The introduction of the rigid shell ski boot served as a foundation for the evolution of what became a science of immobilization and splinting of the joints of the foot and a leg of a skier. By creating an encasement for the foot and the portion of the leg within the rigid shell, mediums such as foam could transfer force to the ankle and leg to substantially immobilize its joints. Supporting the foot in a neutral position with a rigid footbed or orthotic in conjunction with form fitting mediums ensures maximal immobilization that is described as the Perfect Fit. The science of immobilization has evolved over the years to include thermoformable liners and even thermoformable shells.
Even though the medical textbook, The Shoe in Sport, cautioned 30 years ago that “the total immobilization by foam injection or compression by tight buckles are unphysiologic (against physiologic function)” the proponents of immobilizing the joints of the ankle continue to claim that this puts the foot in it’s strongest position for skiing.
The paper, Recent Kinematic and Kinetic Advances in Olympic Alpine Skiing: Pyeongchang and Beyond, published on February 20, 2019, cited better transfer of the skier’s action to the skis through improved boot-fittings with individual liners and insoles. If in fact, skier performance is improved due to improvements in the science of immobilization through boot-fitting then it should be evident in studies that look at skier performance.
One such study, Challenges of talent development in alpine ski racing: a narrative review, published in March of 2019 found:
Youth and adolescent ski racers report lower injury rates compared to World Cup athletes. The knee was the most affected body part in relation to traumatic injuries. The most frequently reported overuse injuries were knee pain (youth) and low back pain (adolescent level). Athlete-related modifiable risk factors were core strength, neuromuscular control, leg extension strength and limb asymmetries.
Neuromuscular Function (NMF) affects Neuromuscular control (NMC). NMC is an unconscious trained response of a muscle to a signal associated with dynamic joint stability. This system of sensory messages (sometimes referred to as “muscle memory”) is a complex interacting system connecting different aspects of muscle actions (static, dynamic, reactive), muscle contractions, coordination, stabilization, body posture and balance. The movements of the lower extremity, including the knee joint, are controlled through this system, which needs correct sensory information for accurate sequential coordination of controlled movement.
It has been known for decades that restricting the action of a joint or joint system, especially immobilizing the joint, will cause the associated muscles to atrophy. But a study, Effect of Immobilisation on Neuromuscular Function In Vivo in Humans: A Systematic Review, published in March 2019, suggests that the effects of immobilizing joints of the body are far greater than simply causing muscles to atrophy. This is the first systematic review to consider the contribution of both muscle atrophy and deterioration in neuromuscular function (NMF) to the loss of isometric muscle strength following immobilisation. The fact that the study, Challenges of talent development in alpine ski racing: a narrative review, cited core strength and neuromuscular control as issues in the development of talent is significant. The feet are part of the core in what is called foot to core sequencing. Immobilizing the joints of the foot can affect lower limb and core strength.
Immobilisation in the study the Effect of Immobilisation on Neuromuscular Function In Vivo in Humans: A Systematic Review, was achieved by using casts, braces, slings, unilateral suspension, strapping or splints with the following locations immobilised: knee, ankle, wrist and finger. All studies measured isometric muscle strength. No studies were cited that involved bilateral immobilisation of both ankles such as occurs in form-fitting ski boots. However studies did find that multiple joint immobilisation was likely to produce the largest change in the NMF of segments consisting of both mono and biarticular muscles. Other key findings were:
- The greatest changes in all variables occur in the earliest stages of immobilisation.
- The loss in muscle strength during immobilisation is typically greater and occurs faster compared to the loss of muscle volume.
- The choice of joint angle for immobilisation using the brace or cast method appears likely to play a large role in the outcomes.
I started this blog six years ago for several reasons. A primary reason was to identify whether any influences existed in skiing that would serve to change the focus from immobilizing the joints of the foot and leg with the associated claims to a science-based focus. Since the future of the ski boot appears to be continued refinement of the science of immobilization this will be my final post.
I have learned a lot over the past six years that led to huge breakthroughs on skis for myself and those who I have worked with. Thank you to those who commented and contributed to The Skier’s Manifesto.