News & Features — 29 January 2017 at 1:47 pm

Francesco Feletti: Extreme Sports Medicine

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Dr Francesco Feletti is a consultant at the Hospital of Ravenna, ItalyHe’s Board Certified in Medical Imaging and mainly engaged in emergency and interventional radiology, musculoskeletal diseases and sports pathology. Together with the Politecnico di Milano, the largest Technical University in Italy, he is undertaking some groundbreaking research into healthcare in extreme sports. We interviewed him about his passion for adventure, his new book Extreme Sports Medicine and posed him the question – what is an extreme sport?

So Francesco, how did you get into extreme sports medicine?

Ever since I was a child I have practiced – and still do – various sports, competitively and at international level. They have included athletics, sailing and windsurfing. Enthusiasm and curiosity have also led me to various other adventure pursuits including kite-buggying, snow-kiting, downhill mountain biking, paragliding and skydiving. I’m also attracted to BASE jumping and wingsuit proximity-flying and as soon as I have enough time, I’d love to have a crack at them too.

However, my main focus since 1999 has been kitesurfing. When I began, there were no modern safety systems. So, more than once I found myself having to rescue a kiter who had sustained serious injuries after losing control of their kite. That’s when the desire to put medicine at the service of these sports came into being.

It’s interesting that you mention BASE jumping. Its dangers have always led to a certain amount of controversy, but the debate has become more heated after a difficult last summer for the sport. What are your thoughts?

In writing the chapter of my book that deals with BASE jumping I spent a lot of time with the jumpers themselves. I found them to be remarkable, capable of working for months on a single jump, meticulously attentive to every detail, dedicated and precise. It’s a reality that contrasts sharply with the ‘adrenaline junkie’ label the media has given these athletes.

There is no exact figure for the number of BASE jumpers, so accurately quantifying the risks of the sport through epidemiological studies is difficult. It is true that some authors have estimated injury rates and found them to be significantly higher than those seen in skydiving but the fact that this is a young, fast-growing sport needs to be taken into account.

Are you saying that BASE jumping might, in the future, be seen as a safe sport?

A look back at motorsport shows us that racing drivers and motorcycle riders used to risk their lives every time they took to the track. Later on, safety improved to the point where these sports were universally accepted and appreciated. Moreover, the use of motorsport-proven safety systems was extended to production vehicles, making a considerable contribution to road safety.

I believe the same could happen in BASE jumping, that the safety systems developed for it could later be used in other areas such as ultra-light flight, paragliding or even in the airline industry.

Your new book begins by questioning the definition of ‘extreme sports’. How do you define them? What makes them stand apart from others?

In the opening pages of my book I attempt to provide a definition, but it is difficult: ‘extreme sports’ covers such a broad range of activities and they are evolving constantly.

The word ‘extreme’ immediately evokes the concept of risk. Yet extreme does not necessarily mean dangerous. In truth, while epidemiological data exists only for certain disciplines such as surfing and climbing, it nevertheless shows that, in some extreme sports, both the incident rates and the severity of injuries are lower than in many traditional sports. In many cases the risk is more perceived than real, a perception shaped by the spectacular nature of such disciplines.

And that, I think, is the first key aspect that characterises extreme sports: they are, indeed, ‘spectacular’, a quality that makes them extremely media-friendly and excellent vehicles for advertising and fashion. Their sheer visceral appeal and “watchability” is undoubtedly why the International Olympic Committee is gradually beginning to slip extreme sports into the Olympic programme.

The second key characteristic is the role played by the natural environment, the unpredictable arena in which these sports play out, in contrast with the controlled surroundings of traditional sports.

A third element concerns performance evaluation. In traditional sports, these are typically quantitative: who came in first? who scored the highest? However, in many extreme sports there are no competitions, just events.

There are many more, but I shall limit myself to stating just a fourth, which I think is crucial: the technological aspect. Many extreme sports would be very different or, perhaps, not even exist without the advancement of materials and equipment.

Along with other key authors, I delved deeper into the question of what actually characterises these sports in the paper “Understanding action and adventure sports participation – An ecological dynamics perspective”, currently pending publication.

What are the biggest challenges facing extreme sports medicine as a developing speciality?

There are plenty! First, many disciplines are practiced in remote, austere locations where it’s hard to find transport, equipment or the researchers to travel to such places.

Second, creating controlled, reproducible conditions for studies is tricky; this is because we are managing so many more variables including the weather, and a complex web of reciprocal interactions.

Perhaps the biggest problem is posed by the participants’ own cultural attitudes. As I argued during the 2nd international Extreme Sports Medicine Congress, held in Boulder, Colorado in 2016, many extreme sports participants simply prefer not to talk about their injuries. The reasons behind their reluctance are multiple including, for example, the fear that drawing the attention of science to the risks might lead to new legal restrictions on their sports. That said, we should make distinctions: aerial sports, for example, are influenced by aviation safety culture and are perhaps more likely to engage in research programs.

In any case, extreme sports need to be studied from the inside. Researchers must have practiced the sports or have been embedded in these ‘communities’ for some time both to gain an in-depth appreciation of the topic and to win the athletes’ trust and cooperation.

What areas within extreme sports research excites you the most?

I believe technology will play a decisive role in the future of extreme sports medicine. Not just in terms of helmets and ergonomic protection systems, but in keeping pace with the technology of the sports themselves: for instance, in kitesurfing the introduction of hydrofoils requires the development of rescue craft that are at least as fast. Vehicles that are, in fact, likely to be equipped with the same technology.

It is rehabilitation that interests me the most: injured participants are always keen to get back into their sports quickly, and full physical and psychological recovery is vital before returning to extreme sports.

Rehabilitation programs require specific sports simulation systems and the role of bioengineering may prove to be decisive in this area too.

Our audience are mostly expedition and wilderness medics. Is there anything they should be particularly aware of when dealing with extreme sports injuries?

I’m sure your readers are experts on dealing with injuries and other medical problems in hostile environments. They’re probably well informed on extreme sports too.
So I’ll limit myself to two considerations both of which, while pretty obvious, are crucial.

1 / In approaching these sports, please bear in mind the huge differences that exist between the myriad of styles and sub-disciplines needs. Don’t just lump them all together.

2 / Remember that extreme sports don’t just involve serious injury. Indeed, speed-induced vibration might be a key factor in chronic degenerative joint diseases. Since technique is often more important than pure physical performance, many extreme sports can be practiced – at quite a high level – by people who are older than “traditional sportspersons”. This is a tremendous advantage, but also means that “overuse” pathologies take on greater relevance.

Where should we begin if we want to get involved in extreme sports medicine?

Extreme sports have never been so popular, so I think the time is ripe for medicine to become more involved. It is important to consider that extreme sports are complex activities and require a multidisciplinary approach.

In addition, these sports evolve at a breakneck pace, so their study and support demand new models of professional and scientific interaction. In 2013, I co-founded the international ExtremeSportMed association. Our goal is to organise a PhD-level summer school (Extreme Sports Medicine & Engineering). The first edition is expected to be held in 2017, on the shores of Lake Como in the foothills of the Italian Alps, a natural setting for several extreme sports. An international conference is also being planned for 2018. So if anyone feels like getting involved they’re warmly invited to join us by filling out the form at and by joining our Facebook group.

Dr Feletti’s book is available in hard copy and electronic formats from Springer International Publishing, 2017. DOI 10.1007/978-3-319-28265-7. We’ve got it, it’s great!