Mechanisms of injury in competitive off-road bicycling

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.

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.

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.

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.