As a mountain biker, I love to have a good time out on the trails and if you’re reading this, there’s a good chance you do too. Or at the very least you’re curious about the sport and are doing your due diligence on the risks before diving in. While the vast majority of rides end with fist bumps and beers back at the parking lot, occasionally they do end with an injury and possibly a trip to the emergency room. Fortunately though, even if you do get hurt, mountain biking injuries are most commonly of the minor variety – scrapes and bruises. But, for those more serious, and fortunately less common injuries, it’s worth knowing something about them and how to minimize your risk.
This post is NOT a comprehensive list of all the ways one can get injured while mountain biking (that would be quite long…). Rather, this post is aimed at discussing the most common traumatic injuries, how they are treated, and what you can do to minimize your risk.
Here are the most common mountain biking injuries and a few tips on what you can do to prevent them.
This post was written by my brother who is an Emergency Room Doctor and a badass mountain biker. He’s also had his fair share of trips to the emergency room. Check out his other guest post: From an ER Doc: What to Carry in your Mountain Bike First Aid Kit.
Mountain bike injury Risk Mitigation & Assessment
Biking. Any type of biking can be dangerous. Hard stop. That said, certain disciplines in the cycling world carry more risk than others. I often tell people, only half-jokingly, that I feel safer on my mountain bike than my road bike. I may be more likely to sustain some cuts, scrapes, or even broken bones while mountain biking but I’m less likely to get hit by a car or blow a skinny tire going warp speed down some asphalt luge of a road.
Likewise, I’m a lot less likely to get hurt riding flow trails than I am hucking myself off giant drops at the bike park. The point is, not all rides carry the same risk. Where you fall along that spectrum is a personal assessment that should take into account your skill level, fitness, and overall risk aversion. The harder you charge, the more risk you’ll have a mountain biking injury at some point.
Also, make sure your gear is appropriate for what you are riding. ALWAYS WEAR A HELMET and frequently check to make sure your bike is in good working order. If you are going to be riding features at a bike park, consider wearing a full-face helmet and some protective gear like knee and elbow pads.
It’s also a good idea to get in the habit of carrying a medical kit specific for mountain biking with you when you ride.
Common mountain biking injuries
Again, this isn’t a comprehensive list of every mountain biking injury I’ve ever seen in the ER, but it’s a general idea of the most common injuries that result from crashes.
Abrasions, Lacerations, & Contusions:
This group of injuries represents by far and away, the most common types of traumatic mountain biking injuries. While not representative of all mountain bikers and disciplines, a study of Enduro World Series athletes found that lacerations and abrasions accounted for 26% of all injuries¹.
Abrasions occur when the topmost layer of the skin is sheered away resulting in a superficial wound. Abrasions can sometimes be quite large and frequently contain debris from whatever surface caused the abrasion – like dirt. These small foreign bodies should be removed (either with vigorous scrubbing or with some type of instrument like forceps) to help minimize infection risk.
Abrasions can take some time to heal, so proper wound care is important. The wound should be washed twice a day with warm soapy water and then coated with a thin layer of petroleum-based ointment. Cover the abrasion with a non-stick bandage after cleaning.
The biggest risk with abrasions is cellulitis, which is an infection of the skin or soft tissues due to bacteria. Signs of cellulitis include increased redness, swelling, warmth, purulent drainage (pus), fevers, chills, and sweats.
Lacerations are what most people know as ‘cuts’ and they can come in various shapes, sizes, and depths. Small, well-approximated lacerations can often be treated with a simple bandage or steri-strips. Deeper, larger, or more complex lacerations will require repair with sutures or staples for the best possible outcome.
Lacerations are also at risk of becoming infected, so proper wound care and cleaning are critical. Given that lacerations may be deep, there is the additional risk of damage to deeper structures such as veins, arteries, nerves, and tendons.
CONTUSIONS & HEMATOMAS
A contusion is just a fancy word for bruise and the same Enduro World Series study referenced above accounted for 19.2% of EWS athletes experiencing contusions. This type of injury occurs when there is a blunt force applied to tissues (i.e. you come off your bike at high speed). This blunt force can cause rupture of small blood vessels under the skin, which leads to bleeding and bluish-purple discoloration which we know of as a bruise.
Care for contusions includes resting and elevating the injured area and applying ice for the first few days. Contusions are also potentially at risk of infection, although this is less common than with abrasions or lacerations.
Fractures are broken bones. In the EWS study, fractures accounted for 17.7% of mountain biking injuries, so it can be a pretty common injury among mountain bikers. Any bone in the body can break and they can fracture in different ways or “patterns”. These patterns are due to the fact that bones will break in a certain way depending on the direction and amount of force applied to the bone.
As a result, different activities -like mountain biking – tend to see certain types or patterns of fractures more commonly than other types. For example, clavicle fractures are a common mountain biking injury because of the risk of going over the bars and landing on your shoulder.
In addition to clavicle/shoulder fractures, wrist, ankle, and some lower extremity fractures are also common injuries for mountain bikers.
The treatment of these fractures varies greatly depending on the location and pattern of the fracture as well as the degree of overlaying soft tissue damage. In general, fractures are treated either conservatively with splinting, casting, slings or operatively with plates, rods, screws, nails, and wires.
Any fracture needs to be evaluated by a medical professional to help determine the most appropriate treatment.
Ligaments are connective tissues that connect bone to bone. The most well-known ligament in the body is probably the anterior cruciate ligament (ACL) which connects the femur and tibia in the knee, but there are many, many ligaments throughout the body and these ligaments can be injured secondary to trauma.
An injury to a ligament is called a sprain and can range from a mild tear, which will heal well given time, to a complete rupture which may require surgery. In mountain biking, there are two common ligamentous injuries. The first is an acromioclavicular (AC) ligament injury. The AC ligament connects the acromion (shoulder blade) to the clavicle (collarbone). A direct blow to the shoulder as a result of a fall can tear this ligament. This injury is commonly called a separated shoulder. Fortunately, the majority of AC joint separations can be treated with a sling and will heal with time. Rarely, surgery may be needed.
Another common ligamentous injury is a disruption of the ulnar collateral ligament (UCL) in the thumb. This injury is also referred to as “skiers thumb” but it’s relatively common in mountain biking injuries as well. The UCL connects the metacarpal of the thumb to the proximal phalanx (basically envision your thumb getting bend backwards too far). Again, most UCL injuries heal well with time and splinting but occasionally surgery may be required.
Concussions are an injury to the brain along the spectrum of traumatic brain injury (TBI) that occur due to rapid acceleration/deceleration resulting in injury to axons in the brain. (SO WEAR YOUR HELMET). Symptoms of an acute concussion are varied but some common signs and symptoms include headache, nausea/vomiting, difficulty concentrating, irritability/mood swings, light sensitivity, impaired memory, dizziness, amnesia, sleep disturbances, or seizures.
Treatment of concussions involves minimizing any activities that are overly stimulating. This may include academics, work, prolonged screen time, or anything else that is cognitively taxing. It is very important to differentiate a concussion from bleeding inside the skull (an intracranial hemorrhage) as the latter can be life-threatening if not identified and treated promptly.
Tips for preventing mountain biking injuries
Most of us know that crashes can happen in a split second without warning, so it’s important to be prepared in case it is a day when we find ourselves face down in the dirt. Here are a few tips for preventing mountain biking injuries:
1. Wear your helmet
I think that’s pretty self-explanatory.
2. Ride within your skill level
It can be tempting to show off or ‘hang’ with other riders that are better for you, but there’s no need to prove yourself. Let your ego go and I guarantee you’ll have more fun out on the trail regardless of whether you hit that drop.
Now, this isn’t to say you shouldn’t push yourself when you feel like it’s time. I’m all for progression and doing things that scare you, but there’s a difference between moving past your fear and stupidity.
3. Invest in some protective gear and wear it
I never ride my mountain bike without knee pads. Even if it’s a casual spin on the trail, I still have them on. When I ride at bike parks, I’ll snap on my chin guard to make a full-face helmet. I probably should add elbow pads to my body armor, but I guess I just haven’t scraped them up enough to buy some 🙄.
4. Always do a quick bike check before riding
Before you head out for a ride, always give your bike a once-over. Check tire pressure, see if anything feels loose, lube the chain, test the brakes, bounce up and down. I can’t tell you how many times I’ve noticed something is off right before a ride. 2 minutes could literally save you a trip to the emergency room.
5. Keep your bike in good Great working order
When’s the last time you bled your brakes? How are your tires looking? Is it time for a new chain? Keeping up-to-date with bike maintenance is so important! Not sure where to start? Here are 6 bike maintenance projects you can do at home.
6. Don’t stand in the middle of the trail
A final note on mountain biking injuries
Again, this is not an exhaustive list of all the ways you could injure yourself while riding a bike. More severe injuries such as liver lacerations, splenic lacerations, collapsed lungs, and spinal cord injuries for example can, and certainly do happen. Fortunately, these are much less common.
If you ride bikes for long enough there’s a good chance at some point you’ll end up with an injury. It just comes with the territory. Is that a reason not to pedal? For me, the answer is a resounding ‘no’. There is risk in everything that we do, but we need to be honest with ourselves about our skill level and ability and make sure that we’re not over-committing.
We also need to make sure that we’re using the right gear and have a plan to deal with any mountain biking injuries that might happen.
Happy trails and stay safe!
¹EWS Medical Study
Have you experienced a mountain biking injury? What was it and what was your recovery like? Let us know in the comments below!