Welcome to the Bikerumor First Aid Series, where we’ll explore common cycling injuries and what to do if you or your riding partner wreck. In this first installment, we look at the five most common MTB injuries. Followup stories will provide in depth solutions to help you get back to the trail head, recommended first aid equipment to carry with you, and more. If you have specific questions, leave them in the comments and we’ll answer those in future articles.

There are two types of mountain bikers—those who have crashed, and those who will. It doesn’t matter how honed your skills are, eventually good judgment and control give way to poor decisions and gravity.

Chances are you know someone, if not yourself, who has taken a significant spill. Most of us walk away with little more than a few bruises, cuts, and scrapes. While those qualify as injuries they usually don’t keep us off our bikes for long. But mountain biking has proven capable of serious injury—or worse.

Two studies conducted in the last few years have compiled hundreds of crashes to determine which injuries are most common. The data varies slightly but proves mountain bike crashes produce predictable outcomes. The information gathered can help riders better prepare to be first on the scene. It might even help us mitigate injury.

In 2012 a study published in Wilderness and Environmental Medicine recorded injuries treated at the clinic near the Whistler Mountain Bike Park. They documented the medical treatments of 772 patients. Patients—is the operative word. Mountain bikers are a tough lot and many riders never make it to a medical facility. They either tough it out or have injuries they deem unworthy of professional attention. In the United States, many riders don’t seek help for fear of incurring costly medical bills.

Pads seldom protect the most commonly injured extremities.
Image: Adobe Stock

In the WEM/Whistler study, the most common injury was a broken bone. Hands, wrists, arms, and shoulders made up the bulk of the 442 fractures they addressed. Broken clavicles, the cyclist’s favorite fracture, claimed 122 riders. Broken wrists took out 109 more. Life-threatening spine and neck breaks ended the season for 23 people. The amazing takeaway from that number is the fact only 8 patients were brought in on a stretcher. Due to the nature of the terrain, they also saw a large number of head injuries. Nearly one in seven patients suffered some degree of brain trauma.

A more recent study recorded injuries within the National Interscholastic Cycling Association (NICA). A comprehensive project involving a network of sports physicians, first responders, and the University of Utah, NICA is using the statistics to help make the league safer. Despite the narrow focus of the sample set, which only includes school-age riders and a handful of adult coaches, the initial data is telling. The official findings are not complete, but it appears their top five injuries align with the WEM/Whistler report.

The NICA Safety Study’s parameters include only injuries which required medical attention, forced riders into a period of recovery, and/or resulted in time away from work or school. Their top five injuries include:

  • Head trauma and brain injury
  • Fractured hand and/or wrist
  • Fractured forearm
  • Trauma to the face
  • Fractured shoulder or clavicle

One of the medical professionals assisting NICA’s efforts is Flynn George, the founder of Backcountry Lifeline. His organization provides riders with the first-aid skills necessary to respond to victims of a bike crash. According to George, less than 15% of his course participants have received prior first-aid training—of any kind. Considering brain injury tops both the WEM/Whistler and NICA studies, that’s a concerning statistic.

Causation and Avoidance

Pushing limits is the cause of most mountain bike crashes.
Image: Adobe Stock

In 2016 I interviewed the lead patroller at one of the country’s busiest mountain bike parks. My first question was direct: What is the leading cause of mountain bike crashes? His answer was equally pointed, “People make stupid choices.” By his assessment, injuries are often avoidable. In most scenarios crashes are the result of people riding above their skill level. They’re either pressured to keep up with more experienced riders, are on terrain above their abilities, or pushing the envelope to impress their buddies. Velocity is almost always the catalyst of a catastrophic day-ender. As the lead patroller put it: Crashes inevitably occur when a rider’s speed exceeds their skill level.

Few riders are trained to respond to injuries on the trail.
Image: Backcountry Lifeline. BLL provides training in the very settings where crashes and injuries occur.

According to the WEM/Whistler statistics, one way to avoid injury is to not be a 26-year-old male. Most studies, and anectotal evidence, confirm the tendency for ripe-aged men to crash with more frequency and enthusiasm than women of any age. No real surprise there.

In the coming weeks, we’ll revisit these five common injuries and get expert advice on how to treat them on the trail. It will give all of us an opportunity to evaluate our level of preparedness and build out our first aid kits.

In the meantime, keep the rubber side down and tell us about your worst crash.

Author’s note: For nearly a decade I managed bicycle tour companies around the world. I’ve witnessed everything from cardiac arrest and broken legs, to an ejected eyeball. Just three weeks ago while riding a motorcycle in southern Patagonia, a companion crashed and shattered his hand, wrist, and forearm like it was made of peanut brittle. I was his only caregiver while on the side of a remote road in Chile’s frontier. As someone with a considerable amount of first responder training I can tell you—it’s never enough—but any training is better than none.

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25 COMMENTS

  1. shattered wrist (multiple fractures) after wiping out on a loose gravel downhill and plowing into an erosion barrier. killed the 2017 season for me, and left me with a 50% functional right wrist: damaged yes but it could have been worse. a 50% functional spine for instance, or neck, or foot. take your blessings where you find them. hopefully back on the bike soon for the first time in 6 months.

    • Yes. Worst day ever for that poor lady. First time in my life as a first responder I said to myself, “please pass out, please pass out, please pass out.” Didn’t care if it was me or her.

  2. Almost all mountain bikers wear helmets and Brain injury tops the list? I think we need better helmet technology. For the 26 year old males going big. Remember that you need the thing on your shoulders working properly to pay for this bourgeois hobby.

    • Because CPSC helmets are designed to prevent skull fracture and not really do anything else. Yes, we definitely do need better helmet tech.
      Look at the NFL – 99% of deceased players that have been autopsied had CTE. Thankfully we’ve gone from “walk it off” being the treatment for concussion, to at least acknowledging it as a brain injury.

    • Helmets reduce skull fracture, subdural hematoma, and death significantly. Concussions are a hell of a lot harder to reduce, and currently helmets don’t do a good job at it. That said… reducing fractures, death, and bleeding is a big f*cking deal!

  3. An acquaintance was riding “easy” trails without a helmet…went head first into a rock and was de-faced (the medical term for having your entire face ripped off from the forehead down). His riding buddies were able to fold it back on and control the bleeding. A plastic surgeon re-attached it and it healed. The good news…after a year or so you could barely tell it happened.

  4. Great series and glad to see it here. I just completed an extensive training course in outdoor emergency care for the national ski patrol. Much of the course is geared towards these situations. I look forward to reading more.

  5. I’m looking forward to completing the rest of this series. Please let me know if there are specifics you would like me to cover. And I’m still blown away by the number of people in the WEM/Whistler study who WALKED into the clinic with broken backs.

  6. Shattered my c4 ina crash. Had to have it removed and replaced with a bone made from a cadaver’s hip. 1 plate, 2 rods and 10 screws. Was fully paralyzed from the neck down. I’ve had an amazing recovery and while still far from 100% I’m back on the mountain bike.

  7. Great article. After 20 years riding MTB I had my worst crash last year. Crashed very slowly but hit my belly in the steerer that was about 2 inches above the stem. It hit one kidney, got internal bleeding and almost died. Stayed 3 weeks in hospital, 2 in intensive care.

    I had no idea what was happening to me. Was just feeling bad after the crash and had no idea how serious it was. Luckily I was not alone and bad enough not to be able to ride out trail and request an ambulance otherwise it could have been too late.

  8. I took the side mirror off a SUV with the back of my helmeted head at highway speed….and lived. You don’t think of your brain until that is all you think about. After 11.5 years I am finding serious healing with neurofeedback therapy. It is EEG based therapy that helps re-regulate our neural networks. Read books like A Symphony in the Brain (2nd ed.) or Restoring the Brain for the therapy Big Pharma doesn’t want to get the research it needs to advance.

    And yes, I ride again. The yahoo that sideswiped me isn’t going to end my relationship with bicycling.

  9. I’ve been riding MTB since the early 90s and I’ve had one major injury, an AC tear which I received only three years ago. I’ve cracked a few helmets, shinned myself on a pedal from time to time, poked innumerable holes in my calf from my chainring and knocked my out once.

  10. Excellent and much needed series. 2017 was a year of stupid injuries for me and a few buddies (falling in parking lots etc) and I was glad of my basic but outdated training. Knowing what the most common injuries are is a great way to focus on building and updating my knowledge.

    • I imagine it has much to do with the stigma associated with body armor and full face helmets. We have a local rider who rides mild XC trails in full kit. He gets ribbed for doing so, but always takes it well.

  11. My only mtn bike crash was a low speed endo that resulted in a cracked helmet and taco’d front wheel. After the crash, I waited for my brother-in-law who was riding behind me, and I realized I had wrecked in the same spot he had endo’d and broken his collar bone the year before. I guess landing straight on my helmeted head saved me from worse damage.

  12. One common injury not mentioned is a dislocated elbow. Very common when one falls on an outstretched hand. The pressure is placed on the elbow joint and it pops out. It usually has to be popped back in under sedation by a orthopedic surgeon as it can be very painful. Worst case scenario is when a vascular injury happen in concert with it.

    I’m not surprised about people walking in with neck and spine fractures. Cracks to the vertebrae can happen without disrupting the spinal cord. If you have a lot of pain in the neck or back after a crash, get it checked out.

    Helmet tech is interesting. Without a doubt helmets help a ton but they don’t eliminate all brain trauma. A common injury is the result of “coup cotrecoup”. https://en.wikipedia.org/wiki/Coup_contrecoup_injury The brain crashes into the skull and then rebounds and hits the back side. This is really hard to mitigate with a helmet given the firmness needed for the initial impact protection. A giant pillow on your head would likely work but isn’t practical. A deployable airbag around the helmet would likely also work in theory, but cost and weight considerations make this pretty unfeasible. It will be interesting to see if technology evolves over the next number of years.

    • BK, we will have an overview of head injuries, how to spot them, and what to do coming up in the near future. I have a family member who suffered a traumatic brain injury in an auto accident. I think if people fully knew the implications of brain injury they might make different choices. Horrible injury to have–for life.

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