Bicycle injuries are mounting, especially in adults

Beverly Merz

Executive Editor, Harvard Women's Health Watch

For the past month, the Boston medical community has been mourning the death of Dr. Anita Kurmann, who was killed in a traffic accident while biking to work on a Friday morning. Dr. Kurmann, an endocrine surgeon, was completing a three-year fellowship at Boston University and Harvard-affiliated Beth Israel Deaconess Medical Center. She had made great progress with coaxing stem cells to grow into thyroid tissue. Her bicycle has been painted white and chained to a post at the site where she died, one of several “ghost bikes” that commemorate other lives lost in a similar fashion.

It’s ironic that Dr. Kurmann lost her life doing one of the things that kept her fit and healthy. But, as a study described in this week’s Journal of the American Medical Association points out, cycling is becoming an increasingly risky activity. For the study, a team of researchers from the University of California, San Francisco examined data regarding hospital admissions for cycling injuries between 1998 and 2013. They found that the rate of people seeking treatment for bicycle injuries had risen 28%, from 96 to 123 per 100,000 — and the rate of injuries that sent people to the hospital had increased by 120%, growing from 5.1 to 11.2 per 100,000. Head injuries accounted for 16% of all injuries; torso injuries accounted for 17%. And the proportion of accidents on city streets had risen from 40% to 65% of all bicycle accidents. Moreover, it was people over 45 — not children or teens — who had the greatest increase in bicycle-related injuries.

Advice for city cyclists

Nicole Freedman is a former Olympic cyclist who has served as bicycle commissioner of Boston and is currently Chief of Active Transportation and Partnerships in Seattle. She says that cycling is still a fairly safe way to get around in the city, as long as riders are alert to potential hazards. Based on the kinds of accidents she’s seen, she has three pieces of advice:

  1. Stay clear of any trucks. “The last place you want to be is on the right of a truck,” she says. “If you find yourself in this situation, get up on the curb.” The greatest danger arises when a truck, especially an 18-wheeler or a flatbed, makes a right turn. A cyclist on the truck driver’s right may be in his or her blind spot, and it’s often impossible for a cyclist to see the truck’s turn signal flashing from this position. Dr. Kurmann was killed in one of these “right-hook” crashes.
  2. Be hyper-aware of your surroundings. You want to try to predict what trucks, cars, and pedestrians are going to do next. “Cycling on city streets is very different from a recreational ride on a designated bike path,” Freedman cautions.
  3. Give parked cars a wide berth. “Dooring,” in which cyclists are smacked by drivers opening car doors or injured trying to avoid a car door, is one of the most common causes of injuries in urban areas.

Everyday safety tips

Even if you’re cycling on a secluded country lane, it’s a good idea to follow these common-sense suggestions from the League of American Bicyclists:

  1. Protect yourself. Wear a properly fitted helmet and clothing with reflective fabric at night and in cloudy weather.
  2. Maintain your bike. Make sure your bike fits you and that it is fit for road conditions. Get a good light for night cycling.
  3. Learn and follow the rules of the road. Most states require bicyclists to follow the same rules as drivers of other vehicles. You can find the rules of the road for most states here.
  4. Communicate with those who share the road with you. Make eye contact and use hand signals to indicate what you’re about to do. The simplest gestures, like extending your right or left arm to signal a turn, can avert a collision.

For more detailed information on bike safety and all things cycling, check out the League’s website.

If you’d rather let someone else do the driving…

There’s a way to minimize your cycling risks even further — cycle inside a moving vehicle. Entrepreneurs have developed a way for you to get your cycling miles in, enjoy the landscape moving past, and leave the road worries to someone else. Buses equipped with stationary bikes have sprung up on both coasts and may be coming to a place near you sometime soon.

Related Information: Starting to Exercise


  1. TheBikeGuy

    There is some myth about “truck’s blind spot” : most trucks are equipped with big, convex, WIDE-ANGLE MIRRORS and see EVERYTHING –quite UNlike the sideview mirrors on cars, e.g.! I suppose if one were right at/below such a mirror mounted on the door’s mirror mount –and there wasn’t one mounted up at the front corner of the truck, then one would be in a blind spot. Also, long trucks, in turning right, have to move out leftwards to gain enough room to bring their rear wheels around through the travel lane –sometimes, yes, they end up riding over the corner curb–; so, usually, a righthand turn by a tractor-trailer is something well indicated by vehicle behavior.

    The advice section recommends wearing reflective clothing at night, but puts the recommendation for a light –and the sense I get is that what is meant is a HEADlight, not also a rear red blinky– in the next bullet!? There should be a recommendation for cyclists to wear conspicuous attire –“dayglo” or other bright attire; many folks ride around in what is more like camouflage, sadly. And, for rear red blinkies, think “3 is not too many; 1 might be too few!”

  2. Bill Davidson

    Without data on rates of cycling injuries relative to the number of cyclists and the number of miles they ride, the implication that the roads are getting more dangerous for cyclists is irresponsible and alarmist. For all we know the rate of injury per cyclist and/or per mile ridden could be going down.

    As for safety, I recommend a class from Cycling Savvy if you can or a League of American Bicyclists Certified instructor. There are also books like Cyclecraft, Bicycling Street Smarts and Effective Cycling.

  3. David Hoffer

    What is left out of this article, but reported in the original journal paper, is that the total number of cyclists is increasing, probably due to so many people choosing to bicycle commute to work. Of course the absolute number of injury rates will rise, relative to the total population. As suggested in the journal article, what is needed is to compare the rates of injury for all cyclists now vs. all cyclists in the past, but unfortunately, such historical data is not available.

  4. Ediriweera Desapriya

    There are big challenges facing our active and health conscience citizens today. Even though Governments and the policy makers around the globe encouraging communities to engage in active life styles, can our communities engage in active life styles without compromising their safety? “It’s ironic that Dr. Kurmann lost her life doing one of the things that kept her fit and healthy.” There is strong evidence out there on how to make cycling safer for our communities: (1). we need to increase access to more safer and separated cycling routes; (2). there is an urgent need for investments in cycling education programs in communities (3). drivers need to be educated about how to share the road with cyclist and other vulnerable road users, (4). effective laws to protect cyclists (5). encourage cyclists to wear safety helmets.

  5. Brendan Kevenides

    An irresponsible piece of journalism about biking injuries and deaths was published yesterday by National Public Radio under the headline, As More Adults Pedal, Their Biking Injuries and Deaths Spike, Too. The story noted the fact that the number of people biking regularly has substantially increased over the past several years, while spotlighting a “striking” rise in the number of injuries and deaths from cycling among adults. Much emphasis was placed on crashes involving middle aged men who, supposedly wanting to emulate disgraced former pro cyclist Lance Armstrong, ran out in droves a decade ago to purchase uberfast road bikes which they proceeded to crash.

    Yes, bicycling has been on the rise for quite some time, particularly as a form of transportation, as opposed to recreation or sport. Chicago, for example, saw a 150 percent increase in the number of people bicycling to work between 2000 and 2010. Similarly, New York City has seen staggering growth in the number of people biking to work. Despite this growth, “Bicycling remains a healthful, inherently safe activity for tens of millions of people every year,” according to the U.S. Department of Transportation. Tens of millions. In contrast, 743 bicycle related deaths were reported nationwide for the year 2013, according to U.S. DOT. In Chicago the number of fatal crashes decreased by 28 percent between 2005 and 2010, according to the Chicago Department of Transportation. While one death is one too many these numbers neither suggest that bicycling is exceptionally dangerous nor that it is becoming more so.

    With more people riding their bikes there will naturally be more traffic crashes involving bicyclists. But more bicyclists on the road likely makes biking safer for the individual rider. The idea is that there is safety in numbers. As drivers get used to seeing more bikers, they are more likely to be on the lookout for dangerous interactions. It is true that, according to the U.S. DOT, “bicyclists seem to be over-represented in the crash data.” Bicycle trips account for one percent of all trips in the United States, yet represent nearly two percent of all traffic fatalities. But no reliable data exists to correlate the number of miles traveled by cyclists and the risks to which riders are exposed. “Until we have better exposure measures, we just don’t know how bicyclist risk compares to other modes,” says the U.S. DOT, adding, “But the health benefits of riding may offset some of this risk.”

  6. Melissa Orlov

    But is the rate increasing because the absolute number of cyclists per 100,000 is up? Or the amount of time spent on a bike by the people who are riding them has increased? Does texting come into the equation? I find this article leaves me with more questions than it answers…

  7. Michael Rosengarten

    This is a chilling video of the rear wheels of sweeping through the bike lane during a right turn onto the BU bridge. Note if there were a bike in the lane, the bike and the biker would have been crushed.

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