Authors: Danielle N. Broman, Alana N. Seaman

University of North Carolina Wilmington

Corresponding Author:

Alana N. Seaman, Ph.D.

601 S. College Road
Wilmington, NC 28403-5956
910-962-7568
SeamanA@uncw.edu

Danielle Broman graduated from the University of North Carolina Wilmington with a Master of Science in Athletic Training in May 2022. Licensed as both a Certified Athletic Trainer and a Certified Surgical Technologist, she now works at Emerge Ortho in Wilmington, NC.  

Dr. Alana Seaman is an Associate Professor of Tourism, Recreation, & Sport at the University of North Carolina Wilmington. Her research centers on popular culture, cultural trends, and heritage particularly as related to sport, food, place, and/or tourism. 

A Phenomenological Exploration of Neck Brace Use in Motocross

ABSTRACT

Purpose: Despite the evidence indicating a decreased risk of cervical injury with the use of neck bracing in motocross, the frequency of usage appears limited. Given that little academic attention has been focused on the perception and prevention of these injuries, it is unclear why athletes have not more widely adopted the practice of wearing this safety device. This study sought to understand why.
Methods: A phenomenological approach was employed, and semi-structured interviews conducted with riders during three random weekend motocross practices at one track in the southeastern U.S.
Results: Themes surrounding physical discomfort and mental distraction; personal experiences; skepticism about the efficacy of neck braces; and an exceedingly few external influences emerged from the data set.
Conclusions: Regardless of which camp riders subscribed to, most indicated a strong opinion on and adherence to their choice to use or not use a neck brace during motocross. Flow was central to this decision.
Applications in Sport: A clear understanding of why athletes decide to wear or not wear neck braces in motocross would help various stakeholders identify barriers to device use, develop better methods for encouraging its adoption, and improve the overall safety of athletes participating in the popular but understudied sport.

Key Words: Extreme Sports; Injury Prevention; Flow; Sport Safety Devices; Sports Equipment

INTRODUCTION

Motocross is one of the most popular extreme sports in the world with millions of participants around the globe. However, it also has one of the highest rates of head and neck injuries of any sport in the genre. Preventing neck injuries is of central importance as, in the neck, movement is provided by the cervical spine, which consists of vertebrae from C1 to C7, each performing a specific task. Supported by C1 and C2, neck rotation is possible, while flexibility and mobility are provided by C3 to C7. The cervical spine also contains critical nerves, blood vessels, and joints that facilitate communication between the brain and upper body parts. Injury to the cervical spine can result in paraplegia, irreversible spinal cord injuries, and even death (19).

            Neck braces are an effective way to prevent neck injuries in motocross (7). Designed specifically for the sport, motocross braces consist of a ring-shaped neck support, which is designed to absorb the force transmitted by the head and helmet during a fall. To protect the cervical spine, these forces are distributed around the shoulders, chest, and back (19). Despite their availability and effectiveness however, the use of neck braces amongst motocross athletes appears limited.

Given that little academic attention has been focused on the perception and prevention of these injuries, it is unclear why motocross athletes have not more widely adopted the practice of wearing a neck brace as a safety device. A clear understanding of the reasons athletes decide to wear or not wear neck braces in motocross would help various stakeholders identify barriers to device use, better develop methods for encouraging its adoption, and improve the overall safety of athletes participating in the popular but understudied sport.  

Extreme Sports

Extreme sports are defined as a sporting adventure or activity involving a high degree of risk or possibly death. The category consists of a range of activities such as bicycle motorcross (BMX), mountaineering, hang gliding, paragliding, free diving, surfing, personal watercraft, whitewater canoeing, kayaking, rafting, bungee jumping, BASE jumping, skiing, blindfolded skydiving, extreme hiking, skateboarding, mountain biking, in-line skating, ultra-endurance races, snowboarding, ATV and motocross. These sports attract athletes who seek to experience a life-affirming transcendence or to achieve a flow state (20) by overcoming the fear associated with participation.

Flow was originally derived from Csikszentmihalyi’s pioneering studies about the experiences of groups engaging in leisure and work. It defined a state of mind that occurs when there is a balance between the challenges associated with a situation and the ability to accomplish these challenges. The individual feels in control of their actions in the experience of this flow because there is little difference between self and environment, stimulus and response, or the past, present, and future (5, 16).

To achieve flow, an individual must be presented with a task they have a realistic chance of completing. Next, individuals must be able to focus on what needs to be done regarding that task. Third and fourth, the task contains a clear goal and provides near instant feedback, making it possible to maintain focus. Fifth and sixth, each individual engages in the action with a deep but effortless sense of involvement that removes from their conscious awareness of the concern of the action, so they are in a position to control the outcome. This involvement makes the concerns for oneself fade away (5, 16). Optimal flow is achieved by finding the right balance between motivation and competence and establishing an environment in which the action will occur freely and is enjoyable (5). Flow in action is a set of rules and procedures that facilitate concentration, commitment, and autonomous action in meeting challenges and pursuing goals, each of which requires a sense of trust, faith, and comfort with the environment (5, 16).  

In extreme sport athletes, flow in action is the psychological state of being in control, concentrating deeply, and feeling as if performances occur effortlessly. The managing of risk in extreme sports, including the sport of motocross, involves processes of over-learning and practicing skills safely until they become automatic, and riders can reach the desired flow experience. An essential part of this process is mindfulness and continued concentration of staying in an autonomic mental zone as giving in to disruption can lead to an increased risk of injury in motocross athletes (20).

Motocross

The extreme sport of motocross is defined as an off-road motorcycle event where riders race on a dirt track that combines neutral terrain with human-made obstacles combined with high-speed sections and busy racetracks. In 1924, the sport originated in England using bicycles with small internal combustion engines. There were hills, rocks, stream crossings, and other natural terrain features on the original 2.5-mile course and only 40 of 80 participants completed the world’s first motocross race (2). Through the 20th century however, the sport continued to evolve becoming increasingly popular.

In 1948, Buffalo Stadium in Montrouge near Paris, France, hosted the first motocross race held on a manmade course. And by 1969, ABC Wide World of Sports broadcast the first race in Massachusetts (2). In 1972 thanks to the growing popularity of the sport, the AMA Motocross Championship was created by the American Motorcyclist Association. Motorcycles also evolved during this era and by 1974 the event included classes for 250ccs, 500ccs, and 125cc wherein riders reached speeds unfathomable just a few decades earlier. During the late 1970s and early 1980s, Japan developed water cooled two stroke engines as an alternative to air cooled machines. It also featured a single shock absorber rear suspension which allowed riders to conquer larger jumps and bigger obstacles. As a result of these new motorcycles, the next generation of American champions set new speed records. The AMA expanded displacement limits in all three classes in the 1990s which led to the evolution of four-stroke motorcycles. By 2004, all major dirt bike teams were using four-stroke engines and class names began to change accordingly (2). These developments allow today’s machines to weigh less than 225 pounds while generating over 50 horsepower. Speeds of these motorcycles can exceed 100 mph and can jump over 100 feet. Further, athletes take on these courses in varying weather conditions, on crowded racetracks, and in chaotic environments, thus accidents are inevitable (8).

Given that risk is central to their appeal, both professional and amateur athletes must acknowledge the likelihood of injury or even death associated with extreme sports. Thus, medical personnel must also consider the risk of injury (12). Moreover, motocross, like other extreme sports often takes place in remote locations, in variable environmental conditions, often with little or no access to medical care. In the event that medical care is needed, there are challenges related to longer response and transport times, access to few resources, limited provider experience due to low patient volumes, and more due to extreme geographic and environmental conditions (12). Nonetheless motocross athletes continue to push the limits of their sport with increased speed, and more difficult tracks and terrain, increasing their risk of serious injury. Motocross athletes’ safety however has not been given adequate research consideration, as the scholarly emphasis has been placed more on the thrill of the sport than injury prevention. 

From 2000 to 2011, the National Electronic Injury Surveillance System gathered data from 7 sports that were included in the Winter and Summer X Games. Of the 4 million injuries reported, 11.3% were HNIs. Skateboarding, snowboarding, skiing, and motocross had the highest total prevalence of HNI. The most severe HNIs were found in skateboarding and motocross. Among all reported neck fractures, motocross accounted for the highest incidence at 27.6% (18). Overall incidence of motocross injuries in this study was 94.5%. Of the 450 fractures recorded, 50.9% occurred in the upper extremities, 38% in the lower extremities, and the remaining fractures occurred in the spine, chest, and skull. Eight of the 26 patients with spine fractures suffered permanent neurologic problems (6).

Another study found that most motocross injuries involve fractures or ligamentous damage in the upper or lower extremities. However, approximately 10% of motocross injuries involve potentially life-threatening head and/or neck injuries. The significant morbidity and mortality of head and neck injuries involving structures around the airway are the priority with injury management (8). Cervical neck injuries are among the most severe causing potentially irreversible damage to the spinal cord that could lead to different forms of paraplegia. The mechanism of injury for cervical injuries involves hyperflexion, hyperextension, hypertranslation or axial loading of the cervical spine in events of a crash (21).

A 12-year study on the injury ratio, location, causes, and possible preventions analyzed riders’ medical reports, insurance documents, and follow-up forms. In most cases, cervical fractures are caused by miscalculated landings on jumps and a collision between the front wheel and the ascent of the next jump. In the process, the rider is catapulted into the air and into a half somersault landing on their head. This force can cause the neck to hyperextend, and the bike to possibly fall onto the rider’s back (6) causing potentially catastrophic injury.

Neck Braces

Neck braces created specifically for motocross can prevent some of these injuries. The first generation of neck braces entered the market in 2003 and were developed and patented by Dr. Chris Leatt who was inspired to take on the project after he assisted with the treatment of fellow rider Alan Sleby after a motorcycle enduro accident in which the rider died on the track from a suspected neck injury. Leatt based his design on the neck braces used by race car drivers. But, given that motocross riders are not strapped into seats with head support, faced a number of challenges in developing the new type of brace (15). Further, there were no standards or equipment for assessing quality and performance, no theory to guide his design, and no practical testing methods to evaluate the results, though Leatt’s own research indicated that upwards of 60% of fatal injuries to the spine involve the cervical spine and that these injuries are caused by the rider’s head coming into contact with the ground from different angles and forces due to a sudden stop (15).

Thus, the purpose of the neck brace, in motocross, is to reduce the forces generated by rotation or direct impact. Leatt’s brace limits the extreme neck movements and provides distributing external impacts on loads to the torso to avoid and possibly prevent the traumatic injuries to the cervical spine (21). Like all safety devices, neck braces cannot prevent all injuries from occurring because of their limitations, however they work based on the idea that they re-direct extreme forces and axial loads from the head throughout the body, while still supporting the neck. This reduces the severity of impacts with hyperflexion, posterior hypertranslation, posterior lateral hypertranslation, anterolateral hyperflexion, and axial loading (15).

Today, neck braces are designed considering body contact, adjustability, flexibility, rigidity, weight, airflow, emergency release mechanism, and price in addition to fitting securely with or without a chest protector. Regardless, neck braces act as support collars around the athlete’s neck, preventing the rider from being able to bend their head or neck past a certain point in all directions. At first, the padded helmet rim contacts the brace, transferring the force of the impact to the padded load dispersal areas located at the front and rear of the brace. Energy is transferred from the front dispersion area to the rider’s pectoral muscles and from the rear dispersion area to the top shoulder muscles and either side of the spine. As a result of the controlled impact transfer, these areas help to reduce the impact made on the rider’s head, reducing the severity of brain and neck injuries (15).

Action Sport EMS conducted a ten-year study using real-world data to determine the effectiveness of neck braces in preventing cervical spine injuries (9). The study included 9430 patients’ data from January 2009 to October 2018, of which 8529 met the study’s eligibility criteria. Among the total number of participants, 4726 indicated that no neck protection was in place at the time of their injury. Among the injuries were 239 severe cervical spine injuries. In those not wearing a neck brace, 100% of the cases required hospital admission and ALS transport.  Compared to those who were wearing a neck brace 73% required hospital admission and 42% required ALS transport. Study results indicate that a cervical spine injury of any kind is 82% more likely and a critical cervical spine injury is 89% more likely without a neck brace (9).

Researchers have also studied how neck braces affect motocross movement and muscular activity by using biometrics angular sensors to measure the movements for biplanar flexion and another for rotation. The sternocleidomastoid and trapezius muscles were implanted with four pairs of electrodes and an angle sensor. Researchers found that the rider’s focus was on the next obstacle or jump, while accelerations of different types are exerting force on the neck. As a result of stresses caused by external acceleration, isometric contractions dominated muscular activity. Besides providing protection after a crash, the brace also gives the rider support while they make a turn (7). Little other research has addressed this topic.

The American Motorcyclist Association, the world’s largest governing body for motocross, requires riders to wear specific protective gear. This includes protective pants made from leather or other durable material, long-sleeved jerseys and boots that must be at least 8 inches high, have a combination of laces, buckles, or zippers, or be specifically designed for leg and foot protection. In conjunction with a shatterproof face shield or goggles, helmets are mandatory, and they must be approved by SNELL M2010/M2015 or DOT FMVSS 218. Chest and back protectors are recommended for all competitors, especially those under 14 years old and should protect the sternum, anterior and posterior ribs, and the spine from T1 to T12. Gloves, chest protectors, knee braces, and neck braces are also only vaguely recommended as equipment riders should wear to prevent possible injuries (1). The organization makes little effort to persuade riders to wear these pieces of equipment as they do not provide additional details or resources covering how to obtain or properly use them. Education on properly fitting equipment and following manufacturer instructions is essential to maximizing the device’s benefits and effectiveness (9).

Despite a prolific campaign encouraging riders to utilize a neck brace as a piece of safety equipment following his injury was carried out by paralyzed US motocross champion David Bailey in the late 2000’s (21), the high risk of HNI in motocross, and the effectiveness of neck braces in preventing these injuries, anecdotal evidence suggests few wear the important piece of equipment while riding. This study sought to understand why.

METHODS

A phenomenological approach was employed to explore what influenced athletes to wear or not wear a neck brace while participating in motocross. Phenomenological research aims to understand people’s perceptions of a topic and how those perceptions are formed (11, 14, 17). As such, and upon receiving Institutional Review Board approval (IRB 22-0117), semi-structured interviews were conducted with riders during three random weekend motocross practices at County Line Motocross Track in Bolton, North Carolina over the course of several months in the Winter of 2021-2022. 

Researchers used a purposeful sampling method that prompted them to collect data from individuals thought to have the most depth of knowledge (e.g. individuals who were getting ready to ride; working on bikes; and/or working in various staff positions at the events as experienced riders themselves). Topics centering on riders’ knowledge and opinion of neck braces, major factors that influenced their views on the device, and their riding experience guided the discussions, though in line with semi-structured interview practices (3, 10), researchers encouraged participants to expand on relevant comments if they seemed insightful. Sixteen in-depth interviews were collected as data.

Data was analyzed using accepted qualitative methods. Open coding was initially used wherein the data set as a whole was considered with little anticipation about what would be discovered (4, 13). Each member of the research team evaluated the data individually before reconvening to discuss their unique interpretations. This in turn provided intercoder reliability (13). Next, using axial coding, emerging themes were considered from different perspectives, compared, and contrasted to one another, and alternate explanations were explored (4). Finally latent coding was used as a last step. Latent coding aims to identify the essential elements of a data set (14). In this sense it is in line with a phenomenological approach which aims is to discover the overall essence of the topic at hand.

RESULTS

Fourteen adult participants provided data for the study. In total, thirteen males and one female participated in the semi-structured interviews. A total of nine participants elected not to ride with a brace, while five rode with one. Themes surrounding physical discomfort and mental distraction; personal experiences; skepticism about the efficacy of neck braces; and an exceedingly few external influences emerged from the data set.

Physical Discomfort & Mental Distraction

A majority of riders who chose not to wear neck braces cited concerns over the comfort and flexibility of the device. In turn, they felt the neck brace introduced the potential for mental distractions. Many athletes in this category noted that they had tried a neck brace at some point in their riding tenure but found them restrictive. “It prevented my full range of motion which impeded my vision, so I stopped wearing one” said one rider. Another athlete who had ridden for over 20 years echoed the same thought, “you can’t get the full movement… once you take it off and do a couple of slow laps you feel a whole lot different… you get the perspective that you can move around without it”.

In turn, all of these riders indicated that, as a result of the brace, they were mentally distracted. A veteran rider who also coaches newer athletes described his, almost panic inducing experience with a neck brace: “I just remember vividly wearing mine and going to look and like I couldn’t so… I was having to do a great amount of exaggerating and straining to look like as to where I wanted to go… this thing was getting in the way more”. One rider explained that neck braces “are uncomfortable and unnecessary, they are too cumbersome and changing the riding style of guys who are used to riding without one”. Another summed it up “you get to the point of putting all that stuff on riders they are so uncomfortable on the bike that it’s dangerous”.

A rider / parent of a young rider pointed out “yes, it restricts movement, but it also restricts body positioning on the bike, and when you’re racing it’s restrictive on the child… he tells me that it makes him more tense which if you’re more tense and you fall, you’re probably prone to more of an injury”. In this sense several riders alluded to notion that it wasn’t if but when they would take a fall, and with this in mind expressed a desire to have the flexibility to roll with the force of the crash rather than fight against it and risk further injury. Riders made comments similar to what one young adult rider stated, “I do think that they can do their job, but I am like a rag doll when I crash and like the ability to be able to be loose”. 

Personal Experience

Past experiences, both those had firsthand and those witnessed on the track, contributed to a number of riders’ perceptions of neck braces and whether they chose to use one or not. Some noted they had had mishaps in the past wherein they felt the neck brace had saved them from worse injury. Capturing the notion was one rider who told researchers, “I’ve been wearing one since they came out about 13 years old… I’ve had a neck brace my dad got me and told me to wear it… one time I had a big crash. I went up came down landed right on my head and it compressed everything, and I was able to get up… I broke one of the buckles in the neck brace and I don’t ride without one now”. Others stated they no longer wear a neck brace because of previous injuries. A riding coach who sustained rib and clavicle injuries while wearing a neck brace at a race years ago claims he no longer wears one because he feels it exacerbates some of those injuries though allows that the device itself “is protective and does protect your neck”. Experiences like these, particularly in childhood, were especially impactful.

Several participants also mentioned seeing other athletes have accidents while riding that in turn shaped how they viewed neck braces prompting either use of the device or questions about its safety. Several riders noted that after seeing people walk away from what could have been catastrophic crash on the track thanks to a neck brace, they more diligently adhered to wearing one themselves. One long-time rider who does not use a neck brace described his thought process on the subject “I had a good friend of mine – riding buddy passed away on the track… he had one (a neck brace) on and seeing how that it happened with the bike hitting him on the back of his neck resulted in a severed spine… so, if he wasn’t wearing one, would he have passed away? Not sure”. The views of neck braces shaped by these experiences were largely dependent on the factors surrounding the race incident and the ultimate outcome of the situation. Nonetheless they were important in influencing whether riders wore braces or not.

Skepticism about Efficacy of Neck Braces

Skepticism about the effectiveness of neck braces and speculation about the potential for it to cause further injury to the rider was another prevalent theme in the data set. Misinformation was common, particularly amongst veteran riders. One person who has done motocross for over 50 years subscribed to the idea that “they’ve been proven to cause different injuries than saving themselves broken collarbones and more cervical stuff than without”. Another athlete with 46 years of riding experience seemed to agree saying “I think they cause a fair amount of collarbone breaks”. And a coach even felt that “yes, they do prevent certain parts of your neck vertebrae from breaking but in the end, if you hit hard enough that composite or the carbon fiber is not going to give something else is going to give”.

Several other respondents also believed this to be true. However, when used correctly, the brace does not sit on the collarbone. Rather, it is designed with integrated relief areas that prevent contact between the brace and the collarbone. Further, in motocross, studies have found that 90% of collarbone injuries occurred when an outstretched arm, a helmet rim, or a forceful landing caused the collarbone to break.  During these types of impacts, the collarbone breaks outward rather than in the direction that a neck brace emits force (12).

Few External Influences

One parent of a rider speculated that professional and big-name riders may be contributing to skepticism and misconceptions about neck braces. “They see what those guys are wearing… they’re ambassadors of the sport… some guys like Ryan Hughes hate them and has a big podcast and a lot of followers.” Another rider explained that there is a general perception that professional riders need “all the mobility for every ounce of speed”. Thus, if these athletes believe neck braces to be holding them back in anyway, that view may trickle down to amateur and youth riders as well.

Exceedingly few riders mentioned the cost of neck braces, requests from friends or family, or any other external elements as factoring into their decision to wear or not wear a neck brace. Only one participant mentioned neck braces being too expensive for their budget, “a good one is 600 bucks so if you’re half in and half out if you’re not going to spend that”. In contrast, a handful of others noted the cost as reasonable and in line with other pieces of equipment. When asked whether family and friends ever asked them to or expressed a desire for them to wear a neck brace, most riders simply replied “no”. However, riders who had children who also rode admitted that many parents “would wrap their kids (sic) in bubble wrap if they could so they want helmets, neck brace, chest protector, knee brace, everything”. No other external factors were mentioned by riders.

DISCUSSION

Flow Disrupted

From the findings it was evident that flow took precedence when considering neck brace use. If riders felt they could still reach the flow state with a neck brace on or could adjust their riding style to accommodate a neck brace if they felt it necessary for their safety, they wore one. If flow could not be reached, a neck brace was not worn. Lack of neck brace use in this sense was attributed to interruption of athlete focus/concentration – an essential element in flow experiences. Mindfulness and continued concentration of staying in an autonomic mental zone is at the core of flow, which and if disrupted, can lead to an increased risk of injury in motocross athletes (5, 16, 20). Little else made an impact on riders choice to whether or not wear a neck brace.

Given that flow is the primary motivating factor for participation in extreme sports such as motocross (20) it may be come as no surprise that athletes choose what to wear and how to participate in such experiences based on how the element either inhibits or facilitates reaching the flow state. However, the findings do highlight the need for improvements in the design and manufacturing of neck braces for motocross. While some professional riders and coaches commented on how they work to point out the recent improvements made to neck braces to their students, they can only do so much. “Atlas has a new one… it’s a little slimmer, a little sleeker, it’s a little lighter… I believe it’s made out of foam; you know some type of high-density foam… that is the neck brace that I would suggest to riders… I just feel that the Atlas does its job due to being slimmer, sleeker, and it’s made out of foam”. However, these adjustments are viewed as minimal wherein the devices are still restrictive and distracting for riders. Thus, stakeholders must collaborate to improve a single design of the brace to ensure it is user friendly as well as effective in preventing cervical spine injuries. 

The choice to adjust riding style was often based on having an on-track scare or having witnessed an accident firsthand. However, the practice of wearing a neck brace doesn’t have to be based on a traumatic event. Rather, a neck brace, like any piece of equipment, is likely to be more easily accepted by young participants learning the sport, particularly if the parents make it a requirement. Starting riders with a neck brace while they are young or first starting out gives them time to adjust to the brace rather than forcing a change in existing habits, thus likely resulting in its long-term utilization.              

The Need for Evidence-based Research & Education

More improvements must be made industry wide to not only increase the comfort and user friendliness of neck braces but also to combat skepticism and misconceptions about their efficacy. This should be supported by scholarly research. In all cases, riders had limited evidence-based research to base their decisions on when it came to the efficacy of the brace in turn leading some to believe the brace failed to function effectively under real-world conditions. Action Sport EMS is currently the only company utilizing real-word data to determine the effectiveness of neck brace use in preventing cervical spine injuries. The only other published research was produced by the underlying stakeholders of the different brace companies. Testing a neck brace’s effectiveness by gathering real-life data is necessary, as replicating an accident with all its external factors in a laboratory is impossible.  

The Role of Governing Organizations

To further encourage neck brace use, motocross governing bodies, such as the AMA, should aid in disseminating information about the device. Of course, additional evidence-based research must be conducted first. However, researchers should aim to share findings with as many riders as possible. Governing organizations as well as individual tracks may offer the platform through which to do so. Further, in order to maximize protection, rider education is also essential, including providing information on fitting a neck brace and selecting the best combination of adjustment points (e.g. adjusting the height of the front and back pads to fit the rider’s body size, length, and range of motion of the neck) in accordance with the user manual. Organizations such as the AMA and tracks should also provide guidance on and educational resources about neck braces as well. These steps would no doubt boost neck brace use, but to what extent is unclear. To ensure use, organizations such as the AMA might consider making neck braces standard and/or mandatory equipment either for new riders, kids under a certain age, or across the board.

With safety in mind, amateur motocross competitions might also consider adopting the same standards as professional motocross and supercross organizations regarding having medical personnel beyond basic emergency services at races. Given the extreme nature of the sport and injuries it causes, medical professionals, such as doctors, athletic trainers, nurse practitioners, nurses, and paramedics, are likely to be needed for trauma care at the track. Anecdotal evidence suggests that there is often only limited care staff at many amateur events with few if any on-site medical personnel present during informal practice sessions. Research should consider the impacts of having high-level trauma teams available at these races and the potential for them to reduce the risk of injury and mortality during these events. In short, both the safety of motocross and the safety of extreme sports in general has been largely overlooked by scholars.

Conclusions

For this study, a majority of riders interviewed indicated that the benefits of wearing a neck brace outweigh the risks of other injuries and speculated about the “possible repercussions of not wearing one”. However, not all agreed. Regardless of which camp riders subscribed to, most indicated a strong opinion on and adherence to their choice to use or not use a neck brace during motocross. Flow was central to this decision. Thus, stakeholders must consider the nature of extreme sports, wherein riders are dedicated to attaining the desired flow state without interruption, when designing and marketing neck braces.

            Personal experience with and/or having witnessed a dramatic motocross accident where a neck brace was perceived to have an effect on the rider involved (either good or bad), also shaped how people viewed and felt about the device. Skepticism and misconceptions regarding neck brace use were also revealed, likely fueled by the lack of evidence-based research on and other information available to the general public about the efficacy of neck braces in motocross. Few if any other influences were factored into the decision to wear or not wear a neck brace while riding.

Given that a cervical spine injury of any kind is 82% more likely and a critical cervical spine injury is 89% more likely without a neck brace (9), and that approximately 10% of motocross injuries involve potentially life-threatening head and/or neck injuries (8), a thorough evaluation of the efficacy of neck braces in preventing injuries is essential for the improved safety of these athletes. Developing a neck brace that does not inhibit flow as well as conducting research on its efficacy is also essential in overcoming misconceptions about the safety device.  

Limitations

While data was collected at only one track during one motocross season, this exploratory study nonetheless begins to clarify how perceptions of neck braces are shaped and how they inform device usage. The study also highlights the need for additional research on extreme sports, motocross, and participant safety and injury prevention at these events.

APPLICATIONS TO SPORT

The information provided in this study can be used to improve the safety of both motocross and extreme sports in general as it highlights one of the core factors influencing riders’ choice to wear or not wear a neck brace: flow. With flow in mind, strategies to improve neck brace design and marketing can be implemented by equipment manufacturers. Further, the data showed that misconceptions about neck braces and skepticism about their effectiveness are prevalent. Thus, there is a clear need for both additional research on neck braces and an effective means through which to disseminate this evidence-based information. Motocross governing bodies and individual track owners are in an ideal position to communicate the efficacy of neck braces. However, there has yet to be a concerted effort to convey this message to riders. Leaders, facility managers, and riding organizations in the sport of motocross should work together to improve the safety of athletes by both ensuring riders are making sound decisions about safety equipment such as neck braces based on facts and by introducing young or new riders to these devices early in their tenure, so their use becomes habit. Finally, motocross governing organizations and individual track owners may consider stricter rules regarding neck braces to ensure their use and the safety of athletes participating in the sport.

Acknowledgements

No funding was received for this research.

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