Head injury mechanisms in FIS World Cup alpine and freestyle skiers and snowboarders

We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing

BACKGROUND

Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues.

MATERIALS AND METHODS

We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix.

RESULTS

Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season.

CONCLUSIONS

We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.

[Traumatic brain injuries in winter sports : An overview based on the winter sports skiing, snowboarding and ice hockey]

In winter sports, skiers, snowboarders and ice hockey players have the highest risk of traumatic brain injuries (TBI). In skiing/snowboarding severe TBIs are of concern; in ice hockey, repetitive minor TBIs are frequent. The main causes of TBI in recreational skiing are collisions with trees; in professionals falls due to technical or tactical mistakes are the main causes. In ice hockey 10-15% of all injuries are due to a sports-related concussion (SRC), mostly caused by player-opponent contact. The pathomechanism in TBI is a combination of rotational and linear acceleration during head impact, which causes a diffuse axonal injury. Long-term complications such as neurodegenerative diseases and functional deficits are of relevance. Prevention by wearing helmets is effective, but less effective in TBI/SRC than in focal injuries.

Influence of the frame of reference on head acceleration events recorded by instrumented mouthguards in community rugby players

Objectives

To highlight the need for standardisation in the communication of head impact telemetry from instrumented mouthguards (iMG). The purpose of this study is to examine how the frame of reference for reporting head acceleration events (HAE) may affect the interpretation of head impacts recorded from iMGs in community rugby players.

Methods

An analytical investigation of 825 video verified HAEs recorded from male community players during 5 rugby match exposures. HAEs were captured with an iMG, known to be reliable and valid for this purpose. The linear and angular head acceleration at the centre of mass (head_CG) was calculated from filtered iMG accelerometer and gyroscope data, and the location of impact was estimated. The iMG and head_CG data were examined for systematic bias, geometric differences and the degree of concordance. Finally, mixed model analyses were fitted to assess the differences in peak resultant acceleration (PLA) by impact locations and directions of head motion while controlling for intra-athlete correlations.

Results

The degree of concordance between the iMG versus head_CG measures varied by impact location. The mixed model confirmed differences in the PLA by location (F_(8,819) = 16.55, p<0.001) and by direction of head motion (F_(5,417) = 7.78, p<0.001).

Conclusion

The head acceleration reported at the iMG is not proportional to measurements that have been transformed to the head_CG. Depending on the impact location and direction of head motion, the acceleration measured at the iMG may overestimate, underestimate or miss entirely the PLA with respect to the head_CG. We recommend standardising the reporting of iMG data within the head_CG frame of reference.

Acute Vertebral Fractures in Skiing and Snowboarding: A 20-Year Sex-Specific Analysis of National Injury Data

Background:

The epidemiology of acute vertebral fractures (AVFs) sustained while skiing and snowboarding remains poorly defined in the United States.

Hypothesis:

It was hypothesized that there would be no significant differences across sex and a greater number of AVFs in younger age groups associated with skiing and snowboarding.

Study Design:

Descriptive epidemiological study.

Methods:

The authors utilized the National Electronic Injury Surveillance System to identify patients who were reported in emergency departments in the United States from 2000 to 2019. All patients were noted to have sustained AVFs during skiing or snowboarding. National estimates and demographic analysis were performed.

Results:

A total of 466 AVFs were identified, or roughly 23.3 AVFs per year. Compared with women, men accounted for the majority of AVFs sustained in both skiing and snowboarding: 67.8% (95% CI, 62.6%-73.0%) during skiing and 82.1% (95% CI, 76.3%-87.8%) during snowboarding. This represented a significantly larger percentage of AVFs while snowboarding compared with skiing (P = .002). Women accounted for 32.2% (95% CI, 27.0%-37.4%) of AVFs while skiing and 17.9% (95% CI, 12.2%-23.7%) while snowboarding, which indicated a significantly larger percentage of AVFs sustained during skiing compared with snowboarding (P = .002). Snowboarders were more likely than skiers to sustain an AVF in the region of the coccyx (21.5% [95% CI, 14.3%-28.7%] vs 11.5% [95% CI, 3.5%-16.9%], respectively; P = .003) and as a result of a fall at ground level (69.2% [95% CI, 62.1%-76.4%] vs 52.8% [95% CI, 43.2%-62.4%], respectively; P = .009). A significant decrease in the number of snowboarding-related AVFs was identified over the 20-year study period: 899 in 2000-2003 versus 283 in 2016-2019 (P < .01). The change in skiing-related AVFs over the study period was not statistically significant (694 vs 462; P = .5).

Conclusion:

This national study of AVFs sustained while skiing and snowboarding identified critical sex- and age-specific differences in the population at risk, anatomic location of injury, and mechanism of injury. The national data generated from this study over a 20-year period may be utilized to better inform public health injury awareness and prevention initiatives in the rapidly growing sports of skiing and snowboarding.

The ISPA Int Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting

Evidence-based injury prevention programmes for youth competitive alpine skiers are widely absent. The aims of this controlled 12-month experimental study were to introduce a novel injury prevention programme targeted to the injury patterns of youth skiers, called ISPA_Int, and to compare the differences in injury occurrence between an intervention group (IG) additionally performing the ISPA_Int programme and an independent, historical control group (CG) following their regular training routines. None of the skiers of the CG were part of the IG and vice versa. The study was directly conducted within the real-world youth development structures of skiers competing at the under 16 years (U16) level in Switzerland. Seventy-one skiers (aged 14.4 ± 0.3 years) assigned to the IG were compared to 58 age- and gender-matched controls. The IG was offered the ISPA_Int programme with the recommendation to perform it at least once per week. Skiers’ adherence to this recommendation was surveyed but not enforced. Injuries were recorded using the Oslo Sports Trauma Research Centre Questionnaire. Primary outcomes were the absolute injury rates (number of injuries/100 athletes per season) and epidemiological incidence proportion (number of injured athletes/100 athletes per season). The secondary outcome was the average 2-weekly prevalence of traumatic knee, knee overuse, and lower back overuse injuries. There were lower absolute rates of all traumatic injuries [rate/risk difference, RD: −57.1 (−98.1, −16.0); rate/risk ratio, RR: 0.665 (0.485, 0.884)] and overuse injuries [RD: −35.9 (−71.0, −0.7); RR: 0.699 (0.493, 0.989)] in the IG than in the CG. Likewise, the epidemiological incidence proportion for all overuse injuries was smaller in the IG [RD: −28.4 (−44.8, −12.0); RR: 0.598 (0.435, 0.822)], while the proportion of skiers suffering from traumatic injuries did not significantly differ between the groups. Notably, the IG particularity differed from the CG in the average 2-weekly prevalence of knee trauma, knee overuse, and lower back overuse complaints, three of the major injury-related hot spots in youth skiers. Based on these promising results, the ISPA_Int programme may have great potential to prevent injuries in youth competitive alpine skiers, and the underlying exercises should be considered complementary training content at the U16 level.

Injury risks among elite competitive alpine skiers are underestimated if not registered prospectively, over the entire season and regardless of whether requiring medical attention

PURPOSE

Prospective studies assessing the injuries occurring in elite competitive alpine skiers are lacking, and a full picture of all injuries, including those not requiring medical attention, is absent. Likewise, little is known about the sex-specific injury risks and patterns of elite skiers throughout an entire season (i.e. an off-season preparation period and a competition period). Accordingly, this study investigated the injuries of a national team cohort with respect to season period and sex.

METHODS

Over an entire season, all injuries occurring in 44 Swiss National Ski Team members (25 females and 19 males) were registered, regardless of whether they required medical attention. Skiers were prospectively monitored by the Oslo Sports Trauma Research Centre (OSTRC) questionnaire and by continuously updated team medical records. Finally, these data were used as a reference for supplemental interviews, in which the correctness and completeness of the prospective data were verified.

RESULTS

The risk of suffering at least one injury during an entire season was 75.0% with a 95% confidence interval (73.1%, 76.9%) for traumatic injuries, and 52.3% (50.0%, 54.5%) for overuse injuries. Traumatic injuries concerned the head, lower leg and knee, while overuse injuries affected the lumbar spine, knee and hip. During the competition period, skiers were more prone to traumatic injuries, while during the off-season preparation period, skiers' risk was higher for overuse injuries. Over an entire season, there were no sex differences. However, females were more vulnerable to traumatic injuries during the preparation period and overuse injuries during the competition period, while males had a higher risk for overuse injuries during the preparation period.

CONCLUSIONS

When prospectively registering injuries among elite competitive alpine skiers over an entire season, regardless of whether the injuries required medical attention, the injury risks were alarmingly high and substantially larger than those previously reported. Moreover, since injury risks and patterns are season period and sex dependent, it is strongly recommended that (1) injury registration focuses on both the off-season preparation period and the competition period and (2) prevention efforts are specifically tailored to the sex of the athletes.

LEVEL OF EVIDENCE

II.

A Narrative Review of Injury Incidence, Location, and Injury Factor of Elite Athletes in Snowsport Events

Snowsport athletes face a high injury risk both during training and in competitions. Reducing injury incidence is crucial for athletes to achieve breakthroughs. This narrative review aimed to summarize and analyze injury data of elite athletes in snowsports and provide references for injury prevention and health security for these athletes and their coaches. A total of 39 studies that investigated snowsport injury were analyzed in the present study. On the basis of injury data of elite athletes in snowsports events, this narrative review focused on four aspects, namely, injury incidence, severity, location and causes. The findings of this review were as follows. (1) The highest injury incidence was recorded in freestyle skiing, followed by alpine skiing and snowboarding, the majority of which were moderate and severe injuries. (2) The proportion of injury in competitions and during training was similar. However, more injuries occurred in official training during the Winter Olympic Games; by contrast, injury proportion was higher in competitions during World Cup/World Championships. (3) The most commonly and severely injured body parts were the knees (29.9%), head and face (12.1%), shoulders and clavicula (10.5%), and lower back (8.9%). The most common injury types were joint and ligament injury (41.5%), fracture and bone stress (24.4%), concussion (11.1%), and muscle/tendon injury (10.7%). (4) The main causes of snowsport injury were collisions, falls, and non-contact injuries. Snowsport injury was also influenced by the skill level of the athletes, gender, course setup and equipment. Future studies should further explore the influence of event characteristics and intrinsic and extrinsic risk factors on snowsport injury. An injury or trauma reconstruction may be developed to predict athletic injuries and provide effective prevention strategies.

[Analysis of the mass skiers' injury in a large ski resort in Chongli, China]

OBJECTIVE

To make a retrospective analysis of the injuries of skiing population in a large ski resort in Chongli, China and provide a basis for predicting the rapidly increasing medical needs for ski injuries in the context of the 2022 Winter Olympic Games.

METHODS

The basic data of all injured skiers who were treated in a medical station of a large ski resort in Chongli during the snow season from November 2017 to March 2018 and from November 2018 to March 2019 were collected. The number of skiers, the number of injuries, the causes of injuries, the types of injuries and the locations of injuries were compared.

RESULTS

A total of 753 skiers were injured in two snow seasons, and the estimated average incidence of injury was 4.53 and 4.46 per 1 000 skier days at the resort respectively. The average daily injury rate per 1 000 skiers in November of the two snow seasons was relatively low, with 2.20 and 1.38 cases respectively. The difference of injury rate in different months might have little to do with snowfall and more to do with passenger flow. In both the snow seasons, men accounted for more injuries than women, and injured skiers aged between 21 and 30 accounted for the largest proportion, reaching 36.8%. The main causes of injuries were falls (76.6%). The highest rate of injury was in the head and neck (17.9%), followed by the knee (17.4%) and wrist and fingers (13.3%). The most common types of injuries were contusion and trauma (29.5%) and joint and/or ligament injuries (22.2%). Children (2-12 years old) accounted for 12.7% of all the injured skiers. The rate of moderate to severe injuries (including fractures, concussions, etc.) was 34.8% among the injured patients over 50 years of age.

CONCLUSION

The snow resort should focus on injuries to children and elderly skiers and carry out targeted guidance and rescue work. In order to better ensure the medical safety of skiers, the ski resort medical station and nearby treatment hospitals should be equipped with a corresponding number of medical personnel and equipment, and the ski resort should further improve its safety management and rescue system.

How do the new Olympic sports compare with the traditional Olympic sports? Injury and illness at the 2018 Youth Olympic Summer Games in Buenos Aires, Argentina

OBJECTIVE

To describe injuries and illnesses across traditional and new sports among the participating athletes of the Buenos Aires 2018 Youth Olympic Summer Games (BA YOG) (6-18 October 2018).

METHODS

We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues manned by the BA YOG 2018 medical staff.

RESULTS

In total, 3.984 athletes from 206 NOCs were observed. NOCs and BA YOG 2018 medical staff reported 619 injuries and 334 illnesses, equalling 15.5 injuries and 8.4 illnesses per 100 athletes over the 13-day period. The eight new sports on the Youth Olympic programme (futsal, beach handball, karate, roller speed skating, kitesurfing, BMX freestyle, climbing and break dancing) fell in between the other sports with respect to injury and illness risk. Injury incidence was highest in rugby (43% of all rugby players), followed by boxing (33%) and badminton (24%), and lowest in swimming, archery, roller speed skating, equestrian, climbing and rowing (<5%). The highest incidences of illness were recorded in golf (20%), followed by triathlon (16%), beach volleyball and diving (both 14%). Of the illnesses, 50% affected the respiratory system and 15% the gastrointestinal system. Injury and illness incidences varied between continents with athletes representing Europe having significantly fewer injuries and illnesses compared with other continents, apart from a similar illness incidence to Asian athletes.

CONCLUSION

The overall injury incidence of 15.5 injuries per 100 athletes was higher, while the overall illness incidence of 8.4 illnesses per 100 athletes was similar to previous youth and Olympic Games. The new sports did not differ significantly compared with the other sports with respect to injury and illness risk.

Common Skiing and Snowboarding Injuries

Participation in skiing, and especially snowboarding, continues to rise. As participation and level of competition in these winter sports increases, the number of injuries increases as well. Upper-extremity injuries are more common in snowboarding, whereas lower-extremity injuries are more common in skiing. Head injuries, particularly concussions, are common in both sports. Special consideration in these sports should be given to environmental conditions, such as high altitude and ultraviolet radiation. The purpose of this review is to discuss the most common musculoskeletal injuries seen in skiing and snowboarding, as well as considerations for initial assessment of these injuries and triage to the appropriate level of care. It is important for sports medicine physicians covering these sports to understand initial assessment and treatment of these injuries. Due to the potential for severe injuries in these sports, it is important to be able to quickly recognize an injury that needs to be assessed and treated urgently or emergently. With the increased participation and number of injuries in these sports, it also is important to consider prevention strategies that may minimize risk of injury.

Spinal injury in alpine winter sports: a review

Introduction

Alpine winter sports have become increasingly popular over recent decades, with a similar increase in accident incidence. This review provides an overview of the most recent literature concerning spinal injury epidemiology, mechanisms, patterns and prevention strategies in the context of alpine winter sports.

Material and methods

The PubMed, Cochrane Library, and EMBASE databases were searched using the keywords spine injury, alpine injury, spine fracture, skiing injuries, snowboard injuries. 64 published studies in English and German met a priori inclusion criteria and were reviewed in detail by the authors.

Results

There are various mechanisms of injury in alpine winter sports (high speed falls in skiing, jumping failure in snowboarding) whilst regionality and injury severity are broadly similar. The thoracolumbar spine is the most common region for spinal injury. Spinal cord injury is relatively rare, usually accompanying distraction and rotation type fractures and is most commonly localised to the cervical spine. Disc injuries seem to occur more commonly in alpine winter sport athletes than in the general population.

Discussion

Despite awareness of increasing rates and risks of spinal injuries in alpine winter sports, there has been little success in injury prevention.

What are the risk factors for injuries and injury prevention strategies for skiers and snowboarders in terrain parks and half-pipes? A systematic review

OBJECTIVE

To synthesise the current evidence regarding the risk factors, the injury prevention strategies and the profile of injured skiers and snowboarders in terrain parks (TPs) and half-pipes (HPs).

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

DATA SOURCES

Literature searches from six electronic databases and manual searches were performed.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion criteria were: (1) publication based on original data; (2) injuries sustained in TPs or HPs; (3) recreational skiing or snowboarding injuries; (4) observational or experimental study design with a comparison group.

RESULTS

No study explored the risk factors in HPs or the prevention strategies in TPs or HPs. From the literature retrieved, there is strong evidence that skiing or snowboarding in a TP is a risk factor for head, neck, back and severe injuries. Two papers assessed the risk factors for injuries in TPs, mainly demonstrating that features promoting aerial manoeuvres or a large drop to the ground were associated with higher feature-specific injury rates. The profile of injured skiers and snowboarders in TPs described in the literature suggested some evidence of associations between factors including activity, sex, skill level, helmet use, age and TP injuries.

SUMMARY/CONCLUSIONS

This systematic review demonstrates the need for studies identifying the risk factors for injuries to skiers and snowboarders and on interventions to reduce the risk of injury in TPs and HPs. Studies addressing the issue of TP design should be considered.

PROSPERO REGISTRATION NUMBER

CRD42016045206.

Trends of snowboarding-related fractures that presented to emergency departments in the United States, 2010 to 2016

Background

Since it was introduced as an Olympic sport in 1998, snowboarding has drawn the participation of individuals of all ages. Despite the growing popularity of this sport, individuals can suffer from a number of musculoskeletal injuries. The specific goals of the study were to: (I) compare the number of injuries and trends of snowboarding injuries; (II) identify the injury occurrences, trends, and incidence of snowboarding-related fractures; and (III) identify the injury occurrences and trends of snowboarding-related fractures by body part.

Methods

The National Electronic Injury Surveillance System (NEISS) database was queried for snowboarding injuries and snowboarding-related fractures treated in US emergency departments (EDs) from 2010-2016. The weighted estimate of the number of injuries were obtained by using the NEISS statistical weight calculations that were provided in the data. An estimated total of 248,388 patients (mean age =20 years) experienced a snowboarding-related injury. Linear regression analysis was used to analyze annual trends of snowboarding-related fractures and the snowboarding-related fractures by body part; reported as the correlation coefficient (r) and the coefficient of determination (R²).

Results

The estimated annual number of injuries decreased from 56,223 injuries in 2010 to 17,667 injuries in 2016 (r=-0.967, R²=0.936, P<0.001). The most common types of injuries were fractures (31.7%), strains/sprains (25.2%), contusions (10.9%), concussions (10.0%), internal injuries (7.2%), and dislocations (4.0%). From 2010 to 2016, the estimated annual number of fractures decreased from 18,757 in 2010 to 4,539 in 2016 (r=-0.978, R²=0.957, P<0.001), and the annual incidence of snowboarding-related fractures decreased by 23.1%. The most common location of snowboarding-related fractures was the upper extremity, more specifically the wrist (32.3%). There was a decrease in the estimated annual number of fractures of the wrist (r=-0.965, R²=0.932, P<0.001), forearm (r=-0.821, R²=0.861, P=0.023), shoulder (r=-0.872, R²=0.760, P=0.011), elbow (r=-0.901, R²=0.813, P=0.006), and lower leg (r=-0.929, R²=0.864, P=0.002).

Conclusions

With the growing popularity of snowboarding in the US, it is important to know the common types of injuries that occur. This study found that fractures were the most common injuries, especially of the upper extremity.