Written by Quentin Septer

Few sensations in life are as blissful as those of skiing. The ebb and flow of cuts and turns down the mountain; the sounds of skis surfing through powder; the snow-capped, panoramic mountain views. It’s no wonder why ski hills around the world draw an array of characters with a gravity-like attraction. From the ultra-wealthy tourists sporting the latest and greatest technologies in everything from socks to ski goggles, to the self-proclaimed “ski bums” living and breathing for the stoke of the high alpine, skiing is more than a sport and more like a way of life for many. But the consequences of skiing and snowboarding can be as steep as the slopes themselves.

Any skier will tell you that a day on the mountain doesn't always go as planned. According to data provided by the National Ski Areas Association (NSAA), more than 51 million skiers and snowboarders took laps on America’s ski slopes during the winter of 2019-2020, despite the season being cut short by the onset of the coronavirus pandemic. Among them, more than 600,000 folks suffered skiing- and snowboarding-related injuries. Twenty-nine people suffered catastrophic injuries—paralysis, broken necks, broken backs, and severe traumatic brain injuries (TBIs)—and another 42 human beings lost their lives. Moreover, these numbers are to say nothing of deaths and injuries occurring in the backcountry—such as the 244 skiers and snowboarders caught and killed in avalanches across North America over the last decade.

The statistics above represent important efforts on the part of both medical professionals and the ski industry at large to better understand the dangers of skiing and snowboarding. But numbers alone often fail to convey insights from which we can better inform our own lives and decisions. Millions of us love to push our limits on the ski slopes, but every now and again, we push too far, and being the avid skier (and some would say full-blown adrenaline junkie) that I am, I’ve come to know these harsh realities all too well. I’ve had my fair share of crashes on the ski hill from which I’ve lived to recover and recount over a good laugh, but I nearly had a last, and I hope that fellow skiers and snowboarders alike might benefit from hearing this cautionary tale.

. . .

A few years ago, on a clear spring day atop Peak 9 of the Breckenridge Ski Area, the air held an eerie quality of calm. The views are gorgeous at 13,000 feet. The peaks of the Tenmile Range, of which the Breckenridge Ski Area is a part, rose to the north and the south. Further north were Lake Dillon and the mountains of the Gore Range. Further south was Quandary Peak and the vast expanse of the South Park basin. To the west were the Mosquito and Sawatch Mountains, and in the eastern distance, the high peaks of the Front Range. In every direction, a sea of mountains and deep, chasmic valleys rose and fell toward an ivory and turquoise horizon. Below me, a slope of freshly fallen snow stretched down the mountainside. On the western side of the mountain grew thickets of lodgepole pine, and beneath the trees, Tenmile Creek flowed on the valley floor. On the eastern slope, beneath the runs of the Breckenridge Ski Resort was the Blue River Valley and the charming little town of Breckenridge itself.

I sat and enjoyed the views, catching my breath from a short hike to the summit, a few hundred feet above the highest chairlift in North America. Then, I began my descent down Breckenridge’s Imperial Bowl. The snow was steep and deep. Each turn felt weightless. If I could sum up the sensation of skiing powder with a single word, that’d be it—weightlessness. Reaching the base of the bowl, I kept skiing, linking turns into stands of pine on the lower reaches of the mountain. My mind was still in the sky. Weaving through a compact maze of trees, a familiar, burning sensation of fatigue grew ever more intense throughout the fibers of my calves, quads, and hamstrings. Turns grew evermore difficult to execute as exertion gave way to exhaustion. Against my better judgement, I continued down the slope, absorbed by the challenge of the terrain.

The visceral nature of skiing is so stimulating—so engaging—that conscious thought tends to fade away. It’s a kind of flow state; a moving meditation of body and mind. This is especially true of “tree skiing.” Line choices while skiing through a forest are limited, sometimes leaving mere milliseconds to react and flow with the rhythm of the landscape in a delicate dance of gravity and friction. When the music of skis flowing through snow stops and this dance is interrupted, however, the trajectory of one's well-being can be thrust airborne, falling at the mercy of momentum.

Gliding smoothly through the forest, I settle into a false sense of security. Approaching a tree and attempting a hard, sharp and lazy turn around its trunk, I catch the outside edge of my ski on variable terrain. A cruel combination of momentum and mass and gravity and velocity flings me forward, downhill, head-first through the cold forest air.

Any skier knows the feeling of “catching an edge” or “sliding out.” Regret consumes the mind while crashing on the mountain. Time seems to condense, providing ample opportunity to consider what went wrong, recognize what one should have done, and anticipate the impact to come.

Frantically looking for a soft, snowy landing, my vision fills rapidly with the texture of a pine tree’s bark to which my helmetless skull collides with incredible force, and a high-frequency, resonant ring consumes my consciousness as a shock wave of energy surges through my brain.

. . .

Within a crashing skier’s skull, bathed in a watery substance known in biology-jargon as cerebrospinal fluid, sits the three pound mass of matter that is the human brain. If you could zoom into the structure of your brain, you would see that each of the approximate 100 billion neurons comprising your brain tissues connect to thousands of fellow brain cells through thin, fiber-like extensions. These extensions—called axons and dendrites—allow neurons to communicate with one another, sending electrical and chemical signals throughout the many regions of the brain, giving rise to all that we think, say, and do. 

Despite the tethering of the brainstem and spinal cord by nerves, veins, and arteries, the brain has some room to maneuver within the skull. When one’s head moves quickly and forcefully, the soft tissues of the human brain squish against the skull’s strong, stable structure, slightly malforming on impact. Low-impact, subconcussive forces—like those generated while heading a soccer ball, for example—only warp the brain a little. The brain quickly retains its proper form with little to no harm done (though, over time, repeated subconcussive impacts can do damage to the brain, as evidenced by a growing body of scientific literature). As the force inflicted by a blow to the head increases, however, the shape and structure of the brain is distorted more markedly. And as a result, brain tissues can be bruised and battered. Intricate, delicate networks of neurons can be torn apart. Blood vessels can rupture. Brain cells can die.

It’s fitting that the word “concussion” derives from the Latin concutere—“to shake violently.”

Concussions are often defined as “mild” traumatic brain injuries. An estimated 1.6 to 3.8 million sports-related concussions occur every year in the United States alone, according to data provided by the Centers for Disease Control and Prevention (CDC). A 2008 study published in Epidemiology found that, of the approximate 600,000 skiers and snowboarders to injure themselves on America’s ski slopes every year, about 120,000 (or 20 percent) of them experience some kind of head injury. Moreover, about a quarter of these head-injured snow sports athletes sustain impacts with a degree of force sufficient to cause the loss of consciousness.

Given how complex the human brain is—famously the most complex object in the known universe—the damage done to a crashing skier’s brain is no simple matter, either. Countless factors make every head injury unique: the velocity of a collision, the angle at which a blow to the head occurs, the specific parts of the brain (and more precisely, the specific neurons) receiving the brunt of the impact, the distinct configuration of each human being’s brain cells, the genetic makeup within those cells. The list of variables goes on and on. 

In 2017, a paper titled “Analysis of Injury Mechanisms in Head Injuries in Skiers and Snowboarders” was published in the Journal of Medicine & Science in Sports & Exercise. The study investigated the events culminating in the head injuries of a select 295 skiers and 71 snowboarders admitted to emergency departments across the United States from 2013 to 2015. Among those injured, routine falls were the most common concussion culprits. It turns out, even a slow-going, seemingly low-impact fall on the ski slopes can do damage to the brain. Nearly a third of these injured skiers and snowboarders fell in a head-first trajectory (much like myself), and collisions with obstacles like, say, trees, caused the most severe TBIs documented in the study.

“The primary cause of concussive injuries,” David F. Meaney and Douglas H. Smith of the University of Pennsylvania write, is the “loading experienced by the brain at the moment of impact.” The human brain is soft and pliable and made mostly of water. Thus, “brain tissue deforms easily,” Meaney and Smith continue, “when shearing forces are applied.”

And in the case of a downhill skier colliding head-on with a tree, the skull is brought to an abrupt stop at the moment of impact. The brain, however, proceeds forward with rapid velocity, slamming against the rigid interior of the human cranium in what is known among scientists as a “deceleration impact.” The skier’s brain then rebounds against the rear of the skull as shearing forces twist, bruise, and potentially rupture white and gray matter alike. Pressure swells within the concussed brain, as well. Biochemical signals between impacted brain cells and brain waves propagating throughout impacted neural circuits grow abnormal. Concentrations of sodium and other electrolytes plummet; neurons become dysfunctional.

The force generated by such a collision increases with a skier’s speed; and with enough speed, widespread damage can be inflicted upon a crashing skier’s brain. A skier’s skull can fracture on impact. Blood vessels can be severed, and bleeding can occur within the brain—from an epidural hematoma to an intracerebral hemorrhage. Neurons can be stretched and deformed. Brain cells can die in a matter of hours. A fallen skier can lose consciousness, fall into a coma, and potentially, lose his or her life.

Brain injuries represent the leading cause of mortality and disability among injured skiers and snowboarders, as reported in an evidence-based review published in The Journal of Trauma and Acute Care Surgery in 2012. Of the dozens of individuals to lose their lives on America’s ski slopes every winter, head trauma proves the cause of more than half of these premature deaths.

. . .

“Are you okay?”

The timeless quality of being knocked unconscious is both tranquil and terrifying. Like a deep, dreamless sleep, the world seems to stop—to disintegrate into nothingness—as if entering some dark and vacant void. If sleep is the cousin of death, this state of unconsciousness seems more like a sibling.

“Hey!… HEY! ARE YOU OKAY?”

A shouting voice wakes me from the depths of my senselessness. My only feelings of awareness are those of raw sensation. Regaining my vision, I see a blurry forest around me—my skis, poles, and gloves scattered about from the impact. I hear a woman's voice calling to me through the trees from an adjacent ski run, and in my stubborn, concussed stupor manage to mutter back a ridiculously understated response: “Yeah… yeah, I think I’m fine.”

I wasn't fine. 

My consciousness expanded in waves as I struggled to reclaim my awareness. I found myself on my feet, clipping back into my skis and collecting my ski poles in a half-sentient haze. With the foggy nature of a dream, I navigated a slow, foolish, uncoordinated descent down Breckenridge’s Peak 9 and managed a staggered trek back to my apartment, where I promptly shed my ski gear and collapsed upon the mattress of my bedroom. Seeing my condition, my brother drove me to the hospital. Along the way, I struggled to remember what, exactly, happened up there on the mountain. One minute, I was taking a routine lap through some of my favorite tree runs in Colorado; the next thing I knew, I found myself wrapped around one of those tree trunks with a concussion. Yet, despite the chilling nature of the experience I’d just endured, I felt lucky to be alive. In fact, I was lucky to be alive, as the emergency room staff at the St. Anthony Summit Medical Center in Frisco, Colorado, persisted in reminding me a short while later.

The same sadly can’t be said for many, as underscored by the dozens of human beings who lose their lives on America’s ski hills every year. In my youthful naivety, or perhaps as an attempt to cope with the dangers of this sport that I love so dearly, I thought of myself as somehow immune to the risks of skiing. Sure, the sport is dangerous and people get hurt in the mountains with regularity, but I wasn’t one of them. It took a concussion to shake this illusion from my mind. 

But fellow skiers and snowboarders can learn from these mistakes. By acquainting ourselves with the dangers of the mountains, we can make more informed decisions on the slopes, steering clear of unnecessary risks while engaged in these beautiful, blissful and inherently hazardous sports. As dangerous as these sports are, in other words, the majority of injuries and deaths on the ski slopes are preventable. 

In fact, simply wearing a helmet can reduce a skier or snowboarder’s risk of head injury by up to 60 percent, according to a 2006 study published in JAMA. At the risk of stating the self-evident, a helmet provides a strong, stable structure around the skull to absorb the force and dampen the impact of any object that a human head happens to collide with. Had I been wearing a helmet the day my head slammed into that tree, I very well may have spared my brain of the damage that I so mindlessly inflicted upon it. According to the NSAA, only 25 percent of all skiers and snowboarders were wearing helmets during the winter of 2002-2003. This figure increased to 57 percent in 2010. By the 2019-2020 ski season, about 86 percent of those linking turns on America’s ski slopes were sporting helmets while doing so. 

Despite this precipitous rise in helmet use, however, skiing-induced head injuries have continued on an incline as well. A 2013 study conducted at the Western Michigan University School of Medicine, published in the journal of Wilderness & Environmental Medicine, documented the admission of head-injured skiers and snowboarders to emergency departments across the U.S. from 2003 to 2010. During the 2003-2004 ski season, a combined 9,308 skiers and snowboarders sought emergency medical treatment for their brain injuries. By 2010, this figure rose to 14,947—a 60 percent increase in seven years. Over the same period, the fraction of head-injured skiers and snowboarders wearing helmets at the time of their injuries increased from 37 percent to 58 percent. Moreover, of the 42 human beings to lose their lives within America’s ski resort boundaries during the winter of 2019-2020, nearly two-thirds of them were wearing helmets during their last laps on the ski hill.

Helmets can be literal life-savers, but we often ride at speeds that are simply too fast for the average cranium cap to do us much good. The standard winter sports helmet is designed to protect against impacts occurring at velocities of 14 miles per hour and slower. Even at these relatively reserved speeds, however, a lid can make the difference between life and death, as a fourteen mile per hour impact to an unprotected skull can be lethal. At lower speeds, helmets effectively cushion moderate injuries like cuts and mild concussions, but colliding with a tree, rock, fellow skier or an icy slope at automobile-like velocities means your head—be it helmeted or helmetless—is likely to receive an impact with force sufficient to leave you with a traumatic brain injury. 

“At the present time no suitable helmet exists which is likely to protect all skiers and snowboarders,” Paul McCrory, a traumatic brain injury researcher at the University of Melbourne wrote in the British Journal of Sports Medicine in 2002. “Better injury data analysis and suitable helmet standards are required to initiate the process of developing an appropriate protective helmet.” Helmet technology has evolved considerably in the years since McCrory wrote these words, and today’s helmets are more effective at preventing brain injuries than ever before. Yet, despite these advancements in helmet technology and the increased use of these more advanced helmets over recent years, skiers and snowboarders seem to be out riding the boundaries of their protection.

 Staying safe on the mountain isn’t simply a matter of wearing a helmet, but of using the logic and reason of the brain it's meant to shelter. Devastating physical damage can be inflicted by an accident in the mountains—many winter sports athletes are painfully aware of this unfortunate truth. Yet, many of us persist in pushing our limits on our skis and snowboards. As one ski patroller, of all people, put it to me on a recent T-bar ride up the headwall of Mount Crested Butte, Colorado: “If it’s not a little scary, it’s just not much fun.”

The majority of brain injuries occurring on the ski slopes involve either a jump or recklessly high-speeds, often both, according to the same Journal of Medicine & Science in Sports & Exercise study mentioned above. Furthermore, the majority of these TBI-afflicted skiers and snowboarders are testosterone-crazed 16 to 25 year old males pushing their athletic abilities to the limits in attempts to display just how sick and steezy and gnarly they are, dude. When my head impacted that tree on that fateful day a few years back, I regrettably joined this demographic. I was simply skiing above my abilities, riding too fast in terrain too hazardous for my skill level.

But any skier or snowboarder can make these mistakes regardless of age, gender, or experience. Children and novice women skiers colliding on groomers represent the respective second and third most common demographics to suffer TBIs on the ski slopes, followed by skiers 50 years of age and older sustaining blows to the head as the result of a routine fall. Whether novice or expert, young or old, skiers and snowboarders alike strive to improve their skills on the ski hill. But pushing too hard, too far, too fast, is a quick route towards a traumatic brain injury.

And brain injuries don’t end on the ski hill, either. Suffer a single concussive blow to the head and your risk of developing a condition called chronic traumatic encephalopathy (CTE) increases by about 20 percent. Your risk of developing CTE compounds with repeated head injuries, too—even subconcussive head injuries. In the event of a blow to the head, the brain attempts to repair the damage done with the use of tau proteins. In a healthy brain, tau proteins stabilize the structures of brain cells. Within a CTE-afflicted brain, however, these tau proteins become defective; accumulating within neurons, roving throughout the brain and interfering with proper neurological function. Over time, the brain deteriorates, losing mass and manifesting in symptoms akin to Alzheimer's disease and other forms of dementia.

The earliest scientific documentation of CTE dates back to 1928, when a pathologist and medical examiner by the name of Harrison Martland first described a progressive loss of cognitive function occurring among “punch drunk” boxers. The condition became known as “dementia pugilistica” throughout the twentieth century. Nearly a century on, in 2005, the first study to detect CTE in the brain of a former National Football League (NFL) player named Mike Webster was published in the Journal of Neurosurgery, triggering an avalanche of media coverage and scientific research investigating the dangers of head injuries in American football and other high-impact sports. Since then, neuroscience has come a long way towards better understanding what’s going on within the TBI-afflicted brain, and many people, publications, and organizations have made valiant efforts to inform the public about the risks of brain injuries in contact and action sports alike.

Brain injury awareness in skiing has been gaining momentum in recent years, too. The High Fives Foundation—a Truckee, California-based non-profit founded in 2009—“focuses on preventing life-changing injuries and provides resources and hope if they happen.” For more than a decade, the High Fives Foundation has met the problem of head injuries in skiing and snowboarding head-on, raising millions in funding to aid in the treatment and recovery of nearly 400 athletes suffering TBIs across the United States and Canada.

The National Ski Areas Association, as another example, has funded scientific research investigating skiing and snowboarding-related injuries in attempts to better understand their causes and improve the safety of mountain sports. The NSAA has launched educational campaigns like Lids on Kids and Ride Another Day, as well, in efforts to raise the public’s awareness about the risks of reckless riding. “The collective industry efforts to promote helmet use should be applauded,” NSAA president and CEO Kelly Pawlak stated in a press release. “At the same time, we stress that skiing and riding safely and responsibly, in addition to wearing a helmet, is the best way to prevent incidents and injuries out on the mountain.”

This, as many skiers and snowboarders know, is easier said than done. The proper balance between pushing ourselves on the slopes and riding safely can be difficult to discern, particularly when such an equilibrium exists in constant flux with our athletic abilities and variable terrain. Successfully navigating risk—gliding up to the edge of one’s physical and psychological capacities but proceeding no further—that’s the essence and allure of skiing for many, myself included. More than a mere adrenaline rush, the pursuit of mastery in the face of perilous physical consequences is one of countless things that so many of us love about skiing in the first place. To the mind’s eye of a skier, danger is simply another obstacle to be overcome.

But love is blind, so the expression goes, and we often lose sight of what we put at risk for our love of skiing. I love skiing. The sport has enriched my life in many ways. But I write this story as an open letter to fellow skiers (and snowboarders alike); as a reminder that living to ski doesn’t make skiing to die for.