Glenn Wellmann DPT

If you live along the Front Range, you already know the pattern. Loveland and A-Basin open in October, everybody talks about getting in shape, and then the first real powder day arrives in mid-December and your legs are toast by 11 a.m. Six weeks is enough time to change that. It is not enough time to start in week five.

So here is the plan I give Colorado skiers this time of year, with the reasoning behind each piece.

What actually gets hurt when people ski

Preseason training only makes sense if it targets the right thing. In alpine skiing, the knee is the most commonly injured site, accounting for roughly 27 to 41 percent of all injuries depending on which study you read, and those knee injuries are usually ligament sprains involving the anterior cruciate ligament or the medial collateral ligament (Davey et al., Sports Health, 2019). That same review puts ACL injury incidence at about 0.23 per 1,000 skier days, which is a higher rate per exposure than what is reported in female soccer players.

When Austrian researchers imaged 282 recreational skiers with knee injuries serious enough to need hospital care, the ACL was involved across the board, and most of the time it did not tear alone: the medial collateral ligament was also injured in 50.5 percent of cases and the medial meniscus in 40.1 percent (Posch et al., Knee Surgery, Sports Traumatology, Arthroscopy, 2021).

Two risk factors from that literature are worth flagging because you can do something about one of them. Lower core strength shows up as a risk factor. So does cold exposure, which reduces how fast your hamstrings can produce force and therefore how well you can resist the knee sliding forward. That is a direct argument for building hamstring strength in November, at 5,400 feet in a warm gym, so it is still there in January at 11,000 feet in a wind hole.

What the evidence says about preseason training

The most useful number in this whole field comes from a meta-analysis of strength training for injury prevention across 7,738 participants. Strength training cut the risk of acute and overuse sports injuries substantially, with a relative risk of 0.338, and the effect was dose dependent: a 10 percent increase in strength training volume reduced injury risk by more than four percentage points (Lauersen et al., British Journal of Sports Medicine, 2018). More strength work, up to a point, kept producing more protection.

For skiing specifically, Swiss researchers tested a 20-minute home program on 71 youth competitive alpine skiers against a matched control group of 58, over a full season. The program was built on eccentric hamstring strength (dynamic bridging and the Nordic hamstring exercise), leg-axis stability (deep single-leg squats to load the hip external rotators), and trunk stability (dynamic planks and deadbug bridging). Traumatic injury rates were 33.5 percent lower in the intervention group, rate ratio 0.655 (95% confidence interval 0.485 to 0.884), and overuse injury rates were 30.1 percent lower (Schoeb et al., Frontiers in Physiology, 2022).

Worth knowing: average adherence in that study was only 0.8 sessions per week, below the once-weekly minimum they asked for, and it still worked. And an umbrella review of lower-limb prevention programs found they reduce lower-extremity injury risk by roughly 39 percent and acute knee injuries by about 54 percent, while also improving strength, balance, jumping and agility (Bel et al., International Journal of Sports Physical Therapy, 2021). You are not choosing between skiing better and getting hurt less. They are the same program.

A caveat I will not skip: the ski-specific trial studied 14-year-old racers, not weekend skiers, and used a historical control group rather than randomisation. The broader strength evidence is stronger and points the same way.

The six-week plan

Three sessions per week: two strength days and one day that is mostly legs-on-fire conditioning. Leave at least one day between strength sessions. If you can only do two days, drop the conditioning day and keep both strength days.

1. Goblet squat or box squat, 3 sets of 10. Sit back to a bench at roughly the depth of a ski turn. Knees track over the middle of the foot, not caving in.
2. Romanian deadlift, 3 sets of 10. Hinge at the hips with a long spine, feel it in the hamstrings, stop where your back wants to round.
3. Split squat, 2 sets of 8 per leg. Front shin close to vertical, back knee lowering straight down. This is your leg-axis work.
4. Side plank, 3 holds of 20 seconds per side. Stack the shoulders and hips, do not let the bottom hip sag.
5. Deadbug, 3 sets of 8 per side. Ribs down, low back flat to the floor the entire time.

1. Squat, 4 sets of 6 to 8 with real weight. The last rep of each set should feel like you had one or two left, not five.
2. Nordic hamstring curl or slider leg curl, 3 sets of 5. Lower yourself slowly and under control for 3 to 4 seconds. This is the single most direct answer to cold hamstrings that cannot resist forward shear.
3. Step-down from a 6 to 8 inch box, 3 sets of 8 per leg. Lower for a count of 3, tap the heel, come back up. Watch the knee stay over the foot.
4. Wall sit, 3 holds of 45 seconds. Thighs parallel to the floor, breathe through it.
5. Pallof press or suitcase carry, 3 sets of 10 per side or 30 seconds per side. Resist rotation. That is the whole job.

1. Squat, 4 sets of 5, heaviest of the block. Keep form as the priority over the number.
2. Lateral hops over a line, 4 sets of 20 seconds. Quick, quiet, land on the whole foot. This is your edge-to-edge work.
3. Skater bounds, 3 sets of 6 per side. Push sideways, land on one leg and stick it for a full second before the next one.
4. Single-leg Romanian deadlift, 3 sets of 8 per leg. Slow, controlled, hips level.
5. Conditioning finisher: 6 rounds of 45 seconds hard on a bike or with a sled or ski-erg style effort, 75 seconds easy. A run of moguls lasts about that long, so train that duration.

Two Colorado notes. If you live at 5,500 feet and ski at 11,000, your legs will feel worse than your fitness suggests on the first days up high, so make day one short on purpose. And hiking is excellent joint-friendly aerobic work, which I covered in how hiking supports fitness and joint health, but it does not train the eccentric quad and hamstring control skiing demands. Keep hiking, just do not let it replace the strength work.

When to get it looked at instead of pushing through

• A knee that swells after a session, gives way, or catches and locks.
• Sharp, localised pain that changes how you walk, as opposed to general muscle soreness that eases in a day or two.
• A previous ACL reconstruction where you have never been formally tested for side-to-side strength and hop symmetry.
• Back or hip pain that shows up during the hinge or squat and does not settle with lighter load.

If you are coming back from an ACL reconstruction, the season-opening question is not “does it feel okay,” it is whether your numbers are close enough to symmetrical. I covered what those standards look like in a post on whether your knee is actually ready to return to sport.

If you would rather not guess at the loads

Programs on the internet, including this one, cannot see how your knee tracks under load or how deep you can hinge before your back rounds. If you want the plan built around your actual body and your actual ski goals, training with a physical therapist means a clinician who coaches the lift and adjusts it week to week. If your main question is whether a previously injured knee is ready for a season of skiing, return-to-sport testing gives you the strength and hop symmetry numbers instead of a hunch. Six weeks from now is opening weekend for most of us. Good time to start.

References

• Davey A, Endres NK, Johnson RJ, Shealy JE. Alpine skiing injuries. Sports Health. 2019;11(1):18-26. doi:10.1177/1941738118813051. https://pmc.ncbi.nlm.nih.gov/articles/PMC6299353/
• Posch M, Schranz A, Lener M, Tecklenburg K, Burtscher M, Ruedl G. In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation. Knee Surgery, Sports Traumatology, Arthroscopy. 2021;29(6):1790-1796. doi:10.1007/s00167-020-06221-z. https://pubmed.ncbi.nlm.nih.gov/32803275/
• Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. British Journal of Sports Medicine. 2018;52(24):1557-1563. doi:10.1136/bjsports-2018-099078. https://pubmed.ncbi.nlm.nih.gov/30131332/
• Schoeb T, Froehlich S, Frey WO, Verhagen E, Farshad M, Spoerri J. The ISPAInt injury prevention programme for youth competitive alpine skiers: a controlled 12-month experimental study in a real-world training setting. Frontiers in Physiology. 2022;13:826212. doi:10.3389/fphys.2022.826212. https://pmc.ncbi.nlm.nih.gov/articles/PMC8929391/
• Bel L, Mathieu N, Ducrest V, Bizzini M. Lower limb exercise-based injury prevention programs are effective in improving sprint speed, jumping, agility and balance: an umbrella review. International Journal of Sports Physical Therapy. 2021;16(6):1396-1404. doi:10.26603/001c.29860. https://pmc.ncbi.nlm.nih.gov/articles/PMC8856761/