Helen Jaques: Halfpipes and helmets – how Olympic athletes could reduce head injuries in skiers and snowboarders

Helen JaquesThe Winter Olympics this year in Vancouver have been particularly gripping, and not just for the close finishes on lots of the events. Thanks to the poor conditions, even the best skiers and snowboarders in the world have been crashing out in this year’s games.

Swedish skier Patrik Jäerbyn had a truly horrifying crash and earned himself a concussion in the men’s super G, and world champion snowboarder Max Schairer of Austria likewise sustained a concussion in the snowboardcross semifinals.

And so from this wince inducing list of accidents in the elite to the issue of head injury in recreational skiers and snowboarders.

Back in 2000, head injuries made up 3-15% of all skiing and snowboarding related injuries, with more recent studies suggesting that 15-20% of ski and snowboard related injuries are traumatic brain injuries.

And we’re not just talking mild concussion here. A cross sectional survey found that of Colorado residents who sustained a head injury while skiing between 1994 and 1997, 24% sustained skull fracture, 39% had intracranial lesions, and 79% had amnesia. In fact, traumatic brain injury is the leading cause of death and catastrophic injury in both skiers and snowboarders.

Wearing a helmet while skiing or snowboarding, however, is thought to reduce the risk of head injury in an accident by anything from 29% to 60%.

There have been concerns about whether wearing a helmet increases the risk of neck trauma, as the helmet itself might bend or twist the neck in an otherwise “routine” fall. However, several studies, including a meta-analysis published this month in the Canadian Medical Association Journal, have shown that helmet use is not associated with an increased risk of neck injury.

Despite the clear benefits of wearing a helmet while on the slopes, a recent commentary in the Journal of the American Medical Association by neurologist Michael Cusimano and injury prevention researcher Judith Kwok has pointed out that helmet use among recreational skiers is low.

They cite an observational study of kids aged 5-17 years in a western New York ski resort that found that only 42% of skiers and 32% of snowboarders wore a helmet. Another study of 19 ski resorts in Colorado discovered that although 2% to 38% of skiers and snowboarders rented equipment in resort, only 1% to 8.6% of renters also rented helmets.

Cusimano and Kwok suggest several measures to increase helmet use among skiers and snowboarders, such as creating incentives like discounts on helmets and including helmets in all ski equipment rental packages.

Another proposal from the authors is to use role models to promote the use of helmets and change ski resort culture. Ski patrollers, for example, could serve as role models for helmet use, but a study of almost 100 patrollers found that only 23% wore a helmet, despite the fact that 90% believed wearing a helmet would protect them from injury.

However, anyone who has been following the Olympics must’ve spotted by now that all the competitors wear helmets. The Fédération Internationale de Ski, which is in charge of the ski and snowboard events at the Winter Olympics, insists that that all snowsports competitors wear a helmet, for official training as well as for races.

With big names like gold medallist snowboarder Shaun White and downhill ski champion Lindsay Vonn in helmets, hopefully leisure skiers and snowboarders worldwide will start to get the message. What this issue needs now is people of this stature to get behind an awareness campaign.

As Cusimano and Kwok say, “The 2010 Winter Olympics should mark the beginning of a new culture in skiing and snowboarding.”

  • For more stats on head injury in skiers and snowboarders, and on how helmets can be protective, check out A Ackery et al’s systematic review in Injury Prevention.
    Ackery A, Hagel BE, Provvidenza C, Tator CH. An international review of head and spinal cord injuries in alpine skiing and snowboarding. Inj Prev 2007;13:368-75.


Over on doc2doc, Domnhall Macauley raises the issue of sports and exercise medicine at the 2010 Olympics and highlights some of the injuries faced by top skiers and other winter sports athletes.
In response, Portuguese GP trainee Tiago Villanueva wonders “if doctors in general, particularly GPs, in countries with big traditions of Winter Sports have any particular kind of training to deal with winter sports injuries, namely in orthopaedics and trauma.” Anyone out there know the answer?



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  • Good piece. What readers might like to know is that modern helmets are light weight, comfortable, and surprisingly warm. So, if, like me, you put off getting one because you thought it would be less comfortable, and colder, than you favourite hat, then don’t. Save your brain! It will thank you for it….

  • Richard Keatinge

    All the rage at the moment. But there is evidence that helmeted skiers tend to go faster. http://www.astm.org/DIGITAL_LIBRARY/JOURNALS/JAI/PAGES/JAI12092.htm
    “There is no evidence they reduce fatalities,” said Dr. Jasper Shealy, a professor from Rochester Institute of Technology who has been studying skiing and snowboarding injuries for more than 30 years. “We are up to 40 percent usage but there has been no change in fatalities in a 10-year period. http://www.astm.org/DIGITAL_LIBRARY/JOURNALS/JAI/PAGES/1043.htm

    All in all, feel free to wear one, but if my children go skiing I’ll just remind them to take care and not to rely on any head protection. I wouldn’t bother to recommend them to anyone, and I’m not sure it’s really a medical job to do so.

  • Good point Nick, I find I actually get a bit of a sweaty head in my helmet 😉

    And yeah, there is the fact that skiers who wear helmets assume they are safer and ski faster or more recklessly – in fact, I’m sure that happens.

    The issue reminds me of an interview with BBC economics editor Stephanie Flanders that I read last year. She cycles to work but doesn’t wear a helmet, saying: “There’s this issue, common to economics, of moral hazard, where you actually take more risks because you feel safer. So I’ve never been completely persuaded.”

    I think I’ll stick with my helmet though, for skiing and cycling. Although the evidence of their benefit isn’t concrete, they don’t seem to cause any harm, so I can’t lose.