White Paper: functionality and efficacy of wrist protectors in snowboarding—towards a harmonized international standard

Frank I. Michel 0 1 2 3 4 5 6 Kai-Uwe Schmitt 0 1 2 3 4 5 6 Richard M. Greenwald 0 1 2 3 4 5 6 Kelly Russell 0 1 2 3 4 5 6 Frank I. Simpson 0 1 2 3 4 5 6 David Schulz 0 1 2 3 4 5 6 Mike Langran 0 1 2 3 4 5 6 0 K.-U. Schmitt AGU, Zurich, Switzerland 1 K.-U. Schmitt Institute for Biomedical Engineering, University and ETH Zurich , Zurich, Switzerland 2 F. I. Michel (&) Sports Division, Research Department , bfu - Swiss Council for Accident Prevention, Hodlerstrasse 5a, 3011 Berne, Switzerland 3 M. Langran Aviemore Medical Practice , Aviemore, Scotland, UK 4 D. Schulz Office for Sports Injury Analysis, ARAG Sports Insurance, Dusseldorf, Germany 5 K. Russell Departments of Pediatrics and Community Health Sciences, University of Manitoba , Winnipeg, Canada 6 R. M. Greenwald F. I. Simpson Simbex, Lebanon, NH, USA The wrist is the most frequently injured body region among snowboarders. Studies have shown that the risk of sustaining a wrist injury can be reduced by wearing wrist protection. Currently, there are a wide variety of wrist protection products for snowboarding on the market that offer a range of protective features. However, there are no minimum performance standards for snowboarding wrist protectors worldwide. The International Society for Skiing Safety convened a task force to develop a White Paper to evaluate the importance and necessity of a minimum performance for all wrist protectors used in snowboarding. The White Paper outlines the need for a general framework for a harmonized international standard and reviews the existing evidence. Therefore, this White Paper may serve as a common base for future discussions. The broader goal of developing and implementing such a standard is to reduce the incidence and the severity of wrist injuries in snowboarding without increasing the risk of adverse events, such as upper arm or shoulder injury. The European standard for inline skating wrist protectors (EN 14120) can serve as a starting point for efforts related to a standard for snowboard wrist protectors, but certain modifications to the standard would be required. It is hypothesized that implementation of a snowboarding wrist protector standard would result in fewer and less severe wrist injuries in the sport and could translate into more riding days for healthy snowboarders and significant health-care costs savings. 1 Introduction, objectives and method 1.1 Introduction Snowboarding is relatively new compared with alpine skiing. The origin of snowboarding lies in surfing and skiing [1]. Anecdotes tell of early experiments with a stand-up sled in the 1920s in Europe [2]. The first commercial snowboard was launched in 1965, when Sherman Poppen introduced the Snurfer (snow-surfer) [13]. In the 1970s, snowboard pioneer Dimitrije Milovich offered his Winterstick, which is considered to be the first modern snowboard [2, 4]. Before this, few people considered riding a snowboard in high alpine terrain and on slopes with more than 50 inclination [5]. Between 1970s and 1980s, snowboarding gained international popularity [4, 6]. Snowboarding was a demonstration sport during the 1994 Olympic Winter Games in Lillehammer, Norway [7]. During the 1998 Olympics in Nagano, Japan, snowboarding debuted as an official Olympic sport in the disciplines of half-pipe and parallel giant-slalom racing [6, 7]. Currently, Olympic snowboarding disciplines include half-pipe, snowboard cross, and parallel giant-slalom racing for both men and women. There are an estimated 1015 million riders worldwide and it is particularly popular among adolescents and younger adults [6, 8, 9]. However, evidence suggests that the average age of snowboarders is increasing [10]. During the 2009/10 winter season, there were approximately 8.2 million in the United States, compared with 11.5 million alpine skiers and 4.5 million cross-country skiers [11]. This represented a 20 % increase in snowboarders (from 6.8 million) in the US and an 11 % decrease in alpine skiers (from 10.4 million) compared with the 2006/07 winter season [11]. A higher proportion of the US snowboard population were male (66 %), which is similar to alpine skiers (60 %) [11]. Snowboarders tend to be younger than skiers, with approximately 54 % between 624 years old and 31 % between 6 and 17 years old [11]. In addition, the number of snowboarders has increased in Canada from 1.2 million in 2004/05 to 1.6 million in 2009/10, representing an increase of 33 % [10]. Snowboarding is also very popular in Europe. An estimated 438,000 people snowboard every year in Switzerland [12]. Around 5 % of the Swiss population aged 1575 years and 11 % of children and adolescents (1014 years) also participate annually [1215]. The Mach Consumer Survey 2011 declared that 5 % of the Swiss population ([14 years) snowboard on a regular basis and 11 % snowboard at least once a season [16]. This represents a 1.1 % increase since 2001. Active snowboarders number around 500,000 and 700,000 in Germany and Austria, respectively [9, 17]. The increased popularity of snowboarding is clearly reflected within the snow sports industry. Over the 2011/12 season, the US snow sports market conducted a record business volume of $3.3 billion [11]. For example, products purchased at snow sports specialty stores in the US increased by 18 % between the s 2006/07 ($1.7 billion) and 2010/11 seasons ($2.0 billion). Online sales rose by 41 % in the same time period to $652 million in 2010/11 [11]. Snow sport accessories, including gloves and mittens, reached sales of approximately $1.2 billion in 2010/11: an increase of 9 % in units and 14 % in dollars when compared with the previous season. Within the apparel-accessories category, gloves and mittens had sales of $125 million and $40 million, respectively [11]. However, the data did not distinguish between glove and mitten use by snow sports or between gloves/mittens with or without protective elements. Overall, the risk of injuries while snowboarding is higher compared with alpine skiing [1820]. A literature review found that the injury risk ranged from 0.8 to 8.0 injuries per 1,000 snowboard days [7]. Moreover, upper extremities are the most frequently reported injured body region [7, 19, 21]. Wrist or upper extremity injuries comprise 3545 % of all snowboarding injuries [19]. To minimize the incidence and severity of wrist injuries, several studies recommend wearing wrist protectors [7, 19, 2128]. A meta-analysis on the effectiveness of wrist protectors in preventing wrist injuries showed that they reduced the risk of a wrist injury by 54 % with no corresponding increase in the risk of shoulder injuries [19]. However, it was unclear if any specific wrist protector design or protective component provided increased safety function [19, 29]. Kim et al. [21] could not identify which wrist protector type or design was most protective. This is not surprising given the variety in design of wrist protectors currently on the market [30]. The (...truncated)