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ISSUE
SPECIAL
AND
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SUMMER
2020
OLYMPIC
PARALYMPIC

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VO L U M E 6 1 - N o. 8 - A U G U S T 2 0 2 1
© 2021 EDIZIONI MINERVA MEDICA The Journal of Sports Medicine and Physical Fitness 2021 August;61(8):1125-31
Online version at http://www.minervamedica.it DOI: 10.23736/S0022-4707.21.12559-9

SPECIAL ARTICLE
SPORT INJURIES AND PREVENTION

Proposal for evaluation and registration

of sport injuries in skateboarding
Professional skateboarding injury prevention survey
Rodrigo A. MARTÍNEZ STENGER 1, 2, 3 *, Luis V. PARRILLA 1, Facundo QUIROGA 4

1Argentinian Sports Physicians’ Association (AMDARG), Buenos Aires, Argentina; 2A. Lanari Medical Research Institute, Buenos
Aires, Argentina; 3World Skate Medical Commission, Lausanne, Switzerland; 4Skateboarding National Technical Director, Argentinian
Roller Skate Confederation (CAP), Buenos Aires, Argentina
*Corresponding author: Rodrigo A. Martínez Stenger, Argentinian Sports Physicians’ Association (AMDARG), Arismendi 2417, Buenos Aires, Argentina.
E-mail: rodrigomstenger@gmail.com

A B S T RAC T
The recent incorporation of skateboarding as an Olympic discipline has aroused interest in the epidemiological analysis of injuries suffered in
this sport with the aim of adopting preventive measures and thus reduce the athlete’s time out of training or competition. There is little published
on the topic. The few statistical data available refers to amateur practice and analyzes information obtained retrospectively. This situation leads
to bias because It does not register relevant data that could be seen directly on the field of play or through video analysis. For example: issues
involving the mechanism of injury, type of fall, etc. We propose this survey to be trialed in professional competitions and training in order to col-
lect information from non-amateur practice of skateboarding. It will allow us to make effective decisions on preventive actions. All international
federations should have access to it.
(Cite this article as: Martínez Stenger RA, Parrilla LV, Quiroga F. Proposal for evaluation and registration of sport injuries in skateboarding. Profes-
sional skateboarding injury prevention survey. J Sports Med Phys Fitness 2021;61:1125-31. DOI: 10.23736/S0022-4707.21.12559-9)
Key words: Skating; Athletic injuries; Prevention and control; Surveys and questionnaires.

History of skateboarding especially in pediatric population, since they caused great

and initial prevention measures morbidity, deformity (objective in case of fractures) and
serious injuries7-9 frequently associated with vehicles col-

I n the mid-1960’s, skateboarding emerged as an alter-

native practice to the inactivity period of surfing. It
involved moving on a board with wheels on the ground
or other surfaces. Skateboarding becomes popular in Los
Angeles, CA; but it became a real boom in the 1970’s with
the introduction of polyurethane axles and other improve-
ments that made boards more versatile to perform maneu-
vers or tricks, in addition to improving traction and grip on
them.1 These enhancements caused many injuries2-6 and
generated prohibition of skateboarding in public spaces,
lisions.
That is why skateboarding was banned in some coun-
tries, based on the fact that its practice on public roads (de-
scending at high speed on highways, avenues and streets
with vehicular traffic) was extremely dangerous. In later
years, a series of measures were implemented to reduce
the incidence of injuries:
•  creation of skateparks10 with regular friction surfaces
and without vehicular traffic;
•  beginning of sports practice at an age in which psy-

Vol. 61 - No. 8 The Journal of Sports Medicine and Physical Fitness 1125
MARTÍNEZ STENGERINJURY EVALUATION IN SKATEBOARDING
chomotor skills, balance, coordination and judgment were
developed;11 NEVER in children under 5 years of age;12
•  use of personal protective equipment:13 helmets, knee
pads, wristbands, etc.;
•  safe design of boards: it is known that product failure
causes 1% of injuries;14
•  official supervised education and instruction;15
•  suitable footwear,16 among others.
A second wave was observed in the early 1990’s, but
epidemiology of the injuries was much different. Chal-
lenging behaviors when performing tricks and stunts were
now more relevant. The incorporation of new materials on
the manufacturing of boards allowed speeds up to 60-90
km/h.17 On the other hand, there was no effective brak-
ing system. Most of the injuries were acute in nature and
produced by direct collision with an object or falls when
losing balance. Falls were the center of attention and ac-
quired great importance. Training appropriate reactions
in the moment of the fall, reduced the impact of injuries
in the upper limb.18 They constituted between 55-63% of
all injuries19-21 and were produced by an intuitive action
when protecting the head and face22, 23 by extending the
arms during the fall. In other series, the prevalence of con-
tusions, fractures or sprains of the foot and ankle is re-
ported,24 for which the magnitude and effect of the forces
when landing “on” or “off” the board is also important.16
Basic skateboarding postures and movements
The lateral position is known as “stance.” When the left
leg faces the direction in which the skater wants to move
and is also in front of the right one, it is called “regular
stance.” On the other hand, some skaters prefer to keep the
right leg leading, which is known as “goofy stance.” The
usual posture of a skateboarder is called “main stance,”
but when the front leg is substituted for the contralateral
one during the competition, there is a “change” (switch
stance). The scores awarded to tricks performed with the
“main stance” differ from those given when the “switch”
is performed, since the difficulty increases in this case.
The “ollie maneuver” is a very common trick in which
both the skateboarder and the board jump into the air, but
the skater does not take the board on his hands. It is usu-
ally followed by “turning the skateboard” (flip the deck)
in many directions away from his feet and putting it back
underneath, before hitting the ground. A variation of this
twist is to rotate the body at the same time as the board.
When done correctly, it looks like it is coming back to their
feet like a magnet (Figure 1).
1126 The Journal of Sports Medicine and Physical Fitness August 2021
Figure 1.—How to perform ollie maneuver.
Olympic skateboarding
disciplines: street and park
The street category is developed in a straight route that
imitates the street, with stairs, handrails, park benches,
walls, slopes, etc. Park competitions take place on a track
with slopes, flats and curves connected with some transi-
tion trails. Depending on the track, they can reach vertical
style. Both of them are individual competition and the ob-
jective is to demonstrate as many skills as possible on the
track. The evaluation athletes receive takes into account
the difficulty of the tricks, height, speed, originality, ex-
ecution and composition of the movements.
Evolution of the epidemiological
study on sports injury
The International Olympic Committee (IOC) established
by consensus, that an injury is “any tissue damage or other
disorder of normal physical function caused by participa-
tion in a sport, which results from the rapid or repetitive
transfer of kinetic energy.”25 Epidemiological analysis
started with Dr. Roald Bahr’s work. He described a meth-
odological approach for the study of risk factors on sports
injuries using Meeuwise’s multifactorial dynamic model
in 1994.26 Subsequently, several guidelines follow one
another in terms of prevention strategies: from the linear
cause-effect postulates of Van Mechelen et al.,27 to the in-
teractive models of Mendiguchia et al.28 and complex sys-
tems, which have become widely known today with their
“web of determinants” or “neural network.”29 Broadly
speaking, these works allow us to distinguish:
•  internal risk factors, specific to each individual, which
in turn are divided into non-modifiable (age, anatomy, sex,
previous injury, etc.) and modifiable (flexibility, dexterity,
body composition, etc.). They act as predisposers;
•  external risk factors, correspond to characteristics of
the external environment (playing field, footwear, equip-
ment, etc.);
INJURY EVALUATION IN SKATEBOARDING MARTÍNEZ STENGER

IDEAL ATHLETE discipline25 and, furthermore, theorize the possible inter-

Rehabilitation/ + Internal Risk
Factors
Return to play
PREDISPOSED ATHLETE
External Risk
+ Factors
No
recovery INJURY SUSCEPTIBLE ATHLETE
Fatigue + Adaptation
+ +
Excessive
Workload
Inciting
Event
Figure 2.—Determinants which are involved in the genesis of injuries.
•  inciting event, which can appear as a game situation,
position of a joint in the surface on the ground, inappropri-
ate movement pattern, etc.;
•  training load, is the stimulus applied to obtain an
adaptive response. It must be prescribed appropriately, be-
cause excessive workloads will produce fatigue and nega-
tive physiological effects as well as insufficient ones. On
the other hand, appropriate stimuli will improve physical
fitness, causing a positive physiological adaptation to the
stress that it produces. This is a dynamic process, since
all these factors are interrelated and interact in multiple
ways.29 The predisposed individual becomes susceptible
when exposed to external risk factors. This fact, added to
the application of a work-load and the occurrence of an
inciting event, can result into an adaptation to this stimulus
or produce a failure in the athlete’s bio-psycho-mechan-
ics, with consequent damage to the different tissues of the
anatomy and/or the psychic apparatus (Figure 2).
Our proposal
After exposing these concepts, we propose the following
alphanumeric descriptive injury report in order to identify
them, classify them, monitor them, compare their inci-
dence and/or prevalence with other groups, create a stan-
dardized database to use a common language within the
actions of this neural network.
Modifies To begin with, we must discriminate athletes according to
whether they participate in national or international tourna-
ments, whether or not they use protective equipment, type
NO INJURY
and brand of skateboard, level of experience (beginner, am-
ateur or advanced) and years of practice in skateboarding,
date of injury occurrence, category (Street or Park), stance,
Appropriate
Workload gender and age. The report will include the following.
Injured body part and location
We will use the classification established by the Sport
Medicine Diagnostic Coding System (SMDCS) that dis-
criminates head (face, brain [concussion], eyes, ears and
teeth) and neck, (cervical spine, larynx and major vessels)
trunk (thorax [sternum, ribs, breast, chest organs], thoracic
spine [thoracic spine and costovertebral joints], lumbosa-
cral [lumbar spine, sacroiliac joint, sacrum, coccyx and
buttocks], abdomen [below diaphragm and above inguinal
canal, includes abdominal organs]), upper limb (shoulder
[clavicle, scapula, rotator cuff and biceps tendon origin],
upper arm, elbow [ligaments, insertional biceps and tri-
ceps tendon], forearm [includes non-articular ulna and ra-
dius injuries], wrist [carpus], hand [includes fingers and
thumb]) and lower limb (hip/groin [hip and anterior mus-
culoskeletal structures], thigh [femur, hamstrings, ischial
tuberosity, quadriceps and mid-distal adductors] knee [pa-
tella, patellar tendon and pes anserinus], leg [includes non-
articular tibia and fibula injuries, calf and Achilles tendon],
ankle [includes syndesmosis, talocrural and subtalar joint],
foot [toes, calcaneus and plantar fascia]) (Table I).
Tissue affected and type of injury
Muscle (contusion, contracture, tear and compartment
syndrome), tendon (tendinopathy [includes conditions of
the paratenon, bursa, fascia, subluxation and enthesopa-
thy] and partial or complete rupture), nerve tissue (in-
cludes concussion, all forms of brain injury, spinal cord
spinal and peripheral nerves), bone (acute fracture [in-

Table I.—Codes and classifications for injuries: injured body part/location of injury.
Head and neck Cod. Trunk Cod. Upper extremity Cod. Lower extremity Cod.
Head and brain 1 Chest 11 Shoulder 21 Hip/groin 31
Face 2 Thoracic spine 12 Upper arm 22 Thigh 32
Neck/cervical spine 3 Lumbar spine 13 Elbow 23 Knee 33
Larynx 4 Abdomen 14 Forearm 24 Lower leg 34
Vessels 5 Wrist 25 Ankle 35
Finger 26 Foot/toe 36
Thumb 27

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MARTÍNEZ STENGERINJURY EVALUATION IN SKATEBOARDING

Table II.—Tissue affected, type of injury, and diagnosis. cluding avulsion and dental injury], stress injuries [stress
Tissue affected Cod. Type of injury Cod. fracture, bone edema and periostitis]), contusion [acute
Muscle A Contusion 1
injury without fracture], avascular necrosis and injuries to
Tear/rupture 2 the physis), cartilage (includes conditions of the labrum,
Muscle compartment syndrome 3 meniscus, articular cartilage, and osteochondral injuries),
synovium (includes impingement, arthritis, synovitis, and
Tendon B Tendinopathy 1 capsulitis), bursa (traumatic or calcific bursitis), ligament
Rupture 2
(ligament sprain, tear, acute and chronic instability), joint
Bone C Fracture 1
Stress Injury 2 capsule (dislocation and subluxation), skin and superficial
Contusion 3 soft tissues (contusion, laceration, hematoma, abrasion
Avascular necrosis 4 and vascular injury), vessels (vascular trauma), stump (in
amputees) and internal organs (trauma, excluding brain)
Cartilage D Labrum 1 (Table II).
Meniscus tear 2
Osteochondral Injury 3 Position of the body part in trauma
Arthrosis 4
Synovium/bursa E Arthritis 1 Flexion, extension, abduction, adduction, inversion, supi-
Synovitis/capsulitis 2
nation, eversion, pronation, neutral or other (Table III).
Bursitis 3
Ligament/joint F Sprain (ligament tear or acute instability) 1
Mechanism of the fall
capsule Chronic instability 2
Dislocation 3
As a result of video analysis, ascent and descent directions
Nervous system G Concussion 1
Other brain injuries 2
with different physics behavior have been described. In
Spinal cord 3 ascension, the kinetic energy of the upward trajectory de-
Peripheral nerve 4 creases due to the negative work of the force correspond-
Vessels H Vascular trauma 1 ing to the skater’s body weight. While, in descension, its
Laceration 2 kinetic energy increases due to the positive work of the
Superficial I Contusion 1
tissues/skin Bruise 2
weight force, decreasing the potential energy in the jour-
Laceration 3
Abrasion 4 Table IV.—Mechanism of the fall.
Internal Organs J Trauma 1
Drowning 2 Event Cod. Sub-event Cod.
Stump K “Describe” Drifting descending path 1 Loses skateboard on the air 11
Drifting ascending path 2 Lands with the skateboard 22

Table III.—Position of the body part in trauma.

Table VI.—Estimated duration of absence from training or com-
Position Cod.
petition.
Flexion a
Duration Cod.
Extension b
Abduction c 1-7 days 1
Adduction d 1-21 days 2
Inversion/supination e 3-8 weeks 3
Eversion/pronation f >8 weeks 4
Neutral g Sequel or permanent disability Yes/No
Other h Death Yes/No

Table V.—Cause of injury.

Cause Cod. Sub-cause Cod. Sub-cause Cod.
Acute 1 Direct trauma 11 Exacerbation 21
Overuse (Gradual onset) 2 Indirect trauma 12 Subsequence 22
Overuse (sudden onset) 3 Non-contact trauma 13 Recurrence 23
Sudden and gradual onset 4

1128 The Journal of Sports Medicine and Physical Fitness August 2021
INJURY EVALUATION IN SKATEBOARDING MARTÍNEZ STENGER

ney. It must also be observed whether or not the skater los- Trick or maneuver performed
es his balance and the skateboard in the air when executing
the acrobatics, or if he lands with the board on the ground Depending on the category — street (more frequently an
and the fall occurs after this fact (Table IV). ollie is observed) or park.

Cause of the injury Imaging technique used

Acute or overuse. Overuse can be gradual, sudden or X-ray, TC, MRI, echography, etc.
mixed onset. Non-contact trauma, indirect trauma, or di-
Treatment
rect trauma; recurrence, subsequence or exacerbation of
previous injury (Table V). Unloading body weight, rest, immobilization, surgery, etc.
Estimated duration of absence from training or competition Characteristics of the training
We selected Dr. Vicente Paús classification to stage inju- On the other hand, the questionnaire emphasizes the char-
ries. It is based on recovery time required for returning to acteristics of the training: periodicity, members of the
sport,30 recognizing that it has certain limitations: coaching staff, specific type of physical preparation with
•  grade 1 (mild): 1 to 7 days; a description of activities carried out and whether or not
•  grade 2 (moderate) 1 to 3 weeks; they develop any training to avoid falls. It should also be
•  grade 3 (serious): 3 to 8 weeks; clarified if athletes do warm up and/or cool down before
•  grade 4 (severe): more than 8 week (Table VI). and after the sessions, and if they practice any other sport
Side (Table VII) (Supplementary Digital Material 1: Supple-
mentary Text File 1).
Right or left.
Action Conclusions
Training or competition. We hope that through the elaboration of the injury report,
information about the origin of skateboarding injuries can
Obstacle be gathered, creating the first professional athletes’ data-
Gap of stairs, ramp, flat, hubba, etc. base. We want to stimulate searching for other agents that
have not been taken into account in this work and to iden-
Risk factors tify the “web of determinants” of each type of injury.
Individuals should be trained on collecting information
Internal and external. and filling the blanks in the survey. Perhaps, it would be
Inciting event better if he or she handles anatomy terminology.
Documented injuries must be related to time spent in
Previously analyzed. competition or training. The estimated time of absence in

Table VII.—Training and prevention program questionnaire.

Periodicity Team work Specific training Activities during training Training how to fall and roll
• Days per week • Alone • Flexibility • Skating • No
• Hours per day • Trainer (level of expertise) • Cardiopulmonary • Cycling • Yes
• Physician resistance • Gym • By your own
• Other • Muscle strength and • Other • Parkour
endurance • Other
• Coordination and balance
• Other
Warmup: Yes/No
Cool down: Yes/No
Other sports: Yes/No (which?)
Comments:

Vol. 61 - No. 8 The Journal of Sports Medicine and Physical Fitness 1129
MARTÍNEZ STENGERINJURY EVALUATION IN SKATEBOARDING
training and competition depends on the type of injury and
should be objective, although sometimes there is no clear
criterion for sports return, and this is biased by other vari-
ables.
A clear criterion must be established to define the level
of experience of the skaters, since currently, to our under-
standing, it does not present a satisfactory classification.
This survey is based on the literature published in the
IOC Consensus Statement, which describes injury body
part and location, type and cause of injury. Our team also
included some aspects which are typical of skateboarding
in order to find or rule out an epidemiological link when
collecting data, because its practice is not popularly pro-
fessionalized as an Olympic sport. That is why we consid-
ered the Delphi method consensus approach concerning
training and injury prevention program, stance, obstacles,
tricks performed31, 32 and mechanism of the fall, among
others. We hope it will allow us to make effective deci-
sions on preventive actions.
The data published so far allow us to ensure that:33
•  it is convenient to bend down on the board if you are
losing your balance;
•  landing on a body region with a large amount of mus-
cle and/or adipose tissue (soft parts) helps to avoid direct
trauma to areas with less protection, more exposed;
•  it is preferable to roll on the ground when falling, in-
stead of absorbing the force with the arms and relaxing the
body instead of generating a rigid posture.
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Vol. 61 - No. 8
Medicine Commission.
INJURY EVALUATION IN SKATEBOARDING

History.—Manuscript accepted: June 9, 2021. - Manuscript revised: June 7, 2021. - Manuscript received: March 18, 2021.
Supplementary data.—For supplementary materials, please see the HTML version of this article at www.minervamedica.it

The Journal of Sports Medicine and Physical Fitness 1131

physics. Special thanks are given to Dr. Patricia Wallace, who trusted the authors and gave them the chance to start working with the World Skate’s Sports
assistance of this manuscript. They are also grateful to Federico Sevlever, PhD, and Pablo Martínez Stenger, engineer, for their advice on issues related to
MARTÍNEZ STENGER