Young athletes have long been convinced of the importance of wearing helmets when riding bicycles or playing football, but have been slow to accept them when participating in snow-related sports. A study by researchers at Johns Hopkins found that 120, 000 ski and snowboard related head injuries are reported in the United States each year and that “head injuries are the chief cause of death among skiers and snowboarders.”
Helmets Essential for Skiing Safety

In 2011, New Jersey became the first state to require helmets for skiers and snowboarders 18 years and younger, an effort that many advocates across the country refer to as “Lids on Kids.” California tried twice to pass similar legislation but the governors vetoed it both times.
Some critics claim that helmets impede visibility and cause skiers and snowboarders to take unnecessary risks. Adil H. Haider, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine, says, “These are all just excuses. Our research shows none of those theories hold water.”
The journal We Make It Safer supports the National Ski Areas Association’s (NSAA) recommendation for the use of snow-sport helmets, especially by children who ski at slower speeds, where helmets can make the greatest difference between life and death. According to the NSAA, helmets can reduce the risk of head injuries 30-50%. The story of actress Natasha Richardson who hit her head during a beginner’s ski lesson and refused medical treatment because she felt fine, only to die shortly thereafter, is a reminder to take all head injuries very seriously, no matter how minor they may at first appear or feel.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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