Incidence of Injuries, Illness and Related Risk Factors in Cross-Country Marathon Mountain Biking Events: A Systematic Search and Review

Endurance Sporting Events

Endurance sports encompass a broad range of events from marathons and triathlons to ultramarathons, long-distance cycling, skiing, and swimming. As these events have experienced a surge in popularity, we have a greater need to understand the associated medical risks. This article reviews the history of endurance races, reviews the most critical and common causes of cardiovascular, heat, electrolyte, and musculoskeletal injuries/illnesses, and discusses considerations for medical directors/personnel associated with such events.

Sex Differences in Mountain Bike Accidents in Austria from 2006 to 2018: A Retrospective Analysis

Woyke, Simon, Anja Hütter, Christopher Rugg, Willi Tröger, Bernd Wallner, Mathias Ströhle, and Peter Paal. Sex differences in mountain bike accidents in Austria from 2006 to 2018: a retrospective analysis. High Alt Med Biol. 25:89-93, 2024. Introduction: Mountain biking is becoming increasingly popular, and mountain bike (MTB) accidents are on the rise. The aim of this study was to assess sex differences in mountain biking accidents in the Austrian Alps. Methods: This retrospective study includes all MTB accidents in Austria from 2006 to 2018. Data were collected by Alpine Police officers and recorded in a national digital registry. Results: The accidents involved 5,095 mountain bikers (81% men and 19% women). The number of MTB accidents rose markedly from 208 in 2006 to 725 in 2018. Men wore a helmet more often than did women (95% vs. 92%; p = 0.001). The most common injury category was "wound/bleeding" for both sexes (men 40% and women 41%). Women were more frequently transported by helicopter or terrestrially (p > 0.001). Conclusion: In the Austrian Alps, the number of MTB accidents more than tripled between 2006 and 2018. Women were involved in only one fifth of all accidents. Sex differences in MTB accidents include (1) women wearing helmets less often, (2) women being less frequently injured, (3) women suffering fewer serious injuries, and (4) women being more frequently transported by helicopter or terrestrially, while men more often did not require transportation.

Health Service Impacts and Risk Factors for Severe Trauma in Mountain Biking: A Narrative Review

Mountain biking is growing in participation but carries risk for severe injury and burden on health systems. Little is known about the impact of these injuries on emergency medical services, definitive healthcare, and factors contributing to accidents. This review aimed to determine the health service impacts of severe mountain bike trauma and risk factors, with a view to understanding critical gaps and needs. A systematic online search was conducted using the databases PubMed and MEDLINE complete and grey literature relating to mountain bike injury since the databases' inception to July 2023. The results show that although mountain biking has relatively high injury rates that are increasing, the impacts on health services were rarely documented, with some evidence indicating that even small increases in injuries from race events can overwhelm local health services. Severe injuries were more common in downhill disciplines. However, the definitions of what constitutes severe injury were variable. Severe injuries were more common in downhill disciplines, influenced by the rider skill level, demographics, participation in competitive events, trail design, environmental factors, and healthcare availability. Further research in these areas is needed, along with the more consistent reporting of injury severity.

Types and anatomical locations of injuries among mountain bikers and hikers: A systematic review

BACKGROUND

Mountain biking and hiking continue to grow in popularity. With new participants to these sports, it is likely the number of injuries will increase. To assist medical personnel in the management of these patients we attempted to quantify the types and locations of injuries sustained by mountain bikers and hikers. Objective The objective of this systematic review is to identify the type and anatomical location of injuries for both mountain bikers and hikers.

METHODS

A systematic search was undertaken using CINAHL, Cochrane, ProQuest, PubMed and Scopus databases. Reviewers assessed the eligibility of articles by a title/abstract review and final full-text review. Studies were included if the types of injuries were reported by medical personnel and contained anatomical locations. Studies were excluded if it did not take place on a trail or if the injuries were self-reported. Risk of bias was assessed utilising the Joanna Briggs Institute (JBI) checklists for study quality. No meta-analysis or comparison between mountain bikers and hikers was possible due to the high heterogeneity of the definition of injury.

RESULTS

A total of 24 studies met the inclusion criteria, 17 covering mountain biking and 7 hiking. This represented 220,935 injured mountain bikers and 17,757 injured hikers. The most common type of injuries sustained by mountain bikers included contusions, abrasions and minor lacerations, which made up between 45-74% of reported injuries in studies on competitive racing and 8-67% in non-competitive studies. Fractures represented between 1.5-43% of all reported injuries. The most injured region was the upper limbs reported in 10 of 17 studies. For hikers the most common injuries included blisters and ankle sprains with blisters representing 8-33% of all reported injuries. The most common body location to be injured by hikers was a lower limb in all 7 studies.

CONCLUSIONS

This is the first systematic review to report on the injury epidemiology of the two most common trail users; mountain bikers and hikers. For participants in both activities the majority of injuries were of minor severity. Despite this, the high proportions of upper limb fractures in mountain bikers and ankle sprains in hikers cannot be ignored.

TRIAL REGISTRATION

Registration: This systematic review was prospectively registered with the University of York PROSPERO database on the 12/4/2021 (CRD42021229623) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021229623.

Current Perspectives of Cross-Country Mountain Biking: Physiological and Mechanical Aspects, Evolution of Bikes, Accidents and Injuries

Mountain biking (MTB) is a cycling modality performed on a variety of unpaved terrain. Although the cross-country Olympic race is the most popular cross-country (XC) format, other XC events have gained increased attention. XC-MTB has repeatedly modified its rules and race format. Moreover, bikes have been modified throughout the years in order to improve riding performance. Therefore, the aim of this review was to present the most relevant studies and discuss the main results on the XC-MTB. Limited evidence on the topic suggests that the XC-MTB events present a variation in exercise intensity, demanding cardiovascular fitness and high power output. Nonetheless, these responses and demands seem to change according to each event. The characteristics of the cyclists differ according to the performance level, suggesting that these parameters may be important to achieve superior performance in XC-MTB. Moreover, factors such as pacing and ability to perform technical sections of the circuit might influence general performance. Bicycles equipped with front and rear suspension (i.e., full suspension) and 29″ wheels have been shown to be effective on the XC circuit. Lastly, strategies such as protective equipment, bike fit, resistance training and accident prevention measures can reduce the severity and the number of injuries.