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.

Shoulder reduction on the scene: current practice and outcome of the Bavarian Mountain Rescue Service-a prospective observational study

Out-of-hospital reduction of shoulder dislocations using the Campell method is recommended by the International Commission for Alpine Rescue and applied in the Bavarian Mountain Rescue Service (Bergwacht Bayern, BWB) protocols. This prospective observational study includes patients out-of-hospital with suspected shoulder dislocation and treated and evacuated by the BWB. Data were systematically collected using three questionnaires: one completed on-site by the rescuer, the second in hospital by the physician and the third within 28 (8-143) days after the accident by the patient. The suspected diagnosis of shoulder dislocation was confirmed in hospital in 37 (84%) of 44 cases. Concomitant injuries in other body regions were found in eight (16%) of 49 cases and were associated with incorrect diagnosis (p = 0.002). Younger age (p = 0.043) and first shoulder dislocation event (p = 0.038) were associated with a higher success rate for reduction attempts. Out-of-hospital reduction of shoulder dislocations leads to significant pain relief and no poorer long-term outcome. Signs that are associated with successful out-of-hospital reduction (younger age and first event), but also those that are associated with incorrect diagnosis (concomitant injuries) should be considered before trying to reduce shoulder dislocation on site. The considerable rate of incorrect first diagnosis on site should give rise to an intensive discussion around teaching and training for this intervention.Trial registration: This study is registered with the German Registry for Clinical Trials (DRKS00023377).

Acute Effects of Sprint Interval Training and Chronic Effects of Polarized Training (Sprint Interval Training, High Intensity Interval Training, and Endurance Training) on Choice Reaction Time in Mountain Bike Cyclists

This study evaluated the acute effects of sprint interval training and chronic effects of polarized training on choice reaction time in cyclists. Twenty-six mountain bike cyclists participated in the study and were divided into experimental (E) and control (C) groups. The cyclists trained for 9-weeks and performed five training sessions each week. Types of training sessions: (1) sprint interval training (SIT) which consisted of 8-16, 30 s repetitions at maximal intensity, (2) high-intensity interval training (HIIT) included 5 to 7, 5-min efforts at an intensity of 85-95% maximal aerobic power (Pmax), and (3) endurance training (ET) performed at an intensity of 55-60% Pmax, lasting 120--180 min. In each week the cyclists performed: in group E a polarized training program, which included 2 × SIT, 1 × HIIT and 2 × ET, while in group C 2 × HIIT and 3 × ET. Before (acute effects) and after the 9-week training period (chronic effects) participants performed laboratory sprint interval testing protocol (SITP), which consisted of 12 maximal repetitions lasting 30 s. During SITP maximal and mean anaerobic power, as well as lactate ion concentration and blood pH were measured. Choice reaction time (RT) was measured 4-times: before and immediately after the SITP test-before and after the 9-week training period. Evaluated the average choice RT, minimal choice RT (shortest reaction), maximal choice RT (longest reaction), and the number of incorrect reactions. Before the training period as acute effects of SITP, it was observed: a shorter average choice RT (F = 13.61; p = 0.001; η² = 0.362) and maximal choice RT (F = 4.71; p = 0.040; η² = 0.164), and a decrease the number of incorrect reactions (F = 53.72; p = 0.000; η² = 0.691), for E and C groups. After the 9-week training period, chronic effects showed that choice RT did not change in any of the cyclists' groups. Only in the E group after the polarized training period, the number of incorrect reactions decreased (F = 49.03; p = 0.000; η² = 0.671), average anaerobic power increased (F = 8.70; p = 0.007; η² = 0.274) and blood pH decreased (F = 27.20; p = 0.000; η² = 0.531), compared to the value before the training period. In conclusion, a shorter choice RT and a decrease in the number of incorrect reactions as acute effects of SITP, and a decrease in the number of incorrect reactions and higher average power as chronic effects of the polarized training program are beneficial for mountain bike cyclists.

Serious cycling-related fractures in on and off-road accidents: A retrospective analysis in the Australian Capital Territory region

Cycling is an increasingly popular activity which is widely supported by health advocates. In the last year, more than a third of Australians used a bike [1]. While road cycling remains popular, participation in off-road recreational cycling, including mountain biking, bicycle moto cross (BMX) riding, and outdoor leisure cycling, is increasing and this is associated with an increase in the number and cost of cycling injuries [2-5]. The aim of this study was to describe and compare contemporary patterns of cycling fracture requiring hospitalisation as a function of cycling mode in the Australian Capital Territory region. This retrospective analysis of cycling-related-fracture hospitalisations in the ACT region described data recorded between July 2012 and December 2019. Logistic regression models were used to calculate probabilities of sustaining a fracture at different sites for each of the cycling modes (on-road, mountain, BMX, leisure, unspecified). These likelihoods were then compared against the on-road fracture profile. Cycling-related-fracture hospitalisations increased by 32% in the seven years analysed. Of all fracture admissions, 442 (33%) were on-road, 658 (49%) off-road, and 242 (18%) unknown. The majority were male (79%), median age 37 (IQR 16, 52). Median length of stay was two days. The number of fractures per admission ranged from one to thirteen with a median of one. Wrist, clavicle, ribs, and skull were the four most frequent fracture sites for all cycling modes. Fracture profiles of on- and off-road accidents were similar, with the exception of wrist fractures which were more likely in off-road (OR 1.96, p < 0.01) and unspecified cycling accidents (OR 5.07, p < 0.01). Skull fractures comprised 19% of all BMX-related fractures. More than half of all fracture-related admissions required surgery. With increasing support for sustainable and healthy transport and recreation activities, the fracture profiles of different cycling modes must first be assessed in order to inform strategies to reduce and manage this injury burden.

Mortality in Recreational Mountain-Biking in the Austrian Alps: A Retrospective Study over 16 Years

Despite recreational mountain-biking's growing popularity worldwide, the literature on mortality in this leisure sporting activity is scarce. Therefore, the aim of the present study was to investigate the characteristics of fatal accidents as well as resulting dead victims during recreational mountain-biking in the Austrian Alps over the past 16 years. For this purpose, a retrospective study based on Austrian institutional documentation from 2006 to 2021 was conducted. In total, 97 fatalities (1 woman) with a mean age of 55.6 ± 13.9 years were recorded by the Austrian Alpine Police. Of those, 54.6% died due to a non-traumatic (mostly cardio-vascular) and 41.2% due to a traumatic event. Mountain-bikers fatally accidented for non-traumatic reasons frequently belonged to older age classes (p = 0.05) and mostly (73.6%) died during the ascent, whereas traumatic events mainly (70.0%) happened during the descent (p < 0.001). Throughout the examined period, the absolute number of fatalities slightly increased, whereas the mortality index (proportion of deaths/accidented victims) did not (mean value: 1.34 ± 0.56%). Factors such as male sex in general, above average age and uphill riding for non-traumatic accidents, as well as downhill riding for traumatic events, seem to be associated with fatalities during recreational mountain-biking in the Austrian Alps. These results should be considered for future preventive strategies in recreational mountain-biking.

The National Interscholastic Cycling Association Mountain Biking Injury Surveillance System: 40,000 Student-Athlete-Years of Data

ABSTRACT

A web-based injury surveillance system was implemented through a collaboration between University of Utah researchers and the National Interscholastic Cycling Association (NICA) to better understand injury characteristics in mountain biking. Data were collected from NICA leagues during the 2018 and 2019 seasons. Injuries were tracked in 41,327 student-athlete-years, identifying 1750 unique injuries during 1155 injury events. Rider-dependent and rider-independent variables were analyzed. The most commonly reported injuries were concussion (23.6%), injuries to the wrist/hand (22.3%), and shoulder (15.6%). Half of all injury events occurred on downhills. Men and women reported similar yet significantly different injury rates (2.69% and 3.21%, respectively; P = 0.009). Women sustained more lower-limb injuries (37.8% vs 28.3%; P = 0.003). Nearly 50% of crashes resulted in an emergency room visit. Youth mountain bike racing is a rapidly growing sport. Acute traumatic injuries are common. Injury surveillance system data are now being used to inform injury prevention strategies and direct future research.

The National Interscholastic Cycling Association (NICA) Mountain Biking Injury Surveillance System (ISS): Analysis of 66,588 Student Athlete-Years of Injury Data

Interscholastic youth cross-country mountain bike racing in the United States has grown significantly over the past decade, yet little is known about the risk profile in this age group. Aiming to protect participants, we implemented a prospective, longitudinal injury surveillance system for the purpose of better understanding youth mountain biking injuries and implementing safety measures. Data were collected during competition years 2018–2020, totaling 66,588 student athlete-years. Designated reporters from each team received weekly emails with exposure and incident report forms. Variables analyzed included demographic, rider-related, trail-related, and other data. Injury characteristics during the COVID-19 pandemic in 2020 were compared to the years 2018 and 2019. More student athletes participated in the 2020 season (25,261) than in prior seasons (18,575 in 2018 and 22,752 in 2019). During competition year 2020, overall injury proportion was lower (1.7% versus 3.0% in 2018 and 2.7% in 2019). Variables associated with injury, body part injured, type of injury, time-loss, and disposition following injury were similar between all years. Despite the pandemic and resultant changes to competition, student athletes continued to ride their bikes and become injured, but the proportion of injuries differed. This report details injury characteristics in youth mountain bike racing, including a comparison of before and during the pandemic.

Head Over Wheels: Traumatic Head and Neck Injuries Secondary to Mountain Biking

OBJECTIVES

The popularity of mountain biking (MTB) in the United States has risen in recent years. We sought to identify the prevalence and distribution of MTB associated head and neck injuries presenting to emergency departments across the U.S. and identify risk factors for hospital admission in this patient population.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for MTB related injuries of the head and neck from 2009 to 2018, with analysis for incidence, age, gender, anatomic site, and diagnoses.

RESULTS

A total of 486 cases were identified, corresponding to an estimated 18 952 head and neck MTB related ED visits. Patients were predominantly male (80.7%) and white (69.8%) with a median age of 35 years (interquartile range, 21-46 years). A majority (88.4%) of patients were released from the ED, but a significant proportion of patients were admitted (9.2%) or transferred (1.2%). The most common facial fractures were facial/not specified (35%), nasal bone (29%), mandible (15%), orbit (12%), and zygomaxillary complex (9%). The greatest predictors of hospital admission/transfer were injury to the mouth or neck and avulsion-type injury (P < .001).

CONCLUSIONS

MTB results in a significant number of traumatic head and neck injuries nationwide. Patients are primarily adult, white males. The majority of injuries result in discharge from the ED, however a small amount of these patients experience significant morbidity necessitating hospital admission. Understanding the distribution of MTB head and neck injuries may aid in the clinical evaluation of these patients.

LEVEL OF EVIDENCE

4.

The effects of vibration on efficiency in off-road cyclists

Objectives

The aim of this study was to investigate whether vibration significantly affected the efficiency of off-road cyclists.

Patients and methods

Eight male mountain cyclists (mean age 21.1±1 years; range, 19 to 22 years) between August 2017 and November 2017 were included. The experimental protocol included four testing sessions with a one-day interval between testing sessions: a familiarization session; performance of submaximal tests; performance of maximal graded exercise test; and a 30-min mountain bike trial performed with vibration or without vibration. Physiological measures including volume of oxygen uptake (VO₂), volume of ₂), VO₂, VCO₂, heart rate, respiratory exchange ratio, rating of perceived exertion, and gross efficiency (GE) were compared between the trials performed with vibration or without vibration.

Results

There was a significant increase in the GE with the addition of intermittent vibration, particularly over the last 15 min of the cycling trial (p<0.05). There were no significant effects of vibration on other parameters.

Conclusion

This study demonstrates that addition of intermittent vibration may provide positive benefits in improving GE during a 30-min submaximal cycling trial.

The NICA injury surveillance system: Design, methodology and preliminary data of a prospective, longitudinal study of injuries in youth cross country mountain bike racing

OBJECTIVES

To describe the design and implementation of an injury surveillance system for youth mountain bike racing in the United States, and to report preliminary first-year results.

DESIGN

Descriptive sports injury epidemiology study.

METHODS

After two and a half years of development and extensive beta-testing, an electronic injury surveillance system went live in January, 2018. An automated email is sent to a Designated Reporter on each team, with links to the injury reporting form. Data collected include demographic information, injured body part, injury diagnosis, trail conditions and other factors associated with injury occurrence.

RESULTS

837 unique injuries were reported in 554 injury events among 18,576 student-athletes. The overall injury event proportion was 3.0%. The most common injury among student-athletes was concussion/possible concussion (22.2%), followed by injuries to the wrist and hand (19.0%). Among 8,738 coaches, there were 134 unique injuries reported that occurred in 68 injury events, resulting in an overall injury event proportion of 0.8%. The shoulder (38.2%) was the most commonly injured body part among coaches. Injuries among coaches tended to more frequently result in fractures, dislocations and hospital admission compared with injuries among student-athletes. Among student-athletes, female riders sustained lower limb injuries more than male riders (34.0% vs. 20.7%, p<0.001).

CONCLUSIONS

A nationwide injury surveillance system for youth mountain bike racing was successfully implemented in the United States. Overall injury event proportions were relatively low, but many injury events resulted in concussions/possible concussions, fractures, dislocations and 4 weeks or longer of time loss from riding.

Prevalence of Hip or Groin Pain in Adolescents: A Systematic Review and Meta-Analysis

Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population-based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into "0 to 3 months" and "3 months and above." Meta-analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overall prevalence of hip or groin pain in all adolescents from 0 to 3 months was 12% (95% confidence interval [CI] 6%, 23%) based on 10 studies, and was 7% (95% CI 6%, 10%) based on 7 population studies. Caution should be applied to these estimates due to substantial study heterogeneity. The pain prevalence in cerebral palsy from 0 to 3 months based on 4 studies was 13% (95% CI 10%, 15%). Individual prevalence estimates were 6% and 31% in obese and 4% in hypermobility populations, respectively, and ranged from 6% to 100% in 4 sports studies. The validity of these estimates is compromised by poor methodological quality.

Mortality in Different Mountain Sports Activities Primarily Practiced in the Summer Season-A Narrative Review

Millions of people engage in mountain sports activities worldwide. Although leisure-time physical activity is associated with significant health benefits, mountain sports activities also bear an inherent risk for injury and death. However, death risk may vary across various types of mountain sports activities. Epidemiological data represent an important basis for the development of preventive measures. Therefore, the aim of this review is to compare mortality rates and potential risk factors across different (summer) mountain sports activities. A comprehensive literature search was performed on the death risk (mortality) in mountain sports, primarily practiced during the summer season, i.e., mountain hiking, mountain biking, paragliding, trekking, rock, ice and high-altitude climbing. It was found that the death risk varies considerably between different summer mountain sports. Mortality during hiking, trekking and biking in the mountains was lower compared to that during paragliding, or during rock, ice or high-altitude climbing. Traumatic deaths were more common in activities primarily performed by young adults, whereas the number of deaths resulting from cardiovascular diseases was higher in activities preferred by the elderly such as hiking and trekking. Preventive efforts must consider the diversity of mountain sports activities including differences in risk factors and practitioners and may more particularly focus on high-risk activities and high-risk individuals.

Benefits of Outdoor Sports for Society. A Systematic Literature Review and Reflections on Evidence

The combination of physical activity and being in nature is recognized as providing a range of significant benefits. The objective of this literature review was to compile an overview of the social benefits and costs associated with outdoor sports within the academic literature and to reflect on the quality of underlying evidence that supports the relationship. A systematic review was carried out with seven partners from different European countries, including Bulgaria, France, Germany, United Kingdom, Italy, Portugal, and Spain. From a total of 17,560 studies identified, 133 studies were selected with relevant data extracted to standardized forms. The selected studies have been analyzed with qualitative research methods. A meta-analysis could not be conducted due to the heterogeneity of the study designs and outcome measures. As a result, the review gives an overview of the social impacts associated with outdoor sports which have been clustered to six broad categories: physical health, mental health and wellbeing, education and lifelong learning, active citizenship, crime reduction, and anti-social behavior, as well as additional benefits. The review furthermore revealed gaps in the evidence base which are especially notable in the long-term effects that outdoor sports can have on personal and social development.

Autonomic changes induced by pre-competitive stress in cyclists in relation to physical fitness and anxiety

Cycling is a sport which requires great physical effort from athletes. The stress and anxiety of competition might interfere greatly with performance, by impacting the autonomic system. Physiological alterations, such as situations that irritate, frighten or excite the individual can cause a stress response, defined as a response of the organism to reestablish the homeostasis, regardless of its relationship to a sports situation. The aim of this study was to present data on the autonomic changes induced by precompetitive stress in cyclists and their relation with physical fitness and anxiety. Twelve healthy cyclists aged between 18 and 40 years, with previous experience in competition at the regional level, participated in the study. Heart rate variability (HRV) and physical fitness (body mass index, body fat and aerobic capacity) were measured 5 days before the Mountain Bike championship and remeasured 45 minutes before the start of the race (HRV and Anciety). Paired T test, effect size and correlational test were used. Cycling competition is a stressful situation capable of altering autonomic and hemodynamic parameters. We observed the increase in SDNN, reflecting an increase in sympathetic autonomic control. There were correlations between physical fitness with some autonomic parameters, while anxiety correlated with the years of experience in competition.

Mountain Biking Injuries

With the increasing popularity of mountain biking, also known as off-road cycling, and the riders pushing the sport into extremes, there has been a corresponding increase in injury. Almost two thirds of acute injuries involve the upper extremities, and a similar proportion of overuse injuries affect the lower extremities. Mountain biking appears to be a high-risk sport for severe spine injuries. New trends of injury patterns are observed with popularity of mountain bike trail parks and freeride cycling. Using protective gear, improving technical proficiency, and physical fitness may somewhat decrease the risk of injuries. Simple modifications in bicycle-rider interface areas and with the bicycle (bike fit) also may decrease some overuse injuries. Bike fit provides the clinician with postural correction during the sport. In this review, we also discuss the importance of race-day management strategies and monitoring the injury trends.

Recreational Sporting Activity Vehicle-Related Deaths

Deaths occurring in the setting of nonprofessional, vehicle-related, recreational sporting activities occurring on land or in water during warm or winter months represent a diverse group of cases. These deaths tend to involve scenarios where the participants are purposefully attempting to enjoy themselves prior to experiencing sudden, catastrophic accidents resulting in lethal outcomes. Ultimately, many of the deaths are related to the high speed at which these vehicle-related activities normally occur. Three broad categories of factors may play contributory roles in death: human factors, vehicle factors, and environmental factors. A series of selected cases are presented, representing examples of varying activity types, involving motorized and nonmotorized vehicles, land and water activities, and warm weather and cold weather environments. For each case, the various human, vehicle and environmental factors believed to be contributory to the accident are considered, and strategies for prevention of these and similar deaths involving recreational sporting vehicles are presented.

Injury and illness among athletes during a multi-day elite cycling road race

OBJECTIVES

Although road bicycle races have been held for more than a century, injury and illness patterns during multi-day bicycle events have not been widely studied. The aim of this study was to determine the incidence of injury and illness among riders and describe the medical care interventions provided to participants of cycling road races.

METHODS

A prospective observational study was conducted on the Presidential Cycling Tour of Turkey, which was held between April 26 and May 3, 2015. The race lasted 8 days and covered 1258 km of road. There were 166 elite cycling athletes representing 21 teams from various countries. Data collected pertaining to incidents involving injury or illness included the following: type of injury; anatomical location of injury; details of the medical encounter; location of the intervention; treatment provided; medication administered and disposition of the rider. An injury was defined as a physical complaint or observable damage to the body produced by the transfer of energy of the rider. An illness was defined as a physical complaint or presentation not related to injury.

RESULTS

The overall incidence (injury and illness) was 5.83 per 1000 cycling hours. (Injury incidence was 2.82 vs illness incidence of 3.01 per 1000 hours cycling). A total of 31 incidents occurred. Of these, 15 were injuries, while 16 were complaints of a non-traumatic nature. A total of 43 interventions were made in the 15 cases of injury. The most commonly injured body regions were limbs; the majority of injuries involved the skin and soft tissue. The most common medical intervention was wound care (64% of all interventions). Two riders had to withdraw from the race, and one was hospitalized due to a traumatic pneumothorax. None of the non-traumatic cases resulted in withdrawal from the race.

CONCLUSIONS

A broad spectrum of illness and injury occurs during elite multi-day road races, ranging from simple skin injuries to serious injuries requiring hospital admission. Most injuries and illnesses are minor; however, medical teams must be prepared to treat life-threatening trauma.

Pain-Coping Traits of Nontraditional Women Athletes: Relevance to Optimal Treatment and Rehabilitation

CONTEXT

The primary goal of traditional treatment and rehabilitation programs is to safely return athletes to full functional capacity. Nontraditional activities such as rock climbing or rodeo are typically less training structured and coach structured; individualism, self-determination, and autonomy are more prevalent than observed in athletes in National Collegiate Athletic Association (NCAA)-sponsored sports. The limited research available on nontraditional athletes has provided the athletic trainer little insight into the coping skills and adaptations to stressors that these athletes may bring into the clinical setting, especially among the growing number of women participating in these types of activities. A better understanding of the pain-coping traits of nontraditional competitors would enhance insight and triage procedures while heading off potential athlete-related risk factors in the clinical setting.

OBJECTIVE

To quantify and compare pain-coping traits among individual-sport women athletes participating in nontraditional versus traditional NCAA-structured competition, with relevance to optimal treatment and rehabilitation.

DESIGN

Cross-sectional study.

SETTING

Data collected during each participant's respective group meeting before seasonal activity. Participants or Other Participants : A total of 298 athletes involved in either nontraditional, non-NCAA individual sports (n = 152; mean age = 20.2 ± 1.3 years; downhill skiing, martial arts, rock climbing, rodeo, skydiving, telemark skiing) or traditional NCAA sports (n = 146; mean age = 20.3 ± 1.4 years; equestrian, golf, swimming/diving, tennis, track).

MAIN OUTCOME MEASURE(S)

All participants completed the Sports Inventory for Pain, a sport-specific, self-report instrument that measures pain-coping traits relevant to competition, treatment, and rehabilitation. Trait measures were direct coping, cognitive, catastrophizing, avoidance, body awareness, and total coping response. Data were grouped for analyses by type of athlete (nontraditional, traditional).

RESULTS

We found a significant main effect for type of athlete (Wilks' λ F6,291 = 12.922; P = .0001). Nontraditional sport athletes scored lower on direct coping (P = .0001), cognitive (P = .0001), catastrophizing (P = .0001), and total coping response (P = .0001) than traditional athletes.

CONCLUSIONS

Women participating in nontraditional individual-sport activity revealed less pronounced pain-coping traits than women participating in more coach-structured, traditional NCAA sports. Sport and medical personnel should consider the type of athlete when prescribing training, treatment, and rehabilitation for optimal performance and return to play.

Injuries sustained by bicyclists

Although generally a safe activity with considerable health benefit, the wide social prevalence of cycling, its performance by both young and elderly riders, and the increasing operation of bicycles in complex urban environments results in a significant incidence of trauma. Orthopedic injuries, followed by head and facial trauma, are most frequent but all anatomic regions can be affected and the spectrum of injury ranges from minor to severe and potentially fatal. Clinicians need to be aware of the range of injuries and causative mechanisms as many patients may present with relatively minor signs and symptoms despite significant underlying pathology. Non-commuter, recreational cyclists are also at risk for injury due to: variable terrain and environmental conditions; increased competitive and risk-taking behavior; technical equipment failure; and poor compliance with protective equipment. Numerous injury preventative strategies have been advocated including: increased rider training; creation of dedicated traffic lanes for commuting cyclists; bike-awareness education for motorists and interventions to improve cyclist visibility; increased utilization of protective equipment and programs to reduce concomitant drug or alcohol use. Of all preventative strategies, bicycle helmets have received the most study, leading to legislated use in some jurisdictions. As urban environments become more congested for commuter cyclists, and interest in recreational and competitive cycling grows, bicycle injury is likely to become more prevalent.

Grade III Liver Laceration in a Female Volleyball Player

A 20-year-old female collegiate volleyball athlete (body mass, 74.8 kg; height, 177.8 cm), with no previous history of abdominal injury, dove for a ball during a match and was struck in the anterolateral abdominal region by a teammate’s knee. She experienced a solar plexus spasm, shortness of breath, and nausea. On-site evaluation revealed sharp pain in the right upper quadrant and epigastric area, pallor, continued nausea, and excessive sweating. Upon arrival to the emergency department, an abdominal/pelvic computed tomography (CT) scan with intravenous contrast showed a small amount of fluid along the posteromedial surface of the liver indicating a subcapsular hematoma. A trace amount of free fluid in the right paracolic gutter and pelvis was also noted, suggesting a hemoperitoneum. The athlete was diagnosed with a grade III laceration (> 3 cm parenchymal depth) on the right lobe of the liver. She was hemodynamically stable and vital sign values were normal ~2.5 hours postinjury (blood pressure, 118/76 mm Hg; heart rate, 68 beats per minute; respiratory rate, 16 breaths per minute; tympanic temperature, 36.3°C). The athlete was admitted into the intensive care unit for observation, and the attending physician decided on a conservative, nonoperative approach to treatment. Forty-eight hours postinjury, a second abdominal/pelvic CT scan was ordered and revealed no increased bleeding or extensive damage to the liver. Two days later, after being discharged from the hospital, she was prohibited from practicing until a third abdominal/pelvic CT scan was performed and showed no residual injury to the liver (5 weeks postinjury). The athlete returned to play 6 weeks postinjury without complications; however, she continued performing rehabilitation focusing on cardiorespiratory endurance.

Acute hand and wrist injuries sustained during recreational mountain biking: a prospective study

BACKGROUND

Recreational mountain biking continues to increase in popularity and is a significant source of traumatic injury, including injuries to the hand and wrist.

METHODS

A prospective survey of all hand and wrist injuries sustained while participating in recreational mountain biking presenting to the emergency department at the Municipality of Whistler and the District of Squamish was conducted over a 12-month consecutive period.

RESULTS

An analysis of 765 unique emergency department visits with 1,079 distinct injuries was performed. Of these injuries, 511 were sustained to the upper limb. Injury to the metacarpal and metacarpal phalangeal joints was the most common hand injury (52) followed by proximal phalanx and proximal interphalangeal joint (20).

CONCLUSIONS

Mountain biking is a frequent source of a variety of upper limb trauma, and preventative efforts are necessary to minimize the burden of these injuries.

An update on the epidemiology of pediatric fractures

Despite public health measures to prevent childhood injuries, the incidence of pediatric fractures is increasing. This fracture incidence is dependent on many demographic factors, the various contributors to bone health, and an individual's risk-taking behavior. Although traditional play activities continue to be the prevalent causes for fractures, there is an evolving array of new sport and recreation activities that carry significant fracture risk. The following review article outlines the developing epidemiology of pediatric fractures by analyzing some of the individual risk factors that influence fracture incidence as well as the variety of activities that are associated with these fractures.