In-line Skating Injury: A Review of the Literature

Monash University Accident Research Centre - Report #133 - 1998

Authors: S. Sherker & E. Cassell

Full report in .pdf format [200KB]

Abstract:

The aim of this report is to critically review both formal research literature and informal sources of information that describe preventive strategies and countermeasures to in-line skating injury. The increase in popularity of in-line skating has led to a concomitant increase in skating injuries. Most of the injuries occur in older children (aged 10-14 years). In-line skating injuries contribute 1.4% of injuries presenting to hospital emergency departments for this age group of children in Victoria. Hospital admission rates in Australia for in-line skating injuries range from 15%-28% of hospital emergency department presentations, reflecting their serious nature. Falls cause more than three-quarters of these injuries. The most typical fall involves young novice or beginner skaters wearing little or no safety gear, who either spontaneously lose their balance while skating outdoors or fall after striking a road defect or some debris. The fall usually occurs on an outstretched arm onto a hard surface, with the wrist sustaining the injury. The main risk factors for injury are the speed at which skaters travel, obstacles in pathways, and hard landing surfaces. Measures to prevent in-line skating injury recommended in the literature include the following:

  • wearing personal protective equipment (for example, wrist guards);
  • improving environmental conditions for skaters;
  • developing training and certification for skating instructors and providing lessons, particularly for novice skaters;
  • encouraging physical preparation, including warming-up and stretching, training and conditioning, and cooling-down;
  • educating skaters about safety;
  • improving equipment design and standards; and
  • refining local and state government policy and regulation in consultation with skating groups

Few of these measures have been formally proven to reduce injury. More biomechanical and epidemiological research is needed, particularly in the area of wrist/forearm injury prevention. Attention should be directed towards evaluating the role of wrist guards, helmets, fall technique, and lessons in preventing in-line skating injuries. Given the rapidly increasing popularity of in-line skating and the potential for a related epidemic of moderate to serious injuries, research into in-line skating injury prevention should be a priority.

Executive Summary

In-line skating is increasing in popularity with a concomitant increase in the number of injuries associated with this activity. Most in-line skating injuries occur in older children (aged 10-14 years), representing a significant number of injuries in that age group.

Falls from up to one metre are reported to be the direct cause of 85% of in-line skating injuries recorded in the Victorian hospital emergency department database. The most typical fall involves young novice or beginner skaters wearing little or no safety gear, who either spontaneously lose their balance while skating outdoors or fall after striking a road defect or some debris. The fall usually occurs on an outstretched arm onto a hard landing surface, with the wrist sustaining the injury.

The main risk factors for injury are the speed at which the skater travels, obstacles in pathways and hard landing surfaces. Injuries occur frequently because the skater is going too fast and/or strikes an object in the pavement, or because the skater is unskilled at braking. Injuries due to equipment failure or involvement of motor vehicles are surprisingly rare.

Hospital admission rates for in-line skating injury cases in Australia are high, ranging from 15%-28% of hospital emergency department presentations from this cause. This reflects the serious nature of in-line skating injuries.

The overall aim of this report is to critically review both formal research literature and informal sources of information that describe preventive strategies and countermeasures to in-line skating injury. This review is informed by the analysis of in-line skating injury data, which provide a context for the identification of potentially effective interventions. Potential countermeasures to injury are listed in Table 1. Few of these countermeasures have been formally evaluated.

Table 1 Countermeasures to in-line skating injury

Primary Countermeasures
  • Pre-season conditioning and fitness program
  • Adequate warm-up and pre-skate stretch
  • Cool-down and post-skate stretch
  • Skater code of conduct (for example, learning the rules of the road)
  • Wearing bright or reflective clothing if riding at night
  • Equipment factors (for example, ensuring proper fit and condition of skates, fit of helmet, wrist guards, knee and elbow pads)
  • Environmental factors (for example, keeping paths free of obstacles and debris, choosing a flat course, UV protection)
  • Skating instruction, especially for beginners, and training of instructors
  • Adequate supervision of children and novices
Secondary Countermeasures
  • Wearing protective equipment (for example, helmet, wrist guards, knee and elbow pads)
  • Skater code of conduct (for example, obey the rules of the road, yield to pedestrians)
  • Keeping speed in check
Tertiary Countermeasures
  • Prompt access to quality medical care and first aid
  • Availability of first aid equipment on site
  • Rest, Ice, Compression, Elevation, Referral (RICER)

GENERAL RECOMMENDATIONS

Recommendations:

  • Collect in-line skating participation data for all ages
  • Provide pre-season training and safety programs for skaters in the late winter or early spring and before the school holidays
  • Educate carers about the need to supervise young skaters
  • Supervise young skaters, especially novices, until they develop the motor and skating skills that are needed to skate safely
  • Target specific injury prevention strategies to young males, who appear to be more at risk for moderate to serious injury than young females

PROTECTIVE EQUIPMENT

Falls are the most frequent cause of in-line skating injuries, accounting for up to 77% of all emergency hospital presentations recorded on the electronic Victorian Injury Surveillance System (VISS, also known as the Victorian Emergency Minimum Dataset or VEMD) hospital emergency department database. The first part of the skater’s body to contact the ground sustains the greatest force of the fall. Protective equipment works to provide a hard protective barrier between the body and the ground, by absorbing or dissipating the potentially injurious energy.

The effectiveness of protective equipment in preventing in-line skating injuries has not been fully researched. Wrist guards have been subjected to some epidemiological case-control evaluations as well as some biomechanical analyses. They have been found to provide a clear protective effect against wrist fractures. There is some concern that wrist guards may transfer the force of the fall further up the arm, resulting in forearm fractures rather than wrist fractures. This hypothesis requires more thorough examination.

Recommendations:

  • Promote the use of full protective gear to skaters of all ages and abilities
  • Identify and address barriers to wearing protective equipment, especially among adolescents
  • Refine and promote standards for helmets, both multi-purpose and specifically for in-line skating (with extended coverage to protect the back of the head)
  • Encourage all rental outlets for in-line skating equipment to provide protective equipment along with skates in a package deal
  • Undertake further ergonomic research into the design of protective equipment, especially to improve the effectiveness of wrist guards

PHYSICAL PREPARATION

Some of the physical stresses of in-line skating may be reduced by warming-up and stretching, which are known to improve the range of motion of the joints and increase muscle elasticity . Stretching exercises for calves, hamstrings, hips and back (before and after skating) could help to prevent overuse-type injuries to the lower extremities, although their effectiveness for in-line skating requires evaluation.

Recommendations:

  • Develop and promote information about warm-up, cool-down and stretching techniques specific to in-line skating
  • Identify and address barriers to warm-up, cool-down and stretching among skaters
  • Undertake research into the effectiveness of warm-up, cool-down and stretching as an injury prevention measure for in-line skating

SKATING INSTRUCTION

Most injured in-line skaters have received no formal skating instruction, they have learnt to skate by trial and error. Unfortunately, the "error" can result in injury. Younger skaters, among whom the activity is most popular, are often unaware of the rules of the road, and need to be taught them. Lessons can increase skater confidence and improve skating technique, resulting in safer, more enjoyable skating. The International In-line Skating Association (IISA) offers certification training for in-line skating instructors, and there are currently three certified instructors in Victoria . Certification exams must be sat overseas, making it difficult for Australian instructors to access training. Skating outlets do not demand that their instructors be certified.

Skating instruction by certified instructors should be available to skaters through hiring outlets and schools. Skaters should learn proper stopping techniques, and safe skating practices (for example, rules of the road, how to fall safely) before venturing out into public places. More experienced skaters can also benefit from lessons, to help refine their skills. Local certification training should be provided to in-line skating instructors in Australia. Skating outlets should demand certified training qualification of their instructors. A National Skate Patrol should be developed so that in-line skating instruction can be made available to skaters at places where they skate.

Recommendations:

  • Explore the possibility of developing National Skate Patrol chapters in Victoria
  • Provide local certification training for in-line skating instructors in Victoria and Australia
  • Provide all skaters with the opportunity to take lessons given by accredited instructors, for example, through rental outlets and schools
  • Determine the best technique for in-line skaters to use when falling, in order to minimise injury
  • Undertake more research into the effectiveness of skating instruction, including safe falling technique, as an injury prevention measure

SKATE TECHNOLOGY

Skate technology has improved rapidly over recent years. The technical innovations have focused greatly on increasing the speed of the skate and improving braking technology. It seems that the improvements in speed have out-performed the improvements in braking, making it challenging for the skater to stop.

The improvements in skate and wheel technology have resulted in a very fast skate, which requires a certain amount of skill to control. Many novice skaters are overwhelmed by the speed of the in-line wheels and are unable to slow down or stop in time to avoid collisions and/or falling. The in-line alignment of the wheels as well as the heel brake mechanism make it difficult for novice skaters to retain their balance, especially when turning or braking.

Recommendations:

  • Undertake ergonomic research to improve the skate braking mechanism to allow the skater to slow down and stop while keeping all wheels on the ground
  • Teach skaters to use their heel brakes, as well as alternative methods of stopping
  • Undertake more field and laboratory research to improve the effectiveness of each new braking system in preventing in-line skating injuries
  • Improve the fit of equipment (skates and protective gear) for young skaters

ENVIRONMENTAL FACTORS

The choice of an appropriate skating course is an important decision that skaters take prior to setting out to skate. Skating on a designated skate or cycling trail can help to reduce the risk of injury caused by interactions with motor vehicles and pedestrians. Matching the course difficulty to the skaters’ ability can ensure safer skating and a more enjoyable ride.

Recommendations:

  • Create and maintain areas free of traffic, crowds, debris and surface irregularities for the use of in-line skaters
  • Rate trails and areas used by skaters for degree of difficulty and clearly post rating at the start of each trail
  • Educate novice skaters to skate in areas free of traffic and crowds and to avoid hills until they have gained some skating experience
  • Encourage skaters to make themselves visible by either skating in daylight or wearing bright/reflective clothing if skating at night

POLICY AND REGULATION

Reckless skating and damage to public property (for example, steps and railings) has forced a few city councils (for example, Melbourne City Council and Stonnington City Council) to propose local by-laws which restrict skating in public spaces. Councils should consult with local skaters’ groups in order to develop an effective "skate management plan". Good skate management plans should include provision of safe skating venues, as well as incorporate educational campaigns to teach skaters a proper code of conduct.

Recommendations:

  • Local Councils should develop consistent "skate management plans" in consultation with local skater groups which includes a skater code of conduct, and safe skating facilities
  • Local Councils and skating venue managers should promote and enforce the wearing of protective equipment on Council property and at skating venues

Sponsoring Organisation: Sport and Recreation Victoria