P.s The meaning behind this picture is revealed at the end of the blog!
Mountain biking injuries: the occasional pin in a balloon of fun on the hills.
“Are you mad, you expect me to cycle this bike down that steep rocky chute? Not a chicken’s chance in Thailand” my friend once announced! I’m sure many millions of people around the world would agree with his decision, not including the mountain biking community. The mountain biker experiences a beautiful, high-flying buzz when they take that corner and snake their way down the side of a valley, avoiding the obvious avoidables, whilst focussing on nothing else but the best line to take for the next 10 meters and so on until they reach sea-level. My guess is that this natural adrenaline fuelled high outweighs the risk of injury, even if the risk of injury is as high as the buzz itself!
Earlier studies have revealed that up to 85% of mountain bikers sustain injuries. Albeit most of these injuries were minor such as skin and soft tissue wounds, followed by fractures, sprains and dislocations, most commonly involving the arms and hands. These findings have not curbed the continuous growth of the sport since the mid-1970s, currently it is estimated that 11.8 million people own a mountain bike in the UK. Having lived in Scotland for the past seven years, I have noticed this growth, with more and more people talking about mountain biking and riding the man-made and natural trails that Scotland has in abundance. Ireland is next to stand up and show off what lovely hills we have. Wicklow has already proved itself on a world scale after the very successful Enduro World Series Round 2 event earlier this year.
Ok, back to the purpose of this blog, I want to alert you to the most common injuries sustained whilst mountain biking, then speak a little about the diagnosis of some of these injuries and also about potential efforts to minimize injury risk for the future.
Mountain biking appeals to individuals of a wide range of age (8-80 years) with the majority of the riders in the 20-30 age range. There is a predominance of male over female, yet studies have suggested that female riders have a higher risk of injury. Difficult to know why this is so, maybe the more risk averse one is, the bigger the risk of falling from the bike.
A Canadian study looking at mountain bike related injuries requiring admission to accident and emergency over a 10 year period revealed some interesting findings. A threefold rise in the number of injuries was observed over the 10 years, from 1992 to 2002. Also, the number of riders with severe injuries showed an exponential rise over the 10 year period. One reason for this may be the advances in mountain bike technology matching the progressively steeper and more technical trails with bigger jumps. At the end of the 10 year study, 399 riders were injured, sustaining a total of 1,092 injuries. The most common injuries were orthopaedic injuries, i.e. fractures, dislocations and soft tissue injuries to the upper limbs, amounting to 46%, head injuries amounting to 12%, spine (12%), chest (10.3%), facial (10.2%), abdominal (5.4%), genitourinary (2.2%) and neck (1%). Interestingly, despite a high compliance in the use of helmets, there was still 133 head related injuries.
A more recent Canadian study observing hand and wrist injuries resulting from mountain biking over a one year period, revealed half of the 1,079 injuries were injuries to the upper limbs. This study also reported the most common type of fall was propulsion over the top of the handlebars. Click on the link to the youtube video in the last paragraph to learn a few tricks of the trade and avoid this human cannonball experiment! Excluding bumps and bruises, fractures were the most commonly reported injuries. Of these fractures, the collar bone was the most frequently fractured, with the radius (bone on the same side as your thumb), scaphoid (small wrist bone situated at the base of your thumb), metacarpals (mid-hand bones) and fingers also commonly involved. Injuries occurred in the mountain bike park 73% of the time, followed by trails (18%) and hills (5%). Ninety-six percent of riders were wearing a helmet and 50% were wearing armour on their arms.
When it comes to rehabilitation post injury, clearly the most important thing is to locate and diagnose the injury in the first place. This is especially the case with regard to scaphoid fractures. These are infamous for evading diagnosis. If you happen to fall onto the palm of your outstretched hand, and you are tender to touch around the base of your thumb or your anatomical snuff box, the advice would be to get it investigated at the accident and emergency clinic. The snuff box is the area between the two obvious tendons at the side of your wrist, visible when you lift your thumb back towards your wrist. The 1 year study above reported the scaphoid fracture as the most common wrist injury, with a total of 25 scaphoid fractures (24% of total wrist injuries in the study).
From a first aid perspective, if you are in a group of riders and someone sustains an injury to the upper limb. They will typically support their injured arm with their non-injured arm, this is the position that you should protect and support their arm with a sling. A tyre tube works well in this instance if you are struggling to find something appropriate. If this situation arises, you should presume a diagnosis of fracture or dislocation and get the rider to accident and emergency.
What can be done to reduce the incidence of mountain biking injuries?
Since the two large studies above showed a high compliance to wearing protective gear such as helmets and body armour, yet still resulted in the injuries occurring, surely the key to reducing mountain bike injuries is to educate riders of this risk in order to strongly encourage the rider to ride within one’s limits. From my own experience of riding popular trail centres in Scotland, I witnessed many beginners to mountain biking riding with their more competent friends and of course trying to keep up with them – a recipe for becoming another statistic in future studies like the two we have looked at. My wife did just that last year… we were mountain biking with others on the hills surrounding our campsite when the terrain turned a shade more technical. Maybe a feeling of girl-power came over her before suddenly going head over heels and landing on her knees, needing two stitches. On the upside, we got married at the very same campsite one year later!
More emphasis should be placed on the seriousness of obtaining adequate skills training before taking on more difficult terrain. Riders should also be aware of the environment that they are about to enter. This is the reason for the trail centre grading system, where colours represent the difficulty rating of the trail. In the UK and Ireland, blue represents a beginners trail, red for intermediate and black for experienced riders. Youtube videos like this one, https://youtu.be/LXY8SIEnCdA could be more widely promoted amongst the mountain biking community. There are still no studies to date that have looked at the effect of injury prevention programmes.
I hope I have not shocked any readers into thinking mountain biking is up there with rugby in terms of its hard hitting nature, but instead informed readers, who may be thinking about giving mountain biking a go, to do their research first and take her handy.
I will leave you with a video of myself at a scary mountain biking event this time last year in Scotland, seeing as Halloween is around the corner! P.S I will colour this blog with some mountain bike pictures in time, right now I find myself with my wife in Delhi, India! here are a few pictures from our travels so far!