The Use of Wrist Guards By Snowboarders in Switzerland

Transcription

1 The Use of Wrist Guards By Snowboarders in Switzerland Giannina Bianchi, Frank I. Michel, Othmar Brügger, Research Department, bfu Swiss Council for Accident Prevention, Berne, Switzerland Abstract This study analyzed attitudes of snowboarders regarding the use of wrist guards with the goal of determining the best way to persuade snowboarders to wear wrist protection. A questionnaire was completed orally by 3791 snowboarders over 6 winter seasons between 2002/03 and 2009/10 at 20 ski resorts in Switzerland. The use of wrist guards was highest, at about 40 %, from seasons 2002/03 to 2007/08; however, usage decreased to 27 % in 2009/10. Snowboarders who did not wear wrist guards were more likely to be 18 years old or older, to have a beginner or expert skill level, to be a resident of a country other than Switzerland, to snowboard in the French-speaking part of Switzerland, and to not wear a helmet while snowboarding. The main reason for wearing wrist guards was safety (68 %). The three most common reasons for not wearing wrist guards were a lack of safety consciousness (35 %), dissatisfaction with the design (25 %), and the perception that the wrist guards did not provide sufficient protection (19 %). Moreover, 78 % of snowboarders who did not wear wrist guards and 26 % of those who did wear them agreed with the statement that wrist guards are uncomfortable. In addition, 59 % and 37 %, respectively, believed that there is a high risk of forearm injury during an accident when a wrist guard is worn. Based on these findings, both the functionality and the comfort of wrist guards should be improved. Towards this end, safety requirements and related performance criteria need to be identified, defined and implemented. Commercially available wrist guards should be required to meet acquired safety standards. Finally, snowboarders awareness of wrist injuries needs to be increased and the effectiveness of wrist protectors communicated more effectively. Keywords: snowboard, snow sport, wrist injury, wrist guard, safety 1

2 Introduction Snowboarding is a very popular sport in Switzerland, with 5 % of the population aged 15 to 75 years as well as 11 % of children and adolescents aged 10 to 14 years participating in this sport [1,2]. In addition, some children under age 10 ride snowboards. Based on these data, about 350,000 people residing in Switzerland snowboard each winter. Furthermore, surveys conducted in Swiss ski resorts indicate that around 25 % of snowboarders are residents of countries other than Switzerland. Thus, we estimate that around 438,000 people snowboard every year in Switzerland. Each year around 24,000 snowboarders residing in Switzerland, as well as approximately 10,000 foreign visitors who snowboard, are injured so seriously that they need to consult a physician [3]. The most common snowboarding injury involves the upper extremities [4 6]. Indeed, in Switzerland, almost half of snowboarders (47 %) who need the help of ski patrol crews have injuries to their upper extremities [3]. Studies from other countries show similar results, with injuries to the upper extremities representing 35 to 55 % of all injuries [4,6,7]. Several studies report that the wrist is the most common site of injury in snowboarding [5,7 11], with injuries to the wrist and hand accounting for around 20 % of all snowboard-related injuries [7,10 15]. Machold et al. reported that 36 % of all injuries, and 52 % of severe injuries, affected the wrist and hand [9]. The most frequent wrist injury is a distal radius fracture [11,14,16]. In Switzerland, one-third of the injuries in the wrist area of adult snowboarders (18 65 years) are closed fractures of the distal radius, another third are sprains of the wrist joint, and around one-sixth are general contusions involving the wrist joint and hand [17]. Sasaki et al. interviewed injured snowboarders at a clinic in Japan and found that around 54 % of the wrist injuries were distal radius fractures [11]. Matsumoto et al. reported that distal radius fractures accounted for 86 % of wrist injuries by snowboarders at a primary emergency center [14]. Wrist fractures are often the result of a fall onto the outstretched hand, leading to extreme extension of the 2

3 wrist [18]. Wearing a wrist guard reduces the risk of sustaining a wrist injury by 38 to 65 % [4]. To establish the best way to persuade snowboarders to wear wrist protection, the purpose of the present study was to identify snowboarders attitudes towards using wrist guards. 3

4 Methods A standardized questionnaire was completed orally by around 600 snowboarders/season over 6 winter ski seasons. Specifically, data were collected during February and March of the following winter seasons: 2002/03, 2004/05, 2006/07, 2007/08, 2008/09, and 2009/10. Snowboarders were interviewed at 20 ski resorts in the German- and French-speaking regions of Switzerland. Eight trained interviewers surveyed snowboarders face-to-face after the snowboarders exited the lifts. Children under 10 years old were excluded because of the complexity of several of the questions. Snowboarders who did not speak German, French, or English were also excluded from the study. To ensure adequate sample size, the study population was disproportional stratified by age, gender, and helmet use. Interviews were conducted in the mornings and afternoons on both weekdays and weekends. The snowboarders were asked about their use or previous use of wrist guards and other protective equipment, their main reason for wearing or not wearing protective equipment, and their opinions about two statements ( A wrist protector is uncomfortable and In case of an accident where a wrist protector is worn, there is a high risk of forearm injury ). Participants scored the statements on a four-point rating scale ( completely agree, mostly agree, mostly disagree, definitely disagree ). For data analysis, the responses were combined into two categories, agree and disagree. Personal data such as snowboarding skill level (beginner, intermediate, expert), age, gender, and country of residence were also collected. To determine the reasons for wearing or not wearing wrist guards, open-ended questions were also asked, and the interviewer recorded the replies according to categories that were determined using the results of a preliminary study. To analyze the data, the response categories were summarized again into four categories for using wrist guards and six categories for not using one (FIG 1, FIG 2). The response categories for using wrist guards were "safety", "integrated into gloves", "previous wrist injuries" and "other reason" (FIG 1). 4

5 Reasons for not wearing wrist guards were "lack of safety consciousness", "design", "costs", "not protective enough", "excuse" and "other reason" (FIG 2). To correct the data for disproportionate stratification, the data were weighted, taking into account age, gender, and helmet use using observational information from a randomly selected sample of around 1500 snowboarders during the same seasons at the same 20 ski resorts. Analyses were carried out using SPSS Descriptive statistics for wrist guard use were calculated. Predictors for wrist guard use were assessed by a stepwise multivariate logistic regression analysis with regard to season, gender, age, skill level, country of residence, language region, helmet use, and use of a back protector. Odds ratios (OR) and 95 % confidence intervals (CI), as well as Nagelkerkes-R 2, were calculated. The relationship between wrist guard use and attitude toward wearing wrist guards was tested using chi-square tests. The P-values are two-tailed, and values < 0.05 were considered to indicate statistical significance. 5

6 FIG 1: Reasons for wearing wrist guards: categories FIG 2: Reasons for not wearing wrist guards: categories 6

7 Results Participants During 6 winter seasons from 2002/03 to 2009/10, 3796 snowboarders were interviewed about their use of wrist guards and attitudes toward wrist guard use. Five questionnaires were excluded because some variables were missing. An average of 632 snowboarders completed the survey during each of the 6 seasons. The youngest snowboarder was 10 years old, and the oldest was 76 years old; however, only 3 % of the snowboarders interviewed were 46 years old or older. Most of the snowboarders interviewed (40 %) were between 18 and 25 years old, and almost one-third (29%) were younger than 18 years. Men accounted for 52 % of the sample. Over half of the snowboarders surveyed (52 %) reported having an intermediate skill level, 40 % considered themselves to be expert snowboarders, and just 8 % described their skill level as beginner. A total of 87 % of the people interviewed were residents of Switzerland, with 81 % of all snowboarders recruited on the slopes in German-speaking regions of Switzerland and 19 % recruited in the French-speaking regions. Wrist guard use Wrist guard use was relatively high, around 40 %, until the 2007/08 winter season (FIG 3, FIG 4). Usage decreased significantly to 26 % in 2009/10 (Nagelkerkes-R 2 = 0.085; FIG 5). In contrast, the use of helmets and back protectors increased continuously during the study period. In 2009/10, 79 % of snowboarders wore a helmet, and 49 % wore a back protector [3]. During the study period, wrist guard use first increased, and then decreased in all age groups, regardless of gender or skill level (FIG 4). This was true both for snowboarders residing in Switzerland and for foreign guests, for people snowboarding on the slopes in either the German- or French-speaking parts of Switzerland, for snowboarders who were or who were not wearing a helmet, and for snowboarders who were or were not using a back protector. 7

8 The rate of wrist guard use in the 2009/10 winter season was significantly lower (P < 0.05) than in all other seasons (FIG 5). Over the study period, children and adolescents 17 years old or younger wore wrist guards more often than did snowboarders who were 18 years or older. Snowboarders who reported having an intermediate skill level wore wrist guards more often than those who considered themselves beginners or experts. Snowboarders residing in Switzerland and people snowboarding on slopes in the German-speaking part of Switzerland as well as snowboarders wearing a helmet used wrist guards more often than guests of foreign countries, people snowboarding on slopes in the French-speaking part of Switzerland and snowboarders not wearing a helmet. Other factors, such as gender or use of a back protector, did not have a significant influence on wrist guard use. FIG 3: The use of protective equipment by snowboarders over 6 winter seasons, 2002/03 to 2009/10, n wrist guard = 3796, n helmet = 8677, n back protector = 3796 [3] 8

9 FIG 4: Wrist guard use (%) by snowboarders over 6 season, 2002/03 to 2009/10, n = 3791 FIG 5: The influence of various factors on the probability of wrist guard use over 6 season, 2002/03 to 2009/10, n =

10 Reasons for wearing wrist guards In the 2008/09 winter season, snowboarders were asked what they thought was the most important reason for using a wrist guard. The prevalence of wrist guard use was 37 % that season. The most common reason cited for wearing wrist guards was safety, and the second most common reason was that wrist-protective elements were integrated into their snowboarding gloves (FIG 6). Reasons for not wearing wrist guards In the 2008/09 winter season, 63 % of all snowboarders did not wear wrist guards. These snowboarders were asked why they did not wear wrist guards. The most common reason was a lack of safety consciousness, followed by "design " (FIG 6). Snowboarders who were not wearing wrist guards were asked if they had worn them in the past, and 60 % reported that they had worn wrist guards previously. Compared to snowboarders who had never worn a wrist guard, snowboarders in this subgroup significantly more often considered themselves to be experts or to have intermediate snowboarding skills and significantly more often snowboarded on slopes in the German-speaking regions of Switzerland, were residents of Switzerland, and wore a helmet (Nagelkerkes-R 2 = 0.255) (FIG 7). The two groups were not significantly different in terms of gender, age, or use of a back protector. The group of snowboarders who did not wear wrist guards anymore and the group who had never used wrist guards had different reason for not using wrist protection (p = 0.000) (FIG 8). The design of the wrist guards was the main reason for not wearing wrist guards for 37 % of the first group, while just 9 % of those who never wore wrist guards before cited this reason (p = 0.000). Responding with an excuse or responding that the wrist guards were not protective enough was more common for snowboarders who did not wear wrist guards anymore than for snowboarders who never wore a wrist guard before (p = and p = 0.107). Snowboarders who never used wrist guards before cited lack of safety 10

11 consciousness as the main reason for not wearing wrist guards almost four times more often than those who do not wear them anymore (p = 0.000). Costs or other reasons were reported by at most 2 % of both groups (p = and p = 0.248). FIG 6: Reasons for wearing or not wearing wrist guards, 2008/09 (n wrist guard = 357, n no wrist guard = 218) 11

12 FIG 7: The influence of various factors on the probability of wrist guard use by snowboarders who previously used wrist guards but do not anymore, 2008/09, n = 200 FIG 8: Reasons for not wearing wrist guards, 2008/09, n =

13 Statements about wrist guard use The opinions of snowboarders who did and did not wear wrist guards differed significantly in terms of how comfortable they thought wrist guards were (p = 0.000) and their perceived risk of forearm injuries induced by wrist guards (p = 0.002) (FIG 9). Of the snowboarders who were not using wrist guards, 78 % agreed with the statement, "A wrist protector is uncomfortable", while 26 % of snowboarders who were using wrist guards agreed with the statement. For snowboarders who were not using and who were using wrist guards, 59 % and 37 %, respectively, agreed with the statement, "In case of an accident where a wrist protector is worn, there is a high risk of forearm injury". FIG 9: Percentage of snowboarders who agreed with the statements about wrist guard use, n statement 1 = 399, n statement 2 =

14 Discussion The use of wrist guards decreased by 16 % between the 2006/07 winter season and the 2009/10 winter season. Only 26 % of snowboarders wore a wrist guard in 2009/10. For methodological reasons, only snowboarders living in Switzerland were interviewed in the 2009/10 winter season. For the 6 winter seasons we surveyed, the odds ratio for wearing wrist guards was 1.8-fold higher for snowboarders residing in Switzerland than for foreign guests. The data from the preceding years showed that the overall wearing rate was, on average, 3 percentage points lower for foreign guests than for snowboarders residing in Switzerland. Accordingly, the overall rate of wrist guard use in the winter of 2009/10 was an estimated 23 %. To our knowledge, no other study has assessed the use of wrist guards by snowboarders on the slopes since the 2002/03 winter season. However, several studies have evaluated the prevalence of wrist guard use among snowboarders with injuries to the wrist, to the upper extremities or to other parts of the body [19]. No mass media campaign was conducted to promote the wearing of wrist guards in Switzerland during the study period. However, the use of wrist guards was promoted in leaflets during this time. Dickson et al. reported similar results regarding the reasons that snowboarders do not wear wrist guards [20]. However, that study involved injured snowboarders. The main reason given for not using wrist guards was that the snowboarders did not see the need (34 %), although 24 % found the wrist guards uncomfortable and 14 % were not able to obtain them. In terms of increasing wrist guard use and thus reducing wrist injuries, the most important thing is that wrist guards protect the wrist and forearm from impact and prevent hyperextension of the wrist [18]. Furthermore, wrist guards must not themselves cause injury. Several studies have demonstrated that some commercially available designs do not provide satisfactory protection against injuries [18 23] or even carry a higher risk of injuries [4,23,24]. Russel et al. reviewed the literature and found that depending on the product and 14

15 the particular sample tested, the safety benefit varied between 38 % and 65 %; notably, they also found that wrist guards can increase the risk of non-wrist upper-extremity injuries [4]. The media has publicized the fact that some wrist guards can themselves lead to injuries, and it seemed likely that some snowboarders would share this opinion. The results of the survey confirmed this. To guarantee the functionality of a product, safety requirements and related performance criteria should be identified, defined, and implemented. After guaranteeing functionality, the effectiveness of wrist guards in preventing wrist injuries could be publicized. Periodic product tests based on international performance standards would be a step in the right direction. Higher safety standards could be used to promote the use of wrist guards and to help customers choose the right product. This objective has been suggested by other researchers as well, including Binet et al. [25,26] and Staudigl et al. [27]. To summarize, the functionality of wrist guards must be ensured and publicized. International standards and related testing procedures must be developed in order to provide effective products to consumers. Based on the data from this study, wrist guard design is very important to snowboarders. Specifically, when snowboarders disliked the wrist guard design, they noted that the guards were impractical, uncomfortable (or even painful), and that they made the user s hands hot or sweaty. Unfortunately, we did not collect more detailed information about what exactly snowboarders perceived as "impractical" or "uncomfortable". For example, does impractical mean that the snowboarder could not manage tasks such as zipping a jacket or answering a mobile phone while wearing a wrist guard? Does uncomfortable mean that a wrist guard feels too tight? Does the wrist guard hurt because it is made of hard material or because it fits poorly? These considerations are related closely to freedom-of-movement, which ensures an optimal range of motion of the wrist during common activities performed while snowboarding. To summarize, in order to convince snowboarders to wear wrist guards, product design is crucial. However, more information is needed to design comfortable, practical wrist guards that will appeal to more snowboarders. 15

16 This study found that a lot of snowboarders have an admitted lack of safety consciousness: they are not aware of the risk of sustaining a wrist injury and are not aware that wrist guards can help protect their wrists from injury. In addition to improving wrist guard functionality and comfort, snowboarders need to be made more aware of the most common type of injury and of the need to protect their wrists. Accordingly, snowboarders should be told about the risk of wrist injury and about the effectiveness of wrist guards by targeted campaign and education. Retailers and assistants at equipment rental agencies who sell or rent wrist guards should be part of such an education. Several studies show that beginners [7,14,19,20,23,28,29] as well as children and adolescents [7,20,29] have a higher risk of sustaining a wrist injury. However, it is not completely clear whether there are some subgroups that are not at risk. Binet et al. found that wrist fractures are the most prevalent snowboarding injury in all age groups regardless of skill level/experience [25]. The present study found that adolescents and adults (older than 17 years), beginners and experts, foreign guests and snowboarders in the Frenchspeaking regions of Switzerland, all showed lower wrist guard use while snowboarding. Research regarding helmet use in snow sports in Switzerland identified similar skier and snowboarder characteristics that were associated with not wearing protective equipment: age over 17 years, being a foreign guest, and skiing or snowboarding in the Frenchspeaking part of Switzerland [30]. It is not clear why various snowboarders in these groups decline to wear protective equipment. For adults and experts, the perception that the risk of injury is low is probably a contributing factor, whereas beginners may not be aware of, or may not have bought protective equipment. People snowboarding in the French-speaking regions of Switzerland, as well as foreign guests, do not seem as safety-conscious as people in the German-speaking regions and as people who are residents of Switzerland. However, snowboarders who used to wear, but no longer wear, wrist guards differ a bit from those who have never worn them. This group mainly includes highly skilled snowboarders on slopes in the German-speaking part of Switzerland who are Swiss residents and wear a 16

17 helmet. To summarize, another important step in increasing wrist guard use is to make snowboarders in Switzerland more aware of the risks of sustaining a wrist injury and the protective effects of wrist guards. It is important that the right message targets the right group. Future studies should identify which groups in Switzerland are most at risk of wrist injury. Efforts have already been made to optimize the protective effect of wrist guards and to develop safety standards. Many studies have been conducted to identify the qualities of wrist guards that offer the most protection [20 23,31 33], while others have analyzed the loading of the wrist [34,35]. In addition, Schmitt et al. quantified biomechanical parameters that are relevant to loading and touchdown kinematics during falling [36]. Greenwald et al. designed an instrumented glove that measured the angle, forces, and moments in the range of movement of wrists and hands while snowboarding on slopes [37]. Moreover, Schmitt et al. tested the dampening and bending properties of commercially available wrist guards according to standard EN used for protective clothing for users of roller sports equipment [35]. In addition, Staudigl et al. made strategic consideration to develop standards for snowboard wrist protectors [27]. This study offers an overview of changes in wrist guard use over time and also describes the attitudes of snowboarders in Switzerland regarding wrist guard use. Snowboarders older than 46 years are underrepresented on the slopes, making it challenging to interview them. Unfortunately, due to methodological reasons, in the winter of 2009/10, no information was collected about the use of wrist guards by foreign visitors. Conclusions Wrist guard use in Switzerland decreased in the last three years. Both wrist guard functionality and comfort are important for increasing wrist guard use. Moreover, the comfort and convenience of wrist guards needs to be improved. To protect snowboarders from wrist 17

18 injuries, safety requirements and performance criteria for wrist guards need to be identified, defined, and implemented, and all commercially available designs must meet the standards. Periodic product tests based on international performance standards would be a step in the right direction. Higher safety standards could be used to promote the use of wrist guards and to help customers choose the right product. Finally, to encourage snowboarders to protect their wrists and forearms with wrist guards, we need to increase snowboarders awareness that wrist injuries can be prevented or mitigated by the use of wrist guards. 18

19 References [1] Lamprecht, M. Fischer, A. and Stamm, H., [Sport in Switzerland 2008: Sport Behaviour in the Swiss Population], Magglingen: Swiss Federal Office for Sport (FOSPO), 2008, pp [2] Lamprecht, M. Fischer, A. and Stamm, H., [Sport in Switzerland 2008: Report on Children and Adolescents], Magglingen: Swiss Federal Office for Sport (FOSPO), 2008, pp [3] bfu - Swiss Council for Accident Prevention., STATUS 2011: Statistics on nonoccupational accidents and the level of safety in Switzerland, Road traffic, sports, home and leisure, Berne, 2011, pp [4] Russell, K., Hagel, B., and Francescutti, L. H., "The effect of wrist guards on wrist and arm injuries among snowboarders: a systematic review," Clin. J. Sport. Med., Vol. 17, 2007, pp [5] Hagel, B.E., "Skiing and snowboarding injuries," Medicine and Sport Science, Vol. 48, 2005, pp [6] Dohjima, T., Sumi, Y., Ohno, T., Sumi, H., and Shimizu, K., "The danger of snowboarding: a 9-year prospective comparison of snowboarding and skiing injuries," Acta Orthopaedica Scandinavia, Vol. 44, No. 6, 2001, pp [7] Idzikowski, J.R., Janes, P.C., and Abbott, P.J., "Upper Extremity Snowboarding Injuries: Ten-Year Results from the Colorado Snowboard Injury Survey," Am. J. Sports. Med., Vol. 28, No. 6, 2000, pp [8] Deady, L.H., and Salonen, D., "Skiing and snowboarding injuries: a review with a focus on mechanism of injury," Radiol. Clin. North Am., Vol. 48, No. 6, 2010, pp

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21 [19] Kim, S., and Lee, S.K., "Snowboard wrist guards-use, efficacy, and design - a systematic review," Bulletin of the NYU Hospital for Joint Diseases, Vol. 69, No. 2, 2011, pp [20] Dickson, T.J., and Terwiel, F.A., "Snowboarding injuries in Australia: Investigating risk factors in wrist fractures to enhance injury prevention strategies," Wild. Env. Med., Vol. 22, No. 3, 2011, pp [21] Schmitt, K.-U., Staudigl, F., and Michel, F.I., "Characterizing the performance of snowboard wrist protectors," Proceedings of the 19th International Congress on Ski Trauma and Skiing Safety, Keystone, CO, May 1 7, [22] Binet, M.H., Wadsworth, P., and Rowlands, A., "Prospective study to compare efficacy of different designs of wrist protection for snowboarders," Proceedings of the 19th International Congress on Ski Trauma and Skiing Safety, Keystone, CO, May 1 7, [23] Machold, W., Kwasny, O., Eisenhardt, P., Kolonja, A., Bauer, E., Lehr, S., Mayr, W., and Fuchs, M., "Reduction of severe wrist injuries in snowboarding by an optimized wrist protection device: a prospective randomized trial," J. Trauma, Vol. 52, No. 3, 2002, pp [24] Hagel, B.E., Pless, I.B., and Goulet, C., "The effect of wrist guard use on upperextremity injuries in snowboarders," Am. J. Epidemiol., Vol. 162, No. 2, 2005, [25] Binet, M.H., Laporte, J.D., and Lamy, D., "Prevention of snowboarding wrist injuries for teenagers," Proceeding of the 2nd European Conference on Injury Prevention and Safety Promotion, Paris, France, October 9-10, [26] Binet, M.H., "Snowboarder's wrist protection," Proceedings of the 16th International Symposium on Ski Trauma and Skiing Safety, Niigata, Japan, April 17 23,

22 [27] Staudigl, F., Michel, F.I., and Schmitt, K.-U., "Strategic considerations towards a standard for snowboard wrist protectors," Proceedings of the 19th International Congress on Ski Trauma and Skiing Safety, Keystone, CO, May 1 7, [28] Ronning, R., Ronning, I., Gerner, T., and Engebretsen, L., "The Efficacy of Wrist Protectors in Preventing Snowboarding Injuries," Am. J. Sports. Med., Vol. 29, No. 5, 2001, pp [29] Kusche, H., Schaller, C., Gutsfeld, P., and Bühren, V., "Do children and adolescents have a higher risk to suffer a wrist injury in snowboarding?" Proceedings of the 18th International Congress on Ski Trauma and Skiing Safety, Garmisch-Partenkirchen, Germany, April 26 Mai 02, [30] bfu - Swiss Council for Accident Prevention., bfu survey 2011: Use of protective equipment in skiing and snowboarding, Berne, 2011, (Last accessed November 21, 2011). [31] Dann, K., Boldrino, C., and Ring, G., [Wrist injuries at snowboarding Presentation of a new snowboard glove with fixed braces], Sportorthopädie Sporttraumatologie, Vol 18, 2002, pp [32] Hwang, I.K., and Kim, K.J., "Shock-absorbing effects of various padding conditions in improving efficacy of wrist guards," J. Sports Sci. Med., Vol. 3, 2004, pp [33] Jaax, K.N., "Biomechanical analysis of the role of wrist guards in splint-top forearm fractures," Proceedings of the World Congress on Medial Physics and Biomedical Engineering, Chicago, IL, July 23 28, [34] Schmitt, K.-U., Wider, D., Michel, F.I., Brügger, O., Gerber, H., and Denoth, J., "Investigating the Wrist Loading in Snowboard backward Falls," Proceedings of the 18th International Congress on Ski Trauma and Skiing Safety, Garmisch-Partenkirchen, Germany, April 26 Mai 02,

23 [35] Schmitt, K.-U., Michel, F.I., and Staudigl, F., "Analysing the impact behaviour of recent snowboarding wrist protectors," Proceeding of the IRCOBI Conference (ISSN ), Krakow, Poland, September 14 16, [36] Schmitt, K.-U., Wider, D., Michel, F.I., Brügger, O., Gerber, H., and Denoth, J., "Characterizing the mechanical parameters of forward and backward falls as experienced in snowboarding," Sports Biomechanics, submitted 2010, accepted 2011, [37] Greenwald, R., Calabro, S., Thomas, N., and Michel, F.I., "An Instrumented Glove to Measure Wrist Biomechanics During Snowboard Falls," Proceedings of the 19th International Congress on Ski Trauma and Skiing Safety, Keystone, CO, May 1 7,

24 Figure captions Figure 1: Reasons for wearing wrist guards: categories Figure 2: Reasons for not wearing wrist guards: categories Figure 3: The use of protective equipment by snowboarders over 6 winter seasons, 2002/03 to 2009/10, n wrist guard = 3796, n helmet = 8677, n back protector = 3796 Figure 4: Wrist guard use (%) by snowboarders over 6 season, 2002/03 to 2009/10, n = 3791 Figure 5: The influence of various factors on the probability of wrist guard use over 6 season, 2002/03 to 2009/10, n = 3791 Figure 6: Reasons for wearing or not wearing wrist guards, 2008/09 (n wrist guard = 357, n no wrist guard = 218) Figure 7: The influence of various factors on the probability of wrist guard use by snowboarders who previously used wrist guards but do not anymore, 2008/09, n = 200 Figure 8: Reasons for not wearing wrist guards, 2008/09, n = 343 Figure 9: Percentage of snowboarders who agreed with the statements about wrist guard use, n statement 1 = 399, n statement 2 =