By: David A Fein, MD
It’s one of those perfect days on skis. There’s 6 inches of fresh powder and not a cloud in the ski. You have been making fresh tracks all morning. But the runs are starting to get tracked out by the other skiers. So this run you head over to the side of the trail to find some untouched powder. It’s a great run- until your ski catches a branch hidden under the snow. Your ski pops off and you fly through the air. As you see the rock you are headed towards you have just enough time for one thought- “maybe I should have worn a helmet!” Then everything goes black.
It’s a debate you hear frequently on the lift lines. On one side are the helmet fanatics who insist that helmets save lives and it is crazy to ski or ride without one. On the other side are the skeptics who say that helmets make skiing or riding more dangerous by limiting your vision and hearing and making you take bigger risks. A study published this month may help to settle the debate.
The skeptic’s argument has had some evidence to back it up. An article published in the New York Times in December, 2013, noted that “although skiers and snowboarders in the United States are wearing helmets more than ever — 70 percent of all participants, nearly triple the number from 2003 — there has been no reduction in the number of snow-sports-related fatalities or brain injuries in the country, according to the National Ski Areas Association.”
A 2012 study at the Western Michigan University School of Medicine on head injuries among skiers and snowboarders in the United States found that the number of head injuries increased 60 percent in a seven-year period, from 2004 to 2010, even as helmet use increased by an almost identical percentage over the same period.
One concern has been that wearing a helmet imparts a false sense of security leading skiers and riders to take bigger risks. The majority of snow-sport fatalities occur in males in their teens to late 30’s. This is the same population that tends to engage in high-risk behaviors in general. The ski industry has embraced this tendency in recent year building every bigger features in their terrain parks and providing access to every more extreme terrain. Skiing and riding equipment advances have also made it easier to perform more dangerous tricks and to ski faster.
However, a medical literature review, published in November, 2012, concluded that helmets do not appear to increase high risk behavior among skiers and snowboarders. The study also concluded that helmets did not significantly impair hearing or vision and there was no increase in neck or cervical injuries associated with wearing a helmet.
Other studies have shown that helmets do appear to reduce the numbers of less serious head injuries. Scalp lacerations are cut by 30 percent to 50 percent. It has been more difficult to prove helmets protect against more serious head injuries, a classification that includes concussion, skull fracture, closed head injury, traumatic brain injury and death by head injury. Possibly due to a rotational component to the injuries that happen in actual use.
When your head hits an object there is more than one collision. Assume you are skiing at 20 mph when your ski pops off and your head crashes into a rock. On impact, your head comes to a sudden stop. But your brain is still moving at 20 mph until it crashes into the inside of your skull. That is when the real damage to your brain occurs. As the shockwave ripples through your brain, delicate nerve fibers and blood vessels are ripped apart. The loss of nerve connections kills brain cells while the bleeding and ensuing swelling does even more damage.
Wearing a helmet may help to reduce some of the trauma that occurs by cushioning the blow to your skull so it has not yet come to a full stop at the point when your brain and skull collide. But your brain is still going to twist and rattle around inside your head in the milliseconds after the impact. So it is unlikely that any helmet that is light enough and small enough for anyone to be willing to wear it is going to completely protect against all brain trauma.
But preventing all brain injury may not be the right goal. A study published this month in the Journal of Pediatric Surgery found that helmet use among pediatric skiers and boarders in Colorado was associated with a significant decrease in the severity of brain injuries. Wearing a helmet may convert a potentially fatal head injury to a survivable one. In collisions that would not be fatal but could still cause life-altering brain damage, the extent of neurologic damage appears to be substantially decreased in those who are wearing a helmet at the time of the accident. So, it is correct that helmets don’t reduce the overall number of neurologic ski injuries. But they do reduce the severity.
Injuries happen without warning. You may think you don’t have to worry if you don’t do tricks in the terrain park. Your children may tell you, as one of mine once did, that they don’t need a helmet because they “have never hit a tree before”. You may just be standing on the snow answering a text when an out of control skier plows into you. At this point, the evidence appears to be growing that wearing a helmet will reduce the severity of the brain damage that may occur if an accident happens. Tell your children to wear their helmets and then put on yours, too.