Football and other contact sports get a lot of attention for their injury hazards. But for most adults, bike riding is the biggest back-breaker, a new study suggests.
Of more than 12,000 sports-related spinal injuries among U.S. adults, researchers found that a full 81% were due to bicycling mishaps. The injuries mostly included vertebral fractures, often in the neck but also in the middle and lower back. Some cyclists sustained potentially paralyzing trauma to the spinal cord as well.
After biking, the study found, skiing and snowboarding were the most common culprits, accounting for 12% of spinal injuries. Contact sports, meanwhile, were behind at 3%.
Much research and media attention have gone toward the risks of serious head and spinal injuries in contact sports. So it might sound surprising that cycling was involved in so many spinal injuries in this study.
But the findings make sense, experts said. For one, many more adults regularly ride bikes than play tackle football.
"This is reflecting the sheer number of people who take part in these activities," said Dr. Alexander Hughes, a spine surgeon at the Hospital for Special Surgery in New York City.
Bicycling also presents some major risks for spine trauma: falls and collisions with motor vehicles.
Cyclists who do long distances, reaching high speeds, are at risk of high-velocity crashes, whether another person is involved or not, Hughes said. Meanwhile, people who bike in cities often share roads with cars and trucks.
But it's not clear from the study, Hughes noted, what circumstances led to cyclists' injuries.
Another unknown is whether injured cyclists were wearing a helmet. But, Hughes said, while helmets can lessen the risk of a traumatic brain injury, they are not a shield against spine trauma.
So it's important that cyclists wear a helmet, but not have a false sense of security from it.
"Wearing a helmet doesn't make you invincible," Hughes stressed.
The findings -- published online Aug. 24 in the Journal of Neurosurgery: Spine -- come from a nationwide database tracking Americans hospitalized for traumatic injuries.
Blake Hauser and her colleagues at Harvard Medical School in Boston focused on more than 80,000 cases of sports-related injury. Of those, just over 12,000 involved trauma to the spine.
Overall, Hauser said, the "vast majority" of the sports injuries -- including spine trauma -- involved motor vehicle accidents or falls.
Given that, she said, it's not surprising that cycling was the sport most often implicated.
But the picture was different when it came to injuries that affected the spinal cord itself. Those traumas -- seen in 15% of all spinal injuries -- were largely related to "water sports" or contact sports.
It's not clear what was going on in the case of water sports, Hauser said. But diving in unsafe areas is one way people can suffer such devastating injuries.
"Numerous other studies have highlighted the relationship between spinal cord injury and diving in an unsafe environment," she said. "So avoiding that scenario is advisable."
As for bike safety, both cyclists and drivers have important responsibilities, according to Dr. Andrea Cyr.
Cyr is a sports medicine physician at the University of Illinois Chicago and an avid cyclist.
She said that distracted driving -- drivers taking their eyes off the road to text, for instance -- is an issue, as is drunken driving. Plus, Cyr said, many drivers are unaware of how to safely share the road with people on bikes, including how to pass them.
Streets and roads with dedicated bike lanes are one way to help, and in recent years, Hughes noted, communities have been giving that more attention.
The simplest way to designate a bike lane is with painted lines on the pavement. But, Cyr said, there's some evidence that physical barriers between car traffic and bike lanes are a more effective safety measure.
As for what cyclists themselves can do, Cyr recommended using lights on the bike day and night to boost visibility. Knowing which local roads are the most bike-friendly is also key.
In general, Cyr added, everyone on the road needs to exercise patience.
"Have patience and remember that we're all trying to get home to our loved ones," she said. "We need to have respect for each other on the road."
More information
The nonprofit National Safety Council has advice on bicycling safety.
SOURCES: Blake Hauser, BSPH, MD/PhD student, Harvard Medical School, Boston; Andrea Cyr, DO, sports medicine physician, University of Illinois Chicago; Alexander Hughes, MD, spine surgeon, Hospital for Special Surgery, and associate professor, orthopedic surgery, Weill Cornell Medical College, New York City; Journal of Neurosurgery: Spine, Aug. 24, 2021, online
