Common Ski Injuries and How to Prevent Them: A Portland PT's Guide
Every winter, the same pattern shows up in my clinic. Opening day on Mt. Hood comes, people who haven't skied since April go straight for the steeps, and a few weeks later I'm seeing knees, thumbs and shoulders.
The good news: most ski injuries follow predictable patterns, and many can be reduced with the right preparation. As a board-certified orthopedic physical therapist and strength coach in Portland, I treat skiers at every level, from first-season resort skiers to racers and backcountry tourers.
This guide covers:
The most common ski injuries and how they happen
Why skiers tear their ACL, and how to avoid the riskiest positions
What skiing actually demands from your body, plus a sample pre-season workout
When to see a physical therapist, and how to know you're ready to ski again
The most common ski injuries
Modern release bindings have made lower-leg fractures much less common than they were decades ago. Now the knee absorbs most of the force in a fall, which is why knee injuries top the list. Upper-body injuries usually come from the pole plant, an outstretched hand, or landing on the shoulder.
1. MCL sprain
The medial collateral ligament (MCL) on the inside of the knee is the most commonly injured ligament in skiing. It usually happens in a wedge or snowplow position, or when you catch an inside edge and the knee is forced inward.
What to do: Most MCL sprains heal without surgery. A brace may be used early on, followed by progressive strengthening to restore stability and confidence before you get back on snow.
2. ACL tear
The anterior cruciate ligament (ACL) is skiing's signature serious injury. It often happens in a backward fall or a bad landing, and you may feel a pop followed by swelling and instability. (More on how it happens below.)
What to do: See an orthopedic provider for diagnosis. Whether you have surgery or not, a structured rehab plan with objective return-to-sport testing is the key to getting back to skiing safely. Learn more about ACL rehab in Portland.
3. Meniscus injury
The meniscus is the cartilage cushion inside the knee. Twisting under load can tear it, often alongside an ACL or MCL injury. Symptoms include pain along the joint line, catching or locking, and trouble squatting deeply.
What to do: Many meniscus injuries respond well to rehab focused on strength, range of motion, and gradually rebuilding tolerance to deep knee bending.
4. Skier's thumb
Skier's thumb is a sprain or tear of the ulnar collateral ligament (UCL) at the base of the thumb. It happens when you fall with a pole in your hand and the thumb gets bent backward. It's one of the most common upper-body ski injuries and is easy to brush off.
What to do: Get it checked if pinching or gripping is painful or weak. Some cases need a splint, others surgery, and rehab restores grip and pinch strength. To lower your risk, drop your poles when you fall.
5. Shoulder injuries
Falls onto an outstretched arm or the point of the shoulder cause dislocations, AC joint separations, rotator cuff strains and collarbone fractures.
What to do: After medical evaluation, rehab rebuilds shoulder strength and control so it holds up to poling, falls and getting up from the snow.
6. Wrist injuries
Wrist sprains and fractures come from catching yourself in a fall. They're especially common in snowboarders, who don't have poles to absorb the impact.
What to do: After any fracture has healed, rehab restores range of motion, grip strength and tolerance to weight-bearing through the hand.
7. Lower-leg and tibial plateau fractures
They're less common than they used to be, but they mean long recoveries, often with surgery.
What to do: Post-op rehab rebuilds weight-bearing tolerance, quad strength and the ankle mobility you need to flex forward in a ski boot.
8. Low back pain
Long days flexed forward, moguls, chairlift rides and hauling gear all add up. For most skiers, back pain is a load and capacity problem, not structural damage.
What to do: Stay active, build trunk and hip strength, and manage your ski volume early in the season. More on low back pain treatment.
How skiers tear their ACL (and how to avoid it)
Ski ACL injuries tend to happen in a few well-known positions. Learning to recognize them is one of the simplest things you can do: awareness training for these high-risk positions has been shown to reduce serious knee sprains in experienced skiers.
The "phantom foot." You fall backward with your hips below your knees. The inside edge of the downhill ski's tail catches the snow and acts like a lever, twisting the knee. Avoid it: when you feel yourself falling back, keep your arms forward, hands over your skis, and don't try to sit down or fight your way up while off balance.
Boot-induced landing. You land a jump or drop back on your tails. The stiff boot shoves your shin forward while your quads fire hard to recover. Avoid it: land balanced over the middle of your feet with knees flexed, and build eccentric quad strength so you can absorb the landing.
Valgus–rotation. You catch an edge and fall forward while the knee collapses inward and twists. This often injures the MCL along with the ACL. Avoid it: hip strength helps the knee track over the ski instead of caving in.
Getting back on snow after a knee injury
Return to skiing should be based on what your knee can do, not just how many weeks it has been. Research on ACL reconstruction shows reinjury risk drops substantially when athletes wait at least nine months and pass objective strength testing before returning to sport.
Before clearing a skier to return, I look for:
Full knee range of motion and no meaningful swelling with training
Quad and hamstring strength close to the uninjured side on isometric testing
Symmetry in jumping, landing and single-leg power on force plates
Controlled single-leg deceleration and side-to-side changes of direction
Ski-specific conditioning, progressing from groomers to steeper and variable terrain
Pre-season ski training: get your legs ready before opening day
Burning quads by lunch, getting bounced around in crud, legs that quit before the snow does: that's a capacity problem, and capacity is trainable. The training that protects your knees is the same training that lets you ski harder and longer.
What skiing actually demands
Eccentric and isometric quad strength. Every turn is your quads absorbing force and holding a bent knee.
Single-leg strength and balance. Skiing is mostly one leg at a time, weighted on the outside ski.
Hip and trunk control. Strong hips keep the knee tracking over the ski instead of caving in.
Reactive power. Moguls, ruts and landings demand fast force, not just strength.
Repeat-effort conditioning. A ski day is hard runs with short lift-ride breaks. Fatigue late in the day is when many injuries happen.
Mobility that fits the boot. Ankle flexion, hip rotation and upper-back rotation keep you balanced over your skis instead of in the back seat.
A sample pre-season ski workout
Start 8 to 12 weeks before your first ski day and do this twice a week. Use a weight that leaves 2 to 3 good reps in the tank. If you're new to strength training or coming back from an injury, start lighter or get an individualized program.
Exercise
Sets × reps
Why it helps on the mountain
Rear-foot elevated split squat
3 × 6–8 per leg
Single-leg strength for the outside ski
Single-leg Romanian deadlift
3 × 8 per leg
Hamstring and hip strength that protects the ACL
Tempo step-down (3-second lower)
3 × 8 per leg
Eccentric quad control and knee tracking
Wall sit or Spanish squat hold
3 × 30–45 seconds
Isometric quad endurance for long turns
Lateral bound and stick
3 × 5 per side
Reactive power and controlled landings
Side plank or Copenhagen plank
3 × 20–30 seconds per side
Trunk and inner-thigh strength for stability
Bike or rower intervals
8–10 × 40 seconds hard, 80 seconds easy
Repeat-effort conditioning for full ski days
Once the season starts, one or two shorter sessions a week will hold onto most of your strength without leaving you tired for the weekend. After the season, address the nagging knee, back or shoulder you skied through and rebuild before next winter.
Want a program built around your skiing, your history and your schedule? I offer in-person and remote pre-season coaching.
When to see a physical therapist
Get urgent medical care for a suspected fracture, dislocation, head injury, or a knee that swells quickly and won't bear weight. Once serious injury is ruled out, physical therapy is often the next step.
It's worth booking a PT visit if:
Your knee gives way, catches, or feels unstable on stairs or when turning
Swelling or pain hasn't settled within a week or two
You're returning from surgery and want a plan that goes beyond basic exercises
Your thumb, wrist or shoulder still feels weak weeks after a fall
You keep skiing through the same nagging pain every season
You want to train for next season and reduce your injury risk
At Beyond The Barbell, every session is one-on-one with me, a board-certified orthopedic clinical specialist (OCS) and certified strength and conditioning specialist (CSCS). Progress is measured with blood flow restriction training, isometric strength testing and force plate analysis, so decisions are based on numbers, not guesswork. I see patients in Portland and Beaverton, with hybrid and fully remote options.
Frequently asked questions
What is the most common ski injury?
Knee injuries are the most common, led by MCL sprains, followed by ACL tears. Among upper-body injuries, skier's thumb and shoulder injuries are the most common.
How long before ski season should I start training?
Ideally 8 to 12 weeks before your first ski day. That gives you time to build strength first, then add power and conditioning. Starting later still helps; any training beats none.
How long after ACL surgery can I ski again?
Most skiers return somewhere between 9 and 12 months after surgery. The timeline depends on passing objective strength and movement tests, not just the date. Returning before nine months is linked to a higher risk of reinjury.
Should I ski in a knee brace after an ACL injury?
Some surgeons recommend a functional brace for the first season back, and some skiers like the confidence it gives. A brace is not a substitute for strength. Talk with your surgeon and PT about what makes sense for you.
Why do my thighs burn so fast when I ski?
Your quads work hard holding a bent knee and absorbing every turn. Burning early usually means your legs lack strength and endurance for that demand, or you're skiing in the back seat. Pre-season strength training and better ski position both help.
Can physical therapy help skier's thumb?
Yes. After a doctor determines whether you need a splint or surgery, physical therapy restores range of motion, grip and pinch strength so you can hold your poles and catch yourself confidently.
Do I need a referral to see a physical therapist in Oregon?
Oregon allows direct access, so you can usually see a physical therapist without a referral. Some insurance plans have their own rules. See insurance and payment details.
Get ready for your strongest ski season
Whether you're recovering from a ski injury or want to show up to opening day with legs that last, I can help. I work one-on-one with skiers in Portland and Beaverton, with hybrid and fully remote options.
Questions first? Email josh@beyondbarbelltraining.com or call or text 419-205-2118. I respond personally.
Josh Davis, PT, OCS, CSCS, is a board-certified orthopedic physical therapist and strength coach and the owner of Beyond The Barbell Physical Therapy & Performance in Portland, Oregon.
This article is for general education and isn't a substitute for an individual medical evaluation.
