Recreational Injury Interventions

In-Line Skating

Background

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 guards.

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:

Author

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.

Intervention

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 the body.

Outcomes

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.

Results

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 skating interventions

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 research

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.