Winter Is Coming: Skiing,Snowboarding – And Brain Injuries

The American Association of Neurological Surgeons reported in 2009 that, of the 447,000 sports-related head injuries treated in emergency rooms, 19 percent were from bicycle accidents, while baseball and football each accounted for about 10 percent of head injuries.

Of all the bicyclists killed in the U.S. in 2009, 90 percent were not wearing helmets. While bike-riding commuters average about 10-12 mph, the recreational skier averages about twice that speed, about 18-22 mph. Skiers and snowboards can reach up to 40 mph on open stretches of snow, speeds seen in most motor vehicle accidents.

Johns Hopkins Medicine reports that nearly 20 percent of the 600,000 reported injuries each year are head injuries caused by a skier or snowboarder hitting a rock, tree, or a hard patch of ice. A 2012 study at the Western Michigan University School of Medicine on head injuries among skiers and snowboarders in the U.S. found that the number of head injuries increased 60% from 2004 to 2010, and a March 2013 study by the University of Washington found that the number of snow-sports-related head injuries among youths and adolescents increased 250 percent from 1996 to 2010. Head injuries continue to be the leading cause of death in the sport of skiing and snowboarding in the U.S.

Extreme Sports

Many adolescents and young adults see advertisements and articles in the media raving about athletes engaging in extreme winter sports, leading many skiers and snowboarders to engage in more risky behaviors – skiing faster, jumping higher, and going out of bounds to ski in uncontrolled areas. Many resorts cater to these young people to get them on their slopes by providing more access to extreme terrain and “double diamond” runs. Advances in equipment have also made it easier to ski and snowboard faster and perform more dangerous tricks. As a consequence, 70 percent of snow-sports fatalities involve men in their late teens to late 30s, according to the Ski Area Association.

What Causes Brain Injury – and Death?

Damage to the brain of a skier or snowboarder is no different than an individual in an auto accident. A person moving at high speeds (above 20 mph) comes to a sudden stop by hitting a tree (which killed singer Sonny Bono and Michael Kennedy, son of Robert Kennedy), rock outcropping, or a hard patch of ice. When the head comes to a sudden stop, the brain continues to move forward, crushing against the wall of the skull, then rebounding and hitting the opposite side (called a coup-contrecoup injury).

While the back of the skull is very smooth, the front of the skull, which includes the bones of the eye sockets and nose, has many sharp and pointed edges, which cut into the brain when it moves forward. If the head is hit from the side, causing the brain to rotate, these sharp edges cut like a knife through the brain as it rotates, causing extensive damage to the brain (called diffuse axonal injury). The impact can also cause hemorrhage, or bleeding in the brain, which was the cause of death for actress Natasha Richardson following her skiing accident.

Image by Maarten Duineveld

The Need for Helmets

The main reason for wearing a helmet is to avoid a skull fracture, which turns a minor concussion into a major traumatic brain injury with serious long-term consequences. Experienced skiers and snowboarders who travel at high speeds down treacherous terrain take as much risk as any athlete engaged in high-speed sports, from the Tour de France to luge. As professionals, they learn to weigh their skills and experience against the challenges they set for themselves. Many adolescents and young adults often take risks far in excess of their abilities, leading to serious falls. For these individuals, helmets can offer some protection.

The majority of people who strap on skis and snowboards are less experienced and travel at slower sleeps, and many are young children and adolescents learning how to ski or snowboard, or come out to the slopes only once or twice a year. For these people, falls usually result in mild head injuries, or concussions, which often resolve over time if the person takes the time to rest and heal (anywhere from 1-7 days, depending on the severity of head injury). Unfortunately, these falls can also result in skull fractures, and the only way to avoid a skull fracture is to wear a helmet.

Some European countries (e.g., Italy and Croatia) have mandatory helmet laws for children under 14 years of age, and Austria requires helmets for kids under 15 years of age. In the U.S., only one state, New Jersey, mandates helmet use for children 17 years old and under. In California, a law proposed in 2011 to impose a $25 fine for kids who ski or snowboard without a helmet was vetoed by Governor Jerry Brown, who wrote, “While I appreciate the value of wearing a ski helmet, I am concerned about the continuing and seemingly inexorable transfer of authority from parents to the state.” California does have a similar law for bicycle helmets, which also imposes a $25 fine.

Parental Responsibility

In the end, the ultimate responsibility falls on parents. In the same way that we see parents line their children head-to-toe with helmets, elbow pads, and knee pads before sending them off on bicycles, they should make sure that they have helmets before sending them off on skis and snowboards.  There is a false sense of security that “snow is soft” and falling will not cause any injury, and in most cases that is true; however, remember snow is only a covering, and it’s what we don’t see underneath (e.g., rocks, tree roots, etc.) that can hurt a child. And with snow, there is ice, and patches of ice can be as hard as any pavement of road.