Head injuries - How often have you seen them?

[nicklaszlo]

I have been recovering from a minor concussion for the last two weeks.  I got it attempting lobe two of the senior spirals.  It's a pretty weird (and inconvenient) experience.  One of the doctors said "no comment" when I asked if a helmet would have prevented the injury.

[ChristyRN]

Ugh. Mine is still too recent for me to not feel sympathetic. How are you feeling/doing now? Any lingering problems?

[nicklaszlo]

Ugh. Mine is still too recent for me to not feel sympathetic. How are you feeling/doing now? Any lingering problems?

Yes, after three weeks, tiredness, headaches, poor balance, weird vision.

[ChristyRN]

I'm more eight months out and the only residual issues I have are memory problems that are a bit worse than they were before. Little things like the fact that I was bad with names and needed to make lists for more than four items.  Names take even longer for me to remember now and I have to make lists for more than three items, or I will forget at least one.

My coach also says two of my bronze MITF patterns deteriorated a great deal, but are finally getting back to passable range. She blames that on balance problems.

[Sk8tmum]

Okay, I'm going to be THAT poster.

a) girl in synchro team. Fell, hit head. 1.5 year recovery. 9 months in darkened room. Still has residual effects 3 years later.  Not a violent hit, just, a hit on the ice.
b) my DS watched a guy die in front of him from a hit on the head on the ice, while DS was stabilizing the skater's head and neck waiting for EMS. Not a bad fall, just a freak fall over backwards.
c) my DS has had 3 concussions. They did an MRI and a FMRI on him recently, and, fortunately, no damage seen. All 3 concussions from figure skating; one a freak slip out of a 2LZ, one a slide into the boards, and one a fall getting out of the way of an unobservant skater who cut him off going into a 3T. DS is/was a competitive skater, so it wasn't a weak skating thing.

I could keep going, but, I'm not going to.  My brothers were part of the old "rock 'em sock 'em" pre-helmet days, and concussions were just - what happened in hockey.  And, hanging around arenas, I see lots of head injuries. I would say 3 in the past week, 1 figure skater, one hockey, and one public skater.  None unskilled, just unlucky.

My DD works with people who have had TBI (Traumatic Brain Injuries) and sees lots of MRIs. The apparently "mildest" bumps can cause major damage; what looks like big bumps can be immaterial.  Helmets just cushion the fall and hold the skull intact. They do not protect from concussion - as noted, it is the brain "sloshing" around inside of the skull itself. And what they are seeing now is the long-term effects - the consequences are popping up years after the original injury.  Cheery thought, isn't it?

So. Learning how to fall and protect the head is a very good idea. My DS was able to avoid many potential head hits by using what he was taught in martial arts in terms of how to fall properly - it was just the freak out of control ones that injured him. But, you can also get the same nasty fall from walking down the street and tripping over the curb (like I did!) ... soooo ... not planning on putting him in bubble wrap, just yet.

[dlbritton]

This was my reasoning for only leaving the 2 rear pads in my Crasche (so it would fit comfortably). I'm not as concerned about a forward fall as I am a backwards fall. Never had a fall (forward or backward) where my head did hit (knock on wood), but after wearing a Crasche for a few weeks I don't feel comfortable on the ice without it now. Same for my wrist guards.

I posted this a while back, but in light of my recent fall have revised my thinking.

My new Crasche fits a little looser so I can keep all of the pads in. The fall I had 2 weeks ago certainly needed the 2 side pads in the Crasche and possibly the front pads as well. I hit in the temple area, above and in front of my right ear. I had no bruising or marks on my shoulder, arms wrist or knees so I went sideways onto my right hip and right side of my head. I don't know if the Crasche would have lessened the impact of the fall but I believe it would.

I still have minor lingering headaches that are about a 2 on a 1-10 pain scale. My migraine pills knock it out but I am taking them 2 or 3 times a day. No lingering memory or cognitive issues as far as I can tell. The sports medicine doctor said the headaches may continue for a while. He also has me taking Coenzyme Q10 and magnesium for the headaches and doubling up on my fish oil for memory issues.

[lutefisk]

My problem with head protection gear is that there are no hard standards for anything beyond a bicycle helmet.  ASMT provides voluntary standards for various activities but there is limited  data as to which type or brand of helmet, foam doughnut, etc. actually provides real protection.  In one report which I read, ASMT compared several different brands of lacrosse helmets (manufactures for lacrosse helmets tend to follow the ASMT's recommendations) and several hockey helmets.  All of the lacrosse helmets received passing marks during the ASMT's test.  Only one of the hockey helmets passed.  So, even in an on-ice sport which features collisions, fist fights and hard falls it appears that there isn't much attention given to any sort of voluntary industry standard.   

I'm still sitting at home, not allowed to drive or go to work (just about blown through all my sick leave; still have a good amount of vacation leave) after having fallen and whacking my head and shoulder on the ice back in early July.  I had a craniotomy and a broken humerus.  So far it appears that my outcome will be good, but before returning to the ice (my wife wants to burn my skates) I'd really like to get headgear which provides real protection and not just the illusion of protection.  When I do go back on the ice it will be interesting to discover just how much of the pre-crash skater remains.  I wish the ASMT would do a comparative test featuring the ice halo, crashe middie, ribcap etc.  I have a skateboard helmet, which like a bicycle helmet is supposed to be good for a single impact and then must to retired.  Concrete sports are obviously different from figure skating but at present this is what appears to offer the best protection.  I can't afford a second subdural hematoma.  If anyone knows of a link to a comparative test featuring the usual brands of protective headgear offered to skaters I'd love to see it.

[skategeek]

I'd love to see that too.  My gut feel is that things like the Ice Halo and Ribcap have more compressibility than the Crasche, which is hard but very thin, and therefore might provide better deceleration with a mild to moderate impact (one that could lead to concussion but maybe not skull trauma like a very hard/fast impact could).  But I'm not an expert, and I'd love hard data on it.

[Query]

FWIIW, people say peripheral vision is extremely important to hockey, and that is what limits hockey helmets. One hockey guy, who learned before helmets came into general hockey use, told me that even the helmets that are transparent fog up, blocking visibility. If you use chemicals to prevent fogging, the condensed sweat just creates a lot of water droplets on the surface that interferes with vision too. That's the reason, so he says, that pro hockey players usually wear very minimal helmets, that provide relatively little protection. He claimed that even the hard wire mesh at the front of hockey helmets interferes somewhat with vision and hockey play.

But you also need to remember that the primary thing that hockey helmets protect you against are fast flying puck impacts to the eyes. A situation rarely encountered by figure skaters in public and freestyle sessions, unless you skate at a very poorly managed ice rink.

Construction workers are most worried about heavy falling objects hitting the top of their heads.

I think speed skaters mostly worry about other skaters running into them with their skates when they are down on the ice.

I think figure skaters are most in danger (for their head) of getting their heads hurt by hitting the back of their heads on the ice, and perhaps secondarily, forehead and chin impacts on the ice - both in falls. And in fact, all the times I have seen a skater hurt who wasn't playing with sticks and pucks, it has been to the back of their heads, after falling stiffly backwards.

I think that many so-called-experts who try to develop standards for a general purpose protective helmet don't take into account that different sports tend to involve different risks - and that protective gear that protects against every possible threat in all activities will be too cumbersome and uncomfortable to be used. There is no reason why the same types of protective gear should be optimal for these very different situations, so we can mostly ignore helmet ratings designed for other activities.

E.g., if I'm right, soft compressibility at the back of the head, not hard shell abrasion resistance, is pretty much all that matters to us.

My personal intuition, which may be wrong, is that something like the Ice Halo HD, which resembles a  head-band and only cushions the top-back part of the head, not the central-back part of the head, may only offer borderline protection to figure skaters.

I'd bet that if you took a thin ski cap, and sewed two layers of foam - one open cell foam, one closed cell foam - into the back, it would do all you are mostly likely to need. Maybe even just the closed cell foam - e.g., carpet foam, say a 4" tall by 6" wide piece, for an average size adult. You might be able to get a scrap piece that you can cut down to that size from a carpet store, for $1 or $2 - though the salesperson may not consider it worth their time. BTW, carpet stores can also sell you open cell foam, if you want to use two layers.

BTW, the foam in my suggested design would serve two purposes - first, the gradual compression would reduce the deceleration suffered by the head when you fall backwards. Second, it would help prevent you from rolling the cap up too high to provide protection to the back of the head. 

But even that suggested design will cover enough of the head to make it harder to get rid of sweat and heat. And a lot of figure skaters, particularly ladies, care a lot about how they look, and may not want any portion of their head, especially the front and sides, covered - so it's far from perfect.

[riley876]

I'd bet that if you took a thin ski cap

Or two!  Sew them together with the foam in between them.   Not that ski caps are particularly challenging to sew from scratch.   

, and sewed two layers of foam - one open cell foam, one closed cell foam - into the back, it would do all you are mostly likely to need. Maybe even just the closed cell foam - e.g., carpet foam, say a 4" tall by 6" wide piece, for an average size adult. You might be able to get a scrap piece that you can cut down to that size from a carpet store, for $1 or $2 - though the salesperson may not consider it worth their time. BTW, carpet stores can also sell you open cell foam, if you want to use two layers.

I extensively tested a bunch of foams, I'd be hesitant to recommend carpet foam.  It's just not dense enough.  Especially for the likely sub-par thickness you'll likely end up with in this setup.

My picks:
- Closed cell (i.e. dry) floral foam.   Absolutely has to be the closed cell one, the open cell ("wet") stuff isn't dense enough.  Downsides are that it's fragile, messy, and absolutely a one shot deal.    But the performance is superb.
- Expanding polyurethane foam.  i.e. "Space Invader" or other hardware store clone.   The trick is to make it dense enough, by squirting a bunch into a plastic soda bottle and quickly screwing the lid on (don't worry it won't explode, the vapour pressure is fairly low).  Then cut it open to get the foam out when it's dry.
- Good old polystyrene foam.   You need stuff that has some give, i.e. softer than bike helmet polystyrene,  but otherwise the higher density the better.

Less good picks:
- EVA foam.   It'll last well, but it's not really that great at absorbing energy.  i.e. you get the energy of hit straight back.  Which is OK for hip pads etc, but not a good thing for your brain.
- Long thin strips of corrugated cardboard rolled up into spirals (make sure you get the corregations vertical).   It's a crap shoot about how densely to roll it up,  but it works surprisingly well at absorbing energy.   Also needs lacquering to stop it absorbing water.

Highly NOT recommended:
- Any open cell foam.  Without the trapped air pockets of closed cell foam, it's just not hard enough.
- Bubble wrap.  Literally completely useless.
- D3O/Sorbothane/clones.  Hardens like concrete on impact, which is totally the opposite to what you need.

[ChristyRN]

I'm still sitting at home, not allowed to drive or go to work (just about blown through all my sick leave; still have a good amount of vacation leave) after having fallen and whacking my head and shoulder on the ice back in early July.  I had a craniotomy and a broken humerus.  So far it appears that my outcome will be good, but before returning to the ice (my wife wants to burn my skates) I'd really like to get headgear which provides real protection and not just the illusion of protection. 

Did you tell us this and I missed it?? I came thisclose to a crani because they thought I had a hematoma too. I hope you are feeling better by now and can soon start resuming a normal(ish) life again.

And yeah, everybody I know wants to burn my skates and never allow me on the ice again.  I have a Crasche band and it seems ok so far. I haven't tested it yet and don't plan to.

[riley876]

If anyone knows of a link to a comparative test featuring the usual brands of protective headgear offered to skaters I'd love to see it.

I do have a collection of helmet literature.   But the trouble is that all the recognised standards test only for killer-hits,  e.g. must be less than 300G at 5.5m/s for CSPC bike helmet standard.   300G is probably the line between "you'll recover eventually" and "you won't recover ever".  5.5m/s is near the speed of being hit by a car.    No one tests the little hits, e.g. 2m/s that you might get from your average figure skating half-saved SNAFU.   Consequently, the helmet makers all make helmets that probably also rate near 300G for these impacts too.   Simply because they use polystyrene foam that doesn't compress one jot at the lower impact speeds, so it may as well be concrete.    It's no wonder people think helmets don't stop concussions, because in general, they're right.

If you want the ultimate protection, IMHO you should follow my path - buy a hard shell skateboard/roller derby type helmet, rip out the foam, throw that away, and build a new foam interior from dry floral foam or constrained expanded polyurethane.   I tested the former to give < 50G at 4m/s (though that's about it's velocity limit, at much higher speeds the G's will be very high, likely exceeding 300G).  The latter is only slightly worse, but may perform better at higher speeds.

Anyway will zip up all my lit and put it somewhere.

[riley876]

BTW, if anyone wants to send/lend me a crasche, rip cap, hockey helmet, etc,  I'm more than willing to put it on my drop test rig.

I highly doubt any of them are any good though.  The foam is just not thick enough.

[Query]

Riley876, can you tell us what type of tests you did, and what your criteria were? I know for sure that even the minimal thickness and crushability that wearing a reasonably thick pair of sweatpants provides made a huge difference to my hip impacts.  (This was before I learned how to fall, of course - now I don't need anything but gloves and a long sleeve shirt, and those only to prevent abrasion). I would guess that that only added about 1-2 mm to my deceleration distances - yet it was enough to prevent bruising. (Yes I know. Hips are much better padded than heads. But it shows that even a little bit can help a lot.) Compared to the 10 - 20 mm crushability of a decent carpet foam (which crushes that much with a few hundred PSI of pressure - it depends a lot on the foam), I would think that carpet foam would help a lot. I know that is a pretty crude way of estimating things, but I'm not sure how to get a better one.

I'm not even sure what criteria to use to prevent severe injury. Based on figure 12 in http://www.smf.org/docs/articles/hic/King_IRCOBI_2003.pdf you can possibly take a few hundred m/sec^2. But there are several factors that can affect deceleration.

Am I correct that all of the materials you like are good for single impact only? That isn't very practical. Almost no one will throw away a helmet because they had a minor fall. Carpet foam, OTOH, can compress zillions of time with essentially full recovery.

I'm also not sure how you calculated 2 m/s.

Consider an approximate free fall from standing height as worst case. (Not really - if you are going really fast, and your blade catches on something, you can go down faster. But it's a good first cut.) If we assume that your center of gravity is 1 m, then the standard formula for uniform acceleration at 1 g (essentially gives you the kinetic energy speed obtainable from converting your potential energy to motion)

  v^2 = 2*g*d

gives you about

v=4.43 m/s

And that is for uniform motion of your whole body. If you consider that your head will probably move faster, in a worst case backwards fall in which the back of your head smashes directly onto the ice, and the skater's body doesn't bend much, which seems pretty typical of what we see at ice rinks when people get badly hurt, you might estimate about twice that speed.

Incidentally, the facility where I work sends someone to the hospital or requires other emergency treatment about once a day. I don't know how many of those are head injuries, and how many of those are for figure skating - I think a lot less. Plus, that is for up to 6 ice surfaces (I don't think the person who told me that was counting the 6th surface, a separately managed curling rink, and I'm not sure it includes the separately managed hockey training center surface, though it is in the same building), depending on the season and what was counted. I think typical less intensely used single surface rinks send send someone to the hospital or require emergency services about once every week or so.

[riley876]

Thread on my testing:   http://www.skatelogforum.com/forums/showthread.php?t=45084

Hip and heads need different strategies.  With hips, if you can simply spread the impact load you can reduce injury,  because muscles are quite compressable.   OTOH, if you land hard on the bone, ouch.    With heads, you can't avoid landing on a bone. 

Heads, it's all about minimising internal G forces, (more accurately it's about minimising the area under the time vs decel^2 curve, if you believe the HIC story).   There's also the Gadd Severity Index, which is similar, but a slightly different formula.

Single impact materials, I agree would be economically impractical for an typically horrendously overpriced commerical helmet,  but if you're DIYing it's doable.   And I firmly believe you can do a better job if you DIY.    A perfect single impact material literally halves the energy transfer vs a perfectly elastic object (e.g. a spring, or foams with full instant recovery).   I'll take that as the very easiest low hanging fruit.  i.e. it halves the HIC numbers.

Yes, 1m free fall is 4.4m/s.  2m free fall is about 6m/s.   But whilst it certainly possible to get these hits on ice,  going by the now 4 figure skating head hits I've personally witnessed,  none of them were even close to free fall velocity.   All were semi-saved.   So I pulled the 2m/s figure out of thin air,  as a very rough estimate.

Boxers apparently routinely take 75G ish punches.  And boxers routinely get concussions.  So I consider this my limit for "reasonably damage".  300G OTOH is an incredibly hard hit.   You have to witness the sound of an object hitting a floor at 300G to appreciate just how violent it is.   I cannot believe the 300G would not be on the verge of permanent noticeable damage.   Yes, of course all of this neglects rotational accelerations,  but I don't think that's a big risk for skater's falls.  Especially ice skater's falls, where the surface is effectively permanently lubricated.

I'm more than willing to test carpet foam.  In fact, I'll endevour to source some modern stuff.   But the 70s stuff under my current carpet, I can tell you now for sure it'll be WAY too soft.   Just by comparison with what I've already tested.

[Query]

BTW there is a HUGE difference between open and closed cell carpet foams. Open cell foam IS soft - like a sponge. A high quality closed cell carpet foam is hard to compress much with your fingers. Good closed cell carpet foam would be very roughly 1.5 - 2 cm thick. Maybe you could try more than one layer too.

Boxers are different from skaters. They get hit A LOT. Hopefully, skaters will rarely if ever impact their heads. So we can probably take a larger impact. So I think the biggest concern should be skull fractures, not repetitive brain injures. Skull fractures are a very serious injury, potentially even lethal, that you sometimes see in backwards falls at ice rinks.

A brick falling on a flat surface might be different from a head impact in skating falls. When your head hits, only a very small area takes the impact - which is what makes it very dangerous for skull fractures. That creates more bend (which creates tension, among other things) and sheer. Bones are not nearly as strong against tension and sheer forces as against compression.

If you don't want to fracture your skull, you should try to equalize the pressure over the entire outside of the skull, during the impact. That means you need the foam to apply roughly equal pressure everywhere, which means shaping the foam, and that it needs to cover as much of the head as possible. In principle, you also want the helmet to spread out impacts laterally, like Kevlar cloth would. (Look up how bullet proof vests work.) This is why I would be a little hesitant to assume that any soft helmet, like Ice Halo or Crasche, substitutes well for a good, well fit, hard one. I was only suggesting the cheap carpet foam solution, another soft solution, because I don't think many figure skaters are willing to wear a full coverage head helmet, because, they care too much how they look. In principle, one might place a few layers of Kevlar cloth next to the foam - but that would make my solution much more expensive!

[dlbritton]

Prior to my latest fall I thought protection to the back of the head was really mattered. On all of my forward falls I have always landed on my (padded knees) or on my wrist guards and my head never contacted the ice. My Crasche was very tight with all of the pads in so I was only using the back pads prior to when it got stolen. The hit I took 2 weeks ago falling was to the temple area of my head so at the least I needed to have the side pads and possibly the front pads in place as well to have any protection. That fall convinced me to order a replacement and wear it with all of the pads in place. Fortunately the new one is a little looser than the previous one so I can comfortably wear it with all of the pads in place.

On the topic of "protection" I too wish there was some type of standard and testing applied to the various headbands available. The construction of the Crasche leads me to believe it has to offer some type of concussion "mitigation".  It has a hard plastic outer layer and a 1/4" neoprene rubber inner layer. I don't know if it would have prevented me from getting a concussion altogether but I do believe it would not have been as severe. I also worry about skull fractures and again I think the Crasche would provide quite a bit of protection against a fracture.

I have noticed I am somewhat apprehensive each time I get on the ice now (4 times since fall). It does go away after a few minutes on the ice, but I don't remember having any apprehension when I got back on skis after my knee injury had healed. I believe the difference is this was a brain injury (mild but TBI none the less) where my knee was was a physical injury only.

[lutefisk]

My recent fall also resulted in an impact near my right temple region.

[Feebee]

Kind of unrelated, but I took a pretty fast/hard fall the other day. It was mostly onto my side, fleshy part of my hip, so I didn't think much of it. My coach was across the ice at the far end, and wasn't sure if I hit my head. I had a pretty bad headache afterwards, and went to a walk-in clinic aftewards. The Dr. did some tests (checking pupils, eye tracking, balance, etc. ) and said I was ok, just to take it easy. I did, and after a long headachey day, realized I was just dehydrated! I drank a lot over a couple of hours, and poof, the headache disappeared.

HOWEVER, I woke up with a seriously strained neck, and now I realize it must be whiplash. Any of you ever experience whiplash from a fall? I've been icing it regularly, but I want to know how concerned I should be...If you've experienced this, how long did it take to recover (regain full range of motion and be able to skate again?)

[Query]

Also unrelated, but I took an unexpected fall the other day too.

I was watching the way hockey players burst super fast onto the ice. What they was to lean far forwards and running off their inside edges, and put everything into a fast sprint. It was annoying to be beat out in speed by a 10 year old hockey kid, who'd only been skating 7 years.

I decided to try similar sprints too.

Guess what? I discovered something amazing. Figure skates are not ideal for sprints on deep forward leans! "Toe pick!" Especially since I only switched from Dance to Freestyle blades a month or so ago, and am not yet used to freestyle toe picks.

I went down very fast. The trip over the toe pick rotated me down to the ice much faster than freefall. I landed on my knee, but managed to turn it into a forwards slide. But, despite a lot of fall practice, it hurt. And, shame on me, despite knowledge that I should ice it immediately, I didn't. So I got a bruise around one knee that lasted several days.

Gee, could there be a good reason that freestyle skaters are mostly taught to lean BACK while skating forwards?  Since the fall, I've tried sprinting that way too. It feels very awkward and inefficient, though that may be because I was trained by certain ice dance coaches to lean forwards during forward skating, and have practiced that for over 10 years.

I still think freestyle blades are evil.

[emitche]

Yes. I took a bad fall once and got whiplash. That fall led to me purchasing a helmet because I wanted to avoid head injury in a future fall.

[JSHalo]

This thread always makes me cringe when I come back to it. A week ago I slipped backwards out of a waltz jump and nearly smacked my head. I'll forever be thankful for a strong core that kept me from flopping like a rag. I'm either a glutton for punishment or I'm just really stupid, because I got back up and starting jumping again. Maybe one of these days my brain will repair itself and suddenly realise that none of this is a good idea 

I'm still sitting at home, not allowed to drive or go to work (just about blown through all my sick leave; still have a good amount of vacation leave) after having fallen and whacking my head and shoulder on the ice back in early July.  I had a craniotomy and a broken humerus.  So far it appears that my outcome will be good, but before returning to the ice (my wife wants to burn my skates) I'd really like to get headgear which provides real protection and not just the illusion of protection.  When I do go back on the ice it will be interesting to discover just how much of the pre-crash skater remains.

I hope you have a good recovery from here. I think a lot of us who have had brain injuries (of any sort) have a Before and After, and I hope this isn't the case for you. A large part of me still mourns for the "Before" version of myself. I speak pretty freely about my accidents and my surgery, but it's difficult for other people to understand why things are so different now. If you ever find yourself having any difficulties (even small things) there is a large network of people out there who are going through the same thing, so never be afraid to reach out.

[lutefisk]

Thanks JSHalo.  I am now cleared to drive, go back to work and have returned to the ice.  After three public sessions things such as remembering the steps to simple ice dances that I previously knew my heart, and skills such as power pulls, inside 3s, etc. are slowly coming back.  I told my coach that I'd be in touch once I get to the point where lessons will not be a waste of time.  I'm wearing a Bern "Watts" skateboard helmet and am still researching the topic of protective head gear.  An individual commenting on one of my blog spot posts has tipped me towards a headband made by Force Field.  Unlike the Ice Halo and the Crashe Middie, the Force Field headband appears to comply with an ASMT standard (F 1045) recommended for hockey helmets.  Those interested can read more here:  http://www.forcefieldheadbands.com/testdata.html  At $15 to $20, depending on the model, these headbands seem reasonably priced and I plan to order one to see if it will fit within my existing Bern helmet.  If not I may wear the headband without the helmet--provided I can convince myself that I'll have adequate protection.  I can't afford another blow to the head at this point.   

[AgnesNitt]

I have a Force Field. It's for heading soccer balls. An Ice Halo would be better.

[lutefisk]

I have a Force Field. It's for heading soccer balls. An Ice Halo would be better.

Agnes:  Is there any test data published on the ice halo?  I keep looking and hoping to discover some.