The ramp stretched as tall as a nine-story building, so by the time pioneering skateboarder Bob Burnquist reached the bottom he was traveling as fast as 40 miles per hour. He shot across a 60-foot gap — and then on the ensuing jump he plummeted 45 feet onto his face, shattering his nose in four places and the orbital bone under his left eye.

Such daring displays of athleticism are a hallmark of the summer edition of the X Games, an annual extreme sports competition that will take up residence at U.S. Bank Stadium for four days beginning Thursday. The event, sponsored by broadcaster ESPN, is expected to draw 166 competitors from around the world, who will compete for medals and a purse of $1.1 million.

Injuries, sometimes catastrophic, are nearly unavoidable in X Games competition as athletes attempt ever more daring and dangerous tricks on the megaramp and other structures. They also mean mounting pressure to install sophisticated safeguards — often despite athlete resistance — to protect those pushing the limits of creativity and physics on dirt bikes, BMX bikes and skateboards in pursuit of bigger paychecks and greater fame.

"That's the lifeblood of the sport — progression. Doing something no one has seen," said Nate Adams, the most decorated motocross rider in X Games history. "Literally 10 years ago, some tricks I thought were just going to be video game tricks."

A medical crew of ESPN-hired professionals and local emergency medical service workers will preside this week over Minneapolis' first summer X Games at U.S. Bank Stadium. It won't hurt that the Hennepin County Medical Center is just across the street.

"Lucky for us, we're right next door," said Michael Trullinger, Hennepin EMS deputy chief. "So if anyone is seriously injured, they have a top-notch, Level I trauma center" nearby.

Sometimes, getting the athletes to accept the help is another story.

Medics at the X Games have wide-ranging discretion, but only so much power when an athlete is injured but still coherent and capable of competing. A robust concussion protocol keeps competitors out for the duration of the games if diagnosed or knocked unconscious. That wasn't the case for Burnquist in 2013, when he was badly hurt making a minor error on the quarterpipe, nor the policy when the X Games began in 1995.

"I just got up, was bleeding and they started taking my board away and I'm like no, give me my board," Burnquist recalled. "They're like, no you can't. And I'm like, I didn't get knocked out — give it to me."

For medical professionals, it's a patience-grinding experience. But for these athletes, it isn't as complicated.

"Because in our world, we keep going," said Burnquist, who still won a 2013 Big Air bronze medal after breaking his face. "That's our world. In their world, they're following through on the protocol."

Practice landings used to involve falling from the sky onto a pile of bark mulch. Those were the days when Adams, who started at age 8, began his life of pain: dislocated shoulders; a broken collarbone; knocked unconscious while pioneering the motocross back flip.

Improved safety measures crafted over the last 22 years, like the soft foam pits and air bags riders land on during practice runs, are now in place. Those upgrades push both sides — athletes test boundaries in part because they feel safer. At the same time, care and precautions are enhanced to better deal with the inevitable injuries.

"It's more like a vehicle-related trauma you might see in these types of sports, higher speed, higher height, et cetera," said Dr. Greg Lervick a surgeon for Twin Cities Orthopedics who has not previously worked with the X Games. "So, as a result the medical coverage has to be really well-prepared in terms of almost kind of like a disaster preparedness for the extreme situations you could encounter."

Minneapolis medical officials were further prepped last month in a presentation with ESPN and its medical director, Dr. Joel Buzy. Aside from in-house operations, ESPN has contracted with Medicine in Motion, which provides specialized athletic trainers, since 2010. In addition, Minneapolis EMS expects a "significant" staff increase to cover the events without interrupting regular 911 services, Trullinger said.

"The nature of these sports, they're always progressing and evolving," said Danny Chi, director of communications for ESPN X Games. "As we've always done, we figure how we can refine and make improvements to our medical plan."

Athletes praise the work done by sport organizers, consultants who meet with riders after practice runs to ensure ramp design and stability are ideal.

They'll close the events altogether if conditions aren't right. Last year in Austin, Texas, wind gusts were so strong the megaramp events were canceled. That won't be an issue inside U.S. Bank Stadium, where they're planning to fit nearly every high-flying, gravity-defying event.

An abundance of caution is especially critical for these athletes in less-regulated, non-team sports. For insurance, each athlete is on his or her own. There are no licensed unions, so much of the assistance is welcomed. And unlike the countless hours spent practicing unsupervised, each X Games competitive run features paramedics waiting at the ready.

A recent advancement was the revamped concussion protocol, which now follows guidelines by the American Academy of Neurology. BMX pioneer Dave Mirra's suicide last year furthered awareness as he was the first action sports athlete diagnosed with chronic traumatic encephalopathy (CTE), the same brain disease found in many former football players.

There has been one fatality as a result of an X Games injury. In the 2013 winter X Games, Caleb Moore was crushed under the weight of a snowmobile after attempting a back flip during the freestyle run. He died a few days later. Both the winter and summer games have gone to lengths to minimize the worst-case scenarios.

Helmet technology has come a long way too, says BMX veteran Chad Kagy.

"It's saving a lot of minds and injuries," said Kagy, the 38-year-old rider who is all but retired from competition because his latest crash caused a broken back, two broken heels and a torn ACL.

Kagy, who first competed in X Games in 1998, recalled when the protocol was less robust.

"I've watched my friends get the same five words repeated to them after a concussion," Kagy said.

"Repeat these words: firetruck, apple, train, ball and ocean. Well those guys had been knocked out a handful of times, they already knew those words."

Veterans like Burnquist, the summer game's winningest athlete with 30 career medals, and Kagy don't approach 40 years old without overcoming debilitating injury. Burnquist has suffered more than 30 broken bones on a skateboard. Kagy is pressing through his latest challenge, two broken heels, with a flickering hope of competing on a BMX bike again.

"You will find out who truly loves what they do," Kagy said. "Not based on punishing themselves, but based on what they endure and recover from to do what they love. We do assume the risk. We're not just a bunch of loose cannon extremists hanging out in the back parking lot scrawling graffiti."

Kagy has already endured a broken neck and broken femur to win X Games gold. Now his daily physical therapy includes dry needling in his Achilles tendons — an uncomfortable method of breaking up scar tissue with needles and electrodes.

Finding a trusted doctor is half the battle, Kagy said.

He says he was told after his broken neck in 2003 that he'd never ride competitively again. Then in 2011, when Kagy fractured his femur on an X Games run, a doctor grabbed his heel and lifted his broken leg — mistakenly trying to evaluate his lower leg bones.

"Usually your hip bends," Kagy said. "My hip didn't have a chance to bend, because my femur snapped in half right in my leg."

The misstep caused more complications, he said, setting Kagy back in his rehab. Two years later, he still reclaimed BMX Big Air gold at the X Games in Munich, Germany.
That perseverance is shared among the games' veterans. For most, riding is a way of life.

"When I have injuries, it's always been a 'when can I get back on?' " said Adams. "It's what I do for fun, it's a stress reliever, it's my job, it's a hobby, it's kind of everything wrapped into one."

Andrew Krammer • 612-673-4689