Posted by: Chris Maloney | January 23, 2012

Helmets for Skiers and Snowboarders? Good Thing or Death Traps?

A typical ski helmet (left) and paragliding helmet

Image via Wikipedia

Sorry for the headline, but every time we see someone die in a ski accident, he or she seems to be wearing a helmet.  At some point one wonders:  did the helmet cause it?

Here in Maine helmets for skiers is a big deal and somewhat controversial.  It’s usually the snowboarders we see cruising down the slopes helmetless.  (Snowboarders have a greater risk of injury than skiers).  They don’t seem to need helmets, and love the feeling of the wind blowing through their icy hair.

What are the facts?  Is there a case for making helmets mandatory?

First, when you make helmets mandatory, you’d better make them mandatory for everyone.  When the Austrians made helmets mandatory for the under fifteen set, there was no real change for the under 15ers (most of them were wearing helmets anyway).  But helmet use DROPPED among the over 15s.  Guess it got cooler to not wear a helmet.  “Hey look, I’m sixteen and I don’t need a helmet!”  So it’s an all or nothing thing.

But do helmets work?  Yes, they reduce severe head injuries by about fifty percent.  To put it differently, out of 3277 injured skiers, 147 had potentially serious head injuries.  Those that did were better off with helmets.  In real terms, wearing a helmet reduces your risk of bad head injuries from about 5% to about 2.5% if you are injured.

What about cervical injuries because of the helmets?  A small study found no increase in risk of cervical problems or any change in collisions for the helmets vs. non-helmets crowd.  What they did find was the 50% reduction in serious injury for the helmeted.

A small study?  I want a meta-analysis!  You’ve got one.  The results?  Slightly less than 50% risk of serious injury overall for the helmeted crowd.  No increased risk in cervical injury from the helmets and possibly a lower risk of cervical injury.

Summary:  helmets good.

But don’t believe me, here are the studies:

JAMA. 2006 Feb 22;295(8):919-24.

Helmet use and risk of head injuries in alpine skiers and snowboarders.

Sulheim S, Holme I, Ekeland A, Bahr R.


Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.



Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is no policy of mandatory helmet use for recreational alpine skiers and snowboarders.


To determine the effect of wearing a helmet on the risk of head injury among skiers and snowboarders while correcting for other potential risk factors.


Case-control study at 8 major Norwegian alpine resorts during the 2002 winter season, involving 3277 injured skiers and snowboarders reported by the ski patrol and 2992 noninjured controls who were interviewed on Wednesdays and Saturdays. The controls comprised every 10th person entering the bottom main ski lift at each resort during peak hours. The number of participants interviewed corresponded with each resort’s anticipated injury count based on earlier years.


Injury type, helmet use, and other risk factors (age, sex, nationality, skill level, equipment used, ski school attendance, rented or own equipment) were recorded. A multivariate logistic regression analysis was used to assess the relationship between individual risk factors (including helmet wear) and risk of head injury by comparing skiers with head injuries with uninjured controls, as well as to skiers with injuries other than head injuries.


Head injuries accounted for 578 injuries (17.6%). Using a helmet was associated with a 60% reduction in the risk for head injury (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.55; adjusted for other risk factors) when comparing skiers with head injuries with uninjured controls. The effect was slightly reduced (OR, 0.45; 95% CI, 0.34-0.59) when skiers with other injuries were used as controls. For the 147 potentially severe head injuries, those who were referred to an emergency physician or for hospital treatment, the adjusted OR was 0.43 (95% CI, 0.25-0.77). The risk for head injury was higher among snowboarders than for alpine skiers (adjusted OR, 1.53; 95% CI, 1.22-1.91).


Wearing a helmet is associated with reduced risk of head injury among snowboarders and alpine skiers.

PMID: 16493105

J Trauma. 2011 Oct;71(4):1085-7.

Impact of a ski helmet mandatory on helmet use on Austrian ski slopes.

Ruedl G, Brunner F, Kopp M, Burtscher M.


Department of Sport Science, University of Innsbruck, Innsbruck, Austria. gerhard



A helmet mandatory for people younger than 16 years was implemented in most Austrian provinces in the winter season 2009/2010. The objective of this study was to evaluate the impact of a ski helmet mandatory on age-dependent helmet use.


We compared helmet use in people aged 15 years or less and older than 15 years of Austrian provinces with and without helmet mandatory between the 2008/2009 (n=16,342) and 2009/2010 (n=32,011) winter seasons.


Helmet use in people aged 15 years or less in the 2009/2010 season increased by 16.2% in provinces with helmet mandatory and decreased by 2.1% in provinces without helmet mandatory (all p<0.001), respectively. However, provinces with and without helmet mandatory did not differ regarding mean helmet use in people aged 15 years or less (92.2% vs. 92.8%, p=0.506) in the 2009/2010 season. Helmet use in people older than 15 years in the 2009/2010 season had increased by 11.7% in provinces with helmet mandatory and by 17.9% in provinces without helmet mandatory (all p<0.001), respectively. Helmet use in people older than 15 years was lower in provinces with helmet mandatory compared with provinces without mandatory (63.1% vs. 68.1%, p<0.001) in the 2009/2010 season.


A helmet mandatory for people aged 15 years or less may increase helmet use in involved age groups when helmet use is relatively low. However, public discussions and preventive helmet campaigns based on sound theories of health behavior change may also induce increases in helmet use in skiers aged older than 15 years without helmet mandatory.

PMID: 21986749

Inj Prev. 2002 Dec;8(4):324-7.

Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders.

Macnab AJ, Smith T, Gagnon FA, Macnab M.


Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.



To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders.


During one ski season (1998-99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets.


Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible.


This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment.

PMID: 12460972


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