With El Nino promising lots of rain that will turn into snow in the Sierras, it could be a great winter to break out the skis. Just make sure to ski safely to avoid knee injuries. (Dino Vourna/2010 AP)

It is snowing: Are you ready?

El Niño is coming, and California will see a lot of water this winter. If it’s cold enough, we’ll also have a lot of snow — that deep, wonderful powder that we’re all jonesing for. To help keep you upright, here’s a brief summary of some of the newer and more controversial points around preventing and treating ski injuries.

Binding settings matter; binding brands don’t

There isn’t much that’s new or effective on the market. Bindings were designed to avoid prerelease for ski racers who didn’t want to fall prematurely. Often, their injuries were greater from the prerelease than from the ACL rupture that can occur when the binding doesn’t release.

The DIN settings on your bindings are designed to prevent prerelease. If you are not racing, you are safer with lower settings. You may (or may not) have a few more releases than you planned, but you’ll also have fewer ACL tears. No brand has been shown to be safer than any other by any high-quality study — neither the Knee binding or the Brainless binding. Not until there is a computer embedded between the ski and the boot, reading the real-time forces on the skier’s body and releasing the ski a split second before a potential injury, will there be a truly safe release mechanism.

Shaped skis are not safer
The increased tip-and-tail to waist ratio increases the “catching” of the ski, and increases torque on the body. Fortunately, skis are now returning to a narrower design with a less radical difference from tip to tail. Most importantly, the tails are getting narrower — which should diminish some of the back seat ACL injuries. If you are skiing mostly on groomed trails, choose the newest ski designs with longer arcs and softer flex. If you have radically shaped skis from just a few seasons ago, trade them in.

Fitness matters
Thanks to high speed lifts — which are becoming ubiquitous — lift lines have shortened. This has increased our time on the snow, and therefore our exposure to injury. Weakened, tired legs respond to changes in terrain more slowly. It is not too late to take preseason ski fit classes. And remember, many people lose fitness during the ski season as they only ski on the weekends. Train daily, stretch daily, swim and focus on flexibility.

Alcohol or pot?
Alcohol, not surprisingly, plays a significant role in skiing injuries. Whether or not this will decline in pot-legal states is an interesting potential research study, with data yet to be revealed. Skiing while mentally altered decreases one’s perception of all the wonderful stimuli in the mountains and increases the potential for injury. Since mental errors still account for a large number of injuries, it is best to wait for happy hour to increase your happiness.

Being mentally compromised includes “distracted skiing,” too. Focus, relax and enjoy the sport by keeping your mind on the hill — and off your electronic devices. Our hope is that cell-free zone mountains are coming to a hill near you, and soon!

To the future ACL, MCL and meniscus injuries, shoulder dislocations and rotator cuff tears — these are the major injuries we see from ski falls. (Hand injuries happen often as well, but they’re not our focus.) Fortunately, the increasing use of donor tissues preloaded with stem cells appears to be speeding recovery after replacement and repair of damaged tissues. While early repair has made the injuries less life-interrupting, they can still end your ski season. Research on speeding the recovery is a major focus for those of us in the tissue regeneration space.

Most people ski safely and love the sport. You can, too. Our message is: “When skiing, ski. When snowboarding, ride.” If something unexpected happens, get it fixed, learn what you did wrong and avoid making the same mistake twice. Here’s to a snow-filled, ludicrously fun, deep powder winter!

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco. He pioneers advanced orthopedic surgical and rehabilitation techniques to repair, regenerate and replace damaged cartilage and ligaments.

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