Ride for the health of it: safety first

---

Recently I was fortunate to observe an elderly man riding his bicycle down the street. He was riding an upright cruiser type bike at a smooth cadence with a look of chillaxed zen-bliss. From his fit appearance and ease at the helm, it was apparent that he had been riding for years. I thought to myself “I hope that is me in 20 years."  In that moment, I questioned whether or not I would be able to ride at any capacity when I reached his age. Why shouldn’t I be able to? I am in my late 40’s and in great health. Why did such a question pop into my head? I’m guessing it has to do with the fact that my riding has recently been sidelined by yet another injury, ten stitches to the forearm after a low speed accident related to diverted attention and being clipped in the pedals. Over the past three years, my mountain bike related injuries include a concussion, a separated shoulder, fractured big toe, periosteal bruise to the femur and several contusions and a few lacerations. You might be asking why I would be recommending ORC for health and wellness given all the injuries I have sustained. I can honestly tell you that the majority of my injuries were preventable and the result of me not fully appreciating the information and safety recommendations that follow in this article. Every one of my major injuries was the direct result of me taking too many risks and riding “out of my lane” and thus they were all preventable by following the few basic recommendations that follow. This article is intended to increase safe participation in off road cycling (ORC) as an adventure hobby based on evidence and from first-hand experience. Safety is something that I will be expanding on often in future articles. 

First Do No Harm 

First and foremost, you must be sure you are healthy enough to participate in ORC. If you can’t answer that question confidently, then you need to see your doctor for medical clearance. You can also use the physical activity readiness questionnaire (PAR-Q+) to help you make the right decision, which is available at https://www.ext.vt.edu/topics/food-health/physical-activity/files/par-q-plus.pdf. Again, I think it is safe to say that if you have any doubts about your medical status, see your doctor. If you are not cleared for ORC, you should enquire about participation in cardiac rehab or community based low impact exercise classes offered by one of your local hospital systems until you are healthy enough to uptake ORC. 

Wear a Helmet 

If you are wearing a properly fitting helmet, then the most common injuries suffered with ORC are skin abrasions and contusions. Not too bad. If you do not wear a helmet, the incidence of concussion and traumatic brain injury increases exponentially, with ORC related deaths being primarily the result of traumatic brain injuries.  (1-6) If that isn’t enough to convince you, consider all the recent attention given to the impact of concussions on overall health and quality of life. There are so many helmet options available today that there is no excuse for not wearing one. Keep calm, be cool and put a lid on it! 

Ride the Right Ride 

Comfort is key to a fun ride and it begins with having the right bike for the terrain you plan to ride as well as having the right size bike for you. Your local bike shop is the best place to find both. Once you have the right ride, making a few easy adjustments can make a fun ride more efficient as well. To maximize output from each pedal stroke, the seat height should be such to leave you with a slight bend at the knee at the bottom of the pedal stroke.  This adjustment correlates to lower knee flexion angles throughout the pedal stroke equalling less overall patella femoral forces.  Furthermore, having a slight bend at the knee, and at the elbow when gripping the handle bars, allows your legs and arms to function as shock-absorbers.  Beyond simple seat height adjustments, if you are a competitive rider, you might benefit from having a certified bike fit and/or trainer work with you to optimize output from multiple adjustments. However, if recreational ORC is more your speed, then you will do fine with having your local bike shop adjust your ride accordingly. Having the right ride and proper clothing maximizes comfort which, ahead of all other parameters, predicts participation and positively influences safety.  (7) 

Ride Off Road 

Where and how you choose to ride greatly determines your risk of injury. I’m working under the assumption that it is known and accepted that if you are in motion, you are at some degree of risk whether that be in a motor vehicle, on a bicycle or even walking. It should also be understood that nothing is completely risk free, not even being stationary. A lack of sufficient physical activity will result in poor health and ultimately lead to severe chronic health conditions that are largely avoidable with regular physical activity. (5,6,8)  Given this, the choice is simple for me: I’d rather be in motion and have fun doing it. Since you are reading this, I’m guessing you agree. Now, “moving” beyond the basic facts, it makes sense to take steps to minimize injury risk without compromising the enjoyment of ORC. By choosing ORC, you are already safer than riding on the road. There are several mechanisms of injury associated with road cycling, but the most frequent and serious injuries seen in emergency departments across the US are related to motor vehicle-bicycle accidents. (1,3,4,5,6)  More simply put, I’d rather take my chances with the rocks, roots and trees compared to the average distracted driver I witness daily. Although statistically safer than cycling on the road, ORC is not without its risks. 

Pick a Terrain According to Your Skill Level 

No matter what we choose to pursue, we all have to begin at the beginning. Rail trails and designated walking and bike paths and are the best place for novice riders to get acquainted with ORC while having the lowest overall risk of injury.  (5,6,9)  If you choose to stay on such terrain and never make the move to single track, then ride on. There is no shame in riding where you feel the safest and have the most fun, just keep riding. However, if you decide you want to venture out into the single track world, there are a few things I recommend you consider. Injuries related to mountain biking are directly correlated with elevated speeds, steep downhills and attempting various jumps and tricks. (2,3,10)  Aside from these factors, mountain biking has a relatively low rate of injury compared with street/road riding and other sports. (1-6)  Match challenges with your skill level. This simple advice is good to consider when you are deciding if you want to get into downhill, which has a relatively high injury rate, compared to cross country, which has a significantly low injury rate. (1,2,3,10)

Stay Riding My Friends 

Finally, resist the advice from Rambo-riders. I’m betting you know whom I am referring to. There is no need or sense in taking risks unless you fully understand the consequences and accept them. It pays to keep in mind that the most severe/highest injury rates are seen at designated mountain bike parks/terrain parks, attracting mostly intermediate to expert riders, who push the limits with known consequence. (11,12)  I have learned my lesson regarding this, and I have changed the way I ride so that I can ride for as long as I’m upright. I hope this information assists you in pursuing ORC as a form of fun, adventure and exercise. See you on the trail, RIDE ON! -----DocMTB 

References 

1. Amoros, E., Chiron, M., Thélot, B., & Laumon, B. The injury epidemiology of cyclists based on a road trauma registry. BMC Public Health 2011; 11(1): 1-12. 

2. Carmont, M. R. Mountain biking injuries: a review. British Medical Bulletin 2008; 85(1): 101-112. 

3. Nelson, N. G., & McKenzie, L. B. Mountain Biking–Related Injuries Treated in Emergency Departments in the United States, 1994-2007. The American Journal of Sports Medicine 2011; 39(2): 404-409. 

4. Chen, W. S., Dunn, R. Y., Chen, A. J., & Linakis, J. G. Epidemiology of nonfatal bicycle injuries presenting to United States emergency departments, 2001–2008. Academic Emergency Medicine 2013; 20(6): 570-575. 

5. Centers for Disease Control and Prevention. Bicycle Safety. http://www.cdc.gov/motorvehiclesafety/bicycle/. Updated April 11, 2016. Accessed June 28, 2016. 

6. Rails to Trails Conservancy. Addressing Safety and Health Concerns to Increase Active Transportation. http://www.railstotrails.org/policy/building-active-transportation-systems/addressing-safety-and-health-concerns/. Accessed June 29, 2016. 

7. Performance Bicycle. Cycling in comfort. https://www.performancebike.com/images/performance/web/PDFs/08_BuyersGuide_Comfort.pdf. Accessed June 28, 2016. 

8. Chomistek AK, Manson JE, Stefanick ML, Lu B, Sands-Lincoln M, Going SB, et al. Relationship of sedentary behavior and physical activity to incident cardiovascular disease. J Am Coll Cardiol. 2013;61:2346–53. 

9. Pedestrian and Bicycle Information Center. Pedestrian and Bicyclist Crash Statistics. http://www.pedbikeinfo.org/data/factsheet_crash.cfm. Accessed June 29, 2016. 

10. Roberts, D. J., Ouellet, J. F., Sutherland, F. R., Kirkpatrick, A. W., Lall, R. N., & Ball, C. G. Severe street and mountain bicycling injuries in adults: a comparison of the incidence, risk factors and injury patterns over 14 years. Canadian Journal of Surgery 2013; 56(3): E32. 

11. Ashwell, Z., McKay, M. P., Brubacher, J. R., & Gareau, A. The epidemiology of mountain bike park injuries at the Whistler Bike Park, British Columbia (BC), Canada. Wilderness & environmental medicine 2012; 23(2): 140-145. 

12. Romanow, N. T., Hagel, B. E., Nguyen, M., Embree, T., & Rowe, B. H. Mountain bike terrain park-related injuries: an emerging cause of morbidity. International journal of injury control and