Mountain Biking InjuriesCLINICAL REVIEW

Mountain Biking Injuries Current Sports Medicine Reports Ansari, M; Nourian, R; Khodaee, M. American College of Sports Medicine Nov/Dec 2017 16(6)4:404-412

https://journals.lww.com/acsm-csmr/Fulltext/2017/11000/Mountain_Biking_Injuries.10.aspx

By Rose Lampen-Smith

The authors have provided a summary of Mountain Biking Injuries (MBI) following a review of literature over the last 20 years. There has been a definite increase in numbers of mountain bike riders (MBR) over this period of time, and so concurrently with an increase in the popularity of the sport there has been an increase in the number of injuries reported. A 2016 study undertaken in Colorado, USA reported 50% and 80% of recreational and professional MBR have reported at least one major injury directly related to the sport. Meanwhile a study in 2015 reported overuse injuries in over half of MBR. Therefore the prevention of MBI requires recognition of both traumatic and overuse mechanisms. There are differing types of mountain bikes with associated injuries, for example Cross Country(XC), Downhill (DH) and Freeride bikes, with terrains, environmental factors, riding at Mountain bike Parks, competing in events and overall expertise of the riders creating a multitude of scenarios where injuries can occur. In general DH riders have a greater incidence of traumatic injures than XC and males are more likely to get injured than females. ‘Bike Fit’ is the process of making the cyclist and bicycle geometry compatible to minimise the risk of injury and optimise performance. It is widely acknowledged that poor bike fit can lead to overuse injuries. Assessment needs to be made of each component of the bike to rider interface, including but not limited to, saddle height, saddle positioning (setback), foot/shoe/pedal interface, assessment of the riders ‘reach’, and choice and height of handlebars. Due to the repetitive action of pedalling, length of time of events and training loads, there is risk of overuse injuries that occur across all proficiency levels of riders. The average MBR will rotate the pedals between 3600 to 6000 times per hour and endurance events can last for many hours and even days. Overuse injuries can be related to poor bike fit, or changes with load and types of training. The knee is commonly overloaded causing patellar femoral pain, ITB friction and patellar tendinopathies. Higher training volumes and intensity, with low or anterior seat positions are risk factors for anterior knee pain, and conversely, positioning the seat too high and/or posteriorly can cause ITB friction pain. Cervicalgia is another common complaint among MBR. Weakness and fatigue of cervical stabilisers with an associated postural mechanical disadvantage on the bike can lead to pain. Assessment of scapular stabilisers, maintenance of thoracic and cervical mobility and ensuring a good bike fit are essential. There is a similar incidence of low back pain (LBP), reported in up to 40% of riders, however, there is a paucity of research on the precipitating factors linking LBP to MBR. The general consensus is that poor bike fit, training methods and riding techniques with anatomical imbalances will lead to LBP. Other overuse injuries include ulnar (cyclists palsy), median nerve neuropathies and genital area injuries. With respect to acute injuries, the occurrence of fractures has been reported at over 74% of all MBI reported, with over two thirds of the fractures reported in the upper extremities. Head injuries resulting in concussions, dental trauma and facial fractures accounted for a high percentage of injuries too with severe spine injuries less common. Chest and abdominal injuries were also reported with blunt trauma received from bicycle handlebars. Interestingly at the time of the review, the authors comment that helmet use in MB has not been fully investigated as to its use in respect to the incidence of brain injuries. The above types of injuries –due to their severity are reported however more minor injuries of lacerations, blisters, chafing and abrasions are also very common. Due to the nature of the sport the rider needs to be prepared for many conditions and what injuries they will be prone to especially with endurance events. The rider will be faced with scenarios where they could be at risk of altitude illness, sunburns, heat stroke or conversely hypothermia. Therefore Race Directors need to develop medical protocols specific for each Mountain biking event. Overall, predictive factors for MBI from crashes included a prior history of crashing, riding in a group or in the dark. Further influencers were riders error, fatigue, trail and environmental conditions, speed and riding unfamiliar bikes. However, it is generally felt that the potential risks of cycling are outweighed by the health and social related benefits of bike riding. The authors summarise that there is a paucity of high quality research looking at the pathogenesis, prevention and treatment of overuse and traumatic injuries sustained by MBR. References available by following the link.