Another ISSS meeting behind us

Well that's me just home from ISSS 2009, the main snow sports research meeting that I attend every 2 years - this time held in beautiful Garmisch-Partenkirschen. It didn't get off to a great start with my family's travel plans disrupted by an outbreak of chickenpox - so we had to head home and I travelled out without the rest of my family. All credit to my long suffering wife Jayne for allowing me to go whilst she had sleepless nights back home with our poor spotty son!

The meeting was as ever a great mix of cutting edge research and much needed socialising. ISSS meetings are reknowned for their friendly and inclusive nature and this one was no different. You can read my summary of the research presented by following the link above - good to see so much work underway to keep you and I safe on the slopes. The latest data on injuries amongst elite skiers and snowboarders from the FIS injury surveillance system though is scary - 1 in 3 athletes sustaining an injury every season and many of these serious. The FIS is looking for quick solutions and this might not be easy to achieve.

ForJo Public there is still plenty afoot - electronic bindings for skis, a new release binding concept for snowboarding and moves to make helmets even better than they are now. I am still digesting a lot of the work that was presented and will be updating all the relevant pages of my website in due course.

Wishing our colleagues and friends in the southern hemisphere a great ski season - stay safe on snow

Mike

Helmets 2 - a tragic death

The tragic death of Natasha Richardson this week once again highlighted the fact that no outdoor activity is without risk. The fact that she died from a head injury and was not wearing a helmet reignited the debate about helmets on the slopes - in particular whether their use should be made mandatory. From what we know about her accident (and I fully acknowledge that we do not know the full facts) it would appear that she was extremely unlucky. What seems to have been a fairly innocuous fall onto soft snow on a beginner slope initially left her feeling ok, but within an hour or so her condition had deteriorated and she died from an intra-cerebral bleed. My sincerest sympathies to Liam Neeson, their children and all her family and friends.

The world's media descended en mass - all wanting to speak about how dangerous skiing is and why shouldn't everyone wear a helmet? My opinion on this remains as stated on my website - that I would strongly encourage - but not force - everyone to wear a helmet. I do not think though that they need to made mandatory. The rest of my opinions you can find on my site, I won't bore you with them here.

In about a month's time, I will be heading to Garmisch in Germany for ISSS 2009 - it will be interesting to hear what new information is available on helmets. At the last meeting here in Scotland, my friend Irv Scher continued to produce fantastic research on helmets and I am hoping for more of the same. I will post it up as soon as I can. In the meantime, helmet sales seem to have suddenly shot up, Scotland is braced for more snow this week coming and I am off to the Isle of Lewis for a family holiday.

Stay safe on snow- Mike

Busy times.......

Wow!! Scottish ski areas have just enjoyed that unusual combination of perfect powder snow, light winds, good weather and school holidays! The snowfall was truly amazing; 2-3 feet of beautiful powder falling at a time giving the ski resorts fantastic conditions. Unfortunately, in some ways the snow was too good as resort and road infrastructures struggled to cope at times. From a ski patrol point of view, although we were seeing 2500-4000 skiers per day on the slopes, the overall number of injuries was quite low - mainly because a lot of falls were into soft, fluffy, forgiving snow. I am sure that we are also seeing the benefit locally of all snowboarders taking hire gear from the ski area being offered free use of Flexmeter wrist guards. To date, we haven't seen anything like the number of wrist injuries from snowboarding that we would normally expect - I will have to wait until the end of the season to assess this statistically, but I am sure that we will see a marked benefit.

Our health centre is now electronically linked to the x-ray system of our local hospital (indeed the whole of Scotland) and this makes it so much easier for me to follow up those casualties who are sent straight to hospital in Inverness. A good example was a wee lass of 14 who the patrol thought had injured her femur - I was able to look up her x-rays and yes, indeed she did sustain a supracondylar fracture of her femur. This sort of feedback is essential for the ski patrol team so they can see if their reasoning was correct and they implemented the correct treatment proctocols.

Now the snow has begun to melt, I am off for a week's holiday to the Canaries with my family for some much needed R+R. I hope that we come back to another great dump of snow and some more fantastic skiiing. Scotland has so mcuh to offer and I hope that wherever you are planning to ski, the conditions are excellent too. Above all though, stay safe on snow.

Mike

Snow, snow and more snow....

Mid February, school holidays looming and for once all five Scottish ski areas are plastered with snow. Those of you from the UK will be aware that Scotland has been in the grip of cold weather for the last week or so now. Between 2-4 foot of snow fell last Thursday and Friday alone followed by very cold conditions (it was -19 degrees C in Aviemore last night). Cairngorm, my local ski area, has superb pisted powder snow - point your skis in any direction stuff - just perfect. Not surprisingly, the ski area has been mobbed - car parks full to capacity by early morning, access roads jammed but also lots and lots of happy skiers and boarders. I'm pleased to say from the medical side that we have not been overwhelmed with lots of injuries so far, although for some reason we have seen quite a few pelvic injuries so far this year. Mainly pubic rami injuries from impacts with rocks - which given the generally great snow cover is a surprise and the individuals concerned have been pretty unlucky. This weekend coming promises to be one of the busiest for a long time as most English schools start their holidays and the credit crunch/strong Euro make it more likely that UK skiers will head to Scotland. If you are heading up, and can get up in time to access the slopes, then you are in for a real treat as the overhead conditions are forecast to continue to be cold but sunny with further snow showers. Just remember that Scotland is not Europe, be prepared for all weathers and - as ever - stay safe on snow.

Mike

Helmets - a heads up

As the winter season continues, the (sadly inevitable) new of deaths on the slopes have begun to be reported. With an overall risk of 1 death per 1.85 million visits or so, the USA usually sees about 35 traumatic deaths per season. Just recently, a couple of the incidents in Europe have involved politicians, and rightly or wrongly any issue always seems to attain more importance when "important" people are involved. A recent incident in Austria is a case in point where two skiers collided - one being a mother of four and the other a German politician. The latter was wearing a helmet and survived (albeit wiht serious injuries) whereas the mother who was not wearing a helmet died. Full story here. It is reported in the story that the guy only survived because he was wearing a helmet and a subsequent poll of Austrians has suggested that almost 50% support a law mandating the wearing of helmets.

Let me say right away that I support the use of helmets and I wear one myself - I've never (touch wood) had a serious accident but there is no doubt that it has saved me from many minor/moderate impacts over the years. I wish I could say with absoluyte confidence that it would also save me if/when I do have a big impact. Unfortunately, the evidence would still seem to suggest otherwise. Cleverer people than myself (engineers and fellow epidemiologists) have done fairly conclusive work to demonstrate that that - in general - wearing a helmet does not make you invincible. If you hit a solid object at the average speed of an intermediate skier (about 22mph or so), no currently available helmet it seems will be able to mitigate against disaster. And yet we also find that those who wear helmets are more likely to ski or board fast, take risks and indeed be injured in general. Implying that wearers may get a false sense of security from the fact they have their lid on. Helmet use has increased amongst the general snow sports population from about 5-10% a few years ago to 30-40% more recently. And yet we have not seen a concordant reduction in the relative number of deaths on the slopes as one might expect.

You also have to remember in addition that the absolute risk of a serious head injury as a result of recreational snow sports is really very low. Personally, I recommend wearing a helmet at all ages because there are few if any downsides - those that are frequently touted (may injure the neck, impair hearing etc etc) have all been shown to be myths. My children will wear a helmet in years to come, my colleagues on the ski patrol wear a helmet, my friends wear a helmet - but i still don't think it should be made compulsory for all. Others disagree and indeed we may see some countries in Europe pass laws on this soon - Italy and Austria seem to be prime candidates. I won't be shouting loudly against them, but I sadly suspect in time we won't see a reduction in the death rates on the slopes. Skiing and boarding within the limits of one's ability level are still the best way to protect yourself and those around you.

Stay Safe on that Snow

Mike

We're on again

Start of a new work week and we now have skiable snow at most of the Scottish resorts, including CairnGorm - my local area. People are asking me what's new for this season and, if you've had a look at www.ski-injury.com there are really two things that stand out for me. Firstly, the commercial release of the Knee Binding, and secondly the focus being increasingly placed on wrist injury prevention for snowboarders. The Knee Binding is explained in full on my website, with links to the manufacturer's site as well. I know that opinions on these sort of developments will always be mixed, but let's hope it does make a positive contribution. A major problem will be actually analysing its effect - the only way to really do so is to conduct a randomised controlled trial where you take two (large) groups of skiers - similar to each other in all respects (age, gender, size, ability etc etc) except that one group skis using the Knee Binding and the other group uses standard bindings and then see if there is any difference in ACL injury rates at the end of the study. This is a huge study to undertake. Not impossible by any means, but it would need alot of funding and organisation. Without it though, I fear that we will be left with anecdotal evidence from individual skiers' experiences which is never that easy to analyse.

With regard to wrist guards, we do already have alot of information and this season the ski patrol injury forms for Scotland have been modified so that we can look at this closer. We will be documenting the exact type of wrist guard worn by both injured and uninjured boarders and doing a comparision. I also hope to redo the snowboarding study that i first completed in 2004 looking at attitudes to wrist guards, helmets and risk taking in general amongst this group. The original results caused a bit of a stir and it will be interesting to see what if anything has changed in the last 5 years. A medical student colleague of mine will be doing the same work in New Zealand and we'll see if there are any big differences between boarders in the two countries.

So, hope you get enough snow for a Christmas slide yourselves and remember - stay safe on snow.

Forms, forms, forms....

Early October now and we've already had the first snows on the Cairngorm Mountains. I love this time of year as the nights draw in, the leaves turn and the frosts arrive. Not long til winter. The downside is that this is the time of year when I have to shake the dust off the injury forms that we use at the 5 ski areas in Scotland and update them if necessary. Usually, this doesn't take too much effort, but this year I have decided to re-do several sections - the one relating to wrist guards in particular. This used to be a standard - guards worn - Yes/No, but its not as simple as that now. There are so many guards on the market - short ones, long ones, ones you wear on the palm side, others on the backside, guards in the gloves, guards out the gloves etc etc... you get the picture. And thanks to excellent work by my French friends in Medicins de Montagne, we now know that certain guards are better than others, whilst some guards can actually cause injuries. So its important to know exactly what type of guard snowboarders are wearing and the form has been redesigned to allow us to do this - more questions for the ski patrol to ask, I'm afraid, but it is an important point.

Also, thanks to a generous donation from the Catherine Smith Memorial Trust fund (via Tim Walker of Glenmore Lodge), I have been able to print 10,000 colour snow sports education brochures that will be distributed between the ski areas and some ski shops this winter. Always difficult to strike a balance between getting the messages across without bombarding people with too much information, but I hope I got the balance right on this one. You can let me know if you see one of them.

Stay safe on snow.