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Hit the Trail Safely on a Bike

Mountain biking is a growing trend across the country with even an international push to increase participation. 1 There are so many health and environmental benefits of cycling1,2,3 that there is no end in sight for its popularity and growth. However, with this increase in ridership, injury types and rates are also increasing.


Overuse injuries are reported in 45% to 90% of mountain bikers due1 to how individuals ride and handle the vibrations and motions of going up and down mountains. Classically, overuse injuries are related to the bicycle fit or improper training techniques. The most common lower extremity injury includes knee pain, which is often due to factors such as the bicycle saddle being too low or in a forward position. The most common upper extremity injuries include wrist pain or hand numbness due to poor weight distribution across the handlebars. Other overuse injuries include low back pain and neck due to poor cycling position and mechanics. 1,5


Although, non-traumatic injuries are most common with recreational cyclists, many riders who travel at high speeds, in large groups, over technical terrain, or in traffic are at risk for a traumatic injury. In 2011 Nelson et al. noted that mountain biking injuries had decreased significantly from 1994 to 2007. 3 However, there still are approximately 15,000 bicycle related injuries each year. The most common injuries include upper extremity fractures (10.6%) and shoulder fractures (including clavicle, 8.3%). 3 Overall, fractures accounted for 26.5% of mountain bikerelated injuries, followed by soft tissue injuries (24.0%), and cuts (20.5%). 3 The majority of mountain bike-related injuries were attributed to falls (69.9%) or being thrown from the bike (14.1%). 3

Injury Prevention

Historically, overuse injury management in cyclists has emphasized features of bicycle geometry such as seat height and seat position, seat to handle bars distance, as well as cleat alignment and position. Bicycles are designed for specific demands, from racing performance, to comfort and stability in traffic, to carrying heavy loads or children. The frame geometry, handlebar shape, saddle, and pedal system are selected based on the cyclist’s anatomical measurements and the desired body position and function. Improper body position on the bicycle can contribute to a number of overuse injuries. 6 Small adjustments by a professional, particularly how the body is aligned with the bicycle at the seat, handlebars, and pedals, can improve comfort, efficiency, and power generation. 1,6


The evaluation and management of cycling injury should be a collaborative process involving athletes, physicians, physical therapists, bike fitters, and, for some cyclists, a coach. Correction of bike fit, cycling technique errors, and training habits can all improve comfort and enjoyment on the bicycle as well as avoid preventable injuries.

References 1. Ansari M, Nourian R, Khodaee M. Mountain biking injuries. Curr Sports Med Rep. 2017.16(6):404-412. 2. Khodaee M, Deu RS, Mathern S, Bravman JT. Morel-Lavallée lesion in sports. Curr Sports Med Rep. 2016.15(6):417-422. 3. Nelson NG, McKenzie LB. Mountain biking-related injuries treated in emergency departments in the United States, 1994-2007. Am J Sports Med. 2011.39(2):404-409. 4. Rajapakse B, Horne G, Devane P, Rajapaske BN. Forearm and wrist fractures in mountain bike riders. N Z Med J. 1996.Apr 26;109(1020):147-8. 5. McGrath TM, Yehl MA. Injury and illness in mountain bicycle stage racing: Experience from the Trans-Sylvania Mountain Bike Epic Race. Wilderness Environ Med. 2012.23(4):356-359. 6. Leavitt TG, Vincent HK. Simple seat height adjustment in bike fitting can reduce injury risk. Curr Sports Med Rep. 2016.15(3):130.

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