Mountaineering without knee pain
Dr. Christian Hoser
Prof. Dr. Christian Fink, Consultant at Innsbruck Community Practice
Acute knee injuries and chronic knee trouble are among the most frequent problems in the locomotion system which affect mountaineers. However, with preventative measures, it is often possible to reduce the risks.
Preventing injury
Downhill skiing is the clearest example of how the knee joint is endangered by high forces. The carving ski has not, in itself, led to an increase in injuries, but the injuries are more severe. This is not in the end due to the high speeds which the carving ski makes possible. If the controlled, well-executed turn leads to an uncontrolled situation, the forces are difficult to control and the locomotion system is put under strain, sometimes too much strain. The results are damage to the ligaments of the knee joint (most often to the anterior cruciate ligament), but also complicated damage to the knee joint surfaces is more likely. Modern arthroscopy operating techniques of ligament reconstruction and minimally-invasive techniques (keyhole surgery) used in the treatment of damage are routine in specialist clinics and give very good results. The prevention of accidents must be considered of even greater value. A well-trained musculature, kept strong and well-coordinated, protects must as much as a correctly-adjusted ski-binding.
The entry of the carving ski into ski-touring, in our opinion, has advantages of safety through improved tracking stability; however it requires a higher level of fitness from the skier who wants to use these advantages.
With snowboarding, the knee would be substantially less endangered, because the legs receive less torque, were it not for the half-pipes, kickers and ramps etc. The jumps from these go to breath-taking heights, just like the forces on uncontrolled landing, such as “flat-bombs” etc. Then the skill of the knee surgeon is in demand again. Here prevention is in the hands of the boarder not to overestimate his abilities and to examine the planned jumping and landing area properly.
Wellness for the knee
The mountains also provide activities which can heal the knee. At the top of the list of “knee-friendly” sports are mountain-biking in summer and langlauf in winter. Both include circular, cushioned movements in the hip, knee and ankle joints. And these really are a healant for the meniscus and cartilage tissue. For joints are not made for inactivity, and suffer from it just as much as from overloading, such as when body weight increases. So let us turn to climbing and mountaineering. Here, there are completely opposing pictures of ascent and descent in terms of the load on the knee joint. On the ascent, the positive effects are overwhelming and scarcely anyone complains of knee pain. Many walkers have a completely different experience on the descent from the summit or from the alm. With every step, the bodyweight is multiplied by 4-6 times on the joints, and, although poles can help somewhat, they cannot work magic. Often tiredness has an effect as well, and then the pain remains for several days. What tips can we give here? Firstly you should choose not only the descent but also the descent carefully. Why not take the cable-car down 1000m into the valley, instead of walking? In any case, we regard it as a “knee deadly sin” to take the lift up and walk down. By doing this, you take away the part that is good for training (the ascent) and you damage the joints on the descent. Poles, lighter rucksacks and a softer, more cushioned step help to limit knee pain. If you continually suffer from knee pain, you should consult your doctor, so as not to exacerbate problems which are currently in the early stages.
When the knees are worn out
Although we showed above how you can protect your knee from problems, there are also many keen mountaineers who have been carrying knee problems around for years. If you have exhausted the possibilities of “self-treatment”, you don’t need to throw in the towel. Modern methods of treatment can lead to a painless return to the mountains.
At the beginning of any treatment is a correct diagnosis, which can be made using X-rays, MRI scans and perhaps an arthroscopy by an experienced knee specialist. Depending on the diagnosis, the doctor will then recommend the treatment in discussion with the patient. In the case of obvious tears in either the meniscus or ligaments, an arthroscopy is sensible. Damage to cartilage can also be treated in an arthroscopy: cartilage transplants have opened up new possibilities.
Wear and tear problems respond to non-operative measures in the early stages, and can lead to an improvement in the condition. If the pain from an arthrosis has become frequent and disturbs sleep patterns, it is not a good idea to continually put off the operation. For continued use of painkillers has a damaging effect on the kidneys, and the enforced inactivity reduces their effect and can lead to an increase in body weight. These are all negative effects of an arthrosis which should be ignored. Not to be forgotten is also the mental strain which affects many mountaineers when they have to stay away from the mountains.
Training and Practical Measures
The operation to treat a manifest knee arthrosis is the replacement knee joint surface, an unwieldy phrase but more accurate than “knee prosthesis”! Only the worn-out surfaces of the joint, either part or the whole thing, are replaced. Ligaments, tendons, joint capsule, muscles and of course nerves and blood vessels are retained.
Is mountaineering, or any other sport, possible afterwards? Yes, if you are selective in what you do. All the sports referred to above which are good for the knees (cycling, langlauf and walking uphill) are possible without limitation, With alpine skiing and ski touring, many knee patients experience real feeling of happiness after the operation, however training is necessary and common sense must be exercised in order to avoid getting into risky situations. These patients have enough experience of life, and, in our experience, accidents are rare. We are still waiting for the first patient who wants to snowboard on his “new knee”, but one thing we are sure about, that will happen!
Authors
Dr. Christian Hoser
University Professor Dr. Christian Fink
Consultants in Accident Surgery and Sport Trauma.
The authors specialise in the treatment of sports injuries and knee surgery. They work in Innsbruck at their practice and at the University Clinic Innsbruck as well as at the Sanatorium Hochrum. For further information and contact details see www.activmed.at
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Last updated: 07 February 2007