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Piste Pain - part two

In April 2011 my passion for skiing took a massive physical and mental knock, when I ruptured the anterior cruciate ligament (ACL) in my right knee. It was the second day of a two-week family skiing holiday. My mountain adventure turned to disaster.

 

Since that day normality as a mother and a teacher have returned, but I never lost sight of getting myself physically and mentally fit to return to the slopes.

 

The choice you face with an ACL injury is whether to have surgery and face post-operative rehab of around eight months. Or decide to kiss goodbye to your ACL and instead concentrate on strengthening your other leg muscles and finding the best equipment or kit to aid your future skiing. I have never been a fan of surgery, so for me the choice was easy.

 

Crucial to my recovery has been focused physiotherapy. Initially this was on referral from my GP with an NHS physio. When she first saw me walking and changing direction during zigzag running exercises, she couldn’t quite believe I had done my ACL. She pointed out I had very strong leg muscles and this gave me a big positive boost.

 

As I now approach a return to skiing, the initial physio has been supplemented by Barry Spencer, a vastly experienced physiotherapist in West Sussex with expertise in sporting rehabilitation. He has highlighted two important exercises to concentrate on and helped reign in my expectations for my first day back on snow.

 

I have been concentrating on strengthening my lower limbs, especially my quadriceps and gluteal muscles. At the heart of this has been balance and stability work – including single leg squats on a Bosu pro-trainer ball in the gym. When I get back on the snow I will also be looking to provide extra support for my leg through taping and the use of a knee brace.

 

“In truth, Gayle’s leg will never be perfect again. We have been, however, looking to improve the strength of the muscles supporting the knee and work on stability to compensate for the loss of the ligament,” explains Barry.

 

“With time bodies adapt to make up for deficits by improving what we have left. That's how we can adapt to injuries like ACLs. Gayle can also use Rocktape on the skin to give extra support and proprioceptive feedback to make up for the loss of the ligament, although it can never fully compensate for it.”

 

Proprioception is the body's ability to sense movement within joints and joint position. It enables us to know where our limbs are without having to look. Once a ligament has been torn, there will be a deficit in the proprioceptive ability of the individual. This can leave them prone to re-injury, or reduce co-ordination.

 

What I have learnt during my rehabilitation is that there is no set way of resuming ski or golden rules. The idea is to build it up slowly, allowing the knee to physically adapt to a new and demanding activity. But it is also a big mental adaptation and confidence-building exercise.

 

The subject of confidence was firmly underlined when I went to the Snow Centre in Hemel Hempstead to test my knee on snow, almost a year to the day of the accident. As I clicked my skis on, I suddenly felt a wave of nerves sweep across my body. I physically began to shake – a symptom of the fears inside my head. I had to give myself a good talking to but with each run I felt more and more confident. I would encourage anyone returning from an ACL injury to book in for an indoor snow session.

 

But even with the most careful rehab and preparation there are clear danger signs I must be aware of when I return to the slopes:

 

* Sharp pain is never a great sign and I have to be careful not to push so hard that this happens.

* Some mild aches in the evening are to be expected, but they should be gone by the next morning.

* Likewise some very mild swelling is normal, but again it should be minimal.

* Significant swelling, strong pain or increased symptoms that last into the next day (for example, getting out of bed with a very stiff knee) is a sign that I have pushed beyond my limits and need to take a step back.

* Fatigue will happen quicker and more severely than you expect, and is cumulative so while confidence is higher by the end of the week (assuming all goes well), fatigue is also a factor so don't get over excited

 

There is also a massive range of kit out there to help skiers get back on the slopes. When I return I will be doing so wearing Donjoy Fource Point knee braces. They may look like something out of the Robocop films, but these braces (made from lightweight aircraft grade aluminium) have a spring hinge that cushions movement as the knee straightens.

 

Inside the hinge there is a simple adjustment to set the restricted degrees of motion, with most holiday skiers likely to need the second setting. The brace helps restore knee stability by preventing movement of the shin forward from the thigh, as well as tensioning the hamstring to provide pull from behind.

 

It is also ideal for skiing as the short calf design provides clearance for ski boots. It retails at just under £500, so it is not a cheap option. However if you ski with it for another 10 years, it works out good value. By harnessing the right rehab with the best equipment I hope to erase the bad memories of my last family skiing holiday this time around.

Gayle Turner-Moore ruptured her ACL on a family skiing holiday, but successfully returned to the slopes

The best family ski holidays are ones enjoyed by everyone – an exhilarating mountain experience shared by all. But injury on the slopes can ruin the best planned ski trip, leaving the injured skier depressed and the holiday in tatters. This is what happened to Parallel Trails co-founder Gayle Turner-Moore when she ruptured her anterior cruciate ligament. In the second part of a series of features, here is the story of her rehab.

Back on skis at the Snow Centre, following ACL injury