Mountain biking injuries: an update.

This article reviews the available literature regarding injuries in off-road bicyclists. Recent progress in injury research has allowed the description of several patterns of injury in this sport. Mountain biking remains popular, particularly among young males, although sales and participation figures have decreased in the last several years. Competition in downhill racing has increased, while cross-country racing has decreased somewhat in popularity. Recreational riders comprise the largest segment of participants, but little is known about the demographics and injury epidemiology of noncompetitive mountain cyclists. Most mountain bikers participating in surveys reported a history of previous injuries, but prospective studies conducted at mountain bike races have found injury rates of <1%. The most common mechanism of injury involves a forward fall over the handlebars, usually while riding downhill, which can result in direct trauma to the head, torso and upper extremities. A variety of factors can be associated with this type of fall, including trail surface irregularities, mechanical failures and loss of control. In mountain bike racing the risk of injury may be higher for women than men. Minor injuries such as abrasions and contusions occur frequently, but are usually of little consequence. Fractures usually involve the torso or upper extremities, and shoulder injuries are common. Head and face injuries are not always prevented by current helmet designs. Fatal injuries are rare but have been reported. Improvements in safety equipment, rider training and racecourse design are suggested injury prevention measures. The authors encourage continued research in this sport.

Gender differences in acute mountain bike racing injuries.

OBJECTIVE: To evaluate injury rates and patterns in off-road bicycle racing, and to compare the findings in male and female cyclists. SETTING: The study was conducted from 1994-2001 at a large off-road bicycling competition held for 4 days each summer at Mammoth Mountain, California. DESIGN: Injured cyclists were evaluated at the first aid station or at the local hospital. Registration data were used to estimate the number of male and female competitors in each race. PARTICIPANTS: Cyclists who sustained an injury during a race and were unable to finish the race due to the injury were included in the study. 22 female subjects and 71 male subjects met the inclusion criteria during the 8-year study period. There were a total of 20,769 race participants during the study period. MAIN OUTCOME MEASURES: Injuries were categorized, and injury rates were calculated. RESULTS: The overall injury rate during the study period was 0.77% (22/2,869) for women versus 0.40% (71/17,900) for men (p = 0.01). Fractures were sustained by 45.5% (10/22) of female subjects versus 21.1% (15/71) of male subjects (p = 0.03). Odds ratios indicate that overall, women were 1.94 times more likely than men to sustain an injury and 4.17 times more likely to sustain a fracture. CONCLUSIONS: These data suggest that although participation in this sport is higher among men, the risk of injury is greater for women.

Mechanisms of injury in competitive off-road bicycling.

OBJECTIVE: To describe the mechanisms of injury from crashes during competitive off-road bicycling (mountain biking) and to examine the type, location, and severity of the resulting injuries. METHODS: We examined and interviewed all bicyclists injured while competing at 7 off-road bicycling events. Information regarding the direction of fall and the presence of a collision or mechanical failure was obtained, and the injury patterns were compared. RESULTS: There were 97 injured riders, with a mean age of 28.3 years. Most victims were male (74%), and all cyclists wore helmets. Most injuries were minor and involved the extremities (70.5%). Injuries sustained from falling forward over the handlebars occurred more often than from falling to the side (65% vs 25%), tended to lead to injuries that were more severe (mean injury severity score [ISS] = 3.4 vs 1.7, P < .05), and produced more head and neck injuries (56% vs 8%, P < .05). Falls to the side generally led to a lower extremity injury (88% vs 57%, P < .05). Riders who were involved in collisions had injuries that were similar in severity and location to those of riders who had no collision. CONCLUSIONS: These findings suggest that off-road bicyclists whose mechanism of injury involves falling forward over the handlebars are at risk for more severe injury, especially to the head and neck.

Medicolegal Challenges of Advising At-Risk Patients.

In brief The case of a talented baseball pitcher who has Marfan's syndrome sets the stage for an examination of the medicolegal issues posed by athletes at risk for sudden death. The medical literature is somewhat unclear whether sports participation is unsafe for all individuals with Marfan's syndrome. Legal precedent has established guidelines on the "right to participate" and on informed consent. For medical and legal reasons, physicians need to establish appropriate risk management and informed consent procedures.