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Skiing accidents: advanced medicine and rehabilitation facilitate a speedy return to active life – even for older people

(Vienna, 3 December 2015) Just in time for the start of the season in our national ski resorts, we have now had our first falls of snow and the snow blowers are working at full tilt. According to the Traffic Safety Board, around 40,000 people injure themselves every year in Austria while Alpine skiing. Falls on the ski slopes frequently result in knee injuries, usually involving the anterior cruciate ligament. However, advanced modern medicine and rehabilitation help those affected to return rapidly and safely to an active lifestyle – and, increasingly, also applies to seniors. This point is emphasized by Richard Crevenna, acting Head of the University Department of Physical Medicine and Rehabilitation at MedUni Vienna. 

A torn anterior cruciate ligament results in instability of the knee joint, sensory-motor problems and muscle atrophy. The decision as to whether to surgically reconstruct the cruciate ligament or to take a more conservative approach depends upon individual factors and the potential demands that will be made of the knee joint in the future. Generally, surgery is the approach of choice in younger patients with higher sporting aspirations. The operation is followed by post-operative immobilization using an orthosis (splint) with a stop (to 30°, over 60° – up to 90°), to prevent harmful movements that could jeopardize the success of the operation. 

In addition to further physical measures, rehabilitation primarily consists of mobilisation, possibly using crutches, and techniques from medical exercise therapy and physiotherapy exercises as early functional treatment. Says Crevenna: “The gradual building up of flexibility, strength, endurance and sensory-motor functions is necessary to ensure optimum load capacity and long-term stability of the knee joint. This should produce sufficient functional capacity of the muscles in the movement chain and this is crucial in ensuring subsequent full loading within the desired range."

The interdisciplinary setting at MedUni Vienna – for example, a combination of orthopaedics, trauma surgery and rheumatology – enables even physically active people of the 65+ generation to return to a physically active lifestyle. "Musculoskeletal problems require the involvement of several medical disciplines in order to achieve an optimum outcome," agrees Josef Smolen, Head of the Department of Rheumatology at MedUni Vienna.

Rehab improves the outcome
"Both surgery and rehabilitation are specially tailored to the specific needs of each individual," stresses Tanja Stamm, new Professor of Outcomes Research at MedUni Vienna. Together with her team, she also evaluates and measures the "complex outcome" of patients who receive rehabilitation following surgery and those who do not – as well as those who have received conservative treatment. The results are unequivocal: “Recovery and return to an active lifestyle are much quicker and more effective if patients receive rehab. Especially in fit older people." Tanja Stamm’s research group has developed scores for measuring complex outcomes in different medical areas – including rehabilitation.

The most important factor in rehab, stress the MedUni Vienna experts, is the motto "don't be afraid to put weight on it". Under the guidance of a specialist in physical medicine, the knee joint should be used correctly and phase-appropriately, i.e. to the extent allowed by its current loading capacity, as part of the therapy. "The very effective methods of advanced modern medicine and rehabilitation following skiing accidents should prevent people, and especially older people, from being needlessly afraid of falling," says Crevenna. "A fall or an injury is not the end of the world. It is better to be active and to be well prepared but also to know that you can rely on speedy, high-quality, interdisciplinary treatment, if you should fall."

Bone & Joint Decade

Crevenna and Stamm’s research has been included in the international “Bone & Joint Decade 2010-2020". Crevenna is also acting as the Austrian coordinator for this project. The "Bone & Joint Decade" is concerned with preventative measures and increased funding for research into disorders of and injuries to the musculoskeletal and locomotor apparatus. In Austria alone, around two million people are affected by musculoskeletal disorders or injuries at some time in their lives. "Musculoskeletal problems are the second most common cause of disability throughout the world. They cause pain, functional restrictions and lead to loss of independence. This can have massive socio-economic consequences for the sufferer," says Crevenna.