Mountain-biking injuries go with the territory

Falling forward is common but many believe the benefits of ‘MTB’ outweigh the risks

Mountain-biker Stephen McDonald: “I’m 49, never been fitter or happier with a sport and my life revolves around bikes and my family”. Photograph: Caroline Kerley

The health benefits of cycling are clear to many; not least to the 29,000-plus members of Cycling Ireland from over 450 clubs. An increasingly popular discipline is mountain biking (MTB), which received Olympic status at the 2000 Sydney Games.

Although the exhilaration of MTB involves courting the risk of injury, a review of MTB injuries in US medical journal Current Sports Medicine Reports states: "The potential risks of cycling are outweighed by the health-related benefits of riding a bike."

Stevie McDonald, a Cycling Ireland representative, has ridden and raced in America and Europe, and bikes at least two or three times a week all year round. He told The Irish Times: "I'm 49, never been fitter or happier with a sport and my life revolves around bikes and my family." He emphasises that at all MTB events it's compulsory to wear a helmet, ambulance crews are present and host clubs have trained first-aid members present.

“Should an injured rider block a track, the stage/event is stopped until the rider is treated and removed,” he says.


McDonald outlines three MTB disciplines each with its own safety aspect. “Cross-country involves doing laps of taped-off circuits and tracks which aren’t so technical, with relatively few steep hills or rock obstacles. Most competitors don’t wear body protection – only gloves and an open-face helmet. Injuries are usually scuffed knees and elbows.”

Enduro consists of technical descents, pedal sections and rough terrain, typically over five marked stages, the combined time for each stage deciding the winner. McDonald, currently the off-road commission’s enduro representative, says, “Riders must carry a first-aid kit, and must assist injured riders if required, but can restart after assisting.”

McDonald says that about 40 per cent wear full-face helmets, the rest choosing open-face helmets: “A full-face is safer in a crash but can hamper pedalling uphill, generating extra heat and strain. Around 99 per cent wear MTB-specific knee pads and protective gloves; and around 30 per cent wear elbow pads. Competitors in the 12/13-year-old age group must wear a full-face helmet, gloves, knee and elbow pads. Enduro injuries are common,” notes McDonald, “with scraped shins from the undergrowth, or feet slipping off pedals. Fractures – arms, fingers, elbows and collar bones – can occur.”

The third category is downhill, says McDonald, which involves steep, technical, rough descents over a timed descent of a marked stage. “Riders must wear a full-face helmet, with most wearing a jersey-style back protector with built-in shoulder and elbow pads. Injuries are like those in enduro with an occasional neck and back injury due to the larger jumps and steeper drops involved,” he says.

Injury tally

And McDonald’s injury tally? “I’ve been to A&E twice for stitches, once for my lip, the second for my hand. Each month I usually hurt an elbow, sprain a wrist, have muscle pains after races, and blood oozing from my shins.”

Someone who's no stranger to oozing blood is Dr Cormac Joyce, specialist registrar in plastic surgery at the Mater Hospital, Dublin: "I've seen a number of MTB injuries over the years, the majority facial lacerations whereby the rider has been flung over the handlebars when braking while descending. These injuries are typically caused by jagged stones and require a good clean and suturing, but the scarring can be substantial.

"I've also removed many foreign bodies from hands and foreheads when tiny stones puncture the skin. And I remember one woman who had spent €20,000 on dental implants in the Czech Republic a few weeks previous. She got thrown off her mountain bike, landed face first on the road and lost most of her new teeth."

McDonald remains undeterred: “MTB racing and riding does hurt, be it from physical exertion or injury, but it’s a part of the sport and worth the rush of riding down a mountain.”

Common mountain-biking injuries
(Current Sports Medicine Reports, November/December, 2017)

– The most common acute severe injury in competitive mountain bikers is falling forward (64.9 per cent).

– Constant skin friction produces blisters, and risk factors include heat, moisture, ill-fitting shoes and repetitive movement. Wear appropriate footwear, gloves, moisture-wicking synthetic socks and dry socks.

– Lacerations are common, typically from a fall or equipment failure. A primary step is to control bleeding by direct pressure.

– Although frostbite often affects nose, ears, cheeks and fingers, more than 50 per cent of cases affect toes. The best treatment is rapid rewarming with warm water.

– Ulnar neuropathy – cyclist’s palsy – occurs in 19 per cent to 35 per cent of cyclists and may be caused by pressure, tension and vibration on the ulnar nerve passing through the wrist. Loss of sensation, muscle weakness and pain in the fourth and fifth fingers occur. “Improper reach, narrow handlebars, gloves with poor padding, poor postural habits, longer rides and increased weight may be precipitating factors.”

– Low back pain (LBP) affects 24 per cent to 41 per cent of mountain bikers. Core stability exercises may prevent and treat LBP. Chronic LBP treatments include correcting technical errors, good bike fit and postural corrective exercise.