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  • Nicolas Pahud

Cross Country Skiing Injuries

Edmonton Physiotherapist Skiing

As Albertans, the majority of us have learned to embrace winter. Living in a proclaimed winter city we must welcome the limitless activities that come with the snow and cold. Immersing yourself in these activities undoubtedly help make winters more tolerable and enjoyable. One of the activities increasingly growing in popularity is Nordic Skiing or Cross Country Skiing.

Cross country skiing is a relatively low risk sport and is great for people of all ages and fitness levels. Skiers can perform this activity for fun or competitively. Regardless, this is an excellent activity in the winter months. Cross country skiing exercises both the upper body and lower body simultaneously giving the skier an all around full body workout. It is also a great cardiovascular exercise. This, in combination with a low incidence of injury, makes cross-country skiing an ideal recreational sport for many. In fact compared to alpine skiing and snowboarding, cross country skiing has 20 times fewer traumatic/acute injuries and 5 times fewer injuries overall.

At the moment, there is little literature about the epidemiology of injuries sustained while cross country skiing due to the diverse nature of these athletes. Recent studies suggest that approximately 75% of injuries sustained by cross country skiers are a result of overuse due to the repetitive nature of the sport, while the remaining 25% are a result of trauma.

Risk factors for injury include fatigue, poor ski conditions, downhill segments, poor balance and inexperience.

The more common traumatic cross country skiing injuries are typically muscle strains and ligament sprains. This includes ankle, knee, groin, wrist and thumb sprains. In more severe cases shoulder dislocations may also occur. These injuries are often the result of falling down.

The repetitive nature of cross-country skiing can also contribute to overuse type injuries; injuries that develop more slowly due to repetitive stress. Lower back pain, knee pain, Achilles tendon problems and shoulder/elbow pain are the most frequently reported. This may result from repetitive hyperextension motions during the skate phases and the recurring spinal flexion and extension during the double poling phase. Weak hip and core muscles, improper technique and training load can all contribute to body soreness.

Overuse injuries are easier to prevent than traumatic injuries, through proper training, graded exposure and ensuring adequate strength/flexibility. Despite being easier to prevent, these injuries can still be very limiting and withhold you from participation.

Edmonton Orthopedic Physiotherapist Skiing

Lower Back Pain

Lower back pain has been found to be more common in cross-country skiers. It is more prevalent because of the repetitive flexion-extension loading pattern required during poling.

It is important to have adequate core abdominal, hip, and spinal extensor strength to endure the repetitive nature of cross country skiing. Hence, participants need to make sure to incorporate proper core and hip strengthening routines in their weekly routines. Furthermore, improving hip flexibility has been shown to decrease the rate of lower back pain in skiers. It is wise to make sure to incorporate hip flexor and glute stretching as part of your normal routine.

Elbow & Shoulder Pain

Due to the repetitive strain from pushing through the poles, skiers can develop overuse injuries of both the elbow and/or the shoulder. The most common of these are medial epicondylalgia (Golfer’s Elbow) and rotator cuff strains. The underlying cause of the development of these injuries is often multifactorial in nature. Typically, injury can occur due to poor strength and conditioning, improper poling technique or pole length.

Medial epicondylalgia is an irritation of the tendon of the wrist flexors and presents as pain on the bony prominence of the inside of the elbow. This irritation is caused by repetitive stress to the tendon thereby tendon degeneration appears instead of repair. Prevention can be achieved through ensuring you have proper forearm strength and the capacity to tolerate the repetitive stress.

Shoulder strains are caused by potentially underlying weakness of the rotator cuff and muscles around the shoulder blade. In similar fashion, the repetitive stress to the muscles and tendons of the shoulder can cause changes to the soft tissue composition and result in pain. Therefore to prevent developing shoulder pain make sure you incorporate strength and conditioning of your rotator cuff and periscapular musculature to endure the strain of cross country skiing.

Knee Pain

Orthopedic Physiotherapy Edmonton Physiotherapy  knee tests

Anterior knee pain is the most common type of non traumatic knee pain in cross country skiing. The repetitive stress to the soft tissue around the knee cap can result in irritation of the cartilage femoral groove and inflammation of connecting tendons due to the repeated strain. This can develop from hip and thigh weakness causing poor control of movement, poor stabilisation of the lower extremity, and poor skiing technique.

Proper strength and conditioning of the hips and quadriceps can help prevent this from occurring. Additionally, working on your balance will help prevent the development of patellofemoral pain.

Edmonton Orthopedic Physiotherapist providing low back pain treatment

Luckily, the most common underlying cause of an overuse injury is due to a training error (load/volume and technique). Typically doing too much too soon. So the best way to prevent an overuse injury in skiing is to ease into your season. Nonetheless, if you are experiencing any early season aches and pains from cross country skiing, glide your way over to Shift Physiotherapy & Wellness for a one-on-one orthopedic physiotherapy treatment in Edmonton. We will help ensure your Nordic ski season is a pleasurable and painless one!


Interested in learning about how our orthopedic physiotherapy treatments can help you?


Meet our orthopedic physiotherapy team at Shift!


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