Position Statement

Helmet Use in Skiing and Snow Boarding

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.

The overall injury rate in downhill skiing has decreased in recent years; however, the relative frequency of serious injuries has increased. Each year, 20 to 30 deaths result from downhill skiing accidents in the United States. Lower extremity injuries are often related to equipment. The frequency of these injuries has decreased in apparent response to research and modification of equipment.

There has been no comparative decrease in the rate of upper body injuries and head injuries and fatalities. According to the Consumer Product Safety Commission (CPSC), male skiers have a 50 percent higher rate of head injuries than females and younger skiers. Snow boarders were three times more likely to have a significant head injury than older skiers. One of the most common causes of injury with skiers is collision with fixed objects, such as trees.

Ski injuries tend to occur later in the day and head injuries are no exception. The head injuries due to blunt trauma are more frequent in the afternoon. The increase in frequency of ski injury and the time of day when the injury occurred suggests that fatigue may be an important factor.

Injury patterns differ with experience, although ski injuries, in general, are more common in beginners. The lower extremity is more likely to be involved, and the injuries tend to be nonfatal. Fatalities are more likely to occur in experienced skiers suggesting that speed is an important factor. The incidence of head injury is increasing, most likely due to the improvement in equipment and continued slope maintenance which allow for greater speed.

The American Academy of Orthopaedic Surgeons (AAOS) recognizes the severity of injuries associated with skiing and recommends the use of helmets and protective headgear for recreational skiing and snowboarding.

The purpose of the helmet is to partially absorb the force of blunt trauma and dissipate the energy so that the head alone does not sustain the total force of the blow. 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 recent studies in Sweden show that the use of helmets has reduced head injuries by approximately 50 percent.

Ski 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 sales of helmets.

Bicycle helmet use has resulted in a 70 percent reduction of severe brain injury among cyclists. 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 skiing should be encouraged and possibly mandated. In all recent studies, helmeted skiers have had better outcomes and had less temporary or permanent neurological loss/impairment than those not wearing the proper protective headgear.

References

1. 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.
2. Eriksson E, Johnson R J: The etiology of downhill ski injuries. Exerc Sport Sci Rev, 8: 1-17, 1980.
3. Tapper EM: Ski injuries from 1939 to 1976: The Sun Valley experience. Am J Sports Med, 6: 114-121,1978.
4. 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.
5. Westlin NE: Factors contributing to the production of skiing injuries. Orthop Clin North Am, 7:45-49, 1976.
6. Jaffin B: An epidemiologic study of ski injuries: Vail, Colo. Mt Sinai J Med, 48:353, 1981.
7. Morrow PL, McQuillen, EN, Eaton LA, Bernstein CJ: Downhill Ski Fatalities: The Vermont Experience. J Trauma, 28:95-100, 1988.
8. Criqui M.: The epidemiology of skiing injuries. Minn Med 60:877-880. 1977.
9. Davis M, Litman T, Drill, FE, et al. Ski injuries. J Trauma, 17:802-808, 1977.
10. Shorter NA, Jensen PE, Harmon BJ, Mooney DP: Skiing injuries in children and adolescents. J Trauma 40:997-1001,1996.
11. Thompson DC, Rivara FP, Thompson RS: Effectiveness of bicycle safety helmets in preventing head injuries: a case control study. JAMA, 276: 1968-1973, 1996
12. 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. Revised June 2005 American Academy of Orthopaedic Surgeons

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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