A Review of Countermeasures for Snowboarding Injuries

Monash University Accident Research Centre - Report #94 - 1996

Authors: H. Kelsall & C. Finch

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Abstract:

Snowboarding is quickly becoming a popular sport at alpine resorts. In contrast to alpine siding, where injuries to the knee and thumb are most common, the wrist (and forearm) and ankle are the most frequently injured body regions for snowboarders. General guidelines for snowboarding safety are available and are similar to the recommendations for general snow/ski safety. Unfortunately, the rapid international growth of the sport has not been matched by detailed epidemiological evaluation of the injuries specific to snowboarding or the countermeasures to prevent them. The aim of this report is to critically review the literature describing injury prevention measures, or countermeasures, for snowboarding. In doing so, it provides an evaluation of the extent to which these countermeasures have been demonstrated to be effective. Few countermeasures specific for snowboarding were found to have been formally demonstrated to actually prevent injury. The countermeasures to which some attention has been paid are boots, bindings, wrist guards, skill level and methods of failing. Skill level and the other injury countermeasures apply more generally across the sport. Recommendations for countermeasure implementation include: education for snowboarders, adherence to snow conduct and safety codes, preparing snowboarders for their activity and maintenance of parks and runs. Recommendations for improved data collections include: maintaining existing data collections, collecting information about equipment used by snowboarders. Further biomechanical and epidemiological research needs to be undertaken on knee/ankle and wrist/forearm injuries. Evaluation of countermeasures needs to keep pace with the rapid developments in this field. Particular attention should be directed towards evaluations of the role of wristguards, boots/bindings, fall technique and lessons in preventing injuries. Given the rapidly increasing popularity of the sport, the need for the safety equipment to be evaluated would seem to be a priority, along with identifying the mechanisms of injury.

Executive Summary

Snowboarding is quickly becoming a popular sport in many alpine resorts. Some information about snowboarding injuries is becoming available (eg from the Australian Snowboarding Injury Database) and these data collections are valuable resources for injury prevention research. The Australian Snowboard Injury Database study has reported an injury rate of 4.2 per 1 000 visits at 3 major Australian ski resorts. This rate is comparable to the rates of 4-6 per 1000 visits reported by international studies and also to that of alpine skiing. There appears to be a predominance of males aged around 20 years and novices amongst injured snowboarders.

In contrast to alpine skiing, where injuries to the knee and thumb are most common, the wrist (and forearm) and ankle are the most frequently injured body regions for snowboarders. In Australia, the majority (57%) of injuries are to the lower limbs and followed by the upper limbs (30%). In some international studies, the opposite has been noted. Other studies have shown an increasing, or relatively larger proportion, of upper extremity injuries to snowboarders. The most common types of injuries in snowboarding are sprains (3153%), fractures (24-27%) and contusions (12-19%).

The technology of snowboarding equipment has progressed rapidly and snowboarders, like skiers, have a choice in equipment design. Changes in equipment are rapid and occur as frequently as from season to season. Ankle injuries are more common amongst snowboarders wearing soft shell boots; these soft boots are typically worn by intermediate and advanced riders. Knee injuries and distal tibial fractures, on the other hand, are more common in snowboarders wearing hard shell boots, the type of boot favoured by novices. Falls, often with a torsional movement component, are the most common mechanism of injury.

General guidelines for snowboarding safety are available and are similar to the recommendations for general snow/ski safety. Unfortunately, the rapid international growth of the sport has not been matched by a detailed epidemiological evaluation of the injuries specific to snowboarding. Furthermore, demonstrating the effectiveness of injury prevention countermeasures specifically for snowboarding has not kept pace with the popularity of the sport.

The overall aim of this report is to critically review the literature describing injury prevention measures, or countermeasures, for snowboarding. In doing so, it provides an evaluation of the extent to which these countermeasures have been demonstrated to be effective.

The countermeasures to which some attention has been paid are boots, bindings, wrist guards, skill level and methods of failing. Boots and bindings are particularly relevant to lower limb injuries and wrist guards (and failing techniques) to wrist fractures, sprains and other upper limb injuries. Skill level and the other injury countermeasures apply more generally across the sport.

A limited number of studies have evaluated the effectiveness of countermeasures for preventing snowboarding injuries. Support for these countermeasures is generally in the form of anecdotal or informed opinion. Other studies have concluded that a particular countermeasure would be effective on the basis of an examination of injury trend or epidemiological data only. Neither of these types of 'evidence' can be considered to be a formal or controlled evaluation of the efficacy of the proposed countermeasures. For example, the large frequency of wrist fractures/sprains amongst snowboarders has prompted the recommendation that wristguards be worn. There has yet to be any evaluation of the effectiveness of wristguards for preventing these snowboarding injuries, however, and their use may increase the potential for injuries higher up the arm.

Based on the literature review presented in this report, the following recommendations can be for further research, development and implementation of countermeasures to reduce the occurrence and severity of snowboarding injuries:

Wristguards

• Conduct further epidemiological and biomechanical research into the mechanisms of snowboarding injury.
• Further detailed study of the nature and severity of snowboarding injuries is warranted with particular attention to wrist and forearm injuries. This information has the most potential for influencing the rate of injury, through improved equipment design and new countermeasure development.
• Determine the current levels of protective equipment usage by snowboarders, particularly wristguards. This could be achieved by observational surveys.
• Determine current attitudes about, and barriers to, the use of wristguards in a cross-section of snowboarders.
• The effectiveness of wristguards for preventing wrist injuries needs to be evaluated as a matter of priority. This type of protective equipment is widely promoted. Its potential to increase fractures and other injuries further up the forearm, arm and shoulder needs to be examined in any evaluation. There may be other unwanted effects of wristguards that should also be explored.

Fall technique

• Conduct further epidemiological and biomechanical research into the mechanisms of snowboarding injury.
• The role of specific snowboarder training and lessons (particularly with regard to failing technique) should be explored.
• Determine the extent to which snowboarders undertake specific lessons in snowboarding and failing techniques before they participate in the sport.
• Develop education programs or lessons to teach snowboarders about correct falling and snowboarding techniques.
• Boots and bindings
• Further detailed study of the nature and severity of snowboarding injuries is warranted with particular attention to knee and ankle injuries. This information has the most potential for influencing the rate of injury, through improved equipment design and new countermeasure development.
• Conduct further epidemiological and biomechanical research into the mechanisms of snowboarding injury.
• The effects of different types of equipment design (particularly the boots and bindings) on snowboarding injuries need to be fully evaluated in a controlled way. This also needs to keep pace with the rapid development of new snowboarding equipment, with new equipment being demonstrated to be 'safe'.
• The relative risks of injuries should be determined overall for those snowboarders wearing boots of varying stiffness in future studies, not only among injured snowboarders.
• Develop a Standard for snowboarding equipment that will 'guide' future design directions.
• Encourage snowboarders to maintain their equipment in good order.
• Ensure that rental equipment is properly fitted and adjusted by means of an accreditation scheme for hirers.

Speed control

• Conduct further epidemiological and biomechanical research into the mechanisms of snowboarding injury. Both approaches should be explored to provide information to guide countermeasure development.
• Ensure that snowboarders are well aware of, and adhere to, general snow conduct and safety codes.

Separation of snowboarders and skiers

• Continue to give high priority to the design and maintenance of snowboard parks and runs.
• Conduct further epidemiological and biomechanical research into the mechanisms of snowboarding injury.

Other countermeasures

• Conduct further epidemiological and biomechanical research into the mechanisms of snowboarding injury. Both approaches should be explored to provide information to guide countermeasure development.
• The effects of different types of equipment design on snowboarding injuries need to be fully evaluated in a controlled way. This also needs to keep pace with the rapid development of new snowboarding equipment, with new equipment being demonstrated to be 'safe'.
• Develop an education program to inform snowboarders about the need to be well prepared for snowboarding.
• Ensure that young snowboarders are fully supervised.
• Ensure that injured snowboarders receive adequate treatment and rehabilitation of injuries before resumption of snowboarding.
• Continue to promote the presence of ski patrollers as a major feature of snow safety programs.

Improved data collections

• Establish a 'snowboarder' category of 'resort user' as an integral component of routine alpine injury data collections (eg Ski Patrol Injury Report forms).
• Data collections should collect information about specific equipment used by the injured snowboarders (eg type of boots) and the injury countermeasures leg wristguards used).
• Injury data collections should routinely collect information about the mechanisms of snowboarding injury.
• Maintain ongoing injury surveillance in relation to snowboarding injuries. In Australia, the Australian Snowboard Injury Database should be maintained. Given the rapid pace at which new snowboarding equipment is introduced, the maintenance of ongoing injury surveillance is crucial.
• Where possible, data collection should conform to the requirements of injury surveillance standards and/or minimum data sets (eg the National Data Standards for Injury Surveillance). As sports injury versions are developed, the data should conform with these.

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