Snowboarding Injuries - www.ski-injury.com

Thank the stars for snowboarding! This sport came along just at the right time to completely re-invigorate ski slopes world-side. From fairly humble beginnings as Sherman Popper's 'snurfer' in the 1960's the sport finally took off and enjoyed a phenomenal rise in popularity in the 1990's when for many years it was undoubtedly the fastest growing winter sport. It has been responsible for opening up the piste to a wider spectrum of the population which can only be good for the future of ski areas. Initially, the sport was viewed with great suspicion and even alarm by some - as such it gained an unfair image as a dangerous and reckless sport, pursued only by the young and foolish. Snowboarders, for their part, felt that skiers were unwilling to share the slopes with them and complained about the negative attitudes of some skiers. Globally, some ski areas reacted by banning snowboarding from their slopes and sadly, even now a few resorts still do. I wouldn't pretend that all the problems have been resolved between skiers and boarders but thankfully, most ski areas have now adopted a positive stance towards snowboarding and skiers have learnt to share the slopes with boarders. Indeed, its now the skiers wanting to get in on snowboarder territory! The majority of ski areas have developed specific snowboard parks with half pipes, rails, kickers etc. created to allow boarders the freedom to practice their aerobatic manoeuvres without coming into direct conflict with skiers. The indications are that boarder numbers have begun to plateau out since about 1999. In most ski areas snowboarders account for about 25-33% of all users although there are now many areas where snowboarders are in the majority. For a while, skiboarding (snowblading) overtook snowboarding as the fastest growing sport on the slopes but this trend seems to have flattened off in the last couple of years. One thing is for sure, against the predictions of many, snowboarding is here to stay and I for one am very glad of that.

In terms of injury rates, most ski physicians agree that boarding carries a slightly higher risk of injury than alpine skiing - between 3-4 injuries per thousand boarder days (as compared to 2-3 per thousand days for alpine skiing injuries). Remember though - this rate is still very low - at worst 0.4%! Another way of looking at injury risk to calculate the mean days between injury - this is the total number of snowboarder days in a season divided by the number of injuries seen. The higher the value, the less likely an injury is to occur. Overall, there are about 250 MDBI for all snowboarding injuries. This means that an individual snowboarder is likely to injure some area of the body every 250 days they spend snowboarding. Given that the average boarder does about 12 days per season,

this means an injury on average once every 19 years!! The risk varies with experience as well - the highest risk group being beginner snowboarders (especially those on their very first day). The risk becomes lower for those with between 4 and 8 weeks experience but then climbs again amongst experienced boarders - presumably because they are boarding faster, attempting jumps and tricks etc. The commonest injury is to the wrist, with such an injury occurring once every 1135 days, compared to a lower limb injury once every 3000 days - so you can see that the risk of an upper limb injury is about three times that of a lower limb injury on a snowboard. Interestingly, those with the highest risk of injury overall are teenage snowboarders - there is a wrist injury once every 499 days amongst this age group. The typical profile of an injured boarder is a young male from a non-skiing background who has had no professional instruction. Snowboarding has a completely different pattern of injury to skiing - upper limb injuries predominate, followed by head injuries and lower limb (mainly ankle) injuries. We will look at each of these in turn. You will also find more information on our web page that deals with injury prevention. Of concern is the fact that injured snowboarders are twice as likely (34% vs 17%) to sustain a fracture compared to skiers. Most of these involve the wrist.

There are obvious differences between boarders and skiers that may go some way to explaining the differing injury rates. Firstly, most injured boarders generally fall into one of three camps

The majority of boarders pick up their own boarding technique gradually without ever seeking professional instruction. Unlike skiing, its not that difficult (though it is tiring!) to hire a board and begin to put together some turns without proper lessons. However, one of the first things a novice snowboarder must learn is the ability to maintain a stable stance – not easy, with both feet fixed in non-release bindings to a relatively narrow board. When balance is lost, snowboarders (unlike skiers) cannot ‘step out’ a leg in order to recover, as both feet are firmly attached to the board. The instinctive protective reaction in the event of a snowboard fall is to outstretch a hand to break the landing, thus placing the upper limb at risk of injury. This is one of the main reasons why beginner boarders are at higher risk of injury.

Our research in Scotland indicates that many snowboarders also learn from friends. This can be a risky road to take as professional instruction (coupled with accrued experience) reduces your risk of injury. Interestingly, we have also found though that snowboarders who have lessons but who have little experience on a snowboard are more likely to be injured - probably because they push their limits too far too quickly. Proper instruction should also help prevent the development of bad habits which can be hard to eradicate later on, unfortunately restricting your progress in the sport.

Finally, many snowboarders do not come from skiing families and therefore may not be aware of the sometimes considerable risks the mountain environment can present, although this is beginning to change now, as older boarders breed baby boarders! These risks are especially so off-piste and has been illustrated time and time again by numerous deaths and serious accidents, often involving avalanches - if you are venturing off piste, make sure you know what you are doing (or have a guide with you who does), don't go alone (even venturing a few seemingly innocent metres off the side of a tree-lined piste can be dangerous as the documentation of tree well deaths (NARSIDS) has shown), carry the right equipment and check the avalanche forecast for the area! If you plan to go off piste in a foreign then check the wording of your insurance policy carefully (what d'ya mean, "what insurance policy...."??!!!) as many exclude off-piste activities and require you to be with a professional guide or instructor for cover to be valid. You're looking at a hefty bill if you do get injured or need assistance and you're not covered...(unless you're in Scotland, of course!)

Nevertheless, keep the bigger picture in mind and never lose sight of the fact that snowboarding is an exciting, challenging snow sport with moves that are the envy of many skiers and which still has an injury risk of less than 1%.

On the rest of this page, I am giving you an overview of the commoner and more important injuries that we see amongst injured snowboarders. I am focussing on the more serious and painful injuries that ski patrollers and ski area doctors see and treat. Lots of minor bumps and bruises do not require first aid or medical attention. In addition, virtually any area of the body can be injured whilst snowboarding, so just because I don't talk about a particular injury does not mean it does not happen - this is only an overview.

These usually occur as a result of two main mechanisms - either a fall onto an outstretched hand or a direct traumatic blow to an area of the arm/shoulder. The former leads to the large number of wrist and shoulder injuries seen yearly - an estimated 95,000 snowboard wrist fractures world-wide per season! Beginners are particularly at risk as I've already stated as they try to learn a stable stance on their snowboard. Unlike skiers, who can step out a leg when they lose balance, snowboarders are more likely to topple over and the natural tendency is to fall onto an out stretched hand (hence the term 'FOOSH' used in the Emergency Department to describe this mechanism). These wrist fractures are often not simple injuries and can lead to long term disability and early development of osteo-arthritis, especially when the break goes through the joint line. One simple technique that may protect your upper limb in the event of a fall is to learn to fall correctly - this technique is described and illustrated here.

Highly recommended, is the purchase of wrist protection - either as a standalone pair of wrist guards or as an integrated glove/guard system. There is now overwhelming evidence to support their effectiveness in reducing the incidence of wrist injuries.

Effective wrist guard protection is now easily available online - I would urge all snowboarders to read my page on wrist injuries and seriously consider buying a pair of recommended guards. Its money really well spent IMHO.

It always surprises me that snowboarders are prepared to spend up to £100 yet won't spend £35 or so on wrist guards. Potentially serious head injuries are pretty rare whereas wrist injuries are the number one snowboard injury and guards have been shown to be effective in reducing the risk of them occurring. Most head injuries are minor in nature, but wrist injuries are far more likely to lead to disability and ultimately prevent someone snowboarding often until the next season. Ask any ski area doctor given a choice what the one piece of protective kit a snowboarder should buy is and the answer will likely be... wrist guards!

At the end of the day, of course, the absolute risk is pretty low - but I really hate seeing someone injured, in pain and unable to snowboard. For a meagre £35 or so, do you really want to risk being unable to snowboard again for a long time?....I'd be a wealthy man if I had £1 for every time a snowboarder who had just broken their wrist said to me in the ski patrol room or health centre "...if only I'd been wearing wrist guards". I'd be even wealthier if i had £1 for every boarder (usually beginners) who tell me they have never heard of wrist guards. Don't let that person be you!

As I've already stated, you'll find much more information on my wrist injuries page - click here. Remember, I don't make any money from selling or promoting wrist guards - I am just giving you my honest opinion and I strongly believe that the use of effective wrist guards can reduce the number of snowboarders who injure their wrists every season and end up seeing someone like me in a ski patrol room, with the rest of your season effectively over. So what are you waiting for?!

The other area of the upper limb that is injured quite commonly is the shoulder joint. This is either due to force being transmitted up the arm from a fall onto an outstretched hand or direct trauma from a fall onto the outside of the shoulder itself. Falls can lead to fractures of the upper arm (humerus) or collar-bone (clavicle), damage to the shoulder joint itself (such as a dislocation) or to the joint between the collar-bone and the shoulder blade (the so-called AC joint). See the photo on the right for a classic example of a "sprung" AC joint. Learning to fall correctly is once again a simple way to try and reduce the chances of a shoulder injury - click here for details..

There are a variety of shoulder pads and protectors on the market - whilst there is no direct evidence to prove that they reduce the risks of injury, they are not going to do any harm and are worth considering, especially if you have injured your shoulder before. For more detailed information on shoulder injuries - visit my specific page by clicking here.

Finally, the other upper limb injury we see in snowboarders is acute dislocations of the elbow joint. This is a nasty injury, as there is often associated damage to the nerves and blood vessels around the elbow joint. The injury occurs as the result of forced hyperextension of the elbow (i.e. you land on a straight arm that gets bent back even further by the force of the fall). Not a nice injury.

Lower limb injuries can be divided into those affecting the femur (thigh bone), tibia and fibula (shin bones), the knee and those affecting the ankle. The first two groups of injury are usually the result of direct trauma either with a static object or another boarder/skier. Trees and another person are the commonest things to collide with. Collisions with trees in particular can be associated with some serious trauma and kissing a tree at 25mph+ is definitely to be avoided. Most of these direct impact injuries to the lower leg affect the lead (front) leg and they can range from a simple bruise up

to a nasty fracture.

The risk of sustaining an ankle injury as a snowboarder is related to the kind of boot worn. These are broadly divided into hard and soft shell boots. Hard shell boots tend to worn by more experienced boarders and (as with ski boots) tend to protect the ankle joint. Soft boots are favoured by beginners as they allow some degree of ankle movement which helps the rider to manoeuvre the board. Unfortunately they do not offer the ankle as much in the way of protection. Any forces transmitted back from the board tend to be absorbed by this joint. This is especially so when the ankle is either compressed or turned in (as can happen after a jump).

Increasingly popular are the relatively new hybrid snowboard boots. These boots are constructed either:-

a) With soft leather or synthetic outer shell and a stiff inner boot or
b) By combining a hard shell base with a softer upper component. The idea is to combine the comfort and manoeuvring ability of a soft boot with the stability and protection of a hard boot.

So-called "Moon" boots or hiking boots lack the degree of support required for boarding and should not be used for this sport.

Snowboard binding systems, unlike alpine ski systems, are non-releasable. Essentially, there are four main varieties –

System	Description	Image
Strap	Basically consist of a base plate for the foot and a back plate for the back of the boot. In the middle are a series of adjustable straps that hold the boot into the binding. This binding is used with soft boots and provides a great deal of support. It can be put on, adjusted and taken off with the boarder sat down
Step-in	This binding type combines a back plate with a step-in plate mechanism. They work with soft boots and are easy to put on and off. The downside is that they may not offer as much control as a strap binding. This kind of binding also restricts somewhat your choice of boot as not all are compatible with a step-in binding
Flow	A more recent development and increasing in popularity. The most important difference is the fact that the back can be levered backwards creating an opening for the boot to enter, making these very easy to put on and off. However, this is not the case on steep slopes and/or in many off piste situations. Instead of adjustable straps, flow bindings use a single tongue to provide connection with the front of the boot. Boarders tend to either love or hate flows - depends what works for you I guess! Some argue they are more comfortable to use whilst others say that they lack response and feel when boarding.
Plate	Usually the domain of alpine racers, these bindings are designed for use with hard boots. The boot is held firmly in the binding between a steel bail and a lever system.

Knee injuries

Knee injuries are less common and less serious in snowboarders than skiers for several reasons:-

a) Whilst on the board with both feet attached in the bindings, any twisting force occurring will twist the whole body as one - both legs and trunk must therefore move in the same direction. The same is not true of skiers, in whom one leg can turn in or outwards independent of what the rest of the body is up to!

And even when one leg is unattached to the board…

b) A snowboard only has two edges that can “catch” unexpectedly on snow as opposed to four on skis
c) Snowboards tend to be shorter than skis which reduces the “lever arm” of force produced by any twist.

ACL injuries, though not as common as in alpine skiing, can occur as a result of a "big air, flat landing" scenario. A fair percentage of the knee injuries we see occur on drag lifts. Why? Well, the lead leg is still attached to the board whereas the trailing leg is not. Effectively the boarder is now a skier with one hell of a fat ski! If the board moves awkwardly (as it can do on a lift), any twisting force is applied to the knee joint. Similarly, snowboarders should be aware of the risks of demounting from a chairlift with one foot out of the binding. If the snowboard edge catches this can suddenly and quite violently twist the knee of the attached leg. You have been warned - if unsure how to use a particular lift ask the towie to slow things down and show you - bit of humble pie to be swallowed here but far better that than falling off and holding up the rest of the queue. Unfortunately, ski lift companies have been fairly slow to try and improve the lot of the snowboarder - urgent attention must be given towards designing more "boarder- friendly" lifts - both drag lifts and chair lifts. Until that day though remember, we've all been there as beginners one time or another (friends of mine love to recount the time I got stuck under a chairlift in Les Deux Alpes for 30 minutes......!!)

If these fractures are missed (especially types II and III) then the consequences can be quite severe for what seems like an innocuous injury - the fracture may fail to re-unite and heal properly and this can lead to early development of osteoarthritis in the ankle joint with resulting pain, loss of function and disability.

Diagnosis

Unfortunately, this area of the ankle often does not show that clearly on a normal ankle x-ray and so not only have most doctors outwith ski areas not have heard of it, but they'll look at the x-ray and think it looks normal. To diagnose a FLPT usually requires a CT scan, and it can be difficult to convince a doctor of the need for this if they think the x-ray looks normal! As so often in medicine, we should treat the patient, not the x-ray. In the situation of a snowboarder who has had a heavy fall/landing and injured their ankle as a result, we should all have a high index of suspicion for this injury. If the x-ray looks normal, and a simple ankle sprain is suspected, then you would normally expect this to improve fairly rapidly with standard treatment, and certainly it should be possible to bear weight on the ankle after 7 days. If its not, and/or the ankle remains very painful, then the injured snowboarder needs to go back and get their ankle re-assessed. IF NECESSARY, COPY AND PRINT OUT THIS INFORMATION AND TAKE IT WITH YOU - ASK THE DOCTOR TO LOOK AT THIS WEB PAGE AND/OR DO A GOOGLE SEARCH. This is an important injury that can have bad consequences if it is missed - be persistent!!

Head injuries are usually the consequence of a fall. Beginners in particular tend to fall backwards and hit their occiput (the back of the head) on the snow as a result. Most head injuries are thankfully minor in nature. However, with increasing force of impact the risks increase and can include death or long term disability. A two year study from Nagano (remember the 1998 Winter Olympics?) reported on 143 boarders with head injuries. Nine were serious in nature - three required brain surgery and three were left with long term brain damage. None of the injured boarders (or the 158 skiers with head injuries also seen) were wearing head protection.....

There seems little doubt that wearing a helmet makes sense. They are, however, still viewed as un-cool and not trendy. But what's cool about brain damage?! If you are buying a helmet try and get one that meets one of the US standards (Snell RS 98 or ASTM 2040) or the European standard EN1077). Snell is the most stringent standard and consequently (and unfortunately) very few helmets meet it. Look inside the helmet and check the label. Helmets that meet these standards have at least undergone formal testing - there are many "helmets" being sold that meet no standards whatsoever. The crucial thing about a helmet is that it does not make you invincible!! There is no evidence that wearing a helmet will protect you from death or serious injury if, for example, you collide with a static object (such as a tree) at or above the speed of a normal intermediate skier or boarder (40-60 km/h). Unfortunately, those who have found this out don't live to pass the message on. If you do the maths (and some have), the forces involved with such a collision are way beyond the capacity of all modern helmets. They are certainly likely to be of benefit in more minor impacts, glancing blows and the like. Kids are statistically more likely to sustain a head injury and therefore the argument for kids wearing helmets is stronger still. For more info on helmets check out my page on the subject - click here. There are also some interesting sites listed on my link page. At the end of the day the absolute individual risk of a head injury (let alone a serious one) is quite small - less than 1% in fact. It is for this reason that respected bodies such as the International Society for Skiing Safety and the American Medical Association have agreed that there is no evidence to back a call for mandatory helmets for everyone. But if its your head that gets mashed that figure means nothing....like so many things in life I guess - up to you at the end of the day.

Spinal Injuries

Spinal injuries are relatively rare but devastating when they happen. They usually occur in one of two ways -

a) As the result of a jump that has gone wrong with the boarder landing in an awkward position on the neck/back or on someone or something else. Danger signs include immediate severe back or neck pain, a loss of feeling in the limbs or an inability to move. Use a spotter (a pal positioned where he or she can see your landing area) when jumping so neither you nor someone else gets a nasty surprise. If you see someone have a nasty fall, try to keep their head still in the position you find them and try not to move the casualty unless absolutely necessary (their or your life in immediate danger - rock falls, avalanche etc). Call for someone else to get professional help from the ski patrol as quickly as possible (Preferably not you - you're keeping their head absolutely still!!).

b) After an abrupt stop, the boarder lands heavily on his or her rear end and the force is transmitted up the spinal column causing compression fractures of the vertebral column.

There are now two pages on this website devoted to spinal injuries in detail. Click here.

Other snowboard injuries are usually also the result of direct trauma. Most are contusions of areas such as the hip and chest. The buttocks can take quite a bashing too - we call it 'Aviemore Arse' an example of which is to the left. Several padding devices (see below right) have been designed to reduce the impact.

And watch out for those tree wells that I mentioned on the intro page - if you missed it, the relevant links to the two thought provoking articles by Bob Cadman - ski patroller in BC for 17 years - are here again:

1. Eight non-avalanche (related) snow-immersion deaths (NARSIDs) - click here

2. How to stay alive in deep powder snow - click here

For the complete picture on what a snowboarder can do to prevent injury see our separate web page devoted to injury prevention.

Injuries in snow parks

The country with undoubtedly the largest snow sports injury database in the world is France, a country with nearly 9 million skier/boarder visits per year. The Medicins de Montagne (MdeM) group have collated an impressive database of over 435,000 injuries. At the ISSS 2007 conference MdeM presented the first data I am aware of looking specifically at accidents occurring in snow parks. They found that 2.8% of all winter sports accidents in France occur in a snow park. 64.6% of these injuries occur amongst snowboarders - this equates to 7% of all injuries seen from snowboarding. Looking specifically at snowboarders injured in parks, their key findings comparing snowboarders injured in snow parks to all other injured snowboarders were:

Interestingly, no design standards exist for snowboard jumps - anyone can (and does) just build a ramp that looks about right, and then let the boarders get on with it. Unfortunately, recent litigation cases involving boarders who have sustained serious injuries after jumps went wrong have brought the issue sharply into focus. The challenge is to design jumps that are safe, and yet not boring. Snowboarders (and skiers for that matter) love to jump for many reasons - the challenge and exhilaration involved are but two of these. Take them away though, and all the fun goes out of jumping. So it seems clear that the design engineers, snowboarders and perhaps even the lawyers need to sit down to bash things out. Just remember for now that when you take off from that jump or ramp that chances are high that the person who built it probably has no idea how or where you are likely to land and at what speed or impact angle......

Although many good forums exist on the web for snowboarders, I strongly recommend the guys and gals on Adrenalin trip....

Click here for Adrenalin trip

For those of you in Japan, SnowJapan is also an excellent forum - click here

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