- Let's say that if his feet hadn't hit.
Would have been tipping the scales of pain, for sure.
I've seen people do that
and come away bloody in between their legs.
Hey, I'm Tony Hawk.
- And I'm Dr Andrew Accardi.
- And today we'll be watching skateboarding slams
and discussing the injuries that can occur from them.
This is the Breakdown.
Dr Accardi works at a local hospital
in my area and was a former skater,
so we knew each other from back then.
He's helped me through some of my worst injuries.
Well, besides my dislocated fingers recently.
I broke my humerus, I still have two screws
in my elbow, actually.
Fractured my pelvis all the way through,
sprained my ankles countless times.
My shins have had stitches hundreds, if not more.
I've had stitches in these eyebrows, both twice.
But other than that, I've been relatively lucky
with my injuries.
[high energy music]
That was my very first attempt at a back flip
over what we call a launch box,
which is a launching ramp, and then a landing ramp.
That was, I think, around 1994
or maybe '96 in Tulsa, Oklahoma.
And I had never tried one before.
I didn't know really how to approach it.
I realized as I was taking off,
I didn't have enough lift to do the full back flip,
so I ended up landing on the side of my head and my neck.
And I remember having a very stiff neck for a couple months.
I have never fallen like that before,
so I don't really know how to call it.
And I don't think I've fallen like that since.
- If the neck is really tight
and you have seven vertebra with the spinal cord right
in the middle, so right where he hit,
there's the possibility that you could have
a neck fracture and actually cause paralysis.
He also broke with his two wrists,
so you'd be worried about wrists,
but with the initial hit to the neck
and then rolling down the ramp,
the first thing we'd be worried about was paralysis
or even a hematoma that would encroach
on the spinal cord and cause some kind of life-long injury.
It sounds like you pulled some muscles,
the strap muscles, in the neck and maybe got away lucky.
Maybe you've got some arthritis
in there and certainly concussion,
'cause it looks like you hit the side of your head, as well.
- I'm thankful that Dr Accardi wasn't there
because I would have worried much more,
having heard that afterwards.
- The twisting motion that he's doing, it's gonna help,
but it's not really gonna help your neck.
That type of injury just looks really scary
from the neck standpoint.
- I think what helped mostly with the fall,
was the fact that I was going down a bank ramp.
If it had still been a flat surface,
everything would have collapsed,
but it allowed my momentum to keep going down.
I don't remember hurting my wrists at all.
It was more out of desperation that I put my hands out.
I got very lucky in that sense.
And the next time I ever tried that trick,
I tried to into a foam pit.
That allowed me to actually figure it out,
which I should have done the first place.
But I didn't have that luxury,
at the place I was doing it.
We call that getting sacked.
Basically that means you're straddling a handrail.
I think that he was lucky that his legs were long enough to
actually have his feet hit the ground.
But it looked like there was still
some impact in between his legs.
the biggest reason I don't hit handrails these days.
Usually it doesn't happen like that.
Usually, it's when you go to ollie,
you don't get as high as you need to
and your foot slips off.
So that usually happens at the beginning,
not happening after he's already on it.
But definitely as he shot out,
that gave him more upwards momentum.
So it was almost like he was jumping up more.
Yeah, you see that his feet lands at the same time.
I think that was pretty lucky if he had been any shorter,
it would have been a lot more damaging.
But I'd say that that's not the most common,
maybe the most common for people who are learning handrails,
and maybe have an inflated view of how high they can ollie.
Let's say that if his feet hadn't hit [laughing],
would have been tipping the scales of pain, for sure.
I've seen people do that
and come away bloody in between their legs.
It's so unexpected, you don't really have time to react
to try to save yourself from it.
- Yeah, so that's a classic straddle injury.
So I mean obviously in a male,
you can crush the testicle, you can rupture it.
That's a really common injury
and it's often missed and requires surgery.
You can actually tear the connection
from the bladder to the urethra,
rip that apart, and cause an injury
that you can lose a lot of blood.
Straddle injuries are always scary.
- Have you seen patients come in from skating
and that injury.
- Oh yeah, for sure.
And other hopping fences too.
- I know which a hospital Dr Accardi works at
and there's some irony that there is
a pretty significant handrail right
across the street that people skate.
When you're doing smaller handrails chances are
that even if you can't do it, you're still going to be past
the handrail by the time you're falling.
But when you're dealing with something that's more
in the eight to 10 stair range, that's not an option.
If your board doesn't get on the rail,
you're gonna straddle it.
So that would be more advanced for sure.
[high energy music]
Oh no, that right there,
it looks like he caught his foot,
stuck on the rail and then went straight down.
I like how your buddy just zooms in on the injury.
- [Man] You got your chin, dude.
- I would assume from that injury,
that that would have been worse
because it looks like he hit so hard
that it would have just split right open,
and with my limited medical knowledge,
I know that your chin splits open easily
and your eyebrows split open easily
because I've done all of them, many times.
There was nowhere to go when he got his foot stuck
on the rail there, and then he tried to catch himself
and yeah, it looks like he hit one wrist
and his shoulder, maybe.
So I feel like in an impossible situation,
he got out of it as best he could,
but that was a lot of impact.
I think that after taking so many impacts
from skating, from learning to skate,
you're able to race for a fall a lot better
than it just being full chaos.
- Well, you know, I was always impressed the way
the professional skateboarders were able
to displace energy in a bowl and even street skating.
And even on this one, he looks like he got a little
on his feet and then broke a little with his arms.
The face did take the brunt,
but it looked like his teeth come together squarely.
You can see the mandible here, it's like a ring.
And typically if it gets enough energy,
you'll crack in two places.
So I'd be worried that he maybe has a fracture
in his mandible in probably two spots here.
That can be kind of a difficult repair.
He may have a number of different injuries
to his arms, his chest and his face.
- I fell in a similar fashion to that from the top of
a pool a few months ago, like bouncing off my side.
And I know what that's like
when your elbow hits right in your rib cage.
It made me stiff and kind of unable to sit up for a few days
because of the bruise was so deep.
And that's also at the same time I dislocated my fingers.
So a fall like that is as soon as you hit,
you know that there's a few things wrong
and you've got to assess it all.
- When you involve a big joint,
like a knee or a hip, the ligaments
and the physical therapy that can go
along with that can be quite extensive.
And some things like an elbow,
sometimes those never completely heal.
A dislocated elbow,
sometimes you may have inability to fully extend.
But rule of thumb, a fracture, six to eight weeks.
Physical therapy can be ongoing depending on the joint.
- [Woman] How common are broken bones in skateboarding?
- That's always a good question.
I don't think it's as common as people think it is.
It's usually more sprains
and serious sprains or ligament injuries.
Almost inevitably, people who get to
a certain level of skating have broken something.
I broke my elbow, I broke my pelvis.
Other people have really bad luck
with their wrists or their ankles.
But I'd say in terms of people that skate ramps
and transition skating, that there's more knee issues.
[high energy music]
So this was one of my attempts at a 900, a few years ago.
Yeah, so that was a fall straight to the back of the head.
I definitely saw stars and it rang my bell a little bit,
but right here, I'm assessing how my mental state is.
I think that's when I realized, like I'm just tired,
but I'm still here mentally.
Unfortunately, that just comes
with having had so many concussions in my life.
It's a really strange state of being
when you recognize what it's like to be concussed
and you realize like, "Oh, I'm not sure what's happening,
"I don't know where I am."
But yeah, that was rough.
I mean, I know the problem
with the trick that was happening here.
I went a little too straight up and down
and I should have approached it more of an angle
so that when I did finally land it,
I was overturned right here.
You can see my foot comes off
because I was expecting my board to be all the way straight.
And so as I set it down, I got wheel bite,
which means that my wheel actually hit
the bottom of my board and then falling right here,
straight to the flat on the back of the head.
In vert skating, we call that a chicken neck,
when your head goes back like that.
It doesn't always hit, but just that motion
of whiplash can really make your neck hurt.
I felt thankful that I have one of the best helmets around.
It saved me, and I was able to get up and do that again.
- So he actually has two components to his concussion.
His helmet prevented him from having a skull fracture
and maybe bleeding on the brain.
We call that a subdural or an epidural hematoma.
But what the helmet doesn't protect
from is there's actually a twist of the brain.
That's actually a worst type of concussion.
When you have a torsional component.
That's been sort of helmet research is,
"How do we protect the torsional component
"of these concussions as well?"
And those can be a lot more severe.
So amazing stunt, unbelievable to watch,
it almost looks like we're watching
a video game when it happens.
The helmet definitely saved your life, for sure.
- I also have a much better fitting helmet now,
that one was a little loose [laughing].
The only other time that I got really hurt trying 900 was
when I was first learning it, I broke my rib.
I fractured my rib.
Like I kind of had to go through that to figure it out.
But that was the only time I got truly hurt.
The other times that I got hurt on it were
just more general impact and just soreness,
but nothing too substantial.
All right, it looks like a recipe for disaster right here.
Straight to the back of the head there.
- [Man] You all right there?
- Yeah, I need--
- I'm surprised that he's talking
or understands where he is right there.
'Cause I've seen plenty of concussions,
and usually right at that moment,
either everything goes stiff, or they start snoring,
or don't know where they are,
or what happened, or what day it is.
- There's no, torsional, this is just pure smack.
We've all heard the story, you know,
"Should we let them go to sleep?"
That kind of thing.
The reason why you don't want people to go to sleep is
because if he did hit his head enough to rip maybe
the middle meningeal artery, that could swell
and then they don't wake up in the morning.
It's such a blunt impact from such a height,
it looks like he's hitting not only in the back,
but on the thinnest part of the skull,
here on the temporal area where that artery runs.
I would be worried about not only a concussion,
but actually tearing of an artery
and bleeding in there called an epidural hematoma,
and maybe what's gonna happen
in the next six to eight hours.
- He was leaning too far forward, right as he went.
The angle of his board is not matching that bank.
It's too far down.
And then when he lands all of his weight's
on his front foot and that makes him fall forward
at the worst possible time where this ledge is.
So he wasn't able to catch himself on the ledge, either.
The remedy to that would have been,
you see how as his back leg is more straight
than his front leg, if those were both even,
he probably would have made it.
- There are different levels of concussion,
but as far as we're concerned,
we want to make sure there's no skull fracture
and bleeding first.
Then we're gonna assume that there's trauma
to the nerves and the axons of those nerves,
which are basically like the wires.
It's a lot less important to differentiate one, two,
three than it is to just be really careful,
make sure there's no skull fracture,
and then allow for appropriate healing
and rehab time in identifying that injury.
- [Woman] Why don't street skaters wear helmets and padding?
- That's just kind of how the culture has evolved.
Skating was born in empty backyard swimming pools
and then evolved into skate parks.
And then skate parks closed,
and everyone took to the streets,
and people were not wearing pads out on the streets
and then as skating evolved, the padding didn't.
I feel like we're at a crossroads,
especially with the Olympics coming
and people skating in parks,
but starting to mimic more vert skating tricks
that are up in the air.
There's a threshold there of,
well, you're flying 10, 15 feet in the air.
I think that the only way to
really survive a fall like that is with pads.
There's a lot of sentiment, that's more like,
"Well, this isn't hardcore if you're padded up."
But you'll be able to skate another day
if you are padded up.
So it's an ongoing battle.
All right, here's the next one.
Oh wow, that looks like--
That looks like some yoga splits right there.
So right there, his back foot slipped off upon landing.
His back foot stayed in one place.
His front foot just kept going and his legs paid the price.
You could see him bounce right there on his crotch,
which doesn't look pleasant.
Correct me if I'm wrong, but I feel like people who do
more stretching and yoga could
maybe handle something like that better.
I certainly couldn't.
- Yeah, I know, I mean the muscle belly,
the more that you stretch that,
the better you're going to be able to deal
with extremes before you start ripping the tendon.
It looks like he's actually ripping his knee sideways.
So he may have taken not only a hit to the groin,
where you can tear your groin musculature,
but actually maybe some of the ligaments
around the knee themselves.
So yeah, I mean certainly stretching'd be good.
But boy, that does look like it's pretty extreme.
And you've got the straddle component as well.
- Is a sort of extreme Airwalk right here.
You're doing an Airwalk one way and then went the other way.
And then as he put his back foot back on,
he was too far towards his toe there.
Like his toe should be the thing that's
on the board and not his heel.
And that's what caused it to slip off.
Usually this type of fall happens
when you break your tail off your board.
So generally it's not because your foot slipped off,
it's because you landed properly,
but the board couldn't withstand the impact
and the tail breaks off,
and that forces you to do the split.
- A tendon goes muscle to bone
and a ligament goes bone to bone,
so there's no muscle in between it.
You have sort of one on either side of the knee,
like a medial and lateral,
we call them collateral ligaments.
And then everybody's sort of an ACL and PCL.
They're just white pieces that kind of hold things together.
ACL's very rarely repair on their own.
There's really not much in the way muscle belly there.
So if he's ripped something around his knee,
it all really creates some instability
around the knee joint itself.
Pretty tough to overcome those,
if it's a major structural ligament tear.
- Starting on the handrail is never a good idea, by the way.
That was sort of a half scorpion.
When we say scorpion, it means that you land,
generally, on your face or your shoulders
and your back legs come slapping over your back,
like a scorpion tail.
And there's the scorpion right there.
It's such a common injury that there is
an Instagram page devoted to it called "Scorpion Masters."
But it looks like he hit his head pretty bad too.
So I think that was probably the worst of the injury,
but I will defer to Dr Accardi.
- You can see, as he comes down,
we have all the elements of the straddle injury, initially.
Then there's a second injury that happens
as his chest wall hits the pavement.
You can actually fracture the sternum
and bruise the heart, which is underneath that.
The scorpion piece is actually the third energy piece,
which kind of worries me.
His back actually flips out,
that's the portion that's the scorpion,
and your back isn't supposed to go that way.
And you can actually fracture vertebrae in the back.
Unlike the neck, there's a lot more room.
So the risk of paralysis is a lot lower,
but it's still there.
So there's three components here that really worry me,
the straddle injury, the impact to the chest wall,
and then this scorpion putting the bones
and discs and nerves that traverse that at risk.
- I think that if someone is holding you on a handrail,
that's already a bad idea in the first place
because you don't have the momentum.
Like the momentum is the what gives you the balance.
And so if you're starting from a standstill on a rail,
there's a good chance you're gonna slide off of it.
I think his biggest mistake right here was
that he stepped off willingly
and thought somehow he was gonna be able to catch himself
on the rail or the stairs.
The last part of the handrail got him
and went straight to scorpion on the flat.
I had my share of street skating handrails.
I think probably the fourth time I rolled my ankle
really badly is when I decided I should stick to ramps.
[high energy music]
So that looked like to me,
a pretty standard falling forward to your knees.
And honestly, that's how I'm used to falling a lot.
I know I'm speaking about the character,
but in this particular case.
It's a sticky surface, so that makes you fall forward.
And so if you're a vert skater, you're used to knee sliding.
But if the surface is sticky,
it'll make your knee pad stop sliding
and then you fall forward.
I've actually dusted my chin up in doing that.
So that's a little bit of what this is,
but honestly that looks like a fall I would have survived.
Generally, you're not doing that kind of thing
on flat ground, but if you just take one or two steps
to lessen the impact to your knees, that's the key.
And that's pretty much the art of knee-sliding.
And so right there, that knee-slide position, every day.
- How often do you go through a pair of shoes?
Don't you take the front of your shoes off.
- You just basically burn through your laces.
And it all depends on the surface.
If you're skating pools,
your laces won't last three or four knee slides.
But if you're skating ramps,
because it's more either wood or there's less friction,
your laces will lasts at least a few days.
I definitely experienced my share of face plants, yeah,
to the chin and to the eyebrows.
Mostly it comes with unexpected falls.
When you think you actually made something
and then your board stops for whatever reason,
or if you are a knee-sliding
on something that's particularly sticky
and you're not prepared for it.
Because when you do go to knee slide,
you can kind of adjust your lean
for how much friction there is.
But if it's just too sticky or something catches,
like a nail catches your knee pad,
then you're going straight to your face.
- You can see what happens here is he lands
and hits both of his wrists.
And when that impact happens,
he's going to hit these two bones.
So this is the radius and this is the ulna.
And you can kind of see
that this energy is gonna be hitting here.
And so a lot of times the bony injury, here,
will either be in one of these small bones,
called the metacarpal, or the distal bone here.
Sometimes I'll find distal radius cracks,
fractures, they never even knew that happened.
As you can see, there's an impact that involves both wrists,
a chin, a neck, a chest plate, a sternum.
And so it's not uncommon for them to be distracted
by a major injury and then have one
of these minor injuries actually heal,
and we discover it and they never even knew they had it.
They thought it was just a sprain or a bruise.
[high energy music]
- [Man] Whoa!
- So what happened there was his board didn't
quite flip enough, and he landed on the side of it,
also known as a Primo.
That's named after a skater, Primo Desiderio.
He was the first one to ever land
on his board like that and keep sliding on it, purposely.
This was not what he was going for at all.
He was not trying to land Primo.
The hardest part about that usually is exactly
that landing right there,
can hurt the arch of your feet really bad
because when you're dropping for something,
you're not prepared to land on an edge,
that's going to hit the bottom of your feet.
And then he obviously stopped his momentum
and he jumped off.
- What worries me is not just the fall hear,
but the ability of the board to spear him,
and if he lands on it, to cause extra injury.
If he falls on his tibia, or his shins,
he'll fracture those, but he's got his ankles.
And most injuries occur when we roll our ankles.
And actually you can rip the ankle so many times
that it actually becomes kind of loose.
So there's a whole host of injuries around the ankle,
Achilles tendon, arch injuries,
fractures to the ankles themselves.
So the fact that he's landing on a very small surface,
there's not a lot of place to dispel
that energy except the arch of the foot.
And then a host is secondary injuries that can happen
if he lands on the edge of the board
and then finally the impact.
- But I don't think he got too hurt on this.
This didn't look like a real crucial injury.
- Yeah, he got lucky.
He displaced some of the energy
with a little bit of a slide and then jumped
and then kind of rolled.
As he comes out of this Primo,
he actually has a fall onto an outstretched hand,
and we would call that a FOOSH.
And what that means, he's got his hand out and it impacts,
and when that happens, a whole host of injuries can happen.
You can fracture this bone here called the scaphoid.
You can separate the thumb and these ligaments
and bones down here.
Right here in the wrist, there's so many important nerves.
The median nerve, the for nerve carpal tunnel syndrome,
there's an ulnar nerve.
So the hand does quite a bit.
And when you have a FOOSH show injury like that,
the opportunity to really cause yourself
lifelong disability is paramount.
- This is the very first loop I ever attempted.
Didn't work out in my favor.
But I mean, this is kind of technical,
but what happened was that loop, it was too wide.
So it had this section in the middle of eight feet
that it had a traverse over.
If I had been going straight through,
I would have stayed on the wall.
But because of that, it made me fall here.
I hit my hip pretty hard,
but I managed to keep going that day.
So I feel like I got pretty lucky with that fall.
But yeah, that's the worst spot to fall,
right there because you almost go all the way to the ground.
- As he comes off the loop,
he impacts the lateral aspects here,
which includes this area of his femur called the trochanter.
Ramp wood will displace a lot of the energy.
But if this goes in enough,
you can actually snap the hip or the femur.
Tony's got a pretty good skeleton on him,
but if you were thinner or hit at just the right angle,
you can snap the hip, you can break the pelvis.
It looks like he's falling at least eight feet
and is allowed to dissipate some of that in a slide.
But I think his pelvis
and his right hip took the brunt of it.
And then he rolls up onto his ribs and his right shoulder.
So depending on how much energy gets concentrated
in one particular area, you can fracture a hip,
a pelvis, rip some of internal organs,
or actually even some of the stuff
under the rib cage itself.
- One of my worst injuries was from a different loop.
By that time I had done this,
completed it, over 40 times in my life.
That's when I broke my pelvis and I got a concussion.
The hardest thing for me after the injury,
was to regain my confidence.
I had my physical abilities back a few months later,
but mentally I just couldn't get there.
There were certain things that I used to take
for granted that I thought
maybe these are too dangerous now.
It took me about a year to sort of come
through all of that.
The thing that's hard is shifting your approach
to skating because it's not a trick,
it's actually more of a carve.
If you're approaching it like a trick,
your instinct is to go up one side and come down the other.
And that is not the case.
It's like a roller coaster.
You're just riding the roller coaster through.
If you can hold strong through the whole thing,
you'll make it out.
But that was my learning curve that day.
I want to thank Dr Accardi for all the help he's given me
through the last 10, 15 years.
It is strange to think that I have a Head of ER
on speed dial, but that's kind of the life I chose.
Skating is all about doing it
at your own risk, assessing your abilities.
Obviously injuries can happen at the most unexpected times.
But know your limits and try to skate within them
and only push them so far.
Don't go way beyond your skill levels
because that's when things can get really dangerous.
Stay safe out there.