Skiing or Snowboarding: Which one is safer? Which one is for you? For the shorter version, click here.

   Are you a skier who contemplated snowboarding but were apprehensive perhaps afraid of getting an injury or starting a new sport? How could we find more information? How can we get an answer to these questions? It seems almost overwhelming at first until one begins to analyze the data. Data was analyzed from 384 articles (yes, overwhelming, but I was looking for answers) published in well-known medical journals in which injuries were compared between skiers and snowboarders. Overall the injury rates were equal between skiers and snowboarders in the earlier studies. Later studies have had difficulties with the data because skier and snowboarder days are not distinguished from each other by lift ticket sales. Snowboarding injuries may be on the rise because of larger numbers of boarders in terrain parks. There were virtually no studies comparing alpine snowboarding (snowboarding without the terrain park) with skiing.
    Snowboarding accidents were typically less severe and less likely to require a hospital admission than skiing accidents. When compared with skiing collision is less common and results in less serious injury. Abdominal injuries are caused by falls rather than collisions and facial injuries are less serious. Only one study looked at mortality rates in skiers and snowboarders. The study came out of Vermont. In the study 25 skiers died and one snowboarder died. The majority of the deaths were attributable to head trauma and none of them were wearing helmets.

    Snowboarders have a higher percentage of upper limb Injuries. Wrist fractures are the most common. There is a higher incidence of growth plate injuries and splenic injuries because of the younger age of the participants. The forward ankle or leg is injured 80 percent of the time as opposed to the rear leg 20 percent of the time. There's a higher incidence of cervical spine injuries and other spinal injuries with 77% of these injuries related to jumping. The incidence of head injuries is higher than skiers but the injury is much less severe, usually minor. Most of the injuries to the head are in occipital region, hitting the back of the head.
    Skiers have a higher percentage of anterior cruciate ligament, ACL injuries and knee injuries. There is a higher incidence of severe abdominal and chest injuries. There is a lower incidence of spine injuries. There is a lower incidence of head injuries but skiers are five times more likely to suffer a fatal head injury. Also particular to skiing is a higher incidence of gamekeepers thumb or sprained thumb.

Mechanisms of Injury:

   The mechanisms of injury are different in skiers and snowboarders. In snowboarders ankle injuries are more common with soft shell boots, worn by intermediate and advanced riders. Knee injuries and distal tibia fractures were more common with hard shell boots, worn by novices. Beginners with less than one week on the snow accounted for 60 percent of the injuries overall for snowboarding. 50 percent of these injuries in the first week were wrist injuries particularly wrist fractures. Beginners had a higher incidence of upper extremity injuries. Beginners had a higher incidence of head injuries, usually from falling backwards and hitting the back of their heads. Beginners attempting “big air” accounted for the majority of more severe head injuries in boarders. This mechanism was higher than skiers. Falling backward after losing balance is the most common mechanism for the wrist fracture in beginners. 20 to 36% of the injuries occur the very first day on the snow. Intermediate and advanced riders had a higher incidence of lower extremity injuries. Spine injuries were recorded mostly in the very young snowboarders who were out of control with the thrill of going fast. There is a younger age group for snowboarding and there are more male snowboarders. Lack of experience, as well as boarding outside of marked regions, back country wannabes and occasionally a fearless attitude contributed to snowboarding injuries more than skiing injuries. 2.6% of snowboard accidents are caused by snowboarders running into other snowboarders. Skiers have a higher collision rate.
    In skiers knee injuries are more common due to a tremendous lever arm on the knee created by a ski that is typically five to six ft. long. Injuries are distributed evenly between all abilities, not skewed to beginners like snowboarding. The skiers comprised an older age group, in some studies averaging 20 years older than the average snow boarder. Male skiers were more likely to get injured than female skiers. Common mechanisms include crossing the skis, a backward fall with twisting, splitting the skis and inadequate release mechanisms on bindings to prevent knee injuries. Release mechanisms on ski bindings are too slow to prevent most knee injuries. A lack of experience and skiing outside marked regions contributed to a lower percentage of skiing injuries than snowboarding. Skiers had a higher incidence of frontal head injuries and more severe facial injuries. Spine injuries were generally from skiing out of control. Skiers injured getting off the lift typically would split the skis or tangle themselves with another person. Thumb injuries were more common in skiers from falling with their thumb wrapped around a ski pole. Skiers are more likely to hit a snowboarder than are boarders to hit a skier. Only 1% of all ski injuries are caused by collisions with snowboarders, but 7.7% are the result of skiers running into other skiers.

How to prevent injuries in skiing and snowboarding:

   For snowboarders, wrist guards work but most people do not like to wear them. Since wrist fractures are more common in beginners these would be the most appropriate group for wrist guards. Several studies showed a zero percent incidence of wrist injuries in boarders who wore wrist guards. As far as helmets are concerned, this is a no-brainer (a joke). Seriously, helmets work but not everyone likes to wear them. In beginners, they would help enormously because beginners so often fall backwards. Helmets would also be helpful in those boarders who like to catch air. Some helmets may reduce peripheral vision making it more difficult to navigate between obstacles such as trees. Bindings that release for snowboards are controversial and have not been fully tested. Softshell or hybrid boots for beginners have been shown to decrease the injury rates. Lessons decrease the injury rates. It is better to learn in powder or wet snow and not on hard pack or ice. As far as equipment is concerned this initially may help and some snowboards are better than others and proper tuning is important. In my opinion, it is better to start with a lighter and more flexible board, because it is easier for beginners to turn. Make sure you know which foot is supposed to be forward, usually the left. If you were a prior skateboarder or surfer it helps, if not, which foot is first when you slide across a freshly waxed floor? It is also better to start with high-back bindings because it is easier to balance with them initially, especially on the heel edge, where beginners spend more time on their first days. Also, snow gets into the clicker bindings frustrating beginners trying to “click in” their boots. This is based on my experiences teaching snowboarding including teaching my own two sons. It is important to have the bindings set properly especially regarding the position of the feet. Why so much talk about equipment? The sooner you learn to board better, the less likely you are to be injured. Learning how to fall correctly goes a long way towards preventing injuries. Martial arts training helps, not taebo or kick boxing, but rather sports like judo that teach one how to fall without getting injured. The first two sports however are good for learning balance and stability. It is better to learn how to get off the chair lift before you go up. When getting off the chair lift since rear falls cause most of the injuries it is better to lean forward just a little bit. It is better to practice tricks on the trampoline taping the snowboard rather than on the snow for the first time or if you have access to the Utah Winter Sports Park for those interested in big air. Proper conditioning is important and there's a web site for snowboarding on the internet, burton.com that has good ideas for exercises for snowboarding. Back country education is a must for the more adventurous types especially those going into higher avalanche areas. It is possible that buckle in bindings may reduce the injury to ankles because of more support as opposed to step in bindings or clickers.

   Helmets can prevent injuries in skiers. As release mechanisms on bindings improve injuries to the knee should decrease. “Shape skis” accelerate the learning curve, but some studies have shown increased incidence of knee injuries with these skis. Lessons help prevent injuries and are extremely important in learning how to properly use the newer higher turning radius skis. This is especially true if you have grown up on the older style straighter (or even wooden skis that I learned to use as a very young child). Contrary to snowboarding it is better to not learn initially on powder. It is better to learn on groomed slopes with packed powder. Skiers should also avoid taking lessons when the snow is very wet or slushy as this increases the injury rate. Learning how to fall correctly goes a long way towards preventing injuries. It is more difficult for skiers to get into a protected position when they fall and also frequently the poles get in the way of getting into this proper position to protect themselves from injuries. The University of Vermont has an anterior cruciate ligament awareness program that is very good. Martial arts training such as taebo or kick boxing would be more ideal for skiing as it develops good balance and coordination. Proper conditioning is also important. Backcountry education is important for skiers as well as for snowboarders.

So which sport is safer?

   Analysis of the data clearly shows the earlier rates of injuries were the same but with the advent of more terrain parks snowboarder injury rates may be on the rise. Skiers have a higher incidence of severe injuries and a much higher mortality rate. What if we could eliminate the common beginner snowboard injuries such as wrist injuries and injuries to the back of the head using the above techniques? Since snowboarders improved at a much faster rate than skiers with the learning curve being steeper and additionally since the incidence of snowboarding injuries decreases with ability, if we could eliminate the first week of injuries, it would make snowboarding twice as safe. Getting past the first week is the hard part. That's why I would emphasize that all beginners for the very first week use wrist guards and helmets because it will help prevent the two most common injuries in that group and also pay attention to the conditions of the snow and take lessons. It is not possible to make the same injury rate reductions in beginner skiers unfortunately. When we compare similar age groups and demographics snowboarders are younger and take more risks which seem to be something that teenagers specialize in including my own and if we eliminated this statistically from the data and compared similar age groups, it would make snowboarding even more statistically safer than skiing. If you eliminate terrain parks, you reduce injury rates by as much as an additional three times. For some older folks that may work, but try to talk a teenager out of a terrain park, I don’t think so.

How can we come up with these conclusions?

   Understanding that snowboarders have a lower incidence of severe injuries is easy when you compare the stance of a snowboarder to a skier. When snowboarders crash into an object such as a tree often it is sideways because snowboarders typically go sideways down the slope. The shoulder hits first and the snowboarders are in a naturally tucked position which protects their vital organs, head, chest and abdomen. A snowboarder typically is in a fighter stance, a stance that one would be in for sports such as boxing or martial arts. Since the snowboarder does not have to worry about ski poles and because he is already in a tucked sideways position it is easier for a snowboarder to achieve a safer crash position than a skier. Think of how a kick boxer or judo competitor stands. The stance is sideways with arms forward but not stretched out very similar to a snowboarder stance. When a skier hits an object the skier tends to hit face first because that is the way the skier is going down the mountain. It puts the skier in a much more vulnerable position for head, facial, chest and abdominal injuries which can be quite severe. A boxer would never stand face first with his arms out to the sides unable to achieve an adequate defense. The boxer would always assume more of a sideways stance with the arms protecting the body. Understanding this helps to understand the difference in injuries between snowboarding and skiing. It may be that snowboarding is easier to learn because there is only one edge on a snowboard and it is a much wider surface and there are no poles. It makes it an easier sport to learn because once you learn how to turn a snowboard you're automatically making parallel turns.

   Have fun, whatever you decide to do.

   Dr. Mark Hopkins is a Board Certified Orthopedic Surgeon specializing in sports medicine. He worked at the Utah Winter Sports Park for several years on the ski patrol, as physician for the U.S. Freestyle Skiing team and with many of the National Sports Foundation teams including the snowboarding team. He served as one of the volunteer physicians for the U.S. Track and Field team during the summer of 2003. He is an avid skier, snow boarder and outdoor enthusiast. For more articles on injury prevention in outdoor sports check out his web site at hospitalprivileges.net



Mark Hopkins, M.D.
Board Certified Orthopedic Surgeon
4315 Wild Elk Trail
Flagstaff, Arizona 86004