It is the second week of the season. You caught an edge on a groomer coming down from the lift, nothing dramatic, and you skied the rest of the day on it. Monday morning your knee is swollen and stiff and you are trying to decide whether this is a few days of ice or something that needs a real appointment.
That is the conversation we have a lot of between November and April. Here are the injuries that come through most often, what tends to cause them, and how to tell the ones that can wait a few days from the ones that cannot.
One thing worth knowing up front: skiers and snowboarders get hurt in different places. Skiers have their feet locked into long levers with bindings that release at the boot, so forces travel to the knee. Snowboarders have both feet fixed to one board and fall onto their hands, so forces travel to the wrist and shoulder.
1. Knee ligament injuries, especially ACL and MCL
This is the classic ski injury, and it is usually not a collision. The common mechanism is a slow, awkward twisting fall where the ski stays pointed one direction while your body rotates another, or a landing that drives the knee inward.
Things that point toward a significant ligament injury:
- A pop or snap at the moment of injury
- Swelling within the first few hours rather than the next day
- A sense that the knee is unstable or might give way on stairs or turns
- Inability to straighten the knee fully, which can suggest a meniscus problem blocking motion
Not every twisted knee is an ACL tear. Many are MCL or LCL strains, which often do well without surgery, and some are meniscus injuries that behave differently again. The exam is what sorts these out, and it is more informative a few days after the injury once the initial guarding settles.
What to do in the first few days: relative rest, compression, elevation, ice for comfort, and gentle motion within what the knee tolerates. Keep weight off it if it will not bear weight. Then get it examined rather than waiting to see whether it sorts itself out over a month.
2. Wrist fractures and sprains, mostly in snowboarders
Falling onto an outstretched hand is the single most common snowboard mechanism, and it is especially common in people learning. The wrist takes the full load of body weight plus momentum.
Two things get missed frequently here. First, a fracture can be present without obvious deformity, so a wrist that still works is not proof it is not broken. Second, tenderness in the small hollow at the base of the thumb side of the wrist deserves specific attention, because a fracture of the scaphoid bone there can be subtle on early imaging and can have a difficult healing course if it is treated as a sprain.
Get a wrist looked at if there is significant swelling, pain with any weight through the hand, tenderness over a specific bony point, or pain that is not noticeably better after several days. Wrist guards are worth considering for anyone learning to ride.
3. Shoulder injuries: dislocations, collarbone fractures and rotator cuff strains
Shoulders take the hit when you land on the point of the shoulder or on an outstretched arm. The usual suspects are a dislocation, a fracture of the collarbone, an injury to the joint at the top of the shoulder where the collarbone meets the shoulder blade, and strains of the rotator cuff.
A shoulder that is visibly out of place, that will not move at all, or that comes with numbness or weakness down the arm needs same-day care, not a clinic appointment next week. A shoulder that is sore and weak but functional is usually something that can be evaluated in the next few days, and an ultrasound exam in the office can often look directly at the cuff tendons.
If you have had one dislocation, you are generally at higher risk of another, and the rehab that follows the first one matters more than most people realize.
4. Skier’s thumb
This one is specific and easy to dismiss. When you fall with a pole in your hand, the thumb gets levered away from the index finger, straining or tearing the ligament on the inside of the thumb knuckle.
It often looks like a mild sprain. The reason to take it seriously is function: that ligament is what lets you pinch and grip, and a complete tear that is treated as a bruise can leave a thumb that does not hold up to everyday tasks like opening jars or turning a key.
Signs worth an evaluation include pain and swelling at the base of the thumb web, bruising there, weakness pinching between thumb and index finger, or a thumb that feels loose when you stress it sideways. Dropping a pole during a fall is good practice, and straps that release are worth looking at on your current poles.
5. Concussion and head injuries
A helmet reduces risk of serious head injury and is worth wearing every day. It does not make concussion impossible, and a concussion does not require losing consciousness.
Symptoms can include headache, feeling dazed or foggy, nausea, dizziness, light or noise sensitivity, trouble concentrating, and sleeping more or less than usual. They do not always show up immediately. The safe default after a head impact is to stop skiing for the day and be evaluated rather than to ski the last two runs and see how you feel.
Our post on concussion signs every Colorado parent should know goes through this in more detail, and it applies to adults just as much as to kids.
Red flags that belong in urgent care or the emergency department
Do not wait for a clinic appointment for any of these:
- An obviously deformed limb or joint, or a bone that looks out of place
- Inability to bear any weight on a leg
- Numbness, severe weakness, or a cold or pale hand or foot below an injury
- Loss of consciousness, repeated vomiting, worsening headache, confusion, seizure, slurred speech or unequal pupils after a head impact
- Neck pain with numbness, tingling or weakness anywhere
- Chest or abdominal pain, or difficulty breathing, after a hard fall or collision
- An open wound over a joint or a wound that will not stop bleeding
Anyone on a blood thinner who hits their head should be evaluated promptly even if they feel fine.
What actually reduces your risk
- Get bindings checked and adjusted by a shop, with your current weight, boot sole length and ability level, rather than whatever the setting was two seasons ago.
- Do some preseason legwork. Quad, hamstring, glute and calf strength plus balance work is the most reliable thing in your control.
- Treat the first day like a first day. A large share of injuries happen early in the season and late in the day, when legs are fresh to the motion or already tired.
- Wear a helmet, and wrist guards if you ride.
- Take lessons if you are learning. Technique is injury prevention, especially for falling.
Getting seen without losing a week
The frustrating part of a ski injury is often not the injury. It is the waiting: a call on Monday, an opening in two weeks, an imaging referral after that. Something that would have been straightforward to evaluate at day three gets looked at a month in.
Dr. Christopher Kroner is a family practice and sports medicine physician whose sports medicine experience runs from professional and Olympic athletes to high school sidelines. Evaluations here include an unhurried exam and, where it helps, in-office ultrasound to look at tendons and soft tissue during the visit, with referral to an orthopedic colleague when a problem genuinely needs surgical hands. If you want a sense of how that decision gets made, we wrote about who to see first and when we refer you out.
Sports medicine visits are included in a primary care membership and are also available as a standalone visit if your primary care is elsewhere. A direct primary care membership is not health insurance.
If something is hurting after a day on the hill, you can book a free 30-minute meet and greet with Dr. Kroner or call 720-807-9961. We are at 4045 Wadsworth Blvd #300, Wheat Ridge, CO 80033, open Monday through Friday, and we see patients from Arvada, Lakewood, Golden, Edgewater and west Denver.
This article is for educational purposes only and is not a substitute for individual medical advice. Please see our medical disclaimer.