Heads Up Before Hitting the Slopes: Concussion Research in Skiing and Snowboarding

Updated: Nov 9

Jessie Oldham, PhD


Introduction


We may be done with Game of Thrones, but winter is still coming, and it is never too early to prepare for the upcoming ski and snowboard season. While most attention is focused on the football field this time of year, it is important to recognize that head injuries are also a common occurrence on the ski slopes. Concussion incidence is significantly higher in pediatric and young adult skiers and snowboarders, compared to adult populations, but it is important for people of all ages to be informed and prepared before hitting the slopes this winter.


What does the research show?


  • Head injuries account for up to 20% (22% in children) of the 600,000 annual skiing and snowboarding injures in the United States.

  • Beginner’s skill levels, males, youth-aged individuals, and snowboarders are all at increased risk of sustaining a head injury on the slopes.

  • Snowboarders have a 50% higher rate of head and neck injury compared to skiers.

  • This is thought to be due to increased ventrodorsal instability from facing sideways with both feet fixed to a single surface.

  • As a result, snowboarders tend to fall backwards and are more likely to strike their head as opposed to skiers, who can use their upper extremities to brace themselves for a forward fall.

  • 22%-42% of ski-related head injuries are severe enough to result in either loss of consciousness or clinical signs of concussion.

  • There does not have to be loss of consciousness with a concussion. Most concussed individuals do not lose consciousness.


  • Falling while skiing is the most frequent cause of head injuries, followed by collisions with other objects.

  • Skiers and snowboarders are more likely to suffer a head, neck, or back injury when using terrain parks compared to regular slopes.


Helmet Use


Despite popular belief, helmets are not made to prevent concussions. A review of the National Trauma Data Bank showed that there was no difference in concussion frequency between children and adolescents who were and were not wearing helmets at the time of their ski/snowboard injury. However, helmets are made to prevent more catastrophic injuries, such as skull fractures, and research shows that helmet use decreases the severity of head injuries in both skiers and snowboarders. This is an important distinction, as traumatic brain injuries are the most common severe injury and factor in up to 88% of skiing and snowboarding fatalities.


There are a number of factors to consider when choosing a ski/snowboard helmet, such as getting the right size and proper fit. However, the most important action is to look for the labels. Ski and snowboard helmets are tested to meet certain safety standards, and there should be a label somewhere on the helmet that specifies which standards have been met. The most common labels you will see are the ASTM 2040 (North American certification) and/or EN 1077 (European certification). Both certifications have standards for field of vision, shock absorption, retention, and chin strap/fastening devices. Make sure the helmet you purchase complies with one of these certifications to ensure you are getting the best protection.


What if you do sustain a concussion this winter?


If your time on the slopes this winter does result in a concussion, it is important to know how to take care of yourself throughout the recovery process. Recently, there has been a shift in the approach to concussion recovery. Gone are the days of using “cocoon therapy” to treat concussions. There is increasing evidence that it is no longer in your best interest to stay shut in a dark, quiet room until you feel better. The research is actually showing the opposite- performing activities of daily living (as long as they don’t make your symptoms worse) and even engaging in exercise can help facilitate concussion recovery.


Earlier this year, Dr. John Leddy published the first clinical trial showing that subsymptom threshold aerobic exercise actually sped up recovery in concussed adolescents. Beyond the initial 48 hours, during which rest has shown to be beneficial, adolescents who were randomly assigned aerobic exercise recovered from their concussion in a median of 13 days. Conversely, the group assigned to perform only whole-body stretching took 17 days to recover. These results demonstrate that early prescription of aerobic exercise can safely and effectively reduce concussion recovery time and may even prevent delayed recovery.


If you are interested in learning more about winter sport injuries and how to prepare for the upcoming ski season, attend our Quarterly Lecture Series “Skiing and Snowboarding: Injury Prevention and Strength Training” on November 9th. https://bit.ly/32oe8Yb

The Micheli Center for Sports Injury Prevention offers Concussion Return to Play services that combines this evidence-based research with clinical practice to help improve concussion recovery. Check our website for more information. https://bit.ly/2qwgbMg


References

Audet O, Hagel BE, Nettel-Aguirre A, et al. What are the risk factors for injuries and injury prevention strategies for skiers and snowboarders in terrain parks and half-pipes? A systematic review. Br J Sports Med. 2019; 53: 19-24.


Bergmann KR, Flood A, Kreykes NS, Kharbanda AB. Concussion Among Youth Skiers and Snowboarders: A Review of the National Trauma Data Bank From 2009 to 2010. Pediatr Emer Care. 2016; 32: 9-13.


Davey A, Endres NK, Johnson RJ, Shealy JE. Alpine Skiing Injuries. Sports Health. 2019; 11(1): 18-26.


De Roulet A, Inaba K, Strumwasser A, et al. Severe injuries associated with skiing and snowboarding: a national trauma data bank study. J Trauma Acute Care Surg. 2017; 82: 781-786.


Fukuda O, Takaba M, Saito T, et al. Head injuries in snowboarders compared with head injuries in skiers. A prospective analysis of 1076 patients from 1994 to 1999 in Niigata, Japan. Am J Sports Med. 2001; 29: 437-440.


Greve MW, Young DJ, Goss AL, Degutis LC. Skiing and snowboarding head injuries in 2 areas of the United States. Wilderness Environ Med. 2009; 20: 234-238.


Gil JA, DeFroda SF, Kriz P, Owens BD. Epidemiology of Snow Skiing- Versus Snowboarding-Related Concussions Presenting to the Emergency Department in the United States from 2010 to 2014. Clin J Sports Med. 2017; 27(5): 499-502.


Hagel BE, Pless B, Goulet C, et al. Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study. Papers. 2005. 1-5.


Haider AH, Saleem T, Bilaniuk JW, et al. An Evidence Based Review: Efficacy of Safety Helmets in Reduction of Head Injuries in Recreational Skiers and Snowboarders. J Trauma Acute Care Surg. 2012; 73(5): 1340-1347.


Leddy JJ, Haider MN, Ellis MJ, et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2019; 173(4): 319-325.

Macnab AJ, Cadman R. Demographics of alpine skiing and snowboarding injury: lessons for prevention programs. Injury Prevention. 1996; 2: 286-289.


Owens BD, Nacca C, Harris AP, Feller RJ. Comprehensive Review of Skiing and Snowboarding Injuries. J Am Acad Orthop Surg. 2018; 26(1): e1-e10.

Sulheim S, Holme I, Ekeland A, Bahr R. Helmet Use and Risk of Head Injuries in Alpine Skiers and Snowboarders. JAMA. 2006; 295(8): 919-924.


Weber CD, Horst K, Lefering R, et al. Major trauma in winter sports: an international trauma database analysis. Eur J Trauma Emerg Surg. 2016; 42: 741-747.


The Absolute Guide to Buying a Ski or Snowboard Helmet. https://www.absolute-snow.co.uk/buying-guides/the-absolute-guide-to-buying-a-ski-or-snowboard-helmet

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