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Head injury mechanisms in FIS World Cup alpine and freestyle skiers and snowboarders
  1. Sophie Elspeth Steenstrup1,
  2. Arnhild Bakken1,
  3. Tone Bere2,
  4. Declan Alexander Patton1,3,
  5. Roald Bahr1
  1. 1Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  2. 2Orthopaedic Department, Oslo University Hospital Ullevaal, Oslo, Norway
  3. 3Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
  1. Correspondence to Sophie Elspeth Steenstrup, Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, 0863 Oslo, Norway; s.e.steenstrup{at}


Introduction Head injuries represent a concern in skiing and snowboarding, with traumatic brain injuries being the most common cause of death.

Aim To describe the mechanisms of head and face injuries among World Cup alpine and freestyle skiers and snowboarders.

Methods We performed a qualitative analysis of videos obtained of head and face injuries reported through the International Ski Federation Injury Surveillance System during 10 World Cup seasons (2006–2016). We analysed 57 head impact injury videos (alpine n=29, snowboard n=13, freestyle n=15), first independently and subsequently in a consensus meeting.

Results During the crash sequence, most athletes (84%) impacted the snow with the skis or board first, followed by the upper or lower extremities, buttocks/pelvis, back and, finally, the head. Alpine skiers had sideways (45%) and backwards pitching falls (35%), with impacts to the rear (38%) and side (35%) of the helmet. Freestyle skiers and snowboarders had backwards pitching falls (snowboard 77%, freestyle 53%), mainly with impacts to the rear of the helmet (snowboard 69%, freestyle 40%). There were three helmet ejections among alpine skiers (10% of cases), and 41% of alpine skiing injuries occurred due to inappropriate gate contact prior to falling. Athletes had one (47%) or two (28%) head impacts, and the first impact was the most severe (71%). Head impacts were mainly on snow (83%) on a downward slope (63%).

Conclusion This study has identified several characteristics of the mechanisms of head injuries, which may be addressed to reduce risk.

  • alpine skiing
  • freestyle skiing
  • snowboarding
  • helmet
  • head

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  • Contributors All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be submitted.

  • Funding The Oslo Sports Trauma Research Center has been established at the Norwegian School of Sport Sciences through generous grants from the Royal Norwegian Ministry of Culture, the South-Eastern Norway Regional Health Authority, the International Olympic Committee, the Norwegian Olympic and Paralympic Committee and Confederation of Sport, and Norsk Tipping AS. The FIS Injury Surveillance System is supported by the International Ski Federation and was established through a generous grant from DJO.

  • Competing interests None declared.

  • Ethics approval The study was reviewed by the Regional Committee for Medical Research Ethics, South-Eastern Norway Regional Health Authority, Norway.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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