Ski Case Studies

Jane Harrington

Jane is a thirty year old skier, reasonably fit commuting to work by bicycle several times a week and going to the gym occasionally. She has skied from a young age and despite on-going ski trips twice annually and continued snow tuition, feels her skiing is in a rut.

Observation: a combination of tight Hamstring muscles (rear of thigh) and calf muscles were coupling to draw Jane's hips backwards and thus pulling her into the back seat when skiing. As part of the problem her feet rolled in (pronating) multiplying the effect of the muscle movement and drawing her knees into a knock kneed stance.

Solution: it was discovered that Jane often felt rushed after gym workouts and so skipped stretching. Plus her exercise routines were not performed with much awareness of correct positioning. As a result, Jane tried:
· Stretching for 10 to 15 minutes after her regular gym sessions, focusing especially on her hamstrings and calves.
· Adapted her form on her bicycle plus in her gym work and added some new exercises to aid her deep stomach muscles, leg muscle balance and joined in on some fun pilates classes.
· Custom insoles were made supporting better alignment and stance in her boots.

Result: Jane found new passion for her skiing as she broke through the learning progression with off piste skiing. To top it off she finished the day feeling better than ever as her muscles were working more efficiently rather than fighting for control.

Thomas Harmon

Thomas, who had played rugby in his youth, enjoys being outdoors and generally takes on new activities with gusto, however skiing proved to be agonising. His last ski instructor told him to 'quieten his upper body' as he was trying to initiate turns from his head and shoulders.

Observation: Tight lateral muscles (outside of calf and thigh) bring Thomas into a very bow-legged stance. The muscle tension pulls him forwards and to the outer edges of his skis, thus he is always fighting to find his balance and is very tense. Exemplifying the problem his feet roll out (supinate) with high arches. This means that his foot type has a high instep, often resulting in pressure on top of the foot in rental boots cutting off the circulation. A naturally shortened calf muscle and Achilles chord pulls his rear foot out of the base of the boot, over pressuring the front of the foot and shutting the whole foot down when he skis.

Solution: From years of team sports involving pushing movements in his youth Thomas has overly developed his outside thigh muscles (Iliotibial Band or IT band). This pulls him to the outside of the ski as he flexes making turn initiation very difficult. Shortness in his calf means that heel lift on the custom insole needs to be added to bring even weight distribution inside his boot, whilst still allowing room for his in-step. Thomas tried:
· Lengthening IT band muscles, glutes and calf muscles through stretching and massage.
· Strengthening glute and lower back muscles that were weak.
· Custom insoles allowing good foot alignment and encouraging flexion towards the in-side edge with a raised heel to re-distribute weight more evenly.

Result: Thomas felt more relaxed and balanced on his skis. He persisted with the stretching and ski lessons and found he quickly became a faster and more agile skier, gone was the tension in his body on the snow, and no more agony as his feet overloaded from pressure to the foot.

Circles on left ski depict positioning of Centre of Mass.
Arrows on Right ski show the line of force created from flexion inside the boot.

Jo Ansley

Jo is a competent skier in her mid forties, in her regular time Jo is a busy executive and so spends a lot of time either with clients or sitting at a computer. She is getting frustrated with the diminishing enjoyment she has been getting due to the discomfort on her ski trips. She skis one week a year and can ski most piste runs comfortably, however she struggles on steeper black runs. She has never had comfortable boots due to a burning sensation under the balls of her feet that can only be relieved by stopping and opening all of the ski boot's clips. She often complains of constant heel lift when skiing.

Observation: Jo had very high arches and tight calf muscles. When she flexed forward, bent knees, in the ski position her heels lifted and all the pressure went onto the balls of her feet. This explains the heel lift and numb toes she experiences in the ski boots.

Solution: the shortness in her calf muscle was a result from continual wearing of high heels plus sitting for long periods.
· Stretches were shown to Jo to help lengthen the calf muscles, she could do these at all sorts of moments in her regular routine.
· Jo was happy to spend more time in flat shoes to help increase the length of the calf muscle, especially when commuting and on the weekends.
· Moulds of Jo's feet were taken to redistribute the uneven pressure under her feet
· Small heel wedges were placed inside her boots.
· The ski boot shell chosen was high in the instep to ensure no compression on top of her feet which might reduce blood flow.

Result: Jo felt confident to ski all over the mountain with comfort all day and new found control from the fit of her boots as her rear heel stayed weighted and even support was felt across the foot.

Mark Fry

Mark Fry is a very keen skier, having skied for 15 years a few weeks every year. A motorcycle accident however left him with an ankle that is fused at 90 degrees. He has tried getting into his old ski boots, but the scar tissue around the ankle joint, plus the forward angle in the boot made this impossible. As most ski boots are made with a forward angle of 15 degrees this simply does not match Mark's lower leg causing Mark comfort and performance problems. This created major alignment issues and poor ski edge control which was disappointing for someone of his ability prior to the accident.
Mark came to us feeling disheartened after skiing in a rental boot many sizes too big to get his foot into it. We explained that he may never be able to ski quite like he used too, however we could help a lot with general comfort, alignment and fit.

Observation: Due to the fused ankle, when forced into 'ski position' the ski boots forced Mark's hips into an unnatural position; left hip back, right hip forward, which was creating problems with edge to edge control. To allow him a better fit he needed to have the boot expanded about the ankle joint, but also rebuilt to allow a new forward lean angle.

Solution: We first needed to match the forward angle in both boots to that of the fused ankle.
· The upper cuff of both boots was removed and re-bolted into an upright position to match the angle of his shin.
· We made custom moulded insoles and altered the forward and aft support of these to promote better balance and more natural alignment in the hip.
· We recommended that when hiring skis the bindings were set 2cm forward of traditional mounting point to place his centre of mass in the best position.
· Advice was given on some basic stretches and strengthening exercises to ensure the pelvis and core were kept strong as they naturally were under greater strain than normal from his limited flexion.

Result: After skiing in the more upright boots Mark noted a much more balanced feeling under his skis and felt he was able to ski much better and with more confidence.

Sue Hough

A mother of three young children, she recently was looking forward to the family ski trip. She loved being in the mountains but found the experience really diminished by the great pain she found herself in from the ski boots she hired. Normally a size 5 UK shoe, Sue had to ski in size 9's to accommodate her large calf muscles. She was not able to get an even fit along her calf and lower leg, with the boot feeling overly tight at the top still, plus the large boot size meant she was unable to control her skis.

Observation: Sue has very large calves in proportion to her feet which needed accommodating in the boot fit. As the calf was disproportionately large, the muscle in the leg was also sensitive to pressure. If placed in a ski boot matching her foot size she would squash her toes, as the calf volume would push her foot forward into the front of the boot. On top of this, tight calf muscles meant a great proportion of load was going to be placed on her forefoot in ski position.

Solution: We needed to look at boots offering a comfortable padded liner, low forward lean angles plus adjustable calf volumes.
· Several boots were selected and adjusted to maximize the calf fitting; these were shell checked to confirm their suitability and other adjustments required to improve comfort.
· Heel lifts were made to take weight off the forefoot; this also helped to lift the widest part of the leg out of the liner whilst still keeping a balanced stance.
· After trying on the best boots we modified the positioning of the buckles for her and altered the shape of the tongue of the boot so it sat comfortably on her shins. The rear height of the boot was adapted to ensure less pressure on the sensitive leg muscle.
· We moulded custom insoles to support her feet inside the ski boots and she was also in the best correct size boot for the length of her feet to give her better control.
· Sue's technician talked about some basic exercises to try at home and discussed ways in which she could add a little more exercise into her busy mum's routine.

Result: Sue started doing a little more exercise before her next ski holiday, inspired by the idea of skiing with her children plus the feeling of excitement that this time it would be in comfort. After her ski trip Sue found she was surprised at the effect and felt much more confident to ski more challenging runs.

Snowboard Case Studies

Chris Knight

Chris, now in his late 30's, did a few seasons in Canada and Australia in his early twenties. He now gets two week long trips in a season around Europe. He is confident on his board and rides with good technique having taken advantage of riding with local mountain instructors during his seasonaire days. He has always found the balls of his feet ache when he rides and they often go numb with-in the first few runs. No matter which boots he has bought or hired he has never been able to ride with much comfort. He is confused why its hurts so much and tired of having to stop and take his boots off and rub his feet to relieve the cramping which is particularly bad on the first few days of his trips to the slopes. He has had custom insoles before and did not find them much use; they were quite rigid and made his feet feel dead.

Observation: Chris has a high arch foot type creating a shortened heel cord, tight calf muscle creating a small proportion of the fore foot to bear all his weight when riding. Because of the higher instep from his foot type it is easy for his binding straps to place too much pressure on top of his foot and impinge circulation.

Solution: It turned out that from advice given by his friends he was adjusting his bindings in a manner that was worsening his problems. Limited flexion about Chris's ankle joint was over-loading his forefoot, plus aggressive forward lean on his High-Back's were exasperating the situation. In addition the out of the box positions of his ankle straps were causing excessive pressure on to his instep
· Chris was shown stretches for his calf muscles he could do regularly whilst doing other activities in his daily routine.
· Moulds of Chris' feet were taken utilising his natural riding stance angles.
· Insoles were adapted to ensure excellent flexion about the arch to aid snowboard specific flexion about the knee utilised in steering movements.
· These were supported with EVA allowing flexion through the foot and were also raised in the rear to 'open up' the ankle joint and aid greater flexion.
· Small wedges were placed under his liner inside his boot shells to further open the ankle joint.
· His bindings were tinkered with; forward lean was minimised, plus his ankle strap angles were adjusted to place less pressure on his instep.
· Lacing tricks were shown so he could avoid tightening his boots over his instep.

Result: Chris' feet felt the most relaxed they had ever been, his toe side turns felt more graceful and smooth plus he no longer had any burning sensations or needing to constantly fiddle with the fit of his equipment.

Samantha Yates

Samantha is a young twenty something graduate who enjoyed playing hockey and netball through school and university, though now fits in a little gym time around her full time job.

Observation: Samantha has a small, slim and rather mobile (flexible) pronating foot. This meant the muscles on the outside of the lower limb were kept very active in walking and her previous sports to support the foot function and so were literally over used, creating a muscle sensation of 'compartmental syndrome'. Her snowboard boots were ill-fitting as they were broad around her foot meaning that movements had to be exaggerated to message her snowboard. To top it off, she had been sold a Men's snowboard, whilst matched with her small foot size meant the width of the board made it very challenging to move from edge to edge due to the greater distance required to travel, thus multiplying the energy output required again!

Solution: Samantha's equipment was not suitable for her so advice with specific boot models to try on was offered plus we recommended some leading stores to visit near her. Women's specific boards were discussed plus the various benefits of different lengths and 'waist-widths' to look out for.
· Moulds in a snowboard type stance were taken of Samantha's feet. These were then supported to stabilise the foot in this neutral position.
· Insoles were adapted to ensure excellent flexion about the arch to aid snowboard specific flexion about the knee utilised in steering movements.
· Optimum stance angles, binding widths and other features were discussed.
· Samantha was invited to return for a review of her new equipment to ensure she had been set-up correctly with respect to sizes and stance before her next holiday.
· Sport massage was recommended to aid the over used muscles in the lower leg to relax and release the adhesions limiting natural function and creating discomfort, plus specific stretches to aid improvement.

Note: One of the most common causes of ski boot discomfort is pressure on the under portion of the outer side of the forefoot. This creates a huge hot spot which we often see on our foot pressure scanning machine. This build up of pressure can be quite debilitating. The main reason for this is that as we walk along our feet naturally point outwards like Charlie Chaplain. Whilst skiing our feet, boots and skis are 'forced' into a parallel position. It is this altered foot position that places the foot in an unnatural stance inside the boots creating the burning numb feeling along the under/outside of the feet. At profeet we are able to accommodate the foot in this position using a unique moulding technique and effectively eliminate one the biggest causes of uncomfortable boots on the planet.

Result: Samantha started really enjoying her riding and felt much more at ease on her new equipment. Snow boarding became fun again and her progression around the mountain took off.

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