Dr Mike Langran is the UK ‘s leading authority on snow sports injury and prevention. He is Director of the Scottish Snow Sports Safety Study, an executive committee member of the British Association of Ski Patrollers and both Board member and UK National Secretary of the International Society for Skiing Safety (ISSS).
Dr Langran is also a family doctor at the Aviemore Medical Practice, as well as Ski Patrol Doctor at CairnGorm Mountain in the Scottish Highlands. Dr Langran’s website www.ski-injury.com is the number one online resource for snow sports injury information.
Here Dr Langran shares his expertise on the issues surrounding wrist injuries during snowboarding.
There are an estimated 95,000 wrist fractures each year among snowboarders worldwide. Why are wrist fractures so common among recreational snowboarders?
“The main difference between snowboarding and skiing is that when you lose your balance on a snowboard, because both feet are fixed to the same board you cannot regain your balance easily by simply ‘stepping out’ one foot as you can on skis. This means that until you have mastered your balance on a snowboard, you are going to fall a lot. The natural instinct when you fall like this is to outstretch a hand to save yourself and unfortunately, if you impact onto a hard snow surface with any degree of force or speed then you risk breaking your wrist.”
Torjussen and Bahr (2006) found that elite snowboarders suffered fewer wrist injuries than recreational snowboarders. Do these findings correspond with what you see in Aviemore?
“Yes – following on from what I have just said, it makes sense that those boarders with the worst balance are the most likely to fall over, outstretch their hand to try and protect themselves and are therefore at a higher risk of a wrist injury. That’s not to say that elite boarders can’t and don’t break their wrists – the risk for them is more often related to the speed at which they are travelling and/or the height from which they fall.”
What can snowboarders do to reduce the risk of a wrist fracture?
“Two main pieces of advice:
- Learn to fall correctly.
This is very important from the outset, because beginners are at highest risk of injury. More and more snowboard schools are teaching this now which is good. - Wear a pair of recommended wrist guards.
We now know that the short stubby rigid guards that were originally designed for inline skating are not the best for snowboarders. About £30 will buy you a decent set of wrist guards – far cheaper than a helmet!”
How effective are wrist guards in the prevention of wrist fractures during snowboarding?
“There is now convincing evidence from both laboratory studies and (more importantly) direct comparisons between groups of boarders with and without guards to show that wearing the right kind of wrist guard does significantly reduce the risk of wrist injury. This has been reported from studies in America, Norway, France and New Zealand.
“The main problem is that (unlike helmets) there is no accepted international standard for snowboard wrist guards at present. Recent research has indicated that for snowboarding the ideal guard should be flexible, longer rather than shorter and should not be only on the palm side of the wrist. As I mentioned above, the most popular guard type at the moment are those designed for inline skating – whilst arguably better than no guard, personally, I recommend a specific snowboard guard system. There are two on the market both designed by doctors who treat snow sports injuries. These are the Flexmeter and Biomex systems.”
Some research evidence (Hagel et al 2005) has suggested that the use of wrist guards may increase the risk of injury further up the arm. Have you come across these injuries further up the arm and what are your thoughts on this?
“The July 15th 2005 issue of the American Journal of Epidemiology published this piece of research by Hagel and colleagues from Canada that you mention. They studied 19 ski areas to determine the protective effect of wrist guards on injury. They found that overall – wearing wrist guards reduced the risk of a hand, wrist or forearm injury by 85%. This was a statistically significant finding (i.e. it didn’t just happen by chance). They also found a non-significant finding of a possible increased risk of injury to the shoulder or upper arm as a consequence of wearing wrist guards. As it was statistically non-significant, this result may have occurred by chance. Even if it didn’t, it is still the case that a wrist fracture is generally a more severe injury than one affecting the shoulder or upper arm. Not surprisingly, this paper has been jumped on by the tiny minority who are not convinced of the value of wrist guards, but scientifically their finding of increased upper arm injuries is not significant whereas the 85% reduction in injury to the lower arm is.”
“My own experience and that of colleagues in the major ski centres throughout the world is that the right kind of wrist guard does effectively reduce the risk of a wrist injury. Of course, no guard can ever offer 100% protection, but their benefits far, far outweigh any potential risks of using them.”
References
B. Hagel, I. B. Pless, and C. Goulet
The Effect of Wrist Guard Use on Upper-Extremity Injuries in Snowboarders
Am. J. Epidemiol., July 15, 2005; 162(2): 149 – 156.
J Torjussen and R Bahr
Injuries among elite snowboarders (FIS Snowboard World Cup).
Br. J. Sports Med., March 1, 2006; 40(3): 230 – 234.