Skiing is a winter sport that continues to grow in popularity worldwide. It offers a fantastic opportunity to embrace the colder months, escape the wet and gloomy weather, and enjoy stunning snowy landscapes, mountain slopes, and often clear blue skies.
While skiing continues to increase in popularity and overall injury rates have declined, injuries remain common. Knee injuries continue to account for a significant proportion of skiing-related problems, making up around 20 to 30 percent of all reported injuries.
In this blog, Senior Sports Therapist, Ari Marsden, will explore the most common knee injuries seen in skiing, how they occur, how recovery can be accelerated, and what can be done to help prevent them.
A real-life case from Marsden Health
Before discussing the science behind skiing injuries, it is helpful to look at a real example from clinical practice. Last year, a client attended the clinic with severe knee pain following a skiing accident. During a fall, their ski failed to detach, which placed excessive rotational force through the knee joint. Following a detailed assessment, damage to both the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) was suspected. The client was referred for an MRI scan to confirm the extent of the injury. While waiting for the results, treatment began with initial immobilisation, gentle rehabilitation, and shockwave therapy. This early approach proved highly effective in reducing pain, improving function, and increasing tolerance to load during the first stages of recovery.
When the scan results were received, conservative rehabilitation was recommended rather than surgical intervention. This was encouraging, as strong progress had already been made. Shockwave therapy was continued to support healing of the MCL and to reduce pain in the inner region of the knee. This area was also affected by tendon irritation involving the adductors and medial hamstrings. Rehabilitation progressed steadily, and within eight weeks the client had returned to heavy strength training and functional movement. Although their return to skiing will take place next season, seeing them return to cycling, gym training, and daily activity after such a painful injury was extremely rewarding.
Medial Collateral Ligament (MCL) injuries
MCL injuries are the most common knee injury associated with skiing. They account for approximately 15 to 20 percent of all skiing injuries and up to 60 percent of knee injuries in skiers.
The MCL is located on the inside of the knee and plays a key role in preventing the joint from collapsing inwards. One important advantage of this ligament is its strong blood supply, which allows it to heal well without surgical intervention in most cases.
For this reason, conservative rehabilitation is usually recommended. Treatment typically begins with protecting the joint and gradually restoring movement. As pain and swelling reduce, strengthening exercises are introduced, followed by more advanced functional and sport specific training. With appropriate rehabilitation, most individuals can expect a successful return to skiing.
Anterior Cruciate Ligament (ACL) injuries
ACL injuries are the second most common serious knee injury in skiing and often occur during twisting falls or sudden changes in direction.
Complete ruptures frequently require surgical reconstruction. However, structured rehabilitation before and after surgery plays a crucial role in long term recovery.
Before surgery, rehabilitation focuses on reducing swelling, restoring full and pain free movement, improving muscle activation, and maintaining strength and stability around the knee and hip. During this phase, treatments such as massage, manual therapy, and shockwave therapy can support tissue healing and prepare the knee for more intensive rehabilitation.
What is shockwave therapy?
Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive and non surgical treatment that uses high energy sound waves to stimulate healing in damaged tissues.
It was originally developed for chronic and stubborn conditions. More recent research has shown that it can also be beneficial for certain acute muscle, tendon, and ligament injuries.
When applied to knee injuries, shockwave therapy works by increasing blood circulation, stimulating cellular repair, reducing pain, and helping to break down scar tissue. This process supports improved movement, strength, and overall function.
Research supporting shockwave therapy
Growing scientific evidence supports the use of shockwave therapy in sports rehabilitation.
Research by Zissler and colleagues in 2017 demonstrated that shockwave therapy accelerates muscle repair processes. More recently, Crupnik and colleagues in 2025 reported improved functional recovery, reduced strength deficits, and faster return to sport timelines following treatment.
As research continues to develop, shockwave therapy is becoming an increasingly valuable tool in modern rehabilitation programmes.
Combining shockwave therapy with rehabilitation
Shockwave therapy works best when combined with a structured and progressive rehabilitation programme rather than being used in isolation.
Effective recovery from skiing injuries should include individualised strength training, mobility and flexibility work, balance and coordination exercises, careful load management, and gradual return to sport conditioning. This integrated approach helps restore performance while reducing the risk of re-injury.
Injury prevention for skiers
Preventing injury is just as important as treating it. Many skiing injuries occur when the body is not adequately prepared for the physical demands of the sport.
Maintaining good lower body strength, improving hip and knee stability, and developing strong core control can significantly reduce injury risk. Regular mobility work, particularly for the hips and ankles, helps improve movement efficiency. Using properly fitted equipment and completing a structured warm up before skiing are also essential for keeping the body resilient on the slopes.
Preparing physically in the months before a ski trip can make a major difference to both performance and safety.
Final thoughts
Knee injuries remain one of the most common challenges faced by skiers. However, with early assessment, appropriate rehabilitation, and modern treatment approaches such as shockwave therapy, recovery outcomes are better than ever.
If you are experiencing knee pain following skiing or other sporting activities, professional assessment and individualised treatment can help you get back to the activities you enjoy, feeling confident, strong, and ready for the long term.
Written by Ari Marsden, Senior Sports Therapist
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