Concussions in figure skating: How to prevent themCoaches, experts stress importance of education to make sport safer
One morning in April 2007, I woke up lying on the ice, curled on my side. A gray mist slowly cleared from my vision. A few other adults -- the regular skaters on the public session -- were standing around me, but I couldn't hear what they were saying over the roaring in my ears.
With help, I stood up and wobbled off the ice. I sat on a bench with my head down. The rink manager came over and asked if she should call an ambulance, and I nodded. When the EMTs arrived, they asked basic questions -- "What day is it?" "Where are you?" -- and although I was able to answer correctly, it was a struggle to get the words out.
At the hospital, I was diagnosed with a severe concussion and a skull fracture of the temporal bone. I temporarily lost my hearing in one ear (it came back after a couple of weeks). My sense of smell was gone permanently; the olfactory nerve in my nasal cavity was basically ripped away from its connections in the brain.
I spent three nights in the hospital and a foggy month at home. I had a hard time writing even a simple email, and work was out of the question. My sleep patterns were completely disrupted. I'd fall asleep at 7 p.m. and find myself wide awake at 2 a.m., watching poker tournaments on TV.
Two months after the fall, I was more or less back to normal, except for my sense of smell. I have no memory of what I was doing prior to the fall. Piecing together my various injuries -- I also broke a bone in my lower back -- I have deduced that I must have fallen while skating backward fairly fast and landed on my back, and then my head whipped back onto the ice.
How to fall
Falling is a daily part of any competitive skater's life. Indeed, it might be safe to say that you can't learn to skate at all without falling, and that an elite skater can't learn difficult jumps without falling -- a lot. Most falls don't result in the head striking the ice, but some do. What's more, while concussions can result from on-ice collisions -- whether between partners or skaters who are sharing ice time -- they can also occur from impacts in which the head doesn't directly hit the ice.
Eliminating concussions in figure skating is an impossible task, but through certain types of exercise and by increasing awareness of conditions on the ice, the risk can be reduced.
Boston-area neurosurgeon Dr. Robert Cantu, whose many titles include senior advisor to the NFL Head, Neck and Spine Committee, recommends that athletes strengthen their neck muscles to avoid concussions.
"If they're going to fall, they know they're going to hit before they do," he said. "Tense your neck muscles and core muscles, and keep your head up. The worst thing you can do is fall in a limp position, so when you fall, your head is going to snap backward. If at all possible, get your head out of the direct line of the hit. Most of the time, you know you're in trouble. If you sense it, always try not to directly hit your head."
Mike Cook is a certified athletic trainer and strength and conditioning specialist who has worked with skaters for more than a decade, and has given lectures on such topics as "Injury Prevention through Sports Specific Conditioning." He says that developing the muscles that support the head can help reduce the impact of a fall.
"There is some literature that has shown that increasing the strength and reaction time of muscles in the upper body -- the neck and the shoulders -- can help in decreasing some of the forward-backward whiplash," Cook said. "I work with everybody on upper-body strength; it's not just a lower body-core sport."
Coach Tom Zakrajsek stresses the importance of letting the heaviest part of the body fall first.
"I know this sounds funny, but skaters should fall on their butt muscles," he said. "The glutes are big muscles designed for this purpose. ... As a rule, skaters should always keep their heads in line with their skating foot and/or standing leg.
"Figure skating is a sport of high risk, and skaters need to practice in a deliberate way," Zakrajsek continued. "There should be nothing random or unsupervised about working on new, complex skills."
Pairs coach Bobby Martin agrees that it's important for coaches to not push their athletes too fast when learning new elements.
"I think it's a stepped approach," Martin said. "Once step 'A' has been demonstrated, we can move to step 'B.' That can move at any speed. Also, really knowing your athletes, getting a feel for where they are physically and emotionally, tells you how much you can push them."
"Obviously, if a skater is not comfortable or confident trying a new jump or spin, they have to speak up," Zakrajsek said. "Creating this environment where they feel this type of trust is imperative."
Special risks for pairs
Because of the inherent danger in the discipline, pairs skaters are especially vulnerable to concussions. In the case of a team performing a twist, as the woman descends, her rapidly spinning elbows can hit her partner hard in the face or head.
"I've had my nose broken twice from taking an elbow in the nose," said Rockne Brubaker, who won two U.S. pairs titles with Keauna McLaughlin. "It happens. When there's not enough height, it tends to rotate right in front of the guy. It doesn't feel very good."
John Coughin, also a two-time national pairs champion and now a coach at the Broadmoor Skating Club, says learning proper technique can go a long way toward minimizing the potential damage.
"Most people who get clobbered on twist are not catching the girl on the hips. ... I learned the hard way and, sometimes, the painful way," Coughlin said. "If the boys look at the girl, they have a better chance of catching her. If they turn their head to avoid a hit, they have a worse chance of catching her and are more likely to be hit."
Another element that can lead to disaster is a lift -- breathtaking when performed correctly, horrifying when it goes wrong.
"Lifts are the most dangerous, for the potential for head injuries," Coughlin said. "You work with the boy from the feet up. I always tell any pair guy I work with, the guy with the most boring lift turns wins. We spend a lot of time working on the boy's footwork, without letting him put the girl over his head."
Coach and former pairs skater Doug Ladret fractured his skull in November 1986 while attempting a lasso lift with partner Tuffy Hough during a practice session.
"The ice was pretty rutty," he said. "I put the lift up, and my right foot got stuck in a rut and down we went. I pulled Tuffy forward as I was falling; my first thought was to make sure she was OK. My tailbone hit first, and my neck whiplashed back."
At the hospital, Ladret was diagnosed with two skull fractures. His coach, Kerry Leitch, asked the doctor whether Hough and Ladret would be able to go to their next scheduled competition two weeks later. According to Ladret, the doctor answered, "We'll see if he lives through the night first."
Dr. Bill Moreau, director of sports medicine clinics for the United States Olympic Committee, specializes in athletic concussion research. He notes another risk associated with figure skating: busy rinks. Despite everyone's best efforts to avoid them, collisions in practice are not rare.
"At the lower levels, there can be a lot of skaters on the ice at the same time, and sometimes they're skating pretty fast," Moreau said. "A preventative strategy might be to look at the number of athletes on the ice at the same time."
Recent incidents in Grand Prix warmups involving collisions between Adam Rippon and Nan Song (at the 2012 Cup of China), and Yuzuru Hanyu and Han Yan (2014 Cup of China), received a lot of media attention because they happened in televised events. Song sustained a concussion and withdrew from the event. Rippon, Hanyu and Yan all elected to compete after the collisions.
"I think most of our accidents happen from us not being aware of what's going on," Ladret said. "Mine happened from poor ice conditions; we didn't bother to look at the ice and say, 'Do we need to do another lift?' Look out for what's on the ice. Sometimes you can't, but most of the time you can."
In the wake of high-profile figure skating accidents, like the one involving Tatiana Totmianina and Maxim Marinin at 2004 Skate America, the idea of figure skaters wearing helmets has surfaced over the years. French ice dancer Isabelle Duchesnay wore a helmet to practice a dangerous lift prior to the 1992 Olympic Winter Games.
Following his accident and an extended recovery, Ladret wore one for the first five weeks after his return to the ice.
"The thought was if I hit my head, or hit Tuffy's elbow on the twist, it could be fatal," he said.
According to the specialists interviewed for this article, helmets can reduce the likelihood of some injuries, but they have not been proven to prevent concussions. Moreau said that it would be appropriate to wear a helmet after a skull fracture, as Ladret did, and Cantu noted that a helmet can help prevent fractures of the skull and face.
"The helmet itself would somewhat attenuate the forces but not adequately to prevent a concussion," he said. "Helmets do a good job of attenuating impacts. But when you put a lot of mass behind a hit, you're going to violently wrench the head, whether you have a helmet or not."
Moreau notes that a helmet represents yet another hard object for a skater to run into.
"A helmet could actually put a partner in danger," he said. "Helmets have never been proven to prevent concussions from occurring. In football, helmets prevent laceration, broken noses. They do reduce skull fractures. One of the hardest things for the brain to do is to absorb rotational forces. When it's unexpected and from the side, where the neck rapidly rotates, [a concussion can occur] whether you have a helmet on or not."
When's the right time to come back?
The last risk -- and one that is wholly avoidable -- is resuming skating too soon after a concussion. I returned to the ice, cautiously, about 10 weeks after my injury. Nine years later, I still skate, although I'm far less daring now.
The extensive publicity around the NFL's heightened awareness of the long-term risks of concussions has made many athletes more cautious about rushing back to training after a head injury.
"We know that if you sustain an injury, you're likely to sustain another injury," Moreau said. "You want that athlete to fully recover, both at rest and at exercise. You don't want any athlete to sustain a second concussion before the first one is fully resolved. Athletes need to be cleared by someone who really knows about concussions before they return to their sport."
Ladret mentioned that doctors told him that spinning was the last thing skaters should resume doing after recovery because of the force it exerts on the head. In the past year, several high-profile skaters -- most notably French ice dancer Gabriella Papadakis -- have waited weeks or months before coming back to the ice after sustaining concussions.
"I would say that as we learn more about concussion in all populations, including athletics, we're developing better practices," Moreau said.
While efforts to minimize the occurrence of concussions in skating are ongoing, and the topic of skater safety is being widely discussed throughout the sport, one thing is not up for debate: Identifying when a concussion has happened and taking the proper precautions during the recovery period are of utmost importance.
"If there's any chance, any risk of a concussion, [a skater] should be taken off the ice," Cook stressed. "You need to give them a reasonable amount of time -- it's the brain you're talking about."