. I tried one last week that *used* to be helpful for me - pulling the knee cap toward the exterior - and it clearly caused me extra knee pain while skiing. There's a cool jellyfish looking one that relieves swelling, but that's for the knee and lower leg. I do wonder if there's a K Tape application that would help drain that area of the quad while I'm using it ....

Are you skiing with a brace to help stabilize that knee at all? I'm sorry your knee still hurts. I can relate. Thankfully, mine doesn't bother me after the fact, and I don't notice it very much during skiing, but, subconsciously, it does affect me. Good on you for being aware of it. My first thought is to take some of the load off of that knee with a good stabilizing brace. (I am having to wait WEEKS for mine. :() And also, as was mentioned above, stand taller to try to take the load off of your quads. You and I are working on a lot of the same stuff, it seems. This early season lack of snow is forcing me to focus extra hard on my technique, and I'm actually OK with that. A silver lining to this crappy start to the season.

I really don't want a brace. I've talked about this in the past. A lot. It boils down to:

* I already wear XL pants without much if any spare room, so fitting a brace would be difficult
* I don't like the feel of braces in general. They impede movement.
* I know several people who started skiing with braces after surgery, and then never stopped. I don't want a permanent exoskeleton.
* My doctor actually didn't think a brace was the end-all be-all; he said it does help prevent ligament damage, but can actually increase the risk of meniscus damage in a fall

As mentioned above in my post - I am already excessively upright.[/QUOTE]
 

Fishbowl

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Not just the narrower ski but the shorter ski. Less length on the lever is less torque on the knee.
 
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Monique

Monique

bounceswoosh
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Not just the narrower ski but the shorter ski. Less length on the lever is less torque on the knee.

In this case, the shorter ski is the wider ski ...

If you want to ski your new skis, ski them. Quit if your knee hurts and ski the narrow groomer skis the next day.

I feel you are not properly embracing the spirit of this "I'm stuck at work thinking about skiing" thread.
 
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Monique

Monique

bounceswoosh
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cantunamunch

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I don't want a toolkit - I just want to make a choice between which ski to use this weekend. The idea of a PSIA trained PT is intriguing. If she were in Boulder, that would be interesting, but I can't see spending money to talk to a PT over Skype.
I stand way too tall, and I do not sit back.

I am tempted to wonder if at least some of that 'too tall' is actually compensation for weak upper legs.

If it is, then being too stiff is a real danger, as in stiff ankles and stiff knees both, as in 'every shock gets passed right up the limb'. Which would be ...exhausting.

OMG so much stretching. My quad is so stretched that my yoga instructor can't even force a stretch there anymore. I do daily PNF hip flexor stretches (that immediately provide relief, at least in the short term). I do kneecap mobilization exercises (push to one side and hold for a minute; then the other). I roll, so much. Foam roller doesn't do much for me anymore, so I use variously sized and shaped PT balls and a lacrosse ball to dig into tender places, which at this point is mostly just one spot on my quad that won't stop forming a muscle knot. I've had dry needling on that knot, but it just comes back.

Patience patience - as @Brian Finch pointed out in another thread, it takes time and consistency over 12weeks+ to remould tissue.


I do wonder if there's a K Tape application that would help drain that area of the quad while I'm using it ....

Worth trying.


Probably I could shift a bit back. I don't think that's exactly the same type of thing, though, as the rear portion of a twin tip ...

It is almost the same for heel-push-resistance purposes. The big differences between the two generally only show up in broken-up 3D snow.

On the up side, having more length up front will be a marginal improvement for shock absorption. On the down side, there will need to be more attention to edge engagement at turn start.
 

apache

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OMG so much stretching. My quad is so stretched that my yoga instructor can't even force a stretch there anymore. I do daily PNF hip flexor stretches (that immediately provide relief, at least in the short term). I do kneecap mobilization exercises (push to one side and hold for a minute; then the other). I roll, so much. Foam roller doesn't do much for me anymore, so I use variously sized and shaped PT balls and a lacrosse ball to dig into tender places, which at this point is mostly just one spot on my quad that won't stop forming a muscle knot. I've had dry needling on that knot, but it just comes back. I also have biweekly massages with someone I've seen for a decade now, I do two hot yoga sessions a week (my knee almost always feels better after), and I'm seeing the MAT guy for another modality (he gave me the PNF stretches as well as a "pin and flex" approach to foam rolling that is helpful).

Tell me about eccentric stretching on a slant board? I think that's a thing I tried and rejected - where you try to increase stress on your knees and force inflammation so that it'll heal itself? That was a thing my PT had me trying, but it hurt too much (ie, I couldn't ski AND do those exercises).


I have had more than one ortho tell me that the knee is the "dumb" joint caught between two smart joints, lol. (ankle & hips)
You are having swelling in the region of the VMO or directly adjacent the patella? (medial side) The cho-pat strap is designed to limit the movement of the patellar tendon. Hence, dampen lateral movement of the patella. Doing slant board eccentric exercises stretches the PT while it's under load. I'm not sure either one of these techniques will help you because I don't have a basic sense of the pathologies taking place. Is your PT trying to increase the amount of lateral movement of your patella and patellar tendon? If so, I don't understand why he or she would do that. Have you ever tried doing eccentric leg extensions?
I hardly do any rolling anymore. I didn't feel like I was getting much bang for the amount of time it takes. Some people are rolling fanatics.
 

James

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If it's hard go with your 80's. Or skinnier. The geometry of wider skis isn't favorable for knees. If it's really soft go with your new ones.
Read Josh's post. I'm pretty sure he'd ban you from skis > 80mm to cure the tail pushing.
(4 out of 5 of Josh's clients consider him really tough, but effective * )

Consider a compression knee sleeve. I've found in the past after multiple knee surgeries that it helps. Could have been a. placebo, but nothing wrong with that. Supposedly it does help the muscles to fire more quickly.

* total speculation
 

Brian Finch

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Just my thoughts I like where @Josh Matta is headed.... look at the characteristics of the ski. A 98mm Renoun or even a 108 WhiteDot will be smoother than a Head Rally/Titan - esp if you heel push.
 

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