In Action Sports, Helmets Are Only the Beginning of the CTE Conversation

The news broke Tuesday that BMX legend Dave Mirra, who took his own life in February at age 41, had been diagnosed with chronic traumatic encephalopathy (CTE), a neurodegenerative disease linked to repetitive brain trauma. Scores of former contact-sport athletes—American football players, boxers, and soccer and hockey players—have been diagnosed with the condition, which currently only can be detected in the brain after death.

Mirra is the first CTE case from action sports, but anyone familiar with their head-knocking dangers knows he almost certainly will not be the last.

"I guarantee you that I have more friends than I have fingers who are going to have this," said Mike Escamilla, 38, who's been a pro BMX rider since he was 17 years old. "Dave is not the first to have it. I mean, it scares me."

Escamilla has hit his head many times—too many. He says he's been knocked unconscious on 10 to 15 occasions, taken two really bad falls, and had seven or eight concussions. In 2012, Escamilla was riding in Iraq at an event for American soldiers—on his bike on a fire truck, beside a ramp—when his front brake slipped and he went off the back of the truck. He fell 10 feet and broke his helmet upon impact. The force caused his skull to bruise his face, giving him a black eye.

"That one was the most scary because I could feel my the burn in my brain," Escamilla said. "Those bad ones changed the way my life functioned. I found myself not being able to read or multi-task or talk the same."

When talking about head injuries with Escamilla and other pros, the conversation quickly turns to helmets. Mirra and Escamilla started riding during an era when helmets weren't easy to come by, or worn by many people, or cool. Today, nearly every kid at a skatepark or a ski resort wears one.

The National Ski Areas Association reported that 97 percent of all kids under age nine wore helmets at ski resorts during the 2014-2015 season. Seventy percent of 18-to-24 year olds, the least likely group to wear head protection, had helmets on when interviewed by the NSAA, up from 18 percent of the same age group in the 2002-2003 season.

Several states now have laws requiring children and young adults to wear helmets while riding a bike or skateboard. And that's good: helmets do an excellent job of preventing catastrophic skull fractures, which undoubtedly saves lives.

However, as American football demonstrates, the brain remains vulnerable no matter how well the skull is protected. Think of the brain, a gelatinous mass that floats inside the skull, as akin to an egg yolk, with the skull the equivalent of a shell. Even if you wrap an egg in Kevlar and bubble wrap, the yolk is still jostled by hard impacts and sudden changes of direction and momentum.

A lawyer who represents helmet manufacturers and declined to go on the record for this story reiterated this point, telling VICE Sports that helmet design is far less a factor in head injury risk than simple action sport participation. Hucking off a 30-foot cliff on skis or backflipping a BMX bike off a jump puts the brain at risk, regardless of the helmet.

"This is the first generation of people taking sports to a level where head injuries are common," Escamilla said. "People were doing gnarly stuff in the 1980s, but the potential for injury is just so much bigger because people are doing such crazy stuff now."

Helmet design is a balance between wearability and protection. For a lot of sports, helmets need to be aerodynamic, afford a wide range of vision, and minimally restrict head movement, as well as protect the head during impact.

"Anyone can make the safest helmet in the world, it's just that it would be the size of a beach ball," said David DeMartini, North America marketing director for Poc, a Swedish manufacturer of cycling and snowsports helmets. "For us, the crux is how do we create something that's as safe as a beach ball-sized helmet but, on the cycling side, is lightweight and aerodynamic?"

Most action sports helmets are designed to handle a single big crash. Those helmets are made with EPS foam, and once the foam has been impacted, it doesn't perform to its original ability. Helmets that can handle multiple impacts, however, are becoming more common. Most of those helmets use EPP foam. Poc, Pro-tec, and a handful of other companies sell multiple-impact helmets, which generally use a proprietary combination of EPP foam and other materials.

Multiple impacts have been linked to CTE, and current medical and scientific evidence suggests that repetitive brain trauma is the necessary—if not exclusive—risk factor for the disease. The standard protocol after a crash is to get back on the bike or the skateboard. Shake off the fall and carry on. But, according to DeMartini of Poc, action sports athletes need to shift the paradigm of what we consider an injury, the same way American football is in the process of doing. At least in theory, concussions are no longer a same-day return-to-play injury; athletes are supposed to be sidelined until going through recovery protocols and receiving clearance from medical professionals.

Put more simply: just because an action sport athlete has busted a helmet—and not their skull—it doesn't mean their brain is necessarily OK.

"The value of a helmet is usually placed on a single, significant incident," he said. "One of the most valuable things we take away from the CTE conversation—if there's any light in this dark situation—is that even if there's no apparent sign of injury that doesn't mean there won't be one. When a kid falls down and pops right back up that doesn't mean no injury has occurred."

Mirra's tragic death has fostered conversation about CTE within action sports. To guys like DeMartini, this encourages innovation in protective gear. For pros like Escamilla and all other athletes wanting to protect their heads, it means exercising more caution with regards to concussion diagnosis and recovery, and also realizing that while helmets are not a magic bullet, they are an important and necessary layer of protection.

"You definitely see more pros wearing helmets now when they're street riding," Escamilla said. "Guys like Van Homan and Gary Young are wearing helmets on the street. I saw that skater Mike Vallely is wearing helmets in all his videos now. These are big name pros so it's cool to see them jumping in and supporting it."