Domhnall MacAuley: Epidemiology pitfalls and high jumps

Domhnall MacauleyCyclists sweated and panted alongside the car as we climbed the switchbacks of Holmenkollen mountain. At the top, a huge metal and concrete ramp stretched up towards the sky. And at its base, steep tiers of concrete seating circled the sunken gladiatorial arena. I had seen similar venues on television but the soft winter light and camera shots camouflage the scale of the ski jump hill.  It is simply enormous. The building redevelopment exposed the rugged metal and concrete skeleton. The light of the mid day sun emphasised the naked brutality of this man made colossus, there was no escaping the stark reality of ski jumping, the sheer scale of the mountain, and the madness of these “on the edge” athletes who soar 140 metres across the sky, dropping down into a black abyss. A death wish sport …

Sport was fun. We always enjoyed running together-long conversations on how to change the medical world- but with a subtle competitive athletic edge. Maybe we could take up a new sport. Being at the academic meeting at the Oslo Sports Trauma Research Centre, there was quite an emphasis on winter sports. It sounded great- all that cool crisp mountain air. So, how would we choose our sport. Science could surely give us some direction. Safety first, of course. Avoid injury if at all possible. A presentation on the new International Ski Federation (FIS) register of winter sports injuries might give us some direction:

We were two keen students sitting in the front row as Tonje Flørenes gave her paper. Snowboarding wasn’ t for us. Free style skiing looks great on television, but the injury figures were off putting. Perhaps we should stick to traditional alpine skiing. This wasn’t entirely risk free either with a direct relationship between speed and injury in the different events- increasing rates from slalom to downhill.  But, when Tonje showed her powerpoint comparing the injury rates across all the different disciplines, Karim, my training companion started pointing at the graph. Two disciplines stood out because of their much lower injury incidence rate; one of which was cross country skiing. But, as he was soon to take a six month sabbatical in Norway, that didn’ t seem fair. He would be almost semi professional and able to work on his technique and aerobic fitness. I needed to find another discipline where aerobic training wasn’ t as important, no cardiovascular training was required and it had a good risk profile. The other discipline Tonje showed on her graph had a reassuringly low column height. From these figures, it looked quite safe. And, with such an excellent safety profile and no cardiovascular training needed, it looked perfect. Science tells the truth- but maybe epidemiology should carry a health warning. It pointed to ski jumping.

Domhnall MacAuley is primary care editor, BMJ