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Br J Sports Med
2001;
35
:325–328
325
Skateboarding injuries of today
L Forsman, A Eriksson
Abstract
Background
—Skateboarding injuries
have increased with the rise in popularity
of the sport, and the injury pattern can be
expected to have changed with the devel-
opment of both skateboard tricks and the
materials used for skateboard construc-
tion.
Objective
—To describe the injury pattern
of today.
Methods
—The pattern of injuries, cir-
cumstances, and severity were investi-
gated in a study of all 139 people injured in
skateboarding accidents during the period
1995–1998 inclusive and admitted to the
University Hospital of Umeå. This is the
only hospital in the area, serving a
population of 135 000.
Results
—Three of the 139 injured were
pedestrians hit by a skateboard rider; the
rest were riders. The age range was 7–47
years (mean 16). The severity of the
injuries was minor (AIS 1) to moderate
(AIS 2); fractures were classified as mod-
erate. The annual number of injuries
increased during the study period. Frac-
tures were found in 29% of the casualties,
and four children had concussion. The
most common fractures were of the ankle
and wrist. Older patients had less severe
injuries, mainly sprains and soft tissue
injuries. Most children were injured while
skateboarding on ramps and at arenas;
only 12 (9%) were injured while skate-
boarding on roads. Some 37% of the inju-
ries occurred because of a loss of balance,
and 26% because of a failed trick attempt.
Falls caused by surface irregularities
resulted in the highest proportion of the
moderate injuries.
Conclusions
—Skateboarding should be
restricted to supervised skateboard parks,
and skateboarders should be required to
wear protective gear. These measures
would reduce the number of skateboard-
ers injured in motor vehicle collisions,
reduce the personal injuries among skate-
boarders, and reduce the number of
pedestrians injured in collisions with
skateboarders.
(
Br J Sports Med
2001;
35
:325–328)
development was, not surprisingly, accompa-
nied by a surge in the number of skateboard
related injuries.
1–7
There were calls for restric-
tions that would reduce these injuries,
8
and in
Sweden, skateboarding was banned from pub-
lic roads and sidewalks in many communities
in 1980. Furthermore, legislation was passed
that required all skateboard buyers to be at
least 12 years old and all skateboards sold to be
labelled with a warning notice about the
hazards. Other countries chose an even stricter
approach: in Norway, skateboarding was
banned. This resulted in decreased popularity
during the 1980s. In the 1990s, skateboarding
bans were, however, repealed throughout Swe-
den, and skateboarding again increased in
popularity.
As with many sports that involve speed and
balance, skateboarding can result in injury.
Indeed, when first introduced in the 1960s,
skateboarding was referred to as a “new medi-
cal menace”,
9
and, since then, the sport has
caused many injuries, sometimes resulting in
deformity and morbidity.
610
Although most
studies report a high occurrence of minor inju-
ries, more serious ones have also been re-
ported,
10 11
especially from skateboarding on
roads, which can lead to collisions with cars
which may even result in fatality.
11 12
Contribut-
ing to the danger is the high speeds, 60–90
km/h, that can be reached with today’s
boards,
13–15
and the absence of a mechanical
braking system.
Skateboarding has been around for more
than four decades, but most of the literature on
skateboard injuries was published in the 1970s,
with a second peak in the early 1990s. As the
sport has developed, the types of injury can be
expected to have changed. The purpose of the
this study was to describe patterns of injuries
and accidents among skateboarders today to
provide a basis for preventive measures.
Section of Forensic
Medicine, Department
of Community Health
and Rehabilitation,
Umeå University,
Umeå, Sweden
L Forsman
A Eriksson
Materials and methods
At the University Hospital of Umeå all patients
seeking emergency health care because of an
injury are asked to complete a questionnaire
that asks them when, where, and under what
circumstances their injury took place. Details
about the nature, diagnosis, and treatment of
the injuries and their sequelae were obtained
from the patients’ medical records. This regis-
tration protocol has been in place since 1985
and is now part of the European cooperation
project EHLASS (European Home and Lei-
sure Accident Surveillance System). This
system focuses on collecting information about
the cause of injuries and the injury events. No
information was obtained about the skate-
boarders’ level of expertise or use of protective
gear. From this information, a descriptive
Keywords: skateboard; injury; prevention
Correspondence to:
Dr Eriksson, Section of
Forensic Medicine,
University of Umeå, PO Box
7642, SE-907 12 Umeå,
Sweden
anders.eriksson@rmv.se
In the 1960s, skateboarding became popular
among young people in the United States, but
the first real skateboard craze occurred in the
1970s with the introduction of the poly-
urethane wheel and other improvements that
made skateboards more manoeuvrable. This
Accepted 26 June 2001
www.bjsportmed.com
326
Forsman, Eriksson
20
18
abrasions, contusions, and lacerations, ac-
counted for 24%. Four cases of concussion and
four joint dislocations were recorded. The larg-
est proportion of fractures (56%) occurred in
the youngest age group. Only two fractures
were found among those 20 years or older;
sprains were the most common injury in this
age group.
16
Male
Female
14
12
10
8
6
4
BODY PART INJURED
The largest proportion of the injuries a
V
ected
the lower extremity (50%), whereas fractures
were more common in the upper extremity
(57%, n = 24). Of the fractures of the hand,
two were scaphoid fractures. Fractures in the
lower extremity were most commonly seen in
the ankle or the foot (table 1).
2
0
7
8
9
10 11 12 13 14 15 16 17 18 19 >20
Age (years)
Figure 1 Age and sex
distribution of 136 injured
skateboarders.
analysis of all skateboard injuries recorded in
1995–1998 inclusive was undertaken. The
hospital is the only one in the area, and serves
a population of 135 000.
The severity of the injuries was assessed
according to the Abbreviated Injury Scale
(AIS).
16
Lacerations, contusions, bruises, and
cuts are classified as AIS 1, most non-
complicated fractures as AIS 2, and more seri-
ous injuries up to AIS 6.
SEVERITY OF INJURY
Most of the injuries (70%) were classified as
AIS 1 (minor), the remainder being classified
as AIS 2 (moderate). None was regarded as
“serious” (AIS 3 or more). The moderate inju-
ries included various simple fractures, two knee
sprains, and four cases of concussion. The
severity of the injuries decreased with age, and
three of the four head injuries occurred in the
youngest age groups.
Results
During the study period, 139 people with
skateboard related injuries were treated. Three
of these were pedestrians injured by a collision
with a skateboard rider. Two were young boys,
4 and 5 years old, who su
V
ered minor injuries
such as skin lacerations and contusions. The
third was a 71 year old woman, who was
admitted to hospital with a fracture of the
femoral neck (AIS 3). The following results
describe the injuries of skateboarders only.
The study thus included 136 skateboarders,
95% of whom were male. The age distribution
ranged from 7 to 47 years, with more than half
of the patients being between 13 and 16 years
(fig 1). The mean age was 16. The casualties
were divided into four age groups: 0–9, 10–14,
15–19, and 20 and over.
INJURY MECHANISM
Nine injury events occurred when the skate-
board struck irregularities in the riding surface,
whereas most patients (49) cited more unspe-
cific causes such as loss of balance or “just fell
o
V
” as the mechanism of the injury. Thirty
eight patients reported the cause of injury as a
loss of control when attempting a jump or a
trick, and five were hit by an airborne
skateboard. Eight patients reported a “sudden
movement” and another eight their “foot
getting stuck between the skateboard and the
riding surface” as the mechanism of injury.
One patient was injured while holding on to a
moving car to increase the speed. No injuries
involved any board failure or collisions with
motor vehicles (table 2). In the two youngest
age groups, loss of balance was the most com-
mon mechanism of injury; the older adoles-
cents mostly lost control during jumps and
tricks. Hitting surface irregularities caused the
highest proportion of AIS 2 injuries (56%, n =
5). Failing a jump or trick resulted in AIS 1
injuries in most cases.
TYPES OF INJURY
Of the 147 injuries recorded, the most
common were sprains (44%) and fractures
(29%) (fig 2). Soft tissue injuries, including
Concussion
(3%, n = 4)
Contusion
(9%, n = 13)
Laceration
(9%, n = 13)
Table 1 Distribution of
fractures in skateboarders
LOCATION OF INJURY EVENT
Most of the injury events (24%, n = 33) took
place at specially designed areas, parks, and
ramps for skateboarding. Thirteen occurred in
school yards, 12 in public roads within densely
populated residence areas, and the rest at mis-
cellaneous places such as market places, court
yards, parking areas, etc. A popular place for
skateboarders was the Umeå market place,
where seven of the accidents occurred.
At skateboard ramps, 76% of the accidents
resulted in minor injuries; at schoolyards, 54%
of the accidents were classified as AIS 2.
Site of fracture No
Upper extremity
24
Clavicle
4
Shoulder
1
Humerus
1
Elbow
2
Wrist
8
Fracture
(29%, n = 42)
Hand
5
Finger
3
Lower extremity
18
Distortion
and luxation
(44%, n = 66)
Tibia
1
Ankle
8
Metatarsal
7
To e
2
Total
42
Figure 2 Types of injury sustained in 136 injured
skateboarders.
www.bjsportmed.com
Abrasion
(6%, n = 9
)
Skateboarding injuries
327
Table 2 Primary mechanism of skateboard injury as stated by the injured (n=131)
Inexperience has been suggested by some
authors to be a predisposing factor for
injuries.
824
However, as more experienced rid-
ers often attempt more di
Y
cult tricks and
jumps, reach higher velocities, and exhibit
more risky behaviour, the advantages of
experience are counteracted.
27
Unlike for
other recreational activities, an increase in age
does not automatically mean fewer injuries.
However, as confirmed by our results, the
severity of the injuries decreases with
age.
7122526
Young people are often not fully
mature with regard to balance, coordination,
and estimation of speed, which predisposes
them to more serious injuries.
272728
Most skateboard injuries are minor, even
trivial, but potentially life threatening injuries
such as retroperitoneal haemorrhage,
12
scroto-
abdominal injury,
24
and renal damage,
5
have
been reported, and fatalities have occurred.
11 12
Although none of the injuries in this study was
considered severe, some of the fractures had
the potential to cause deformity and growth
retardation, such as fractures of the epiphyseal
plate and the scaphoid.
123
Severe and fatal skateboard accidents inevi-
tably raise discussions about safety issues.
When skateboarding injuries are compared
with those from cycling
21
or road accidents,
22
which are generally more severe, the question
of banning seems rather implausible. Although
the skateboard injuries discussed here only
represent 0.4% of the total number of injuries
recorded at the hospital studied, the annual
number more than doubled during the four
year period of our study, from 23 in 1995 to 54
in 1998.
The e
Y
cacy of various preventive measures
such as using protective gear, improving falling
techniques, and enforcing age limits has been
debated by many authors.
3–5 13–15 18 19 22 28
As this
study did not gather information about the use
of protective equipment at the time of the
injury, we cannot comment on its value. The
high incidence of fractured wrists and ankles,
however, raises questions on how to avoid this
particular type of injury. The use of padded
ankle support
10 18
and sturdy footwear
3
has
been suggested, although others argue that the
former is not feasible because freedom of
movement of the ankle is important while
skateboarding. Hand and wrist protection has
also been suggested previously.
23
The fatalities reported throughout the years
mainly involved collisions with motor vehi-
cles.
7122529
As skateboarding requires a hard
smooth riding surface, it is not surprising that
adolescents are attracted to public roads. Ban-
ning skateboarding from roads and highways
has been unsuccessful,
811
but a feasible alterna-
tive would be to provide safe areas for
skateboarders,
329
also reducing the risks for
pedestrians. Interestingly, only a few people in
our study group were injured on busy roads,
whereas in studies from the United States up to
one third of the injuries occurred in this
setting.
7
The discrepancy is probably explained
by the fact that the city of Umeå has three
skateboard arenas and ramps, not including
home made ramps, reducing the use of
Primary mechanism of injury
No
“Loss of balance”
49
Failure in performing a jump or trick
34
Sudden stop caused by irregularities in the riding surface
9
Foot stuck between the board and the riding surface
8
Acute straining of limbs caused by own movement
8
Hit by moving airborne board
5
Falling when riding on steps
5
Miscellaneous and non-specified
13
TREATMENT AND SEQUELAE
For most patients (62%, n = 82) only the initial
treatment without any additional appoint-
ments was required, but 15% (n = 20) did
require further appointments. Thirteen pa-
tients did not need any treatment at all and
were sent home after the examination. Eleven
patients were admitted to hospital for observa-
tion and further treatment for a total of 21
days. None of the accidents resulted in perma-
nent injury or deformity.
Discussion
Skateboarding not only may result in injuries to
the skateboarders themselves, but can also be a
danger to pedestrians. This is illustrated by the
elderly woman in our study who required eight
follow up visits and who eventually developed
pseudoarthrosis, necessitating the insertion of
an artificial hip joint.
Of the injuries to the skateboarders, a
surprisingly high proportion was located in the
lower extremity. Nearly all previous studies
have reported injuries a
V
ecting the upper
extremity, such as wrist and hand fractures, to
be the most prevalent.
3 4 13 17–21
An olecranon
fracture, also called “skateboard elbow”,
11
was
seen only in one case, and scaphoid frac-
tures
22 23
were also rare. Wrist fractures are a
common outcome when the skateboard strikes
surface irregularities and the skateboarder falls
forwards and lands on outstretched arms.
There are some possible explanations for the
fact that the results of our study are not
consistent with previous ones. For example, in
our study, loss of balance and failure when
attempting a jump or trick was a more common
mechanism of injury, and the type of fall and
resulting injury are therefore likely to di
V
er.
Depending on the trick attempted, the risk of
landing askew seems to be higher than the risk
of a skateboarder losing balance completely
and falling on outstretched arms. Further-
more, new tricks are likely to change the
pattern of injury. Also, our mean age of 16 is
somewhat higher than the ages stated in other
studies, which may have a
V
ected the pattern of
injuries, because older skateboarders are likely
to be more experienced and to attempt more
tricks and jumps. Most patients older than 25
were using someone else’s skateboard and were
not regular skateboarders. Lastly, when consid-
ering the high proportion of fractures, it should
be noted that EHLASS records only the most
serious injury to a certain body part, meaning
that minor soft tissue injuries are probably
more common than shown in this study. In
addition, skateboarding probably causes many
trivial injuries not requiring medical attention.
www.bjsportmed.com
328
Forsman, Eriksson
skateboards on roads. The current trend of
using the skateboard more for recreational
purposes than as a means of transport may
have contributed.
For most young people of today, skateboard-
ing is not a means of transport but a lifestyle in
which a whole industry of fashion and other
accessories complements the sport. Home
made ramps, skateboard associations, and
professional and amateur competitions are
other attributes of this lifestyle. Like other
sports, skateboarding provides recreation and
enjoyment for its participants and enthusiasts.
It is thus the task of the community to contrib-
ute to increased safety by providing specially
designed skateboard parks and developing
individual protective gear.
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V
Take home message
Skateboarding today is not only a fun sport and a means of transport for young people, but
also part of a lifestyle. To reduce injuries associated with the increased use of skateboards, the
use of protective gear and supervised skateboard parks is recommended.
Commentary
Injury is a problem of our time and a reflection of environmental and product factors in current
society. Injury causation is related to popular opinion, with a bias towards prejudices between
people with di
V
erent value systems such as di
V
erent age groups. “Society should prohibit the use
of this or that”. One of the few standpoints that should be taken by public health o
Y
cials is the
seriousness of the outcome. This is why clinical epidemiological studies are of great importance.
They may not be sophisticated in methodology, but they have great potential for informing the
public. This study on skateboard injuries is such an example from an informed source. Clinicians
meet the patients and can interview those involved. These factual studies are needed for making
comparisons of injury patterns in di
V
erent exposure groups as well as investigating the environ-
ment and dangerous products. The next step should be more detailed interviews in order to sug-
gest better skateboard designs and protection for the skateboarders.
L SVANSTROM
Karolinska Institutet, Department of Public Health Sciences,
Division of Social Medicine, Norrbacka, 8th floor, SE-17176 Stockholm, Sweden
leif.svanstrom@phs.ki.se
www.bjsportmed.com
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1991;
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1979;
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9 Cassorla A.
The ultimate skateboard book
. Philadelphia: Run-
ning Press, 1988:17.
V
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