Injury trends in alpine skiing and a snowboarding over the decade 2008-09 to 2017-18.

OBJECTIVES: This research explores snowsport injury trends in western Canadian resorts over the decade 2008-2018. DESIGN: Ecological study. METHODS: Injury and participation data on alpine skiing and snowboarding was provided by the Canada West Ski Areas Association for 2008-2018. Inclusion criteria were met by 29 of 52 resorts, resulting in the analysis of 107,540 injury reports via SPSS 24, using descriptive statistics and chi-squared analysis. RESULTS: Over the decade: there was a gradual decline in the injury rate, averaging 2.24 injuries per 1000 skier days. Male snowboarders accounted for 1/3 of all injured participants, females were 42% of all. Day-ticket holders were the most injured of all customer-types, with most injuries occurring as the result of falls on marked, green/easiest terrain. For skiers, injuries to lower limbs, and especially knees, were most common. For snowboarders, upper limb injuries, especially wrists, were most common. 12.8% of the injured population required emergency transport. Advanced slopes/terrain had the highest proportion requiring emergency transport. Fewer skiers experienced head injuries than snowboarders. Snowboarders experienced a higher proportion of serious injuries. CONCLUSIONS: Snowsport injuries are relatively rare when compared to other sports. Skiers were most prone to knee injuries and snowboarders to wrist injuries. Emergency transport was proportionally needed more from advanced slopes/terrain. Further research is needed into why and how participants make decisions around risk. Future injury prevention strategies should be evaluated in light of potential risk factors such as, social determinants of injury, fall mechanisms, changing participation patterns, age, snowsport discipline, and legal cannabis use.

Head injury and helmet usage trends for alpine skiers and snowboarders in western Canada during the decade 2008-9 to 2017-18.

OBJECTIVES: This research explores snowsport head injury trends in western Canadian resorts over the decade 2008-2018. DESIGN: Ecological study. METHODS: Head-injury and participation data on alpine skiing and snowboarding (snowsports) was provided by the Canada West Ski Areas Association (CWSAA) for 2008-2018. Injury reports from the ski patrol of 52 western Canadian resorts were analysed. 29 resorts were included where there was both injury and participation data for at least 8 out of 10 seasons, resulting in analysis of 10,371 reports. Data was imported into SPSS 24 for analysis using descriptive statistics, chi-squared analysis, odds ratios and linear regression. RESULTS: Over the decade: the head injury rate was 0.205 injuries per thousand skier days. Head injuries were 9-10% of all injuries, significantly lower for skiers (8.3%) than snowboarders (10.9%). There were no significant differences in helmet-usage rates of injured and non-injured populations. 80.6% of injured participants wore a helmet, those wearing a helmet were 8% more likely to report a head injury than those not wearing a helmet. There was little variation in the proportion of head injuries reported as concussion, but a 50% reduction in ambulance or helicopter transport, a head-injury severity proxy. There was a significant relationship between the proportion of snowsport participants who were snowboarders and the head-injury rate. CONCLUSIONS: Head injuries remain a rare event. There has been a decline in the severity of reported head injuries which may be a function of a decline in the proportion of snowboarders in snowsports.

Proprioceptive abilities improve in expert skiers and snowboarders from early-season to mid-season.

OBJECTIVES: To determine whether the proprioceptive ability of advanced and expert snowsport participants increased with time on-snow, and whether gender, age, snowsport discipline and/or previous ankle injury were factors in proprioceptive ability at the start of the winter snow season (T1, n=80) compared to mid- season (T2, n=39). DESIGN: Observational study METHOD: Participants completed a questionnaire at T1, and proprioception was measured at T1 and T2 by the Active Movement Extent Discrimination Apparatus (AMEDA), which tests lower limb proprioception. RESULTS: At T1 there was no significant difference between the proprioception scores of the two cohorts of advanced and expert snowsport participants, between females and males, younger and older age groups, nor between alpine skiers and snowboarders. At T2, after a minimum of 5 weeks on-snow, the whole group had improved their proprioception by 0.04 (p<.0001) as measured by the AMEDA. Groups undertaking different snowsport disciplines achieved different gains across the season, with minimal change of 0.02 in skiers (p=.056), while snowboarders and mixed ski/snowboard participants gained 0.05 (p=.034) and 0.06 (p=.005) (η2 0.63 and 0.47 respectively). Males, females, instructors and elite youth participants all improved their proprioception by mid-season (η2 0.29-0.46). CONCLUSIONS: Amongst an established group of snowsports participants, lower limb proprioception is a consistent skill that is equally well developed in all cohorts. Several weeks of regular snowsport exposure improves this proprioceptive acuity amongst snowboarders, and those who mix snowboarding with skiing. Exposure to a prolonged period of snowsport improves proprioception, with benefits to neuromuscular control mechanisms.

Snowsport experience, expertise, lower limb injury and somatosensory ability.

OBJECTIVES: Previous research demonstrates that a history of ankle injuries increases the risk of overall future injuries, and that somatosensory scores are correlated to sport performance. This research explores the relationship between lower limb somatosensory scores in snowsport participants and ankle injury history; and the relationship between lower limb somatosensory scores and Instructor qualification. DESIGN AND METHODS: Experienced snowsport participants who were recruited through a western Canadian snowsport school completed a questionnaire that included their ankle injury history, the Identification of Functional Ankle Instability (idFAI), the Cumberland Ankle Instability Tool (CAIT), and their current instructor qualification level, as a proxy for sport performance. Lower limb somatosensory was assessed using the active movement extent discrimination assessment (AMEDA) method. RESULTS: Of the 75 participants, 55% reported at least one previous ankle injury. An independent sample t-test did not show any significant difference in somatosensory scores of those with an ankle injury history (x¯=.66, SD=.05) or not (x¯=.66, SD=.05). Nor was there any difference between those with a functionally unstable ankle (i.e. CAIT<24 and idFAI>11) and all others [x¯=.66, SD=.04 cf. x¯=.66, SD=.05; t(67)=.54, p=.78]. An ANOVA exploring the relationship between Instructor Qualification and somatosensory scores was significant at p<.05 [F(4, 68)=4.0, p=.006]. CONCLUSIONS: The results did not reveal any significant difference in perceived functional instability and somatosensory scores, which contrasts with previous research. The sport performance finding is consistent with previous work examining the relationship between somatosensory scores and sport performances. Further research is needed to explore if the dynamic snowsport working environment impacts ankle instability and somatosensory scores.

The King-Devick test is not sensitive to self-reported history of concussion but is affected by English language skill.

OBJECTIVES: Head injuries, including concussion, are a concern in many sports. Current validated concussion assessment protocols such are problematic with suggestions that an oculomotor examination, such as the King-Devick (K-D) test, could be included. This research explores the role of the K-D test in snowsport concussion research. DESIGN: Experienced snowsport participants were recruited through a western Canadian resort (n=75). METHODS: Participants completed a questionnaire that included their history of prior serious head impacts and were assessed via the computer-based K-D test in English. RESULTS: Of the 75 participants, 23 (69%) reported at least one previous serious head impact. English was the not primary language for seven participants. Independent sample t-tests revealed: significant differences in the K-D average saccade scores for those who had broken their helmets, with or without a serious head injury (̄x¯=171.23, SD=12.9) and those who had not broken a helmet (̄x¯=186.61, SD=20.18; t (70)=-2.53, p=.014, twotailed) and significant differences in the K-D time for those whose native language is English (̄x¯=47.9, SD=6.3) and those where English was not their first language (̄x¯=53.3, SD=7.4; t(73)=.48, p=.04), but no significant difference for their saccade velocities: English (̄x¯=183.64, SD=20.0) versus those where English is a second or third language (̄x¯=188.44, SD=20.1; t(70)=-.56, p=.576). CONCLUSIONS: For subjects whose first language is not English, such as in many snowsport resorts, the K-D test may need to be conducted in a person's native language to provide a valid assessment based upon the time to complete the task.

A human factors approach to snowsport safety: Novel research on pediatric participants' behaviors and head injury risk.

OBJECTIVE: This study applied a human factors approach to snowsport resort systems to contribute to the understanding of the incidence and severity of pediatric snowsport head accelerations. BACKGROUND: Previous research indicates low magnitude head accelerations are common among snowsport participants. This study adds to the knowledge of snowsport safety by measuring aspects of participants' snowsport behavior and linking this with head acceleration data. METHOD: School-aged students (n = 107) wore telemetry-fitted helmets and Global Positioning System (GPS) devices during snowsport activity. Data was collected over 159 sessions (total hours 701). Head accelerations recorded by the telemetry units were compared with GPS-generated data. RESULTS: This study found speeds attained normally exceed the testing rating for which helmets are designed; lower rates of head accelerations compared to earlier studies and that when head accelerations did occur they were generally below the threshold for concussions. CONCLUSION: Pediatric snowsport head accelerations are rare and are generally of low magnitude. Those most at risk of a head acceleration >40 g were male snowboarders. Given the recorded speeds in first time participants, increased targeting of novice snowsport participants to encourage education about the use of protective equipment, including helmets, is warranted. Post event recall was not a good indicator of having experienced a head impact. Consideration should be given to raising the standard design speed testing for snowsport helmet protective devices to reflect actual snowsport behaviors.

Snowboarding injuries in Australia: investigating risk factors in wrist fractures to enhance injury prevention strategies.

OBJECTIVE: To investigate risk factors associated with wrist fractures in snowboarders to inform future snowsport safety strategies. METHODS: A prospective case-control study using a nonprobability convenience sample was conducted with data collected via a respondent-completed questionnaire. Subjects consisted of snowboarders with a snowboard-related injury who presented to one of 10 medical centers and physiotherapy clinics in resort medical centers and gateway communities across the Australian snowsport season in 2007. Those presenting with injuries other than wrist fractures acted as the control. RESULTS: The 611 respondents reported 802 injuries (61.3% were males and 51.5% were aged 16-25 years). Protective equipment was worn by 57.0% of respondents. The main reason for not wearing a wrist guard was that they did not see the need; of these, 12.9% experienced a wrist fracture. Most injuries occurred on-piste, in a terrain park, or in a lesson. The main mechanism of injury was falling. The major risk factors for wrist fractures were being less than 16 years of age (OR 3.97, CI 2.54-6.22), being in the alpine area for a holiday (OR 2.77, CI 1.47-5.21), and being a first-day snowboard participant (OR 2.02, CI 1.15-3.64). A direct logistic regression indicated that 3 variables had a statistically significant contribution to the model (being less than 16 years old, being on holidays in the region, and not wearing a wrist guard). CONCLUSIONS: The key risk factors in this Australian study reflect other international studies, providing a clear market segment for targeted snowsport safety messages: those less than 16 years old, visitors to the alpine regions, and those not wearing wrist guards.