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Neurology Now:
doi: 10.1097/01.NNN.0000444219.88340.3b
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Quick Tips: Avoid Traumatic Brain Injury While Playing Winter Sports

Stephens, Stephanie

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Last year, U.S. ski areas counted almost 57 million visits. But winter sports such as skiing, snowboarding, sledding, snowmobiling, and ice hockey can put people at increased risk of traumatic brain injury (TBI), which occurs when a sudden trauma causes damage to the brain. Winter sports included, more than 1 million young and adult U.S. athletes in all sports sustain a TBI each year.

A 2013 study from Norway found that TBI was the leading cause of death for competitive skiers and snowboarders. In the study, 245 head or face injuries were reported during seven seasons; of those, nervous system injuries or concussions were the most common (81.6 percent) and 58 of these nervous system injuries or concussions were severe (23.7 percent). Freestyle skiers—those who do jumps and ski on hills—had the highest rate of TBI. The study also found that more women than men incur TBI while skiing.

The numbers don't have to be so high, says Jeffrey Kutcher, M.D., associate professor of neurology at the University of Michigan Medical School, director of the University of Michigan NeuroSport program, and member of the American Academy of Neurology (AAN). He is also the Team Neurologist for the 2014 U.S. Olympic Team, providing neurological coverage for all the Olympians, and the first neurologist to have this role.

“There are things people can do to prevent injury. The most important protection comes from participants' behavior,” says Dr. Kutcher, who was also the lead author of the AAN's sports concussion guideline. (To read the guideline, and to access the AAN's Concussion Quick Check mobile app and toolkit, go to aan.com/concussion.) Dr. Kutcher offers the following recommendations while participating in winter sports:

  • ▸ Be aware of your surroundings. This is critical to ensuring that you and others around you are safe, according to Dr. Kutcher. For example, stay on marked ski or snowboard trails, and don't attempt trails that are beyond your level of skill. The National Ski Areas Association's Responsibility Code advises: “Always stay in control, and be able to stop or avoid other people or objects.”
  • ▸ Focus on technique. This is true for team sports as well, such as ice hockey. “Focusing on safe playing techniques and on what's happening around you are critically important,” says Dr. Kutcher. A University of Utah Ski Injury Data Analysis from 2010 cited the importance of skiing and snowboarding technique as an injury reduction strategy. Instructors can also educate beginners on the importance of a good warm-up and cool-down, properly fitted equipment, and safe skiing techniques, says the public outreach program Stop Sports Injuries.
  • ▸ Dr. Kutcher applauds ice hockey coaches who enforce no hits to the head or other dangerous plays. Toward that objective, in April the National Federation of State High School Associations Ice Hockey Rules Committee approved changes that will strengthen the language for dangerous hits as well as give game officials discretion for issuing a game disqualification when a player illegally hits another player from behind.
  • ▸ Wear a helmet. No piece of approved, properly fitted and maintained equipment (or well-learned sports technique) can completely eliminate the possibility of concussion, says Dr. Kutcher. “Still, you must wear a helmet for any type of snow sport.” When tempted to try tricks you may have seen on TV, understand that helmets can instill a false sense of security and are most effective at speeds under 14 mph.
  • ▸ Know the signs of TBI. If you hit your head, you might not notice symptoms immediately, Dr. Kutcher warns. “If possible, continue to observe yourself—or have a friend or family member do it—to determine whether your symptoms become clinically worse. For example, if you get sleepier as time passes, you could become unconscious.” Dr. Kutcher says worrisome signs and symptoms include:
    • Headache and sensitivity to light and sound.
    • Nausea and vomiting.
    • Changes in reaction time, balance, and coordination.
    • Changes in memory, judgment, speech, and sleep.
    • Loss of consciousness, which happens in less than 10 percent of cases.

If you experience any of these symptoms, consult a health care professional trained to identify concussions.

For more Neurology Now coverage of traumatic brain injury, go to bit.ly/1hjZ9SK.

Stephanie Stephens

© 2014 American Academy of Neurology

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