Dr. Keith Cummings joined Shannon O’Kelley from IRG Physical Therapy on KOMO Health Talk to discuss ski season preparation and the best ways to proactively prevent injuries.


It’s a Northwest lifestyle weekend on Komo News. Here’s Tom Hutyler and Shannon O’Kelley with more IRG Health Talk.

Tom Hutyler: Our next guest is Dr. Keith Cummings, a non-operative sports medicine physician treating acute and overuse musculoskeletal injuries and getting ready for the ski season, as we talked about earlier, Shannon, some good advice we’re going to get, I’m sure, from Dr. Cummings.

Shannon O’Kelley: Yeah. If you’re a skier, you should be exercising and starting to prep right now. Snow is probably going to be falling in the mountains soon. The ski resort is going to open into December. You need about six to eight weeks of prep to really be prepared for that activity. Skiing is an aggressive activity on your legs, knees, ankles, and your core.

Tom Hutyler: All right, Dr. Cummings and Shannon O’Kelley.

Shannon O’Kelley: Dr. Cummings. Welcome. How are you?

Dr. Cummings: I’m good. Thanks for having me. Happy to be here.

Shannon O’Kelley: Well, thanks for joining us on KOMO. Here we are, looking at the fall and winter fast approaching, and we’re all fairly excited about skiing. If you’re a skier, I mean, this time of year, you get your equipment out, you start checking it. But not just equipment, you probably should check your body, too. We’re hopeful that skiing is going to start. All things indicate that the mountain is going to open. You have a passion for outdoor activity. I noticed in your bio you’re local, you were born and raised down in Olympia, went to school there at St. Martin’s University, and then went to an osteopathic medical school, and then did your medical training at the University of Utah. What a better place in the world to train if you like to ski. Before we get started into the topic, tell us about your practice, your area of interest, where you’re working, and a day in the life of Dr. Cummings, if you will.

Dr. Cummings: Sure. So, I am working with Proliance Orthopaedics & Sports Medicine situated down in Issaquah, Bellevue, and Redmond, and I’m their first non-operative sports medicine doc. So I provide a lot of the non-operative skill sets that you learn in sports medicine. So basically I see a little of everything musculoskeletal related.

Dr. Cummings: I practice a lot of diagnostic ultrasound, as well as the injections that go with that. So it can be a real handy skill set to have. If you’re just trying to sort out what’s going on, you just grab the ultrasound and take a look which can often tell you a lot, as well as maybe being able to do a procedure to help sort that out. I can numb someone up in one joint or a tendon nearby and see what’s going on—what’s causing the pain—as well as doing some x-ray guided injections for the lumbar spine and some orthobiologics including PRP. You may have heard of that. It is just sort of using one’s own blood products to kind of push people back in a direction of healing for maybe a chronic tendon injury, a little early arthritis, things like that.

Shannon O’Kelley: You talked about being non-operative working with a group of orthopedic surgeons. I could see some real synergy of you identifying the injuries. I mean, diagnosing them doing differential diagnosis. And if it does need surgery, having that team member that you can pass it on to. That’s kind of an interesting concept. It sounds exciting. You must enjoy that.

Dr. Cummings: Yeah, I enjoy it a lot. And we had a similar setup down at the University of Utah where I trained, a big orthopedic center with a rather large orthopedic group, as well as a non-operative sports medicine group. So it was the way I was trained. So I was thrilled to find an opportunity where we would be setting up that model, and we could just sort of run with it and work on that synergy, as you mentioned.

Shannon O’Kelley: Right. I notice in your bio, you seem to like the outdoors, and you’re an avid skier, hiker. You’re happy to be back in the Pacific Northwest. Although Utah is not a bad place when it comes to mountains, but I mean, let’s talk about skiing. I mentioned earlier, this time of year we see ski swaps, equipment, and stuff like that, people focused on equipment. But we should focus on our body. And let’s talk about pre-season ski conditioning and the importance of, and maybe getting to some activities that we should be focusing on. And then maybe if we got some time, we can talk about some common injuries. How about that?

Dr. Cummings: Sure.

Shannon O’Kelley: You want to get started with what should I be doing if I’m preparing to go skiing, timeframe, type of activity? We do some pre-season conditioning here at IRG Physical & Hand Therapy, and our patients really enjoy it. And we know that from conditioning, if your body’s prepared, injuries seem to be fewer and potentially less severe.

Dr. Cummings: Absolutely. Yeah. And now’s a perfect time. We’re in early October. Taking six to eight weeks to get ready for the season is probably ideal. This isn’t a sport where I would recommend just sort of running out and doing the weekend warrior thing. A lot of people are more experienced than others. If you’re like me and you were new to skiing a few years ago, when moving to Utah, you kind of realize you’re a little bit unprepared. So what I did back then was to just sort of get rid of my habit of not skipping leg day. So you really have to focus on your legs. Start slow. Start with low reps. See what you can tolerate. And then just sort of keep working up to higher numbers, stronger muscle contractions, particularly these contractions called eccentric contractions, which involve the sitting phase of a squat for your quads, absorbing that force as you’re going up and down those hills, riding around the slopes. That’ll really set you up for success in preventing injury.

Shannon O’Kelley: Dr. Cummings, again, thank you for joining us here on Health Talk. We’re talking about pre-season ski condition. It’s that time of year. We’re all excited. There’s a little snow in the mountains. You talked about preparing yourself. You were focusing on your legs, super important area of your body, legs, but let’s talk about your core and your shoulders. Because when I go skiing, and I start pulling and skiing and you’re running your poles, and my wrist and my elbows and my shoulders, a lot of activity in the upper body, too, although the lower body’s super important. Let’s talk about core and upper-body strengthening.

Dr. Cummings: Core in particular is very important. I remember when I first started skiing, I went home, woke up the next day, and thought I had appendicitis cause my core hurt so bad. It was probably because my brother’s appendix ruptured, so that is always kind of on my mind. But anyways, you just are doing, basically, a full-body contraction, and you’re twisting and turning. And if you’re not doing a lot of those things regularly, again, you could kind of set yourself up for injury and a lot of pain. Hopefully you can train yourself to fall better too.

Shannon O’Kelley: Right. Falling is a big thing. And if you’re prepared and in shape and not fatigued, you’re going to be able to control yourself if you do fall. So I can just visualize our listeners right now, going, “Okay, what am I supposed to do?” Let’s just have some fun here. I can see people lunging around the office, doing wall squats on the office wall, taking an opportunity to strengthen up their legs, work their calves. I mean, you’re talking, sit-ups, we’re talking planks, we’re talking Swedish ball activity. And we’re also talking maybe upper-extremity stuff, rows. I mean, doing some dumbbell stuff, but just total-body conditioning because skiing is really a total-body activity.

Dr. Cummings: Absolutely. Yeah. And I remember, I did an arm workout the day before I first went skiing and realized how stupid that was because I couldn’t push myself on the level terrain. So you’re really using everything, but in particular, legs and core. You really want to focus on that just as far as absorbing all the energy. You’re going over those hills. Maybe you hit a little jump you don’t realized is there. So things like going up and down stairs, maybe doing some light box jumps to start, getting more aggressive as you go, doing some hamstring curls with your back down on the ground, legs up on an exercise ball, going up into a bridge, as well as some your butt down to your knees with your knees over your ankles. Those are exercises that will work on those eccentric contractions and help you absorb that force and stay strong.

Shannon O’Kelley: And I could see even getting on an exercise cycle, stationary bike and really riding. That’s a great way to strengthen your quad muscles, which are super important. I think it’s deserving of a little attention here. You mentioned eccentric contraction in your quads. There’s two types of muscle contractions. There’s an eccentric and concentric. Maybe real quickly, you can describe those two and why the eccentric is so important.

Dr. Cummings: Absolutely. So concentric would be like your classic bicep curl. You’re contracting, and you’re shortening the muscle. Eccentric would be a contraction while you’re lengthening. So think of what you’re doing when you go into the sitting phase of a squat. Your quads are having to kind of contract to stabilize, but also absorb all that force, which puts a lot of force through them. But that’s really what you’re doing as you’re going down the hill is you’re trying to absorb all that force as your quads are being pulled and tugged on.

Shannon O’Kelley: Well, great information. Get started. Start easy. Progress it. Get prepared for the ski season. You will enjoy it immensely, much more than if you’re not prepared. Dr. Cummings, thank you so much for your time. Great information.

Dr. Cummings: Absolutely.

Tom Hutyler: That’s been Dr. Keith Cummings and Shannon O’Kelley, and you can get more information at www.posm.com. And Shannon, we’ve talked about the importance of getting ready for the ski season, but any activity you want to take. Whether it be raking leaves or anything, it’s good to stretch out and be ready.

Shannon O’Kelley: Yeah. Prep yourself. I mean, if you prep yourself and prepare for any activity, you’re going to eliminate the chances of an injury such as those bumps and bruises, sprains, and strains. And Tom, with skiing, I can’t tell you how many times I’ve treated a patient that the injury occurred on the first run, lack of preparation, or the last run, when they’re too fatigued to manage their skis, and they catch an edge. And all of a sudden they either tear a meniscus, ACL, or injure themselves.

Tom Hutyler: All right. Good advice. Once again, thank you Dr. Keith Cummings.