Sex/gender differences in injury risk, types of injuries, and potential risk factors of adult recreational mountain-bikers in Tyrol
Authors: Pocecco Elena , Werner Inge , Bischofer Theresa , Ruedl Gerhard 
Published: September 2024

Introduction & Purpose
In Austria, 99% of fatally injured (Pocecco et al., 2022) and 81% of accidented mountain-bikers (Woyke et al., 2024) are males. However, these evident sex/gender differences in prevalence do not allow any conclusions to be drawn either about the risk of injury or about potential risk factors between the sex/genders.
Thus, the present study aimed to investigate possible sex/gender-specific differences in injury risk, types of injuries, and related potential risk factors in adult recreational mountain-bikers in Tyrol, Austria.
Methods
This retrospective survey was conducted in the surroundings of Innsbruck (Austria) in 2017-2019, involving randomly selected adult recreational mountain-bikers. A standardized questionnaire was used to collect data on injuries ever experienced during mountain-biking (MTB), including circumstances (e.g., skill level and risk-taking behaviour according to Ruedl et al. (2010), riding alone or in a group) related to the most severe injury.
Proportions were compared by χ2 tests.
Results
In total, 1,439 mountain-bikers (37.8 ± 14.3 years, 33.4% females) were interviewed, 486 (33.8%) of them suffering one or more injuries requiring medical attention. Men showed a higher injury risk compared to women (37.2% vs. 26.9%, p < 0.001) and injured males reported a higher number of injuries during MTB compared to their female counterpart (2.4 ± 2.4 vs. 1.7 ± 1.4, p < 0.001).
In general, concerning the most severe injury ever suffered during MTB, the most frequent injury types were fractures (28.4%), followed by open wounds (15.9%), contusions (14.5%), abrasions (12.0%), and ligament/muscle injuries (10.4%), showing sex/gender differences (p = 0.010). In particular, fractures were the most frequent injury type among male (32.7%), open wounds among female (20.3%) mountain-bikers.
Moreover, men reported higher MTB skills (p < 0.001) and higher risk-taking behaviour (72.8% vs. 50.5%, p < 0.001) at the time of the worst accident compared to women. Additionally, males were more likely to be biking alone on the day of the accident compared to females (30.1% vs. 15.0%, p = 0.007), who tended to ride in groups.
Discussion
Comparably to alpine skiing and snowboarding (Ruedl et al., 2010), men were found to exhibit a higher skill level and engage in riskier behaviour more frequently than women. In alpine skiing and snowboarding, these two factors are associated with higher speeds (Ruedl et al., 2010), which could be therefore also the reason for the higher injury risk and frequency of fractures among the surveyed male mountain-bikers. In the present study, fractures were the most common self-reported injury type with 28%, which seems comparable to 24% of fractures in the study by Woyke et al. (2024). Conversely, biking in a group, which was more common among women, apparently did not lead to a higher risk of injury due to possible peer pressure.
Conclusion
Results of this study found sex/gender differences in injury risk, types of injury, and related potential risk factors in recreational adult mountain-bikers which should be considered in future preventive measures. In particular, relevant information campaigns should address especially males. Moreover, future research comparing injured and non-injured recreational mountain-bikers should be conducted to confirm or reject the hypothesized risk factors.
References
Pocecco, E., Wafa, H., Burtscher, J., Paal, P., Plattner, P., Posch, M., & Ruedl, G. (2022). Mortality in recreational mountain-biking in the Austrian Alps: A retrospective study over 16 years. International Journal of Environmental Research and Public Health, 19(19), Article 11965. https://doi.org/10.3390/ijerph191911965
Ruedl, G., Pocecco, E., Sommersacher, R., Gatterer, H., Kopp, M., Nachbauer, W., & Burtscher, M. (2010). Factors associated with self-reported risk-taking behaviour on ski slopes. British Journal of Sports Medicine, 44(3), 204-206. https://doi.org/10.1136/bjsm.2009.066779
Woyke, S., Hütter, A., Rugg, C., Tröger, W., Wallner, B., Ströhle, M., & Paal, P. (2024). Sex differences in mountain bike accidents in Austria from 2006 to 2018: A retrospective analysis. High Altitude Medicine & Biology, 25(1), 89-93. https://doi.org/10.1089/ham.2023.0086