The biannual ISSS symposia bring together researchers from ski areas worldwide to share knowledge and research findings in the area of alpine sports injuries. Specialist fields include epidemiology, orthopaedics, biomechanics, engineering, psychology and more! Hot topics in recent years have included debate regarding current standards for ski binding settings, the issue of helmet and wrist guard use and the biomechanics of snow sports equipment. As a result, for the first time
The 2005 symposium was held at the superb Mount Arai resort in Nagano in Japan - thanks to all concerned. This page attempts to present a summary of the main research presentations from this symposium. I am not commenting on every paper but concentrating on those that present findings of interest to a general audience. I apologise if I offend any colleagues I don't mention who presented papers! The other pages of this website have been updated in detail with any relevant information.
Presentations were given from the US, Norway, Sweden, Scotland, France and Iran on injury statistics. It never ceases to amaze me how similar injury rates are no matter where in the world you go. There is general agreement that the current approximate injury rates are (expressed as injuries per 1000 participant days) 1-2/1000 for alpine skiing and 3-4/1000 for snowboarding and skiboarding. Obviously, where the injury statistics are taken from is very important. Most countries take their statistics either from ski patrols or from clinics on the mountains themselves and so results are generally comparable. The predominant injuries remain unchanged – knee injuries in alpine skiers, wrist injuries in snowboarders and lower leg injuries in skiboarders. I presented our statistics from Scotland looking specifically at injuries amongst children on alpine skis. This age group is more than twice as likely to be injured as adults. Children using rental gear and on their first day of skiing were more likely to be injured, as were those who had received less than 5 formal lessons and those skiing with friends. Compared to injuries amongst adult skiers, children were more likely to be injured on lift systems and as a result of bindings failing to release. A paper from America looked at all the current statistics for skiboard injuries from several countries (including Scotland) and found that the risk of injury from this sport has increased since 1999. Interestingly, it seems that the popularity of this sport has waned in most countries but not Scotland where about 6% of the population are on skiboards (compared to 1% in the US).
Helmets
The debate about helmets continues, as does the rise in the number of people on the slopes who now wear a lid. In Norway for example, the rates of use amongst those injured are 31% (alpine ski), 26% (snowboard) 26% (telemark ski) and 28% (skiboard). Even more impressive are the figures from Tarnaby In Sweden, where some 58% of all people on the slopes now wear a helmet. In Norway, they found no difference in the incidence of head/face injuries between those with and those without helmets whereas in Sweden not wearing a helmet was associated with a 28% relative increase in the risk of a head injury. A presentation from the bfu in Switzerland (www.bfu.ch) found overall helmet use to be much lower than rates in Scandinavia at 14.5%. Interestingly, they also found that although 86% of ski instructors and 92% of snowboard instructors recommend wearing a helmet to their students, only 51% and 64% of them actually do! So – do as I say, not do as I do! Seriously, instructors are vital role models, especially for children and by wearing a helmet themselves can help to improve user rates. Our own research from Scotland shows helmet use amongst snowboarders to be about 13% - nevertheless 39% of boarders couldn’t see the need for a helmet and 30% felt that they were too expensive – what price a brain though eh?!
So, do helmets reduce the risk of injury? The consensus is that yes they do, but their main protective effect is against more minor injuries such as abrasions and contusions. The problem is that current helmets simply cannot do much if you slam into a tree or other stationary object at the typical speed of an intermediate skier/boarder. Such accidents are the usual cause of traumatic deaths on the slopes and, despite the increasing rates of helmet use, the incidence of these accidents remains static. So the message is, wear a helmet, but don’t think it makes you invincible – you still need to ski and board with care and watch out for trees. If you do decide to buy a helmet, look at the label inside and make sure it meets one of the approved standards for snow sports – EN 1077, ASTM 2040 or Snell RS98.
Wrist guards
So much for helmets then, what about wrist guards (WGs) ? Once again the consensus is that WGs have the potential to reduce the incidence of wrist fractures amongst snowboarders – the two big problems are a) Sorting out which WGs will offer the best protection and then b) getting boarders to wear them! Unlike helmets, there are currently no international standards for WGs so its very difficult for a boarder to know if the guard they see and buy in a shop will in fact do the job. The ISSS is now pressing hard for the standards bodies (such as ISO, ASTM and Snell) to look into this really important issue. There are currently two wrist protection devices on the market developed by ISSS doctors – the Flexmeter and Biomex protection (found in Level gloves). Both of these are to be recommended. Data was presented on the Flexmeter (by the designer) to show that they do reduce the incidence of wrist fractures.
So if WGs can reduce the incidence of the number one injury amongst boarders – why don’t more boarders wear them? Rates of WG use vary between countries, but are usually in the range of 10-20% at best. Research from both Switzerland and Scotland has identified some of the possible reasons, including concerns about comfort and fear of injury from the WG itself. This is an important point that is frequently cited as a reason not to wear WG - that by so doing the fall energy is simply transferred up to the forearm leading to a fracture here instead of at the wrist. In fact, the evidence seems to suggest that this is highly unlikely to occur. What can happen though with some guards (especially short and rigid guards) is that a fracture occurs directly underneath this type of guard. This is a rare occurrence, but nevertheless emphasises the importance of developing an accepted standard for snowboard WGs. So in summary, the general idea of wearing wrist guards is recommended – they are not expensive but could prevent a nasty injury that will prevent snowboarding for many weeks, months or longer.
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Ski bindings
There has been much debate in the last ten years relating to the current binding settings used throughout the world. The majority of alpine countries still employ the ISO 8061 standard relating to recommended torque settings for bindings. One exception has been France, who in 2000 decided to go it alone and introduce their own bindings setting charts. Whilst acknowledging that release bindings using the ISO standards had lead to a reduction in the number of lower leg fractures, they believed that there was scope to reduce binding settings still further in order to reduce the number of knee injuries that were still occurring. And so the French AFNOR standard was born – in general, binding settings have reduced, especially amongst women and children – the two groups felt to be at highest risk of a non-release injury. As a consequence, knee injury rates in France have been significantly reduced. In addition, the French have shown that you do not get an increase in the number of injuries from bindings releasing when they shouldn’t – the so called ‘inadvertent release’. There is now pressure on ISO to go back and look at their standards again and it seems that this will happen in time for the next ISSS meeting. Perhaps all countries will adopt the AFNOR standard or a variation thereof?
On a separate but related topic, investigators from Munich University looked at the percentage of German ski rental facilities that were meeting the required ISO standard for hiring out and setting ski bindings. A previous study in 1999 looking at 353 rental shops in 5 European countries (France, Austria, Germany, Switzerland and Italy) had rather scarily shown that 71% (!!) failed to meet the standard with only 16% meeting the standard in full and the remaining 13% just about reaching an acceptable level. As a result of this initial study, ISO produced and distributed a CD with a simplified guide to meeting the standard and the Munich investigators were looking to see if anything had changed. Sadly not! 70% of rental facilities still set the bindings incorrectly – amongst children, 66% of bindings were found to be set dangerously high. More worrying news was that, on most counts, the worst culprits were rental facilities actually at ski areas! It was pointed out that in this litigious world, poorly performing rental facilities will soon be finding themselves up in court.
Electronic bindings, which I have commented on since 1999, still seem to be on the cards. It was perhaps significant that no presentations were made on them – possibly a sign that they are getting close to production??!! Watch this space....
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