n sports medicine update Section Editor: Darren L. Johnson, MD Overview of Cycling Injuries: Results of a Cycling Club Survey Javier F. Decalzi, MD; Steven J. Narvy, MD; C. Thomas Vangsness Jr, MD minor injuries such as abra- MATERIALS AND METHODS Abstract: Participation in competitive bicycling has in- sions, contusions, and lac- An e-mail questionnaire creased substantially over the past decade, and bicycle inju- erations, whereas high-energy was distributed to all members ries have increased accordingly. Cycling has been reported in mechanisms can result in of a local urban cycling club several studies to have higher rates of injury than other sports fractures, concussions, multi- to determine the following in- and recreational activities; accordingly, riders must be cog- system polytrauma, or death.6 formation: cycling experience nizant of the potential for injury and protect themselves ap- Nontraumatic injuries also (years of cycling or racing), propriately. The purpose of the current study was to survey an established competitive Los Angeles–based road cycling occur, ranging from overuse mileage and training activ- team to determine the epidemiology of and circumstances for injuries, such as tendinitis, ity, race activity, and previous traumatic cycling injuries. sprains, and strains, to com- involvement in road riding or pression neuropathies, such as racing crashes. All club mem- cyclist’s palsy (a compression bers, irrespective of racing ac- articipation in competi- 15,000 injuries result in inpa- neuropathy of the distal ulnar tivity, received the survey. The Ptive bicycling has in- tient hospital admission.3 In nerve that may occur due to epidemiology of the crashes creased over the past decade addition, 900 deaths annually prolonged grip pressure on and the setting in which they as a form of exercise and are believed to occur from the handlebars) and erectile occurred were noted. Crashes leisure activity.1 An increase injuries sustained during bi- dysfunction.7,8 Other common deemed to have occurred has also occurred in the num- cycle accidents,4 of which ap- injuries include knee prob- while getting used to clipless ber of bicycle accidents. An proximately two-thirds occur lems, buttock pain, and neck pedals or other aspects of the estimated 544,000 bicycle in the pediatric population.5 or shoulder pain. In a study learning curve for road cycling injuries occurred in 2009 Numerous potential inju- of 132 participants, Weiss9 re- were excluded from analysis. in the United States.2 In the ries may befall riders. Many ported that riders experiencd pediatric population, more occur in the trauma setting, buttock pain (32.8%), knee RESULTS than 300,000 children are which produces a broad spec- problems (20.7%), neck or Of the approximate 300 examined annually for bicy- trum of injury. Simple falls shoulder pain (20.4%), groin members in the cycling club, cle-related injuries; of these, onto pavement can produce numbness (10%), and palmar 29 (10%) responded to the sur- pain or paresthesias (10%). vey. Median age was 42.7 years The purpose of the cur- (range, 25-64 years), median The authors are from the Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. rent study is to survey an es- years of riding was 13.9 years The authors have no relevant financial relationships to disclose. tablished competitive Los (range, 1-44 years), and me- Correspondence should be addressed to: C. Thomas Vangsness Jr, MD, Angeles–based road cycling dian years in competitive rac- Department of Orthopaedic Surgery, Keck School of Medicine, University of team to determine the epide- ing was 5.3 years (range, 1-20 Southern California, 1520 San Pablo St, Ste 2000, Los Angeles, CA 90089 ([email protected]). miology and circumstances of years), for a cumulative total of doi: 10.3928/01477447-20130327-07 traumatic cycling crashes. 403 years of riding experience APRIL 2013 | Volume 36 • Number 4 287 n sports medicine update and 153 years of racing expe- dent, with the cyclists at fault formal medical attention for dents reflect the entire group; rience. Respondents averaged 58.7% of the time.13 a similar group of activities. however, they demonstrated an 140 miles of riding per week Kronisch et al14 surveyed Cycling placed second on the overall average of more than (range, 25-275 miles). Thirty- participants in an off-road bi- list, with 2.6 injuries per 1000 14 years of riding involving seven percent rode exclusively cycle race and noted a 0.4% (95% confidence interval [CI], more than 4 crashes per rider. solo, 20% rode exclusively in rate of significant injury (de- 2.1-3.1), behind only basket- This is consistent with previ- a small group, 29% rode ex- fined as an injury that prevent- ball, with a rate of 3.9 injuries ous work demonstrating a high clusively in a large group, and ed the rider from completing per 1000 (95% CI, 3.3-4.5). number of cycling-related in- the remainder rode in a combi- the event). Dannenberg et al15 Skating and skateboarding had juries.14,15 nation of settings. prospectively evaluated the an injury rate of 1.4 per 1000 A total of 121 crashes that incidence of and risk factors (95% CI, 1.1-1.7). Among CONCLUSION met inclusion criteria were re- for bicycle injuries among rid- men, basketball was at the top The popularity of cycling is ported, for an average of 4.2 ers participating in the Cycle of the list with 6.4 injuries per rapidly increasing. However, crashes per rider (range, 0-15 Across Maryland tour. The 1000, followed by cycling (4.6 the injury rate is not insignifi- crashes). Of these, 78 crashes 1638 riders in the tour had a per 1000). Among women, ac- cant; cycling has been reported occurred during training: 33 total of 198 injuries. Of these, tivities classified as exercising in several studies to have high- (42.3%) during solo riding, 18 85 were traumatic (15.4 per had the highest rate of injury er rates of injury than other (23.1%) in small groups, and 100,000 person-miles), 76 (2.0 per 1000; 95% CI, 1.5- sports and recreational activi- 27 (34.6%) in large groups. were due to overuse (13.7 per 2.5), and cycling tied with wa- ties. This study demonstrated The remaining 43 crashes oc- 100,000 person-miles), and ter sports with the lowest inju- multiple crashes in this small curred during races. 37 were due to other medi- ry rate (0.7 per 1000; 95% CI, cohort surveyed from an urban cal problems (6.7 per 100,000 0.4-1.0). When these results cycling club. As more DISCUSSION person-miles).15 The most were broken down by age, cy- Americans become more ac- Bicycle riding is a common commonly identified risk fac- cling was the most common tive in their later years, riders form of recreation, fitness, and tors for overuse injuries were cause of injury in the 5- to must be cognizant of the po- transportation. Ridership has inexperience and lack of con- 14-year-old age group (8.3 in- tential traumatic and overuse increased from 62 to 65 mil- ditioning before riding, where- juries per 1000; 95% CI, 6.4- injuries that can be sustained lion participants in 1981 to as inexperience and a his- 10.1) and was the fourth most during cycling. approximately 67 million in tory of racing were identified common among adults older 1997.10,11 From a public health as risk factors for traumatic than 25 years (1.3 injuries per REFERENCES perspective, the cost associ- injuries.15 1000; 95% CI, 0.9-1.8).17 1. Stutts JC, Hunter W. Injuries ated with caring for injured Several studies have com- This study evaluated the to pedestrian and bicyclists: an analysis based on Hospital bicyclists is significant. Data pared the injury rates for com- prevalence of bicycle crash- Emergency Department from a 2000 estimate noted mon sports and recreational es among a group of Los data. Federal Highway that approximately $8 billion activities. In terms of the ab- Angeles–based cyclists; it was Administrative Web site. http://www.fhwa.dot.gov/ is spent annually in the United solute number of injuries per not designed to determine the publications/research/safety/ States in the care of bicycle year sustained from common incidence of such crashes, nor pedbike/99078/index.cfm. Accessed June 26, 2011. crash victims.12 sports, Tan et al16 reported was it designed to evaluate 2. United States Consumer Regarding factors that con- that bicycle riding had the specific injuries. Accordingly, Products Safety Commission. tribute to bicycle accidents, highest absolute number of comparison of injury rates of National electronic injury sur- Kiburz et al13 surveyed active injuries per year (614,594 in- cyclists and other athletes can- veillance system data high- lights 2009. Consumer Product adult bicyclists to determine juries), followed by basket- not be made between the cur- Safety Commission Web site. cycle use and accident pat- ball (597,224 injuries) and rent study and the abovemen- http://www.cpsc.gov/PageFiles/ 106637/2009highlights.pdf. terns. Significant factors con- football (372,380 injuries). tioned studies. Acessed June 28, 2011. tributing to bicycle accidents In-line skating resulted 95,129 A limitation of the current 3. Castle SL, Burke RV, Arbogast included rider carelessness, injuries, and skateboarding re- study was the low response MP, Upperman JS. Bicycle bicycle malfunction, environ- sulted in 59,964 injuries. Conn rate to the survey (10%), helmet legislation and injury 17 patterns in trauma patients un- mental factors, turns, and hills. et al evaluated the rate of which could introduce selec- der age 18.