When news broke in May of 2016 that BMX legend Dave Mirra, who committed suicide on February 4, suffered from chronic traumatic encephalopathy (CTE), a seismic wave rattled the action sports community. The acronym had made headlines in other athletics, but hadn’t been widely discussed, if at all, with regards to sports deemed “extreme.” The degenerative brain disease is a result of repetitive head trauma at both the concussive and sub-concussive level, with symptoms including cognitive decline, memory loss, sleep deprivation and dementia. It has been linked to severe depression and, in cases like Mirra’s, suicide.
The syndrome gained recognition after being posthumously tied to several former National Football League (NFL) players, but Mirra’s diagnosis was the first in action sports. It caused the community to beg the question: Could CTE be a reality for action sports athletes participating in other disciplines, such as freeskiing, where repetitive head trauma is common?
The answer is yes, it is a reality. But it’s still too early to diagnose symptoms in the brains of contemporary athletes; there’s currently no way to detect CTE until after death. The telltale harbinger of the disease—clusters of abnormal tau protein that slowly kill brain cells—an only be seen when a brain is cut open and studied via microscope.
The key to reducing an outbreak like the NFL has seen will be to convince skiers that the response to ringing their bells isn’t to play it tough, shake it off and continue shredding; it’s to seek medical attention, step away from skiing and let the injury heal. Yet, in a sport defined by pushing the limits and an attitude of fearlessness, that’s easier said than done. Spreading awareness and education of the disease’s origins and repercussions related to skiing is the first step.
Concussions, sub-concussive blows & CTE in skiing
“It’s a tough subject; it’s the elephant in the room… It’s undetectable at this point and so we’re just left with people’s stories after they take their own lives because it’s just so painful,” says Sean Cochrane, whose sister, Andrea, committed suicide in 2011 at the age of 32.
Cochrane and his family believe that Andrea was suffering from the effects of CTE. She was a competitive ski racer with an extended history of ski-related concussions, including an eight-month period where she sustained three.
Following her death, Andrea’s mother, Laurie, donated a fragment of her daughter’s brain tissue to the VA-BU-CLF Brain Bank, a partnership between the Veterans Administration, Boston University and the Concussion Legacy Foundation. When it opened in 2008, it was the first facility in the world devoted to the research of CTE.
With the donation, Andrea became the first female athlete—and only known skier—to have contributed brain tissue toward the research of CTE. Unfortunately, only a very small, fragmented portion could be provided, leading to inconclusive results of a CTE diagnosis.
Andrea’s mental health decline preceding her death provided enough symptomatic evidence of CTE for Sean and the Cochranes. “She was a top-marks student at the University of Alberta in the geophysics honors program,” he explains. “She was incredibly smart, had everything to live for and nothing holding her back except that [we believe] she was going through this disease that’s so big it consumes everybody that gets in its way.”
The majority of CTE’s publicity surrounds the NFL. Autopsies of deceased players such as Junior Seau, Ken Stabler, Andre Waters and Mike Webster—Seau and Waters committed suicide—revealed indisputable evidence of CTE. In fact, in 2015, Boston University researchers announced that 87 of the 91 brains of former NFL players studied at the VA-BU-CLF Brain Bank showed significant signs of the disease.
Football is an impact sport, that’s obvious, though so is freeskiing. For the most part, the collisions in skiing are fewer and farther between, and the trauma can range from minor to major and in rare cases result in death. But, no matter the force, according to Dr. Robert Cantu, clinical professor of Boston University’s Department of Neurosurgery and co-founder of the Concussion Legacy Foundation, “Any activity that has repetitive head trauma at the concussive or sub-concussive level has a greater likelihood to produce instances of CTE.”
Pervading public perception is that major concussions involving loss of consciousness are the main factor in brain trauma and the development of CTE. The truth is multiple sub-concussive hits to the head can be just as detrimental for two main reasons: the first being Dr. Cantu’s point that compounding hits to the head—whether major or minor—are detrimental to overall brain health. The second is that an athlete can sustain a hazardous blow, and the effects may not even be noticeable. “Many times there aren’t going to be injuries that are recognized because symptoms won’t necessarily occur or be admitted to,” Cantu explains. “And if you have enough of those sub-concussive hits, you could wind up with CTE even without a recognized concussion.”
If a skier is severely concussed, they’ll most likely end up in the hospital for treatment. But if they ding their head without loss of consciousness, they’re inclined to continue skiing.
“Skiing is a tough sport,” explains Melinda Roalstad, former medical director for the United States Ski and Snowboard Association (USSA) and founder of Think Head First, a Park City-based program for management of mild head injuries. “Many [concussions] go undiagnosed, many go unidentified and unmanaged until someone suffers several of them and it impacts their ability to function.”
In Andrea Cochrane’s case, collisions associated with professional ski racing caused her compounded concussions and detrimental health issues. However, nowhere are repeated head hits more apparent than on the playing field of competitive freeskiing. Park and pipe athletes ski at breakneck speeds, elevate and invert 20-plus feet above icy halfpipes and bulletproof slopestyle courses, making cranial impacts a great deal more common and, in some cases, nightmarish.
“If we were to study a thousand people—we haven’t of course—that participated in freestyle skiing, and have slapped back against ice and snow frequently following flips and tricks, occasionally [sustaining] concussions,” explains Cantu, “and compared those thousand freestyle skiers to downhill and slalom skiers, I would predict that the instances of CTE would be much more frequent in freestyle skiers. There’s a lot more head trauma in that activity.”
“I could pass a concussion test with a concussion. I can get around it if I really want to compete.” – David Wise
Concussion protocols, as a result of freeskiing’s risks, are stricter than they were in the infancy of slopestyle and halfpipe contests; Roalstad was instrumental in implementing ImPACT testing for USSA. ImPACT consists of two assessments: a “baseline” test taken prior to a season that records scores based on “normal” or non-concussive cognitive behavior; and a “post-injury” test, performed following a suspected concussion to compare with base-line scores and evaluate head injuries.
But, the harsh environments freeskiers confront aren’t constrained to park and pipe competitions where watchful governing bodies are in place. Big-mountain, street and backcountry athletes, who are often skiing for the cameras, face high-consequence encounters with concrete, metal handrails, cliff bands, rocky chutes and tight trees. There’s no baseline concussion protocol for a skier putting life and limb on the line in the streets or backcountry—at least outside of sanctioned contests.
Factor in the pressures of contests and filming within those treacherous winter environments, and reward tends to outweigh risk. A competition skier must land freakishly technical tricks to gain the judges’ favor. Athletes who make a living via ski film credits repeatedly drop into high-consequence lines in order to get shots that will stand out above the rest. In both cases, success often translates to monetary stability and eternal glory, deterring athletes from quitting or seeking medical attention after a headfirst crash.
Walk it off
There are many reasons skiers shake off crashes involving the head. On an obvious level, many believe that strapping on a helmet is the answer to combating everything short of the worst hits… Continued on next page.