Enjoying the beauty of the Pacific Northwest on snowshoes is a great way to see the “country” on a beautiful winter day. Snowshoeing was invented sometime between 6,000 – 8,000 years ago; a method of travel for prehistoric people in snow conditions. As you’re climbing a low hill, your moving foot catches the tail of your snowshoe that’s planted and down you go. You feel a tearing pain in your knee. Lying on the ground, you feel your knee swelling like a balloon, and then the agony really starts.
Knee injuries are not uncommon among those who snowshoe.
Falling to one side or sliding downhill while wearing snowshoes can lead to a knee injury because of the torsional forces applied to the joint. Trying to move backwards while wearing snowshoes isn’t really a good idea either; the tail can get caught in the snow and hopefully the only indignity you’ll suffer is landing on your butt. And stepping on the tail of the planted foot with the shoe on the moving foot can result in you landing with your face in the snow and your knee moving in ways that were not intended.
Knee injuries fall into three broad categories: sprains, strains and meniscal tears. Sprains are injuries to ligaments (which attach bone to bone) while strains are injuries to tendons (which attach muscle to bone). You have two menisci in each knee.
The knee consists of four bones: the two lower leg bones (the tibia and the fibula) the upper leg bone (called the femur) and the kneecap (patella). The knee is stabilized by ligaments; the ligament on the inner side of the knee is called the medial collateral ligament (MCL) while the outer is called the lateral collateral ligament (LCL). These ligaments provide left and right stability. You also have two ligaments inside of your knee – the anterior and posterior cruciate ligaments, abbreviated ACL and PCL, which cross from front to rear in an x-fashion. These ligaments provide forward and backward stability.
To complicate things even more, the knee contains cartilage (the same stuff your ears are made of). There are two pieces of cartilage in each knee; each piece is called a meniscus. The cartilage provides a cushion that prevents the tibia from banging into the femur. There is also cartilage lining the back of the patella.
Mechanism of Injury
When one falls while snowshoeing, the knee undergoes a tremendous torsional (twisting) force because the body moves while the foot is planted in one spot. When this occurs, any or all of the following can occur:
- Sprains, which are tears in ligaments are injuries graded from I to III
o Grade I: A mild stretching of the ligament with overly stretch fibers
o Grade II: A partial tear in a ligament
o Grade III: A complete rupture of the ligament
- Meniscal tears, which can range from mild to severe
The first thing to do after a fall is to lie there for a minute and assess your situation. After making sure the rest of your joints are operating properly, focus on the injured knee. A Grade I ligament tear will be painful, but you shouldn’t have much swelling. A Grade II tear is going to result in some swelling and throbbing, while a Grade III tear is going to involve a significant amount of swelling and pain. Since you’ve got two knees, it’s a good idea to compare your injured knee with the uninjured knee. In general, if the two knees look the same and you can move the injured knee without too much pain, you may be able to stand and walk a short distance. As with any injury, it’s best if you flag someone down and have them report your injury to authorities who are trained to manage these types of injuries (another reason to always take a snowshoeing buddy with you).
If you’ve fractured a bone in your knee or leg, you’ll definitely know it; the pain and swelling will preclude walking. If you’ve sustained a fracture, you will need the assistance of trained medical personnel to stabilize your leg and evacuate you so you’ll get proper medical care.
A tear of a meniscus can range from being barely noticeable to incapacitating. If your knee doesn’t hurt too badly, but seems “locked” (meaning that you can’t bend it), you may have possibly torn a meniscus and a piece of it is stuck and is interfering with your knee movement.
Like a meniscal tear, damage to the ACL or PCL can range from minor to severe. If either the ACL or PCL is totally ruptured, you will probably need surgery to repair the damage.
Sometimes a fall can result in a dislocated patella. The patella is the anchoring point for your quadriceps, so if your patella doesn’t “track” or slide well in its grove, the mechanical stability of your whole leg can be compromised. Generally, physical therapy can resolve the problem of a patella that isn’t tracking correctly.
If you sustain a knee injury while snowshoeing, avoid walking if at all possible. If medical help isn’t going to be available, splint your knee with tree branches, rolled newspapers or whatever you’ve got. NEVER try to straighten an injured, bent knee because you can turn a minor problem into something catastrophic. Do not move your knee; if you have a torn meniscus or even a tiny chip fracture and you move your knee, it can create havoc with the inside mechanics of your knee.
How can one prevent knee injuries? The best thing you can do is strengthening your legs by using by exercise. This not only keeps the leg muscles strong and toned, but also keeps your ligaments supple which can minimize the chance of injury. Keep in mind that as you age, your ligaments become less limber, so exercise becomes even more important as you get older.
Keeping in shape, using the proper equipment and keeping common sense foremost can result in the minimization of injury and the maximization of some healthy fun.
Exercises to Strengthen Your Knee
1. High step-up: Place one foot on the floor and the other on a bench about 16” high. Lift yourself to full standing; then lower yourself to the floor. Repeat 15 times, and repeat with the other leg.
2. Lunges: Step out with one leg and bend the other to 900. Step out with the bent leg and bend the other. Walk 15 steps with each leg.
3. Spinal Twist: Place your feet in a comfortable stance. Hold your arms out parallel to the floor and swing one arm forward and the other to the rear. Hold for one minute and repeat with the other arm. Repeat three times.
4. Wall Sits: Place your back against the wall. Slide down until your knees are bent 900 and hold for one minute. Repeat five times.
If you are experiencing knee pain due to a sports injury, please call me at 425-823-400 or email me at ProOrthoAppointment@proliancesurgeons.com to schedule an appointment.