At The Stone Clinic on the edge of San Francisco's Chrissy Field, these injuries are treated aggressively to return board sailors to the water before the winds die. Some examples follow.

The knee meniscus cartilage is a fibrous shock absorber between the thigh bone (femur) and the shin bone (tibia). A twisting motion at the knee such as landing from a chop hop with the board sideways can produce this injury. Sometimes a pop is felt, occasionally with swelling of the knee. The definitive diagnosis can be made by a careful physical exam and an office MRI (magnetic resonance image). It is important to recognize this injury early. The meniscus when torn usually does not heal. Continuing to exercise on a torn cartilage leads to early arthritis. An outpatient arthroscopic repair usually leads to return to sailing at about a month, and sometimes earlier.

The cruciate ligaments crisscross inside the middle of the knee and act as key joint stabilizers. Serious injuries to these ligaments lead to instability and giving way of the knee. In windsurfing, these ligaments are usually torn by a hyper extension motion when being catapulted forward while still in the foot straps or when mislanding a loop. A distinctive and nauseating pop leads to swelling in the knee and a feeling of looseness. The knee usually wants to give way when trying to pivot on it. The diagnosis is made by physical exam. The treatment for most young athletes (up to around 50) is usually surgical repair or rebuilding of the ligament. Early treatment is usually best and is performed as an outpatient procedure with immediate exercises started the next day at The Clinic. Assuming adequate strength has been achieved, return to sailing is at about two to three months.

The collateral ligaments lie on the sides of the knee. Fortunately, they have a good blood supply and when injured can heal without surgical repair. They are injured when the knee caves in or out to one side, most frequently when a sailor lands poorly on a beach or from a jump. The diagnosis is made by exam, though an office MRI helps to differentiate this injury form the more serious cartilage injury that can occur with the ligament injury as well. A specially designed hinged brace is used to protect the ligament during the healing time and specific exercises are started immediately to strengthen the healing ligament.

Specific exercises aimed at regaining full strength are initiated immediately following all of these injuries. Knee bend exercises one or two legs can usually be started if no pain is felt during the exercise. The exercise is performed while standing with feet shoulder distance apart, hips level and back straight. Squat up and down with both legs keeping weight back on heels as if trying to sit down in a chair. Single leg knee bends are performed with one leg on ground and the other in the air in front or behind. Squat up and down single-legged keeping weight back and using a stick for balance as needed.

Step-ups are another excellent way to increase strength and progress back onto the water. Using a step or stool, step up and down trying to focus on lifting with the top leg and not jumping with the bottom leg. As strength and agility improve, speed stepping up and down while alternating legs, as well as two-legged ups and downs will increase the intensity of the workouts. This exercise program is best supervised by the athletic trainers in the clinic to diminish the chance of further injury and to speed healing.

The key to rapid return from serious windsurf injuries lies in early accurate diagnosis, careful repair if needed, and aggressive but safe exercises. It is a thrill for us all to practice next to Chrissy field and watch our friends and patients stay active in the sport we all love.