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Position Statement

Winter Sports Safety and Helmet Use

This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

Every year, thousands of youths and adults are injured by winter downhill slope activities such as snow skiing, snowboarding, sledding and tobogganing. According to the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission (CPSC), in 2009 hospital emergency rooms, doctors’ offices, and clinics treated 353,346 injuries related to these winter sports activities. The medical, legal, work loss and pain and suffering costs were more than $9.28 billion.

Lower extremity injuries are often related to equipment. The frequency of these injuries has decreased in apparent response to research and modification of equipment. Injuries include sprains and strains, dislocations and bone fractures to the arms and legs, as well as facial injuries and trauma to both the head and spine—approximately 14 percent of those injuries sustained were head injuries. The percentage of head injuries among children under the age of 15 is higher—about 22 percent. However, the overall injury rate in winter downhill slope activities has decreased in recent years.

According to the National Ski Areas Association (NSAA), during the last decade, there were about 40 deaths per year as a result from downhill skiing/snowboarding accidents in the United States. Of those fatalities, only eight people (20 percent) involved were reported to be wearing helmets at the time of injury.

The 1999 CPSC evaluation of snow skiing and snowboarding-related head injuries found that snow boarders are 30 percent more likely to have a significant head injury than skiers. One of the most common causes of injury is collision with fixed objects, such as trees. More than 40 percent of the annually reported snow skiing and snowboarding-related head injuries could have been prevented or minimized with helmet use.

Injury patterns differ with experience; however, injuries are more common among beginners. The NSAA reports that fatalities are more likely to occur in above-average skiers and snowboarders who are going at high rates of speed. On average, 11 deaths each year may be attributed to head injuries that might have been prevented with helmet use. Increasing incidences of head injury are most likely due to the improvement in equipment and continued slope maintenance which allow for greater speed.

The purpose of the helmet is to partially absorb the force and dissipate the energy of blunt trauma in an effort to protect the head. While helmets do not decrease the risk of injury, they can decrease the severity. A study found 15 skull fractures among 27 fatal head injuries. Six of these fractures were depressed, suggesting that protective gear may be of benefit. Several studies in Sweden show that the use of helmets has reduced head injuries by approximately 50 percent.

Skiing helmets are graded on their ability to withstand frontal blunt and sharp impact, retention strength, and resistance to roll-off. American standards indicate that those helmets with a rating of RS-98 from the Snell Memorial Foundation of the American National Standards Institute (ANSI) have the highest level of protection in all tested areas of impact. This is approximately 15 percent stronger than those standards used in European testing and sale of helmets.

Helmet use is mandated for ice hockey, alpine ski racing and other competitive winter sports, but, to date, there are few state laws mandating the use of ski helmets. Evidence suggests that routine use of helmets during recreational downhill slope sports should be encouraged and possibly mandated. In all recent studies, helmeted skiers, who have sustained head injuries, have had better outcomes and had less temporary or permanent neurological loss/impairment than those not wearing the proper protective headgear. There is very little potential risk associated with wearing a helmet. However, should an accident occur, protective head gear could significantly decrease risk of serious injury.

The American Academy of Orthopaedic Surgeons (AAOS) recommends the following safety guidelines to improve winter sports safety:

  • Parents or adults should supervise young children during all winter downhill slope sports activities at all times.
  • Avoid slopes that end in a street, gravel road, drop off, parking lot, river or pond.
  • Make sure people at the bottom of the slope have cleared the slope path prior to allowing another sled to go down the slope.
  • Use well-lighted areas when choosing evening activities.
  • To protect from injury, it is important to wear helmets, gloves and layers of clothing.
  • Helmet Use
    • The National Ski Patrol recommends wearing a helmet while skiing or snowboarding. Studies show that helmets offer considerably less protection for serious head injury to snow riders traveling more than 12-14 mph. Safety and conscientious skiing and riding should be considered the most important factors to injury prevent, while helmets provide a second line of defense against head injuries.

• Sledding

    • All participants should sit in a forward-facing position, steering with their feet or a rope tied to the steering handles of the sled. No one should sled headfirst down a slope.
    • Do not sit/slide on plastic sheets or other materials that can be pierced by objects on the ground.
    • Use a sled with runners and a steering mechanism, which is safer than toboggans or snow disks.

• Snowboarding and Skiing

    • Warm-up the muscles that will be used in skiing with exercise activities to help prevent injury such as knee lifts, heel raises, abdominal twists and squats. When done, take a few minutes to stretch out your muscles (hamstrings, arms and calves).16
    • Use proper ski and snowboard equipment such as properly fitting boots and adjusted bindings that attach the boots to the skis/snowboard—bindings are set to skier classification, height and weight and should only be set by a certified technician to help prevent injuries during a fall.17
    • Participants should ski on trails within his or her skill level.
    • Obey trail closure and other warning signs. Do not go off-trail.

Individuals with pre-existing neurological problems may be at higher risk for injury. If you have pre-existing condition you should talk to your doctor before participating in these activities.

References:

  1. U.S. Consumer Product Safety Commision, 2009.
  2. U.S. Consumer Product Safety Commission: Skiing Helmets—An Evaluations of the Potential to Reduce Head Injury, 1999.
  3. Shealy JE: Death in downhill skiing. In Johnson, R. J., Mote, C.D., Jr. (eds) Skiing Trauma and Safety: Fifth International Symposium, Philadelphia, American Society for Testing and Materials, 1985, pp. 349-357.
  4. Eriksson E, Johnson R J: The etiology of downhill ski injuries. Exerc Sport Sci Rev, 8: 1-17, 1980.
  5. Tapper EM: Ski injuries from 1939 to 1976: The Sun Valley experience. Am J Sports Med, 6: 114-121, 1978.
  6. Young LR; Oman CM; Crane, H: et al: The etiology of ski injuries: An eight-year study of the skier and his equipment. Orthop Clin North Am, 7:13-29, 1976.
  7. Westlin NE: Factors contributing to the production of skiing injuries. Orthop Clin North Am, 7:45-49, 1976.
  8. Jaffin B: An epidemiologic study of ski injuries: Vail, Colo. Mt Sinai J Med, 48:353, 1981.
  9. Morrow PL, McQuillen, EN, Eaton LA, Bernstein CJ: Downhill Ski Fatalities: The Vermont Experience. J Trauma, 28:95-100, 1988.
  10. Criqui M.: The epidemiology of skiing injuries. Minn Med 60:877-880. 1977.
  11. Davis M, Litman T, Drill, FE, et al. Ski injuries. J Trauma, 17:802-808, 1977.
  12. Shorter NA, Jensen PE, Harmon BJ, Mooney DP: Skiing injuries in children and adolescents. J Trauma 40:997-1001, 1996.
  13. Thompson DC, Rivara FP, Thompson RS: Effectiveness of bicycle safety helmets in preventing head injuries: a case control study. JAMA, 276: 1968-1973, 1996.
  14. Thompson DC, Nunn ME, Thompson RS, Rivara FP: Effectiveness of bicycle safety helmets in preventing serious facial injury. JAMA, 276:1974-1975, 1996.

December 2000 American Academy of Orthopaedic Surgeons.
Revised June 2005 and September 2010.

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.

Position Statement 1152

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