Question: How did you initially get involved with the U.S. Women’s Ski Team?
Dr. Bill Sterett: I began covering the U.S. Ski Team events and athletes when I moved to Vail and joined the Steadman-Hawkins Clinic in 1993. In 1997, I was named the Head Team Physician for the U.S. Women’s Alpine Ski Team. I have enjoyed that role ever since through 4 Olympic Games and 10 World Alpine Championships.
Q: Why do you enjoy working with such elite athletes?
DBS: Working with elite athletes in any capacity is both extremely challenging and hugely rewarding. I have always been part of teams throughout my life. To work with professional athletes, we need a great team, from injury to surgical care, to rehabilitation and decision making on when it is safe to return to sport. I am very fortunate to lead this team of professionals.
Q: How often do you travel with the team and what kind of care do you provide on the road?
DBS: It seems that I am in contact with someone from the U.S. Ski Team almost every day, whether I am traveling with them or not. By and large, we have the Ski Team in our community during the month of November for training at Copper and I will usually travel to the big events such as World Championships or the Olympics. This past year, I was in Sweden during the Alpine World Championships, which had some of the most exciting races that I can remember. Lindsey Vonn’s last race; Mikaela Shiffrin charging through some significant illness to win World championship Medals — it was spectacular. During the Olympics, I am technically a physician for Team USA for the U.S. Olympic Committee, although I am there because of my affiliation with the U.S. Ski Team. In any of these capacities, I am there less as a surgeon and more as a physician. I can’t tell you how many times over the years we have had to make decisions in the hotel room the night before about an athlete’s ability to compete the next day. Sometimes this is due to an orthopaedic injury like a knee sprain, or shoulder separation, but often I am deciding on upper respiratory infections, gastrointestinal upsets and concussion management protocols. Having a great team internationally that I can rely on for advice has been a huge part of my success. I communicate pretty regularly with Dr. Shiffrin, Mikaela’s dad, while on the road. He is one of the smartest physicians I know and a great resource for me.
Q: What are some of the most common injuries you’ve seen in ski racers over the years?
DBS: The spectacular ones that we have all seen are the knee injuries and concussions. but these aren’t always the “most common.” The most common knee injury in ski racing, for example, is a partial tear of the MCL (medial collateral ligament). Most of us know that doesn’t need surgery, right? But “doesn’t need surgery” doesn’t equate to “can ski tomorrow” like every athlete wants to believe. So now I have to decide how much time off is necessary to allow healing while allowing the athlete back on the hill as soon as possible. It can be a stressful balance of the “push” to compete for medals, possibly being too quick making the injury take even longer to heal, and being too conservative, taking away an athlete’s desire to compete and make a living.
Q: Do the injuries that women ski racers experience differ much from those of the men ski racers? If so, please describe.
DBS: While a lot of the knee ligament injuries to female athletes are often similar to the men, they have much different risk factors for these injuries — and much different risk factors for returning to sport than the guys.
Differences that they can’t control are things like women being more knock-kneed, more often congenitally loose-jointed (unfortunately, this does lead to more injuries), and even having a smaller ACL (anterior cruciate ligament) per body size than the guys. Some of the risk factors that we try to get our women to lessen are things like how they land when they jump (hint: land with your knees bent), quadricep-specific strengthening and even controlling hormonal influences to injury. Unfortunately, even after being fixed surgically, the female athlete born loose-jointed is much more likely to get re-injured than her male counterpart.
Q: For knee injuries specifically, how do women and men differ?
DBS: The easiest thing for adolescent female athletes and their parents to understand is the influence of loose joints on the risk of knee ligament injuries. When your knees hyperextend a lot, and your elbows hyperextend and you can touch your palms flat on the ground when you bend over to touch your toes, you meet the criteria for being “loose-jointed.” Unfortunately, these athletes have almost a 5 times higher risk of tearing their ACL than the athletes that are not loose-jointed. And when we fix them, we need to choose surgical options that do not contribute to this hyperlaxity. Unfortunately, when we hear of athletes that have torn their ACL 3 times by the time they are just 20, they almost always are loose-jointed.
There is some good news, though. Although loose-jointed athletes tend to be the ones more commonly dislocating shoulders or tearing ACLs, they are much less likely to develop arthritis later in life. About 8 to 10 percent of the normal female population meet the criteria of being loose-jointed, but more than 50 percent of female professional athletes are “loose-jointed.” So there is something about being loose-jointed that allows these young competitors to become great athletes.
Q: What are some of the best precautions that ski racers — and everyday skiers and snowboarders, too — can take during preseason and regular season to avoid injury on the mountain?
DBS: Injuries in alpine racers are almost like car accidents. Virtually anything can and does happen. In recreational athletes, we know that skiing or boarding for more than 3 hours without a hydration and calorie break is a significant risk for injury, as is flat lighting and a lack of recent snowfall. So I guess I would tell all of our skiers and snowboarders to make sure they are taking adequate breaks, keep up on their water and snacks, and be super cautious when the clouds are out and it hasn’t snowed for 3 days or more. That sounds like pretty good advice to the professional athlete, as well.
Q: What else haven’t I asked that you’d like readers to know about your work as an orthopaedic surgeon with the U.S. Ski Team?
DBS: Following the progression from injury on a hill in Europe, back to the U.S., through surgery, early rehab, strengthening, and then return to sport, progression is a process. All surgery is able to do is put the anatomy in a better position for the rehabilitation to work. I am super fortunate to work with great athletic trainers, physical therapists, and other doctors that believe in this whole concept of what it takes to get an elite athlete back to their top level.