Recreational Injury Interventions
In-line skating has increased in popularity
in recent years, providing nearly 20 million people with a source of recreation
and fitness, Young et al, 1998.
The CDC reported a 180% increase in the incidence of in-line skating injuries since
1993, indicating a need for prevention interventions. In 1995, there were an estimated
100,000 serious injuries requiring emergency room evaluation. This figure makes
in-line skating the seventh leading cause of injury from recreational activity.
Recent studies that investigated the incidence of injury and effectivness of protective
equipment concluded that use of wrist guards, knee pads, elbow pads, and helmets
does prevent injuries. Yet, in-line skaters often do not wear protective equipment
because they do not believe it is necessary, Young et al, 1998.
Several epidemiologic studies demonstrated
that arm fracture is the most commmon injury warranting an emergency department
visit among in-line skaters. Studies further indicate that the use of wrist guards
significantly reduces the likelihood of fracture when a skater falls or drops. Lewis et al, 1997, reported that the mean number of drops sustained
without fracture in arms with protective devices was almost twice that in the arms
without wrist guards. However, some biomechanical evidence does not support the
notion that wrist guards prevent injury. Giacobetti, et al, 1997, found no statistically significant difference for
the protective effect of wrist guards when compared to impact tests without wrist
Some researchers believe that there is a
need for other countermeasures to prevent in-line skating injury, including improved
braking systems that allow wheels to remain in contact with a skating surface and
do not interfere with skating manuevers. One observational study in Manitoba, Canada
reported that of 123 skaters 14.5% had no heel brakes, Sherker & Cassell, 1999. Furthermore, 75% of young people surveyed in Victoria,
had learned to skate by trial and error. Thus, indicating a need for education and
skating instruction that provides young people with alternative ways of stopping,
such as using a T-stop or spin stop, and with falling techniques that minimize injury.
Prevention interventions for young people should also be considered a priority because
emergency department hospital data has indicated that skaters aged 10 to 14 years
are most at risk for injury, Sherker & Cassell, 1999.
It should also be considered that novices,
with a reported average of 2 months riding experience are at a high risk of in-line
skating injury, Sherker & Cassell, 1999. It takes practice before skaters become agile enough
to stop well, control speed and direction, and balance on rough surfaces. This may
indicate a need for public or private skating environments that match skating ability.
Additionally, some governments have created regulations that increase safe skate
opporunities, such as the City of Melbourne Skatesafe Plan.
One study below outlines risk factors from
in-line skating and the effectiveness of protective equipment in children and adults.
Review of in-line skating studies:
|Schieber, et al, 1996
Study design and target population
|Case control study.
Population: injured in-line skaters who sought
medical attention between Dec 1992 and July 1993.
Mean age of population 20.8, median
age 15. Range 6 to 59 years. 48% Male.
|Injured randomly selected from 91 emergency departments
included in the National Electronic Injury Surveillance System, (NEISS).
Skaters who injured their wrist, elbow, knee,
or head interviewed and compared to skaters with injuries to other parts of
|Risk factors for injury including:
age, sex, dominant hand, ability level, # of times in-line skating, cross-training,
# of lessons taken, performed tricks, perceived level of exertion at time of
fall, and whether fall related to difficulty stopping.
|32% wrist injuries, 25% were wrist fractures.
Only 7% of all injured skaters wore all 4 types of
protective equipment, 46% wore none.
Odds ratio for wrist injury adjusted for age & sex, for
those that did not wear wrist guards compared with those who did, was 10.4
(95% CI, 2.9 to 36.9).
Odds ratio for elbow injury, adjusted for the # of lessons
& whether or not they had performed a trick skating, was 9.5 (95% CI,
2.6 to 34.3).
Nonsignificant increase in knee injury & effectivness
of helmets could not be assessed.
Study quality and conclusions
|Wrist guards & elbow pads are effective in protecting
in-line skaters against injuries.
Possible selection bias resulting from use of emergency department
patients as controls, rather than skaters drawn from the general population.
Type of protective equipment not controlled for. Possible
information bias from self-report.
Summary of in-line skating studies
Schieber, et al, 1996, suggests that in-line
skaters should wear wrist guards, elbow pads, and knee pads. It is also recommended
that skaters wear helmets that meet the existing standards for bicycle helmets,
as they are strongly protective against head injuries in physical environments that
are quite similar to that of skaters. Protective equipment in children and adult
sizes is widely available and relatively low cost, yet the challenge of health care
providers it to educate skaters' about the potential dangers of in-line skating
and to try to get individuals to wear the appropriate gear. Futher equipment safety
measures, such as automatic braking devices and specialized wrist guards for roller
hockey, may also be utilized to reduce the incidence of in-line skating injury.
Recommendations on in-line
Protective equipment including; wrist guards,
elbow pads, knee pads, and helmets should be utilized by in-line skaters of all
ages and abilites. Previous studies strongly recommend implementation of clinician
counseling and education to promote use of wrist guards and protective equipment.
Additionally, skating instruction and safe skate environments should be considered,
in particular for young people and beginners.
Recommendations for future
More biomechanical and epidemiologic
research to identify preventive countermeasures & benefits of protective equipment
are needed, particularly in the area of wrist and forearm injury prevention. Additionally,
prevention programs that focus on skating instruction and safe falling techniques
should be investigated. Randomized controlled trials investigating clinician counseling
and education programs are also needed.