Concussions in Figure Skating

brightphoton · Jul 14, 2017

jf12 said:
Concussions must be fairly common among elite skaters, but I wonder if anyone's even done any kind of survey to see how common they are for non elite skaters? Just anecdotally, I don't know THAT many people who would fit under the category of frequent skaters around the level of practicing double jumps, or doing silver dances, that have had one. Almost all of those I know who jump wear hip pads or padded shorts. In contrast, there are very few recreational hockey players I know (about the level of having played at a serious high school level) who have NOT had one. I don't know that many people who do synchro, but I can see how having to stay tight in formations might make it more dangerous than singles. I still think skating at the level that most people do might on average have less concussions than many of these other team sports, like soccer, hockey, and football. However, we don't really know if there hasn't been any study.

Figure skating is terribly unpopular, and skating coaches tend to not have collaborations with researchers. Which is why I'm skeptical when people say we gotta do more research. Like that's going to happen.

There's a study that included the top 20 sports at the high school level. It's behind an academic paywall so you'll have to take my word for it :scratch3: haha, kidding. If you want to read it, don't pay them $40, just pm me and I'll email you their pdf.

here they are, from highest rate of concussions received at competition:

an athlete exposure is one athlete at one competition/game/practice

football (22.9 per 10,000 athlete exposures)
boys' ice hockey (14.6 per 10,000 athlete exposures)
boy's lacrosse (10.4 per 10,000 athlete exposures)
girls' soccer
girls' lacrosse (8.6 per 10,000 athlete exposures)
girls' basketball
boy's soccer
boy's wrestling (4.8 per 10,000 athlete exposures)
girls' field hockey
boys' basketball
girls' softball
girls' gymnastics (2.4 per 10,000 athlete exposures, but gymnastics is "safe", only 3 reported concussions)
cheerleading (artificially low here. 2 reported concussions at competition, but 21 during practice. If we used the practice stats, it'd be #3)
boys' baseball
girls' volleyball (1 per 10,000 athlete exposures)
girls' swimming/diving
girls' track/field
boys' track/field
boys' swimming/diving
boys' volleyball (zero concussions reported)

They use a reporting system from the Uni of Denver
https://highschool.riostudies.com/Default.aspx

gkelly · Jul 14, 2017

Here is the current information about concussions on the US Figure Skating website:
http://www.usfsa.org/story?id=90254&menu=sportscienceandmedicine#chapter10

USFS does offer grants for sports science research:
http://usfigureskating.org/story?id=84039

If you're a researcher in this area, you could get some support from the organization.

Some recent IceNetwork articles:
http://web.icenetwork.com/news/2016/02/02/163386260
http://web.icenetwork.com/news/2016/02/08/163741802
http://web.icenetwork.com/news/2016...ussions-in-figure-skating-how-to-prevent-them
http://web.icenetwork.com/news/2016/02/08/163921458

If I search for "figure skating injuries" on PubMed I get 58 hits, most about other kinds of injuries than concussions, and mostly only available in abstract form even where there are links to the full articles (which may be behind paywalls).

Here's an abstract of a study comparing injuries in ice vs. roller and inline skating among children:
http://pediatrics.aappublications.org/content/118/2/549.long
I don't get the impression that they're talking about figure skaters -- more likely unskilled recreational skating. Maybe both; would have to read the whole articles to see what the population was.

Study on the biomechanics of cranial forces during rotational elements:
https://www.ncbi.nlm.nih.gov/pubmed/26244218

Here's a 1989 article about injuries in elite pair skaters and ice dancers, coauthored by a prominent coach:
http://journals.sagepub.com/doi/abs/10.1177/036354658901700406

I don't think speed is necessarily directly correlated with concussions in skating, although of course it would take some research to find out.

As I said in the other thread, I've hit my head on the ice several times over the decades that I've skated, although I don't know that I have ever had an actual concussion. But the worst falls were not at high speed.

brightphoton · Jul 14, 2017

^ Rachel and Rachel's mom didn't want a single question on an FAQ and a couple of ice network articles. They wanted a full concussion section on the official USFSA website, with educational videos and official protocol.

Nor did Rachel want a call for applications for research that expired in March 2011.

But tell me, do you think what the USFSA has done is sufficient, in addressing concussions? I'd say, no, it looks like they expended minimum effort they could on the subject so they don't look completely indifferent.

Also re: your own head bumps, knowing what you know now, would you get a doctor to examine you to see if it was a concussion?

Anecdotally, people/skaters will say the worst concussions happen from whiplash, ie, your body stops but your head keeps moving. It's going to be worse at high speed than low speed.

gkelly · Jul 14, 2017

The last time I hit my head was the worst -- on a simple move for me, at low-medium speed for me (very low for an elite skater). My coach did call an ambulance and did accompany me to Urgent Care -- fortunately her schedule allowed her to leave the rink for hours during the day.

There are a few different variables here:

What causes concussions (head hitting ice, head hitting boards as an mrrice's case, collision with other skaters, spinal impacts in falls, rotational forces of advanced jumps and spins with no falls)

Does speed make any of these insults more likely? Does it make the results more dire even if the occurrence is almost as low or lower?

Which of these causes can be prevented by protective headgear? What design of headgear would offer the best protection?

What design of headgear would actually cause more falls and collisions?
What would interfere with performing the moves at all in the first place?

What are acceptable ratios between likelihood of injury, severity of injury, and relevant technical content of the sport? I.e., which moves/skills should be banned or devalued because the risk of injury is too high? How high is too high?

Do you already have the answers to those questions, so you can already prescribe the solution?

bevybean · Jul 14, 2017

I just want to clarify, that for me the idea of more research being necessary was for the helmets specifically. And for anything that is specific to skating that might not be known already --like specific conditioning that might avoid them other than the neck strengthening that Ashley mentioned.

Things I think can happen right now: Making coaches more aware and ensuring that each time a skater hits his/her head he/she is checked out right away even if it seems insignificant. Also, learning how to fall properly. I know that is something taught in other sports and I've seen it implemented at my curling club when someone's feet slipped out from under her and she fell backward (can't remember which sport it was learned from though.)

Incidentally, are coaches required to to learn any kind of first aid? That might be something to institute immediately if it isn't already in place. With my daughter, either my husband or I check her out and decide if she can keep skating that day or not for any kind of fall/injury. I'm okay with it because we both know some first aid and what to look for --especially for a head injury-- but not every parent does.

andromache · Jul 14, 2017

Concussions are a hazard in just about any sport - I think in figure skating, we're rather lucky in comparison to others.

I'm against forcing skaters to wear helmets, but definitely in favor of protocols being in place for skaters in competition and in practice to deal with any event that might result in a concussion or other head injury. If a skater hits their head, they should be required to follow procedures X, Y, and Z (you know, steps decided upon by medical professionals) for concussion screening and further risk management.

brightphoton · Jul 14, 2017

gkelly said:
The last time I hit my head was the worst -- on a simple move for me, at low-medium speed for me (very low for an elite skater). My coach did call an ambulance and did accompany me to Urgent Care -- fortunately her schedule allowed her to leave the rink for hours during the day.

There are a few different variables here:

What causes concussions (head hitting ice, head hitting boards as an mrrice's case, collision with other skaters, spinal impacts in falls, rotational forces of advanced jumps and spins with no falls)

Does speed make any of these insults more likely? Does it make the results more dire even if the occurrence is almost as low or lower?

Which of these causes can be prevented by protective headgear? What design of headgear would offer the best protection?

What design of headgear would actually cause more falls and collisions?
What would interfere with performing the moves at all in the first place?

What are acceptable ratios between likelihood of injury, severity of injury, and relevant technical content of the sport? I.e., which moves/skills should be banned or devalued because the risk of injury is too high? How high is too high?

Do you already have the answers to those questions, so you can already prescribe the solution?

No, but perhaps you should get a job at USFSA. They prescribe to the same "wow, so many unknowns, I guess we should just do nothing different. Not even things that makes sense, or try to make the sport more cautious or safer. Certainly not without research. Oh yeah, and there will not be any research. Gotcha!"

Then in 5 years, we can make posts like, "Why are we seeing a drop in Learn to Skate class enrollment?"

concorde · Jul 14, 2017

The true burden is really on the parent of the skater. USFS, the coach, and the rink can offer advice but it is up to the parent to actually seek out the treatment and then follow the doctor's advice. This is not just linited to head injuries.

Until the sport reaches the point that a skater cannot get back on the ice until a medical expert has cleared then, the issue of returning to the ice too soon will continue.

mrrice · Jul 14, 2017

Concussions often happen in strange ways. When I was in Color Guard at CSUN, one of the marching band members slipped on a muddy football field during our halftime show. He fell and hit his head on a sprinkler. I've seen cheerleaders fall off pyramids more times than I can count.

Tennis player Eugenie Bouchard slipped in the locker room at the US Open and had to withdraw from the tournament after she was diagnosed with a concussion. She had made it to the 4th round in Singles, Doubles, and Mixed Doubles. The amount of money she lost by not being able to take the court was substantial and a lawsuit followed. This goes to show that you can plan but, sometimes fate intervenes. Here's an article on Genie:http://www.huffingtonpost.ca/2015/09/06/eugenie-bouchard-out-concussion-us-open_n_8096798.html

ice coverage · Jul 14, 2017

Adding some assorted facts to this thread:

(1) "Concussion Protocol" is the title of an article in the Jul/Aug 2017 issue of The Professional Skater magazine (publication of Professional Skaters Association for coaches and other skating professionals).

See pp. 18-19 of the magazine (which correspond to pp. 21-22 of the electronic file).

Sample excerpt:

"... U.S. Figure Skating reaches out to medical physicians throughout the country with a national network of providers who can go to local rinks and for the last several years have been conducting webinars for referees. U.S. Figure Skating also has hosted seminars at PSA events, with an engaging roundtable held at conference this past May. Elite athletes also are given this information at their high-performance camps."

The article includes quotes from Dr. Ellen Geminiani, "primary sport doctor at Boston Children's Hospital and chair of the sport science and medicine committee for U.S. Figure Skating" who also is "a figure skater who trained under Gus Lussi and Howard Nicholson."

(2) A baseline test for concussion is part of USFS High Performance Movement Screen (HPMS), which is something new this year, offered in conjunction with S.T.A.R.S testing.

Part of HPMS is Balance Error Scoring System (BESS), discussed in the Jan/Feb 2017 issue of The Professional Skater:
"Athletes demonstrate balance problems on this test immediately after concussion with balance deficits usually resolving within seven days." BESS "serves as the easiest way to baseline test as many figure skaters as possible for evidence-based decision-making to return to skating after concussion."

(3) Anecdotally: "Concussion" was the topic of a mandatory CER for coaches at USFS-sanctioned events at least in 2014-15. Possibly true for other seasons too?

(4) Anecdotally: USFS Governing Council in 2016 had a session on "the growing awareness of concussions and first aid". Possibly other years too?

Anecdotally: An overview of concussion resources available to clubs was included in the SafeSport seminar at 2014 Governing Council. Possibly other years too?

(5) Some documents from USFS:

"Concussion Education Information" (four pages):

http://www.usfsa.org/content/Concussion Education Information updated October 2014.pdf

A link to this document is on the SafeSport Program page in the Clubs section of the USFS site.

"Essential Sports Medicine for Competition 2013-14 (a document for referees, with concussion discussed on the first two pages):

https://www.usfigureskating.org/content/Essential_Sports_Medicine_for_Event_Referees_2013-14.pdf

And I have no way of knowing whether the USFS Members Only site has other information??

gkelly said:
Here is the current information about concussions on the US Figure Skating website:
http://www.usfsa.org/story?id=90254&menu=sportscienceandmedicine#chapter10

USFS does offer grants for sports science research:
http://usfigureskating.org/story?id=84039 ...

Thanks once again to gkelly :bow:

for always providing a wealth of information. (Only for the sake of brevity, not quoting your helpful post in entirety.)

brightphoton · Jul 14, 2017

mrrice said:
Concussions often happen in strange ways. When I was in Color Guard at CSUN, one of the band members slipped on a muddy field during our halftime show. He fell and hit his head on a sprinkler. I've seen cheerleaders fall off pyramids more times than I can count.

Tennis player Eugenie Bouchard slipped in the locker room at the US Open and had to withdraw from the tournament after she was diagnosed with a concussion. She had made it to the 4th round in Singles, Doubles, and Mixed Doubles. The amount of money she lost by not being able to take the court was substantial and a lawsuit followed. This goes to show that you can plan but, sometimes fate intervenes. Here's an article on Genie:http://www.huffingtonpost.ca/2015/09/06/eugenie-bouchard-out-concussion-us-open_n_8096798.html

Cheerleading is one of those concussion-prone sports, like football and hockey, so I'm not surprised. Personally, I'm not a fan of girls piling themselves into pyramids, sounds like a recipe for trouble.

But think about how much worse those concussions would have been if those people were moving really really fast. If you're moving slowly, at least you're only going to get slip-on-a-banana-peel concussions. I'm actually surprised how much resistance from normal people to the suggestion that we make our figure skaters move slower, to make the sport less risky.

I'm not surprised, but disappointed when I see how USFSA has responded to these concussion revelations. They make shiny videos, crisp promotional materials, trendy hashtags, interviews, and teaser trailers all the time, so you know that if they wanted to make a concussion social media blitz, with shiny educational videos and matching hashtags, epic music soundtracks and snazzy video intros, and get Scott + Sandra, Tara + Johnny, former great skaters to give testimonials and interviews, they would have done it already.

The way that the figure skating governing body is reacting, ie, concentrating on telling people to go see a doctor after a possible concussion, and not re-evaluating and changing the sport so that fewer concussions happen in the first place, is similar to how NFL reacted to concussions. It took a sharp decrease in parents enrolling their children in kids football to convince the NFL to make changes to youth football. Fewer kids playing football = less talent pool = less fans = less $$$$. I believe they are now, at the youth level, encouraging less tackling, teaching kids to not use the head to tackle, and maybe age limits. Too little, too late. Football is already gaining a reputation as a dangerous sport with an indifferent governing body.

concorde · Jul 14, 2017

ice coverage said:
(2) A baseline test for concussion is part of USFS High Performance Movement Screen (HPMS), which is something new this year, offered in conjunction with S.T.A.R.S testing.

Part of HPMS is Balance Error Scoring System (BESS), discussed in the Jan/Feb 2017 issue of The Professional Skater:
"Athletes demonstrate balance problems on this test immediately after concussion with balance deficits usually resolving within seven days." BESS "serves as the easiest way to baseline test as many figure skaters as possible for evidence-based decision-making to return to skating after concussion."

Unfortunately I would not put too much stock in USFS's HPMS.

I was told that during a traditional pre-screening, the athlete is asked a series of questions. When there is a concern about a possible concussion, you ask the same questions and see how the answers change. My daughter did HPMS this past May. When I asked about the questions they asked, she looked at me like I was crazy. After reading the initial ESPN article, I had decided that she needed a traditional pre-screen since I am not comfortable with the HPMS.

As a parent of a skater, it is interesting to observe other parent's views of concussions as they relate to skating. For some parents, if the doctor advises that the skater needs to be off the ice for xx time, that skater is off the ice for the entire specified time. With other parents, I have seen their skater knocked out cold after a fall and the parent says the skater is fine (but even several days later the skater looks dazed) - my guess is that skater is not checked over by any medical expert.

TGee · Jul 14, 2017

concorde said:
The true burden is really on the parent of the skater. USFS, the coach, and the rink can offer advice but it is up to the parent to actually seek out the treatment and then follow the doctor's advice. This is not just linited to head injuries.

Until the sport reaches the point that a skater cannot get back on the ice until a medical expert has cleared then, the issue of returning to the ice too soon will continue.

Totally agree...the national federations need to implement 'return to play' protocols, and insist on a medical clearance. To avoid cross-posting, I'm going to ask folks to look at my comments on this point in the Ashley Wagner ESPN thread...

brightphoton · Jul 15, 2017

TGee said:
Totally agree...the national federations need to implement 'return to play' protocols, and insist on a medical clearance. To avoid cross-posting, I'm going to ask folks to look at my comments on this point in the Ashley Wagner ESPN thread...

I think that's the "return to play" policy is good, but only up to a certain point. What is there in place to prevent more concussions? By the time Evan got his 12th concussion, do we still file the same rest and then return standards?

There's something fundamentally wrong with the sport when the elite skaters are getting 3, 6, 15-20 concussions, not because they are particularly reckless or stupid or sloppy, but as a nature of competing in the sport.

concorde · Jul 15, 2017

brightphoton said:
I think that's the "return to play" policy is good, but only up to a certain point. What is there in place to prevent more concussions? By the time Evan got his 12th concussion, do we still file the same rest and then return standards?

There's something fundamentally wrong with the sport when the elite skaters are getting 3, 6, 15-20 concussions, not because they are particularly reckless or stupid or sloppy, but as a nature of competing in the sport.

Agreed the policy would do nothing to prevent injuries but it would protect the skater once one occurred.

My guess is no reputable doctor would currently tell Ashey it is ok to continue after she has publicized her current status.

For the skater that I know of with 2 in one year, that doctor told the family that the skater needed to take a year off to recover AND the family decided to follow their doctor's advice.

TGee · Jul 15, 2017

concorde said:
Agreed the policy would do nothing to prevent injuries but it would protect the skater once one occurred.

Actually, it would prevent injuries. Premature return to play, including off-ice training or even physical education classes at school leads to [1] a worse outcome; [2] increased risk of a second and more severe concussion shortly after a skater returns to play.

One of the big issues is that, up to now, rules of thumb rather than real assessments have been used to get skaters back on the ice after mild concussions. And that an assessment by a family doctor may not be sufficient to really assess the severity of the concussion.

Scanning one of the protocols linked to below, the guidance was just to take a week off from training after a mild concussion. This likely isn't enough. The return to play guidance talks about a full stop in activity until sufficient recovery....and this is to be assessed by a physician with sufficient specific skill in evaluating concussions.

The other thing in my view is that, education about concussions aside, if coaches realized that their skaters would lose significant training time for concussions, and that return to play required specialist medical clearance, they would be much more motivated to learn and adapt their instruction techniques towards minimizing concussion risks.

And it is possible to develop consensus guidance for physicians on "return to play": here is one from the American College of Sports Medicine

brightphoton · Jul 15, 2017

TGee said:
Actually, it would prevent injuries. Premature return to play, including off-ice training or even physical education classes at school leads to [1] a worse outcome; [2] increased risk of a second and more severe concussion shortly after a skater returns to play.

I agree, an enforced and conservative "return to play" prevents more injuries from prematurely returning back to training.

Although, imagine the chaotic mutiny if doctors told skaters they had to full-stop training for a year

I wonder how Ashley would react if a doctor wrote an open letter to her, telling to stop skating, because she can't risk a single additional concussion. And poor Evan. He very likely has CTE...

Skater Boy · Jul 15, 2017

I wonder what people are defining as concussions. There are certainly different degrees but if someone had 15 to 20 I believe that is worse than boxers. Poor Evan must have scrambled brains? I think we have to look at the definition of concussions or degrees. Obviously Totminana, Farris and Sequin had serious concussions that it prevented them from skating and competing for a while. My mom told me she saw Doug Ladret from Canada have to compete with a helmet and then after I believe the twist he took off the helmet. some might say that would warrant a deduction today but some nations have laws about duty to accommodate so maybe not (duty to accommodate people with special needs). I wonder if Evan has 15 to 20 how many someone like Nathan Chen or Yuzuru have had since they try so many quads or what about Anna P who jumps with such reckless abandon and falls even more recklessly one wonders how she hasn't killed herself or seriously injured herself.

Ender · Jul 15, 2017

Skater Boy said:
I wonder what people are defining as concussions. There are certainly different degrees but if someone had 15 to 20 I believe that is worse than boxers. Poor Evan must have scrambled brains? I think we have to look at the definition of concussions or degrees. Obviously Totminana, Farris and Sequin had serious concussions that it prevented them from skating and competing for a while. My mom told me she saw Doug Ladret from Canada have to compete with a helmet and then after I believe the twist he took off the helmet. some might say that would warrant a deduction today but some nations have laws about duty to accommodate so maybe not (duty to accommodate people with special needs). I wonder if Evan has 15 to 20 how many someone like Nathan Chen or Yuzuru have had since they try so many quads or what about Anna P who jumps with such reckless abandon and falls even more recklessly one wonders how she hasn't killed herself or seriously injured herself.

And it's not all concussions are life-threatening. Sometimes I think people are taking the word too serious. You scratch your hands on the ice during practice and you can call it injury as well.

Skater Boy · Jul 15, 2017

Not sure they can do much regulation. We all remember a few seasons ago Yuzuru and that bandaged head. Concussion or not head injuries are serious business. I am still disappointed and shocked he competed. I will not glorify this as courageousness. while I don't wish him ill will really people need to know there are consequences (though in Hanyu's case he still got to go to GP final and do well so the lesson may not have been so well learned or taught. Thank goodness he seems okay but if these skaters are getting that man concussions, again I am wondering what they are using as a definition of concussion - headache or... I think another key is how many were knocked out unconscious. I wonder with the push for quads and all if we will see skaters like Evan in vegetative states. I hope not; we love skating but we treasure lives too.

Concussions in Figure Skating

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