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国产吃瓜黑料 Online Brain Injury TBI Peruzzi
(Hannah McCaughey & Michael Karsh)

After the Crash: A Closer Look at the Rising Incidence of Brain Injury

The rewards of risk are fueling a catastrophic increase in TBIs. How can we protect ourselves?

Published: 
国产吃瓜黑料 Online Brain Injury TBI Peruzzi
(Photo: Hannah McCaughey & Michael Karsh)

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On March 24, 2012, skied through the south boundary gate at Jackson Hole Mountain Resort, in Wyoming, heading for 10,150-foot Cody Peak. Once on the ridge, the four skiers in her 颅party鈥攊ncluding her boyfriend at the time, Jeff Brines鈥攃ould have descended the backcountry line Pucker Face, but on inspection it looked icy, rocky, and as unpleasant as its name implied. A safer option would have involved down-climbing the back of Cody Peak and skiing one of the mellower pitches farther along the ridge. Instead, the four decided on a chute known as Once Is Enough.

Also: Building a Better Brain Bucket

The future of helmet design

Plus: Use Your Head

The best info on head injuries

Anatomy of an Impact

Your Friend Hit His Head

The Sally Francklyn Story

The Sally Francklyn Story

The entrance to Once Is Enough is 20 feet wide and pushes 55 degrees. Dropping in is a major commitment, but once you do there鈥檚 no real crux. The fall line, however, is deceptive. While the slope appears straight, it鈥檚 actually off-camber, and the couloir subtly doglegs through rock walls. A fall up high will likely catapult you onto sharp granite, and at these angles, you鈥檇 have only the briefest chance to self-arrest.

Francklyn, 24, was not a seasoned ski moun颅taineer. She鈥檇 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鈥檛 skied many high-consequence lines.

Brines, 28, an experienced backcountry skier who鈥檇 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鈥檚 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鈥檚 ski rocketed out of the couloir. 鈥淚 had one of those mental hiccups where you鈥檙e overcome by dread and willful positivity at the same instant,鈥 he recalls. 鈥淚 thought we鈥檇 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鈥檇 suffered a severe head injury. I didn鈥檛 know how much longer she鈥檇 be with us.鈥

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.

TBIs can be tricky to define. They range from concussions, with primary symptoms lasting a few days or weeks, to death. While the exact terminology can be confusing鈥攖he terms concussion and mild TBI are often used interchangeably鈥攈it your head hard enough and you may experience wide-ranging physical and psychological effects. 鈥淭he trauma causes the brain鈥檚 wiring to become inefficient,鈥 says Alan Weintraub, medical director of the Brain Injury Program at Denver鈥檚 Craig Hospital. 鈥淭he result is varying levels of disturbed consciousness.鈥

While automobile accidents and falls cause more than half of the 1.7 million TBIs annually, war and football have received more attention of late. According to a 2011 study, some 320,000 severely brain-injured servicemen and women have returned from Iraq and Afghanistan, most of the trauma the result of concussive IED blasts. And this fall, more than 4,500 retired NFL players, athletes who鈥檇 spent entire careers pummeling their gray matter, sued the league and were 颅awarded a $765 million settlement. The story of how some of those players believed the NFL had covered up the dangers of head injuries was painstakingly laid out this fall in the book League of Denial and a Frontline documentary of the same name.

But non-vehicular concussions are not limited to the gridiron and the battlefield. The Centers for Disease Control and Preven颅tion estimates that between 1.6 million and 3.8 million sports-related concussions 颅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 颅American Asso颅ciation of Neurological Surgeons, 颅roughly 600 cyclists die annually as a result of head injuries, and in 2009, some 85,000 concus颅sed 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鈥攍ike 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鈥檛 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鈥檛 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鈥檚 only part of the picture. 鈥淭here鈥檚 a greater trend of brain-颅injury awareness,鈥 agrees Weintraub. 鈥淏ut there is a brain-颅injury trend. We鈥檙e seeing more of them from falls and sports.鈥

It鈥檚 not that helmets have gotten worse or gravity more powerful. It鈥檚 that our behavior has changed. In the past few decades, we鈥檝e fundamentally altered how we recreate outdoors. From massive halfpipes to full-颅suspension mountain bikes to junior-level big-mountain freeskiing competitions, we鈥檙e playing at a more intense level. 鈥淥ur sports are supersizing,鈥 says Mike Douglas, a pro skier from Whistler, British Columbia, who helped launch the freeskiing movement in the 1990s. 鈥淚t鈥檚 all about going higher, farther, faster. It鈥檚 not sustainable.鈥

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 颅nineties they grew to 12 feet, then 18. 颅Today鈥檚 com颅pe颅颅tition standard, established in 2010 by the 颅International Olympic Committee, is a 22-foot, vertical-walled superpipe. Elite snow颅boarders routinely launch 20 feet above the lip. Skier Peter Olenick set the record for amplitude鈥攁 physics term appropriated by the Red Bull generation to measure how far an athlete soars above a halfpipe鈥攂y reaching 24 feet, 11 inches at the 2010 X Games in 颅Aspen. At the zenith of his record jump, Olenick was 47 feet above flat ice.

A similar progression has affected the rest of us. Our gear, terrain choices, and lay-off-the-brakes attitude mean we鈥檙e spending more time at high velocity and at the mercy of gravity. It鈥檚 a phenomenon I鈥檓 intimately familiar with. I ride my 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 shattered my collarbone. Before my 12-year-old son鈥檚 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 鈥渢he evolution of the human body is not keeping up.鈥 We long ago outpaced our biology鈥攁nd, disconcertingly, the level of protection afforded by our helmets. Our brains simply can鈥檛 sustain the massive hits that result when things go wrong.

When Sally Francklyn鈥檚 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鈥檚 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鈥檛 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鈥檚 something she鈥檚 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鈥檚 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鈥檚 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鈥檛 visit as often anymore. She hopes to live independently in Colorado鈥檚 Summit County again. 鈥淚 don鈥檛 need assistance,鈥 she tells me emphatically.

Like many of the TBI afflicted, Sally鈥檚 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 颅injuries cover the cost of rehab.

As much as we can learn from Sally鈥檚 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, 鈥渢here 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.鈥

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鈥檛 trauma in the same vein as a broken ankle or a deeply bruised hip. Axons are the fibers that serve as your brain鈥檚 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鈥檚 lofty brain-mapping initiative doesn鈥檛 promise that. When tens of millions of neurons smash about inside your head, the exact nature of the damage is anybody鈥檚 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鈥攕cars left from the brain鈥檚 attempt to heal itself鈥攆orm 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鈥檚 and Parkinson鈥檚.

Unfortunately, the only way to identify CTE is by performing an autopsy. That鈥檚 probably why, in 2012, when former NFL star Junior Seau committed suicide, he shot himself in the chest instead of the head, like 颅safety Dave 颅Duerson had done the year before. Seau鈥檚 family 颅donated his brain for study, and the postmortem revealed the telltale brown 颅fibrous balls deep within his brain.

Julian Bailes, a Chicago neurosurgeon who also works with the Sports Concussion Insti颅tute, is a leading authority on CTE. He鈥檚 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. 鈥淲e don鈥檛 know,鈥 he said. 鈥淚n terms of subconcussive hits, we think it鈥檚 years and years of exposure. In terms of 颅major concussions, we believe it鈥檚 three.鈥 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 snow颅mobiler Caleb Moore died, at age 25, he had already sustained at least 11 颅major concussions. Professional snow颅boarder 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 颅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鈥檛 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鈥檛 have been able to leave Jackson Hole鈥檚 gates, since the resort, like many others in North America, didn鈥檛 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 free颅skiing events for boys and girls as young as 12. Skiing powder in trees was a much slower 颅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鈥檛 become a national spectacle until 2002, when the 颅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鈥攕lopestyle skiing and snowboarding and halfpipe skiing鈥攎ake 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鈥檚 59 lift-serviced bike parks. On the road, pelotons are bigger and faster than ever, and group rides where you鈥檙e 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. 鈥淭here was always risk,鈥 says JT Holmes, a big-mountain freeskier and wingsuit pilot who, after seeing too many friends suffer TBIs, started working with High Fives. 鈥淏ut new technology has made higher speeds the norm.鈥

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 颅descending safer. It takes very little effort to throw boat-shaped skis sideways to scrub speed, and today鈥檚 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. 鈥淵ou can now buy performance in every sport,鈥 says Holmes. 鈥淵ou can cut to the chase.鈥

Of course, once you taste speed, it鈥檚 hard to slow down. Of all my cycling and skiing friends, only one shows much restraint. He鈥檚 a doctor, and his brother is a neurologist; he understands high-velocity brain injuries. The rest of us need to keep in mind some 颅basic physics. Once in motion, a body wants to stay in motion. Pedaling a 颅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 veloc颅ity is equal to 7,650 pounds of 颅momentum. That鈥檚 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鈥檚鈥266 times the force of gravity. The resulting force acting on you is a sickening 39,900 pounds. At 266 G鈥檚, without a helmet, you鈥檙e dead or irreparably brain-damaged. With a helmet you at least have a chance. If you鈥檙e 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, 鈥渁 helmet can be the difference between life and death.鈥 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鈥檚 and 48,000 pounds. Pretty much instant death, regardless of whether you鈥檙e 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鈥檚 used in surfboards and styro颅foam coolers.

Think of a simple EPS helmet as a catas颅trophic 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鈥檚 acting on your brain. While EPS helmets don鈥檛 offer much if any cushion in low-velocity impacts and are overwhelmed by massive hits over 300 G鈥檚, 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鈥檚 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鈥檚 of force鈥攖he accepted norm being that a hit greater than that isn鈥檛 survivable or results in a vegetative state. (Researchers arrived at the upper limit in the 1950s by dropping 颅cadavers down ele颅vator shafts.)

The hitch here is that the CPSC鈥檚 high-velocity test is pass or fail, and every helmet sold is a winner. But not all helmets are 颅equally adept at the job: one might provide 20 percent more force reduction than 颅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鈥檇 love to say so. But 颅doing that would expose them to personal-颅injury lawsuits. If someone is injured wearing a helmet that a company promoted as safer, that company is likely to get sued鈥攁nd lose. The 颅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 contrap颅tions at high margins while making little ongoing investment in safety. As Helmet.org鈥檚 Swart, who is also a vice chairman of an ASTM committee, told me, 鈥淣obody takes you to court over a fashion claim.鈥

Fortunately, the market is starting to change. In 2010, Stefan Duma, an enterprising researcher from Virginia Tech鈥揥ake Forest University鈥檚 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 颅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-颅velocity hits can be life altering, too. And because 颅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 颅Koroyd, designed to dampen low-speed blows. (Because of legal concerns, it isn鈥檛 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鈥檚 high-velocity standard.

When it comes to rotational forces, one innovative technology鈥攆rom a Swedish company called MIPS, which stands for multidirectional impact protection system鈥攊s 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鈥檒l 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鈥檛 plan to manufacture helmets. The company鈥檚 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. 颅Sadly, a test that addresses all four pillars鈥斅環igh- and low-velocity, multiple hits, and rotational effects鈥攊s nowhere in sight. That鈥檚 because there鈥檚 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鈥檛 well understood. Another challenge: engineering a foam that鈥檚 soft enough to absorb low-velocity impacts while remaining unaffected by temperature and moisture fluctuations. 鈥淭he ASTM is slow moving, but their heads are in the right place,鈥 says Drew Chilson, director of development at Smith. 鈥淭hey are trying to improve standards. But to devise a holistic test that evaluated all four design principles would take years.鈥

For more on helmets, check out Building a Better Brain Bucket

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.

鈥淣ew athletes just don鈥檛 know how to keep themselves in check,鈥 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鈥 new Instagram-targeted #helmetsarecool campaign, in which tagging yourself wearing a helmet enters you in a contest to win one.

It鈥檚 not the only catchy social-media campaign you鈥檒l see this winter. In December, The Crash Reel, a transfixing 颅documentary about professional snowboarder Kevin Pearce, who suffered a devastating brain injury during a halfpipe accident in 2009, hits theaters. Inspired by Pearce鈥檚 remarkable story, and troubled by how little information about TBIs is available, the film鈥檚 director, 颅Oscar nominee Lucy 颅Walker (see 鈥淏rain Booster,鈥 page 40), and her colleague 颅Julian Cautherley decided to start an outreach campaign called Love Your Brain, which hopes to raise awareness about brain injuries, provide those who鈥檝e 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鈥檛 play nice. As Smith鈥檚 Chilson says, 鈥淵ou can put a helmet the size of a watermelon on your head, and the world will find a way to hurt your brain.鈥

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鈥檚 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鈥檚 jumps remain the same size as men鈥檚. 鈥淚 had national-team coaches that actually said, 鈥業f women want smaller jumps, women will get less pay and less exposure,鈥欌夆 says Leskinen. 鈥淢y response was that if we don鈥檛 scale back on the injuries, parents won鈥檛 allow their kids to compete anymore.鈥

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. 鈥淗opefully, it won鈥檛 have to reach the point of deaths for organizers to make safety changes,鈥 says 1973 U.S. national champion alpine skier David Currier, whose son Lyman is one of the country鈥檚 top slopestyle skiers and hopes to make his Olympic debut in Sochi.

In the meantime, it鈥檚 up to us to 颅regulate ourselves. There are signs that this is 颅already happening. Up in Whistler, where Mike Doug颅las lives and skis with his kids, he reports that skiers and snowboarders have been grav颅itating 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 鈥減rogression parks.鈥

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鈥檚 most heralded ski and snowboard movies don鈥檛 feature the gnarliest hits or the scariest lines. Instead, the buzz is about creativity and high production values鈥攁n indication that the bigger picture is starting to change, too.

For my part, I鈥檓 buying my family 颅better ski helmets this winter. But I also need to do a better job of keeping myself, and my kids, in check. In his first day at 颅mountain-bike camp, my son encountered an adult writhing in pain with a compound fracture and a teammate with a concussion that 颅necessitated an ambulance ride. He rode with restraint and had only one minor tumble鈥斅璦fter an instructor insisted he attempt terrain he wasn鈥檛 ready for. I won鈥檛 put his healthy brain in the hands of a downhill coach again.

Of course, exercising caution only goes so far. As I was finishing this story, another acquaintance of mine, Dale Stetina, had just entered Craig Hospital to begin rehabilitation following a severe TBI suffered in a road-bike crash a few weeks prior. He lost control on a canyon road outside Boulder after avoiding a car. It was a routine crash. He was riding fast with friends鈥攇uys I ride with every week鈥攑reparing for a much anticipated group trip to the Dolomites.

It was yet another reminder that the ills of velocity are insidious, veiled as they are in pure joy.

From 国产吃瓜黑料 Magazine, Dec 2013 Lead Photo: Hannah McCaughey & Michael Karsh

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