SNOWBOARDING INJURIES

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. The current indications are that boarder numbers have begun to plateau out since about 1999. In most ski areas snowboarders account for  between 15-25% of all users although there are now many areas where snowboarders are in the majority.  I wouldn't pretend that all the problems have been resolved between skiers and boarders but thankfully, most ski areas have now long since 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 terrain/fun 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. Until recently, we had very little research data on the types of injuries that occurred in these parks. But now we have quite detailed information from France, Canada and the US which I have now posted elsewhere on this webpage. Snowboarding is an exhilarating sport and I for one (as a part time and pretty poor boarder) love it!



Injury rates


Current injury rate in Scotland (2009/10 season) - 5.31  injuries per 1000 boarder days (188 MDBI) 

 In terms of injury rates, most ski physicians agree that boarding carries a slightly higher risk of injury than alpine skiing - between 3-6 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 0.6%! 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 190 MDBI for all snowboarding injuries. This means that an individual snowboarder is likely to injure some area of the body every 190 days they spend snowboarding. Given that the average boarder does about 12 days per season, this means an injury on average once every 16 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.
 

Injury profiles from snowboarding

 

 

The commonest injury is to the wrist, with such an injury occurring once every 750 days, compared to a knee injury once every 1646 days - so you can see that the risk of an upper limb injury is about twice that of a knee injury on a snowboard. Interestingly, those with the highest risk of injury overall are beginner teenage snowboarders. 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 broken bones involve the wrist joint.

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:

   1. Skiers looking for a new challenge

   2. Young kids keen to try the trendiest sport

   3. Teenagers and young adults with little or no previous experience of the environment

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.

 

Upper Limb Injuries

 

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.

 

 

I strongly recommend wrist guards - either as a standalone pair of 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 pages on wrist injuries and wrist guards and to seriously consider buying a pair. Its money really well spent IMHO.

It always surprises me that snowboarders are prepared to spend up to £60+ on a helmet 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. 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. See the shoulder injuries page for more detailed information.

Finally, the other upper limb injury we see in snowboarders are 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

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 arebroadly 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).

Hybrid snowboard boots are pretty common these days. 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.

For more detailed information on snowboarding boots - click here. Snowboard binding systems, unlike alpine ski systems, are non-releasable. Essentially, there are four main varieties - strap, step-in, flow and plate. You can find more detailed information on snowboard binding systems on this page.

 

Knee injuries

Knee injuries are generally much less common and less serious in snowboarders than skiers. The reason for this is related to the fundamental difference between skis and boards. On skis, each leg is able to move and twist independently of the other leg. The skier (and therefore their skis) also generally face forwards which means that it is potentially easier for a ski edge to catch and apply a twisting force. In comparison, a snowboarder usually has both feet attached in the bindings to the same board, and therefore most twisting forces that occur will turn the whole body as one - both legs and trunk moving in the same direction. Because of this different stance, boarders generally spend more time with their board turned at an angle to the fall line of the slope and the chances of catching an edge are therefore reduced. 

However, snowboarders are vulnerable to knee and lower leg in three common circumstances: 

  • When one leg is out of the binding - typically when using a surface lift (e.g. a button or T-bar) and also when dismounting from a chairlift. In both these situations, 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. And, because a snowboard is much bigger and heavier than a single ski, the actual force applied to the lower leg can be significant. 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......!!) 
  • Direct impact collisions - not surprisingly its the lead leg that usually takes the impact. If this is with a solid object (tree, pylon, fence or other person) then a lower leg fracture can result
  • Injury to the ACL (anterior cruciate ligament), though nowhere near as common as in alpine skiing, can occur in snowboarding as a result of a "big air, flat landing"
     

Snowboarder's ankle


** This is an important injury that all snowboarders should be aware of **

Ankle injuries can occur after attempting a snowboard jump, when (especially if things go wrong and the landing doesn't go as planned) a combination of compression and inversion forces are applied to the joint (as the ankle turns inwards). Depending on the size of the force(s) applied, this may lead to an ankle sprain or to a more serious and specific condition - a fracture of the lateral process of the talus (FLPT) bone. This is a specific and very important injury and prior to snowboarding coming along was rarely seen by doctors - occasionally it was seen as a result of road traffic accidents, falls from a height or forceful twists of the ankle. Unfortunately, its relative rarity away from ski areas means that it frequently goes undiagnosed. In fact, its usually misdiagnosed as an ankle sprain. Because it is associated with snowboarding and rarely if ever seen as a result of any other activity, it has picked up the name "Snowboarder's ankle". It is believed to constitute about 2% of all injuries from snowboarding. 

Anatomy of the ankle

The ankle joint is composed of the distal end of the tibia (shin) bone, fibula bone (on the outside of the lower leg) and the talus bone. The talus bone and the tibia bone form a joint called the tibio-talar joint. This joint allows your ankle to move bakwards and forwards (flex/extend in medical language). The lateral process of the talus bone articulates with both the fibula and the os calcis (part of the heel bone - the calcaneum), thereby forming the lateral part of the subtalar joint.

Fracture classification/complications 

Hawkins in 1965 classified FLPT into 3 categories, with type II and III being the more serious:

    * Type I - Non-articular fractures (i.e. not involving the joint surfaces)

    * Type II - A single fragment fracture involving both the talofibular and subtalar articulations

    * Type III - A comminuted (multiple fragments) fracture again involving involving both

                       talofibular and subtalar articulations

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

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 by some 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.  This web site now has separate pages with information on both head injuries and the evidence relating to the use of helmets. 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 -

1. 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!!).

2. 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 two separate pages on this website devoted to spinal injuries in detail - click here.

Other injuries

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!  Several padding devices have been designed to reduce the impact on the buttocks - there's no objective research evidence showing that they actually do any good, but common sense suggests that they will help to reduce the effects of repeated contusions. 

Finally, watch out for those tree wells that I mentioned on the intro page - if you missed it, you can read up on the subject here.

For the complete picture on what a snowboarder can do to prevent injury see my separate web pages devoted to injury prevention on the left hand side menu.

 

Injuries in terrain/fun parks


The popularity of terrain parks has been increasing year on year and as a consequence, so have the number of injuries occurring in them. We now have alot of data available from several studies that have focussed either on the injury patterns seen or on the design of jumps and features in terrain parks.

This topic has expanded so much that I have now added a separate page on the subject. Click here to access this page.


 



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