We all were horrified by Lindsey Vonn's high-speed crash during the World Alpine Skiing Championships in Schladming, Austria, on February 5, 2013. Sports media outlets kept replaying her accident, while commentators speculated on the extent of her injuries.
In the end, Vonn sustained tears to the ACL and MCL in her right knee and fractured her lateral tibia plateau. (See Knee Injuries: Types, Causes, Treatment and Prevention.) At the time, she had just been named to the U.S. Alpine Ski Team for the 2014 Winter Games and was aiming for a World Cup Title.
For Vonn, getting back on the slopes may be several months away. Here's a look at what her recovery will look like, based on the difficulties typically faced by others with injuries similar to the reigning Olympic downhill champion's.
Overview of Lindsey Vonn's Injuries
Recovering from an ACL/MCL tear combination is difficult but doable; however, tibia fractures have ended careers. Vonn's injury was reported as an impaction fracture. This indicates the direction of force caused some cracking rather than actually breaking the bone. Had the bone been broken, it would have required surgery to repair the tibia itself.
After ACL surgery, athletes typically don't remain in a non-weight bearing status for a significant amount of time. Since the tibia is a weight bearing bone, it must heal before Vonn can resume walking. With an injury similar to Vonn's, an athlete could remain non-weight bearing for up to six weeks. It depends on the individual's healing process. If it is problem-free, recovery can be speeded up.
Activity doesn't cease when an athlete is confined to non-weight bearing status. Once the wounds are healed, recuperation can begin in a gravity-free environment like a Hydroworx pool. This allows activity without stressing the joints.
With any injury, swelling is probable. For situations similar to Vonn's, where there are three different injuries and surgery to two ligaments, more swelling is likely in at least one area, because the body has to work overtime to recover.
Managing this takes many forms:
- Compression through a device like Game Ready Cold Compression System
- Simple elevation of the joint
- Light movement
- Underwater training (hydrostatic pressure can assist in moving fluid out of the joint)
Loss of Range of Motion
Swelling, pain and the injury itself all decrease range of motion. It's an unfortunate side effect that takes hard work to fully restore.
There are many ways to improve range of motion. The most important one is to gradually move as much as the tissue can tolerate in the painful areas. A trained professional who understands the mechanics of the joint and the surgical procedure should guide what is safe.
Loss of Muscle Size and Strength
Another unavoidable effect of injuries like Vonn's is atrophy. It sets in almost immediately after an injury, worsening over time with non-weight bearing, surgery, and immobilization.
A good treatment I would recommend to Vonn and athletes facing similar injuries is electrical stimulation, especially Russian stem. This is used to strengthen muscles. It is a common and necessary way to improve control of the musculature after ACL surgery, specifically the quadriceps. Restoration of the quads is necessary to resume normal walking patterns.
Loss of Balance
More than most athletes, skiers rely on balance. But balance is lost when athletes sustain injuries like Vonn's, due to impairments in proprioception and inactivity. However, once an individual reaches weight bearing, several options are available:
- The Biodex Balance System
- The Wii
- Exercises on TheraDiscs, sand or simply closing your eyes during exercise to challenge the proprioceptive and vestibular systems
Loss of Functional Strength
Besides having initial difficulty walking, when returning to weight-bearing status, Vonn and other athletes will find that they have lost strength. Specifically for Vonn, this will impair her ability to stabilize on skis, perform jumps, and land from jumps.
For any athlete, this is when it's time to get serious in the weight room. The jumping muscles are the quads and calves; the landing muscles are the hamstrings and glutes; and the stabilizing muscles are the lumbar extensors, abdominals, and hip rotators/abductors. Skiers should not neglect upper-body training either.
- Squats: Goblet Squats, Front Squats, Back Squats
- Deadlifts: Trap Bar, Standard Deadlift, Sumo Deadlifts and Romanian Deadlifts
- Olympic Lifts: Snatch, Clean and Press
- Functional Lifts: Lunge variations, Step-up variations, back strengthening
Loss of Endurance
Suspending high-intensity training during recovery ultimately affects conditioning. But endurance building can begin early in a pool or on a bike and progress further once weight bearing is resumed. The best fix is whatever is functional for your sport, whether it's running, elliptical work or rowing.
Loss of Hip Mobility
Hip mobility is lost from the injury, surgery and lack of activity. For a skier, especially a female (see Why Hip Strengthening Is Essential For Female Athletes), it is critical to restore movement and strength in the hips. Yoga, bodyweight mobility exercises, Dumbbell or Kettlebell Swings and stretching are all good hip mobility strengthers.
Fear and Loss of Confidence
These are the last two big pieces of the puzzle for an elite athlete returning from a long layoff. Their first event back will be a mental hurdle. It takes the whole length of the recovery period to regain full confidence to go all out again.
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