DECEMBER 14 Merry Christmas!

It’s a beautiful winter day. You’re out in the country, away from the hustle and bustle of the city, stomping your way to, well, anywhere. 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 begin to literally feel your knee swelling like a balloon, and then the agony really starts.

Knee injuries are not uncommon among those who snowshoe. This article will cover some of the basics of knee care and injury prevention.

The History of Snowshoes

The origins and age of snowshoes are not precisely known, although historians believe they were invented sometime between 6,000 to 8,000 years ago.1 As the prehistoric people traveled, snowshoe design evolved into different types depending on the different types of snow conditions, while in Scandinavia, snowshoes evolved into skis.2

Snowshoes that were long and narrow and (Alaskan style) made travel over the snow quicker, while the upturned toe was used to break trail for dog sled teams. The oval shape of the Bear Paw was the most versatile, allowing the hunter to carry heavy loads and made turning around easier.2

And you can bet that people have been suffering knee injuries from snowshoeing ever since.

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. Menisci will be discussed further on.

The Anatomy of the Knee

The knee is considered a “hinge joint” which means that your knee can only move in two directions. Your knee does not normally move to the left or right unless you’ve sustained a severe ligament injury. The knee may seem like a simple hinge joint, but it is a very complicated mechanism.

Image Courtesy of the National Institute of Arthritis and Musculoskeletal and Skin Diseases

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. These injuries are graded from I to III – Grade I: a mild stretching of the ligament with overly stretch fibers – Grade II: a partial tear in a ligament – Grade III: a complete rupture of the ligament – Meniscal tears, which can range from mild to severe – Fractures

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. After such surgery, your orthopedic surgeon may tell you that your snowshoeing days are over and that you should take up something less damaging such as embroidery.

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, have your buddy splint your whole leg and build a travois to haul your carcass back to civilization. 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 wreck 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.

Sidebar

Several exercises you can do to strengthen your knees are as follows:

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, then repeat with the other leg 4

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 4

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 5

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 5

References

1. Wikipedia. Snowshoe. Available at Accessed October 30, 2011

2. Harrington K. History of the Snowshoe – Fact Sheet. Available online at Accessed October 30, 2011

3. MedicineNet.com. Muscle Sprains and Strains. Available online at Accessed October 31, 2011