Francklyn, 24, was not a seasoned ski mountaineer. She’d moved to Jackson only a few weeks prior, from Colorado, where most of her skiing had been on less-technical terrain. Though she was a strong skier, she hadn’t skied many high-consequence lines.
Brines, 28, an experienced backcountry skier who’d lived in Jackson for four years, went first. He found the snow in the upper hourglass firm but edgeable, and he advised the rest of the group to descend cautiously. Lower down, conditions improved dramatically. Brines set careful turns in softening corn snow that skied like resort corduroy.
Francklyn scooched in next. What happened then is unclear. The skiers above her could see only a bit of her head and shoulders beyond the steep entrance. It’s likely that, while negotiating the tricky first move, she caught an edge, lost her balance, and fell backward. When she appeared again, briefly, five feet down the slope, she was sliding on her back, minus one ski. Then she disappeared into the throat.
Five hundred vertical feet below, Brines watched as Francklyn’s ski rocketed out of the couloir. “I had one of those mental hiccups where you’re overcome by dread and willful positivity at the same instant,” he recalls. “I thought we’d shortly be reliving a scary moment. And then, seconds later, Sally came through. Headfirst on her back. Her helmet exploded on the rock, and she rag-dolled the rest of the way down. I yelled up to my buddies that we needed a helicopter. I knew she’d suffered a severe head injury. I didn’t know how much longer she’d be with us.”
A year and a half later, after 11 days in an induced coma, two surgeries, ten weeks at two different hospitals, and countless therapy sessions, Francklyn now lives with her parents in Colorado Springs, where she continues to recover from a traumatic brain injury.
Anatomy of an Impact
But non-vehicular concussions are not limited to the gridiron and the battlefield. The Centers for Disease Control and Prevention estimates that between 1.6 million and 3.8 million sports-related concussions occur in the U.S. each year. A report funded by the City of New York found that brain injuries are responsible for 74 percent of cycling deaths. Nationwide, according to the American Association of Neurological Surgeons, roughly 600 cyclists die annually as a result of head injuries, and in 2009, some 85,000 concussed cyclists ended up in emergency rooms.
The National Ski Areas Association reports that TBIs are the leading cause of skiing and snowboarding fatalities. And the numbers are growing. In 2004, 9,308 skiers and snowboarders suffered head injuries they deemed serious enough to visit a doctor. By 2010, that number had jumped to 14,947.
Despite the trends, we tend to pay attention only when famous people suffer a TBI—like actress Natasha Richardson, who died after a routine ski fall in 2009, and, more recently, Olympic freeskiing hopeful Sarah Burke, who died in 2012 after sustaining a TBI during a fall in a Park City, Utah, halfpipe. Last January, it was snowmobiler Caleb Moore, who died from brain and heart complications after his snow machine landed on top of him when an aerial maneuver went awry at the Winter X Games in Aspen, Colorado.
What the numbers don’t reveal is that the rise in brain injuries has happened during a period when helmet use among skiers and snowboarders has increased by 20 percent. (There hasn’t been a reliable study about bike-helmet usage in 15 years.) Neurologists and helmet makers attribute the uptick in TBIs to better reporting, but that’s only part of the picture. “There’s a greater trend of brain-injury awareness,” agrees Weintraub. “But there is a brain-injury trend. We’re seeing more of them from falls and sports.”
It’s not that helmets have gotten worse or gravity more powerful. It’s that our behavior has changed.
In the past few decades, we’ve fundamentally altered how we recreate outdoors. From massive halfpipes to full-suspension mountain bikes to junior-level big-mountain freeskiing competitions, we’re playing at a more intense level. “Our sports are supersizing,” says Mike Douglas, a pro skier from Whistler, British Columbia, who helped launch the freeskiing movement in the 1990s. “It’s all about going higher, farther, faster. It’s not sustainable.”
The evolution of the halfpipe is a good example. When they were introduced in the eighties, halfpipes were barely four feet high, with moderately sloped walls. In the nineties they grew to 12 feet, then 18. Today’s competition standard, established in 2010 by the International Olympic Committee, is a 22-foot, vertical-walled superpipe. Elite snowboarders routinely launch 20 feet above the lip. Skier Peter Olenick set the record for amplitude—a physics term appropriated by the Red Bull generation to measure how far an athlete soars above a halfpipe—by reaching 24 feet, 11 inches at the 2010 X Games in Aspen. At the zenith of his record jump, Olenick was 47 feet above flat ice.
Your Friend Hit His Head
A similar progression has affected the rest of us. Our gear, terrain choices, and lay-off-the-brakes attitude mean we’re spending more time at high velocity and at the mercy of gravity. It’s a phenomenon I’m intimately familiar with. My friend rides his mountain bike perilously fast through dense woods and ski down steep couloirs where falling could be fatal. While I was reporting this story, I suffered one bike crash that left me nauseous, with a cracked helmet and a lump on my head, and another that fractured my collarbone. Before my friend's 12-year-old son’s first day of downhill-mountain-biking camp last summer, I nearly traumatized him as I outlined the risks he would face.
We ride bikes and glide down mountains at tremendous speed for the pleasure it brings. The problem, as Douglas points out, is that “the evolution of the human body is not keeping up.” We long ago outpaced our biology—and, disconcertingly, the level of protection afforded by our helmets. Our brains simply can’t sustain the massive hits that result when things go wrong.
When Sally Francklyn’s head made contact with exposed rock, her helmet shattered, as it was designed to do, and her skull fractured. The impact broke bones in her neck and back. Jackson Hole’s ski patrol arrived at the scene in less than an hour. Three hours and two helicopter flights later, Francklyn was wheeled into emergency surgery in Idaho Falls, where doctors inserted a licox, a device designed to alleviate the building intracranial pressure that would surely have killed her. Then they induced a coma.
Tall and strong, with an easy smile, Francklyn was once an intern at a ski magazine I edited. We weren’t close friends, but she was the fifth acquaintance of mine to suffer a life-altering brain injury while skiing or biking. Much of the damage was to her left frontal lobe, which controls her working memory, but she also injured her brain stem. The crash impaired the hearing in her left ear and injured her right optic nerve, which has left her with vision problems. Balance is still a major challenge, but in the pictures that she posts on Facebook, I see her old smile, alongside the slightly faraway look common among TBI survivors.
It took me a long time to gather the strength to call Sally. On the phone, her voice is shrill and off-pitch as she flows through octaves. It’s something she’s working on. Her thoughts track, but lucidity is difficult. She tells me that, with the help of an ankle brace and a lot of physical therapy, she’s now able to walk again, but slowly.
She remembers nothing from the day of her fall, but she tells me that once was enough for her. It’s a canned one-liner. I take it as a sign of her positive attitude. And then, in a more earnest tone, she explains that the hardest part is living at home with her parents. Her friends don’t visit as often anymore. She hopes to live independently in Colorado’s Summit County again. “I don’t need assistance,” she tells me emphatically.
Like many of the TBI afflicted, Sally’s long-term rehabilitation costs outstripped her insurance coverage. Fortunately, her mother was able to retire early from a teaching career to help with her care, and Sally has been lucky to receive the support of the Truckee, California, High Fives Non-Profit Foundation, an advocacy group that, among other things, helps athletes with brain and spinal-cord injuries cover the cost of rehab.
As much as we can learn from Sally’s fall, there is no single anecdote that covers the TBI spectrum. With any brain injury, the force of the impact, the number of hits taken, and how the brain shifts as it bounces around inside the skull lead to unpredictable outcomes. On top of that, says Weintraub, “there are subtle differences in anatomy and genetics. Your brain is different than my brain. A male brain is different than a female brain. A younger brain is different than an older brain. And the medical care you receive is different.”
Inside your head, your brain is like a Jell-O mold, connected to your vascular and nervous systems at the stem and floating in viscous cerebrospinal fluid in your cranial cavity. When you run rough trail, backflip into a pool, or trip and bang your head at walking or jogging speed, your brain deforms slightly as it bumps into your skull, then bounces back into place without injury. In severe hits, the Jell-O gets jostled more violently, crashing, twisting, and rebounding against the front and back of the skull.
All that trauma and contortion has an immediate effect on the axons and neurons involved. But this isn’t trauma in the same vein as a broken ankle or a deeply bruised hip. Axons are the fibers that serve as your brain’s messengers, and neurons are the command centers tasked with the functions that make up who you are. One neuron might be involved with short-term memory, another with balance, another with impulse control. Simple, except that there are an estimated 100 billion neurons in the human brain.
Neuroscience has a handle on what each region of the brain is responsible for. But each cell? Even President Obama’s lofty brain-mapping initiative doesn’t promise that. When tens of millions of neurons smash about inside your head, the exact nature of the damage is anybody’s guess.
One thing neurologists are certain of is that even mild concussions are more serious than they once thought. Axons can be stretched hard only once, or lightly many times, before rupturing. And when they do, brown balls of protein—scars left from the brain’s attempt to heal itself—form in the pathways, shutting down communication. The resulting chronic traumatic encephalopathy has been linked to everything from depression and dementia pugilistica (punch-drunk syndrome) to diseases like Alzheimer’s and Parkinson’s.
Unfortunately, the only way to identify CTE is by performing an autopsy. That’s probably why, in 2012, when former NFL star Junior Seau committed suicide, he shot himself in the chest instead of the head, like safety Dave Duerson had done the year before. Seau’s family donated his brain for study, and the postmortem revealed the telltale brown fibrous balls deep within his brain.
Julian Bailes, a Chicago neurosurgeon who also works with the Sports Concussion Institute, is a leading authority on CTE. He’s involved with some promising new testing methods that could soon allow doctors to diagnose the condition in living patients. In the meantime, I asked Bailes how many concussions or mild TBIs a person could safely recover from before risking CTE. “We don’t know,” he said. “In terms of subconcussive hits, we think it’s years and years of exposure. In terms of major concussions, we believe it’s three.” This is especially alarming when you consider that athletes may endure double-digit concussions over the course of their careers, often beginning in the preteen years, when the brain is particularly vulnerable. When snowmobiler Caleb Moore died, at age 25, he had already sustained at least 11 major concussions. Professional snowboarder and Olympic medalist Gretchen Bleiler has reportedly had four or five, and Scotty Lago has had six or seven. By his own estimation, Shaun White, who has been competing since the age of six, has suffered nine. Former BMX racer Jay Fraga started the Knockout Project, a concussion-advocacy group, after his ninth, and professional cyclist Sinead Miller has been sidelined since sustaining her seventh in 2010. Miller still can’t work out or be around large crowds without experiencing migraines and nausea.
Twenty years ago, many of those TBIs never would have happened. Sally Francklyn wouldn’t have been able to leave Jackson Hole’s gates, since the resort, like many others in North America, didn’t provide backcountry access until 2000. Without lifts, accessing Once Is Enough would have been a demanding, all-day affair.
But increased backcountry access is just one of a slew of changes in how we recreate. Even into the mid-nineties, big-mountain freeskiing competitions were largely unheard of. Now there are junior big-mountain freeskiing events for boys and girls as young as 12. Skiing powder in trees was a much slower adventure, thanks to skinny, conventionally cambered skis, which forced most of us to carefully hop-turn down ski-area steeps as well. And the Winter X Games didn’t become a national spectacle until 2002, when the entire U.S. Olympic freestyle snowboarding team showed up to compete just a few weeks before the Salt Lake City Games. This winter in Sochi, Russia, three new freestyle events—slopestyle skiing and snowboarding and halfpipe skiing—make their Olympic debuts.
In the cycling realm, we used to pick our way down singletrack on fully rigid mountain bikes. Downhill mountain biking was an extremely niche sport until the early 2000s. Now you can strap on body armor and a full-face helmet at one of the country’s 59 lift-serviced bike parks. On the road, pelotons are bigger and faster than ever, and group rides where you’re expected to maintain a certain power output are now common. With the rise of social media and GPS-tracking apps like Strava, cyclists can turn solitary rides into virtual races at breakneck speeds. “There was always risk,” says JT Holmes, a big-mountain freeskier and wingsuit pilot who, after seeing too many friends suffer TBIs, started working with High Fives. “But new technology has made higher speeds the norm.”
Directly or indirectly, everything from advances in gear to bigger jumps in snow and dirt has been in the service of velocity and hang time. In theory, rockered skis and snowboards and full-suspension mountain bikes with better brakes make descending safer. It takes very little effort to throw boat-shaped skis sideways to scrub speed, and today’s bikes, with powerful brakes and shocks that allow you to fly over uneven terrain, enhance control. In practice, however, we use these innovations to go faster. “You can now buy performance in every sport,” says Holmes. “You can cut to the chase.”
Of course, once you taste speed, it’s hard to slow down. Of all my cycling and skiing friends, only one shows much restraint. He’s a doctor, and his brother is a neurologist; he understands high-velocity brain injuries. The rest of us need to keep in mind some basic physics. Once in motion, a body wants to stay in motion. Pedaling a mountain bike on a steep descent, you might reach speeds of 35 miles per hour, or 51 feet per second. Punch your front wheel into a hole and endo off the trail, and your mass (say, 150 pounds without the bike you just left behind) multiplied by your velocity is equal to 7,650 pounds of momentum. That’s only a few hundred pounds less than what gets produced by a 310-pound lineman at a full sprint.
What happens next is called a deceleration injury. Hit a tree or rock squarely and the skull stops in six milliseconds. Your head decelerates at a rate of 8,500 feet per second, or 266 G’s—266 times the force of gravity. The resulting force acting on you is a sickening 39,900 pounds. At 266 G’s, without a helmet, you’re dead or irreparably brain-damaged. With a helmet you at least have a chance. If you’re a helmet skeptic bored by science, consider this: according to Randy Swart, founder of advocacy group Helmets.org, an impact speed of 14 mph can generate enough force to kill you.
Above that, says Swart, “a helmet can be the difference between life and death.” And slight changes can have enormous consequences. If, in the already bleak scenario above, your head decelerates just one millisecond faster, the forces jump to 319 G’s and 48,000 pounds. Pretty much instant death, regardless of whether you’re wearing a helmet.
Despite our changing behavior and bleeding-edge gear, helmet technology has languished. Of the thousands of bike and snow-sports helmets on the market, at least 95 percent of them are built almost entirely from expanded polystyrene (EPS) foam, similar to what’s used in surfboards and styrofoam coolers.
Think of a simple EPS helmet as a catastrophic insurance policy for your head. By deforming, cracking, or, if the forces are great enough, controlled shattering, the foam actively reduces the number of G’s acting on your brain. While EPS helmets don’t offer much if any cushion in low-velocity impacts and are overwhelmed by massive hits over 300 G’s, they do a pretty good job of dissipating high-velocity forces, preventing countless brain injuries and skull fractures every year.
In 2006, the Consumer Product Safety Commission created a mandatory industry-wide standard for bike helmets. The CPSC based its standard on work done by the American Society for Testing and Materials International, an agency that has published more than 12,000 standards for everything from kitchen blenders to fireworks to military identification cards. (While there’s no equivalent CPSC benchmark for snow-sports helmets, most manufacturers choose to meet a similar, though not mandatory, ASTM standard.) To determine whether it meets the CPSC standard, a bike helmet is placed on a 22-pound, head-shaped weight and rammed into an anvil at 14 mph. The helmet must slow deceleration enough to produce less than 300 G’s of force—the accepted norm being that a hit greater than that isn’t survivable or results in a vegetative state. (Researchers arrived at the upper limit in the 1950s by dropping cadavers down elevator shafts.)
The hitch here is that the CPSC’s high-velocity test is pass or fail, and every helmet sold is a winner. But not all helmets are equally adept at the job: one might provide 20 percent more force reduction than another costing half as much, while a third might cost less but weigh more. Helmets.org, which has independently tested helmets from most major manufacturers, has seen thick, cheap, ugly helmets sold at big-box stores outperform thin, expensive, sexy models found in specialty bike shops.
Helmet manufacturers, of course, do their own testing and know precisely how well they stack up against other brands. And if they make a helmet that tests better than average, they’d love to say so.
But doing that would expose them to personal-injury lawsuits. If someone is injured wearing a helmet that a company promoted as safer, that company is likely to get sued—and lose. The arrangement hurts consumers most. Litigious paralysis means there has been a disincentive to invest in R&D, and many helmet makers have been perfectly happy to reap the profits of selling molded-foam-and-nylon-webbing contraptions at high margins while making little ongoing investment in safety. As Helmet.org’s Swart, who is also a vice chairman of an ASTM committee, told me, “Nobody takes you to court over a fashion claim.”
Fortunately, the market is starting to change. In 2010, Stefan Duma, an enterprising researcher from Virginia Tech–Wake Forest University’s School of Biomedical Engineering and Science, did something obvious: he tested the major football helmets on the market and then, the following year, published the results. The fallout was immediate. Manufacturers spent more on R&D and began designing safer helmets.
The same thing is finally happening in the bike and winter-sports worlds. In the past few years, companies have started investing in new safety features. Doing so means rethinking how a helmet reacts to various forces. The CPSC has a single high-velocity standard, and an EPS helmet is designed to withstand only one major impact before it should be replaced. But multiple low-velocity hits can be life altering, too. And because every blow to the head, regardless of angle, strength, or speed, inevitably causes a brain to twist and turn, how a helmet reacts to rotational forces is also important.
Responding to the need for protection from both high-and low-velocity impacts, Smith recently introduced multilayered ski and bike helmets. Beneath a traditional hard plastic shell are layers of EPS into which Smith inserts a honeycomb-like soft polymer, called Koroyd, designed to dampen low-speed blows. (Because of legal concerns, it isn’t marketed in those terms.) In a different approach, an Australian company called Conehead Technology designed a system that employs an array of foam cones of varying densities that crumples on impact, like the front of your car. But because the cones are narrower at the tips, the deformation starts at low velocities. Giro, looking to deliver the one-and-done benefit of traditional EPS, recently introduced a helmet with softer foam that can handle multiple hits at lower velocities and still meet the CPSC’s high-velocity standard.
When it comes to rotational forces, one innovative technology—from a Swedish company called MIPS, which stands for multidirectional impact protection system—is already being widely adopted.
MIPS is essentially a harness that fits inside a helmet and is designed to reduce rotational forces the same way the scalp does, by shifting slightly when you hit your head. In a crash, the MIPS harness shifts 10 to 15 millimeters, ostensibly reducing external rotation of the head by that same amount. This winter, you’ll find MIPS in dozens of models from POC, Rossignol, and Scott, among others.
Perhaps the most promising new design comes from a recent startup called HIP-Tec. As with MIPS and Conehead, HIP-Tec doesn’t plan to manufacture helmets. The company’s goal is to build multidensity, multilayer helmet innards that address the widest range of impacts possible. The inner layer slowly deforms and rebounds, much like the brain floating in its fluid, but is still capable of withstanding multiple low-velocity hits. The outer layer is an EPS-like foam designed to dampen high-velocity impacts. And, to go between the two layers, HIP-Tec uses a shearing layer that accommodates rotation. The first HIP-Tec-equipped helmets should be available in 2014.
In the meantime, the ASTM is working on a low-velocity standard, with a rotational standard to follow some time after that. Sadly, a test that addresses all four pillars—high- and low-velocity, multiple hits, and rotational effects—is nowhere in sight. That’s because there’s still much work to be done. Trying to set a rotational standard is a good example. All helmets shift to some degree when something (rocks, asphalt, trees) grabs at them. How that combines with a helmet that has a built-in rotating harness isn’t well understood. Another challenge: engineering a foam that’s soft enough to absorb low-velocity impacts while remaining unaffected by temperature and moisture fluctuations. “The ASTM is slow moving, but their heads are in the right place,” says Drew Chilson, director of development at Smith. “They are trying to improve standards. But to devise a holistic test that evaluated all four design principles would take years.”
In September, Sally Francklyn spoke before an audience of skiers attending the Denver premiere of the backcountry-themed ski film Valhalla. During her remarks, she took the opportunity to promote High Fives. With the help of JT Holmes, the foundation recently launched a program called Basics that produces online videos about topics like backcountry line selection and how to avoid overshooting the landing on slopestyle jumps.
“New athletes just don’t know how to keep themselves in check,” says Holmes, which is why Basics runs clinics at Squaw Valley and Park City to help them perform tricks safely. On stage, Sally, who is writing again and interviewing athletes for ESPN.com who have overcome tragedy, gave props to High Fives’ new Instagram-targeted #helmetsarecool campaign, in which tagging yourself wearing a helmet enters you in a contest to win one.
It’s not the only catchy social-media campaign you’ll see this winter. In December, The Crash Reel, a transfixing documentary about professional snowboarder Kevin Pearce, who suffered a devastating brain injury during a halfpipe accident in 2009, hits theaters. Inspired by Pearce’s remarkable story, and troubled by how little information about TBIs is available, the film’s director, Oscar nominee Lucy Walker, and her colleague Julian Cautherley decided to start an outreach campaign called Love Your Brain, which hopes to raise awareness about brain injuries, provide those who’ve suffered them with a place to share stories, and promote helmet use.
While educational videos, social-media campaigns, critically acclaimed films, and more people wearing safer helmets are all undeniably positive developments, whether they lead to fewer brain injuries remains to be seen. The problem runs deep. The physics of our amped-up, supersized sports don’t play nice. As Smith’s Chilson says, “You can put a helmet the size of a watermelon on your head, and the world will find a way to hurt your brain.”
Athletes of all types, event organizers, and coaches need to make better decisions about the parameters of our sports. After Caleb Moore died last year, the X Games discontinued its freestyle snowmobiling events. Canceling patently dangerous, made-for-TV spectacles after a high-profile death was probably an easy call for X Games officials, but there are more-difficult decisions ahead.
In 2007, Kristi Leskinen, one of the world’s top female freeskiers, noticed something: as the features at freeskiing competitions got bigger, injury rates were rising. She decided to survey 90 slopestyle skiers and snowboarders. Her findings were startling. Female competitors were 3.5 times more likely than men to injure themselves. Furthermore, the majority of women agreed that reducing the size of the jumps in slopestyle events would make the sport safer. When she shared her results with coaches and event organizers, they were unmoved; women’s jumps remain the same size as men’s. “I had national-team coaches that actually said, ‘If women want smaller jumps, women will get less pay and less exposure,’ ” says Leskinen. “My response was that if we don’t scale back on the injuries, parents won’t allow their kids to compete anymore.”
Now that the majority of freestyle skiing and snowboarding events are part of the Olympics, more scrutiny should be forthcoming. Unlike action-sports event producers, who are heavily influenced by television ratings and sponsor desires, Olympic organizers, while certainly not immune to external forces, are also supervised by international committees focused on athlete safety and injury prevention. “Hopefully, it won’t have to reach the point of deaths for organizers to make safety changes,” says 1973 U.S. national champion alpine skier David Currier, whose son Lyman is one of the country’s top slopestyle skiers and hopes to make his Olympic debut in Sochi.
In the meantime, it’s up to us to regulate ourselves. There are signs that this is already happening. Up in Whistler, where Mike Douglas lives and skis with his kids, he reports that skiers and snowboarders have been gravitating toward smaller features: the 22-foot superpipe is deserted, the 18-foot pipe sees a little traffic, and the 12-foot pipe is teeming with kids and adults. Across the industry, resorts are building smaller, safer “progression parks.”
Backcountry skiers and mountain bikers are also starting to rein themselves in. Too many high-profile, preventable avalanche deaths over the past few winters have convinced opinion leaders to preach the virtues of skiing safer lower-angle slopes. In mountain biking, suspended bridges and big drops are giving way to intermediate-friendly flow trails that keep riders close to the ground.
Even action-sports filmmakers, who in the past tended to glorify dangerous stunts, are starting to shift focus. Some of this year’s most heralded ski and snowboard movies don’t feature the gnarliest hits or the scariest lines. Instead, the buzz is about creativity and high production values—an indication that the bigger picture is starting to change, too.
For my part, I’m buying better ski, snowboard & bike helmets this winter.
There are constant reminders that the ills of velocity are insidious, veiled as they are in pure joy.
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