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AAOS Now

Published 8/1/2016
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Alan S. Hilibrand, MD

Preventing Bicycle Injuries

I encounter bicyclists nearly every day on my way to and from work in downtown Philadelphia, as well as in my own neighborhood. I'm frustrated when I see riders darting in and out of traffic, not signaling before they turn, and generally creating potentially dangerous situations on crowded roads and sidewalks.

However, the AAOS Public Service Announcement (PSA) campaign, developed in partnership with the Orthopaedic Trauma Association, has given me a new perspective on bicycle safety. The campaign's print advertisement, which features a bicycle made entirely out of bones, reads: "Riders Aren't Always in the Right. But They Are Always Fragile." It is a powerful reminder that bicycle safety involves all of us—not only the riders themselves, but also drivers, pedestrians, runners, and even orthopaedic surgeons.

Bicycling is becoming increasingly popular in the United States. Not only is it an economical way to get around, it's also a great way to stay fit. Unfortunately, the growing enthusiasm in cycling brings with it a rise in injuries and fatalities. According to the Consumer Product Safety Commission, more than 1.3 million cycling injuries were reported in 2014. Bruises and minor cuts are the most common injuries, followed by fractures (eg, collar bones and wrists), muscle strains, and sprains. But serious injuries, including death, do occur. In June, for example, a truck in Kalamazoo, Mich., struck a group of cyclists, killing five and seriously injuring four of the riders.

What can orthopaedic surgeons do to help ensure their patients stay safe when cycling? For starters, consider the following:

  • Direct patients who are cyclists to the AAOS Bicycle Safety page at OrthoInfo.org/bikesafety
  • Click on the Store tab at aaos.org and type in "riders" to order the new AAOS bike safety PSA posters or postcards for your office waiting room.
  • Link to the AAOS Bicycle Safety page on your practice website and social media pages, and include the tagline @AAOS and #bikesafety.
  • Write a letter to your local newspaper on bicycle safety. If you can, include a personal anecdote about a bicycle incident you may have witnessed, or mention if you're seeing an increase in fractures and other bicycle-related injuries. View a sample "letter to the editor" in the AAOS newsroom: http://newsroom.aaos.org/member-resources/member-opportunities/

When you are riding a bicycle, set a good example by wearing a helmet and following the rules of the road. And when driving, walking, or running, remember that the bicyclist sharing the road or sidewalk with you has more than 200 bones. As orthopaedic surgeons, we're committed to keeping all of them safe and in one piece.

Alan S. Hilibrand, MD, chairs the AAOS Communications Cabinet.

AAOS Bike Safety Rules from OrthoInfo.org/bikesafety:

  • Wear a helmet. Studies show that wearing a bike helmet reduces your risk of serious head and brain injury by 85 percent. Always wear a helmet approved by the American National Standards Institute.
  • Make sure the helmet fits snugly but comfortably, and does not obstruct your vision.
  • Your helmet should have a chin strap and buckles that stay securely fastened.
  • Follow the rules of the road. Familiarize yourself with all of the bicycle rules of the road in your city or state. Ride in the direction of traffic. Follow traffic signs and lights. Signal your turns or your intentions so that drivers can anticipate your actions. If you are riding with others, ride single file.
  • Ride defensively. Understand that drivers often do not see cyclists, so you must be fully aware of your surroundings and ready to act to avoid a collision. Intersections are especially dangerous because drivers making turns are not necessarily looking for cyclists. Be careful when riding next to parked cars to avoid being hit by an opening door.
  • Choose bike routes wisely. Avoid riding on high traffic roads. The most direct route to your destination is often not the safest because more vehicles will also take that route. Select streets with fewer and slower cars. Whenever possible, choose streets with designated bicycle lanes. If there is not a bicycle lane, ride on the right shoulder of the road. Choose wide streets. When a street lane is too narrow for a vehicle and bicycle to safely ride side-by-side, or if there are several parked cars on the street, you will need to join traffic and ride toward the center of the road. If this causes traffic behind you to jam, or if cars are switching lanes trying to pass you, it is safest to find a different, quieter street.
  • Avoid distracted cycling. Do not listen to loud music with head phones, talk on your phone, text, or do anything else that can obstruct your hearing and/or vision while riding.
  • Take extra precautions while bicycling at night. Wear bright fluorescent colors and make sure to have rear reflectors. Both a working tail light and headlight should be visible from 500 feet away.
  • No drugs or alcohol. Never ride a bicycle while under the influence of drugs or alcohol.
  • Never underestimate road conditions. Be cautious of uneven or slippery surfaces.
  • Maintain your bicycle. Check your bicycle's mechanical components on a regular basis (brakes, tires, gears, etc.), just like you would for a car. If your bike is not in good condition, do not ride it.
  • Adjust your bicycle to fit. Make certain the bicycle is the proper size for the rider. Appropriately sized frames, handlebar and seat heights will improve your ability to control the bike, and reduce the risk for overuse injuries. If you ride regularly, consider a professional fit from a bike shop.
  • Dress appropriately. Avoid loose clothing and wear appropriate footwear. Never wear flip-flops. Wear padded gloves. Use appropriately padded cycling shorts for longer rides. Wear sunscreen. If you commute on your bike, carry your belongings in a bag with close fitting straps.
  • Pace yourself. Cycling can be vigorous exercise. Make sure you are fit enough to participate before you start pedaling. In addition, make sure you understand how to use the gear systems on your bike to help control your physical exertion level. See your doctor before you begin any exercise program.
  • Change riding positions. Slight variations in your position can reduce stress on pressure points on your body and avoid overstressing muscles.
  • Hydrate. Be sure to carry water and food on longer rides. Drink a full water bottle each hour you spend on the bike.
  • Supervise younger riders at all times. It is recommended that younger children ride only in enclosed areas—away from moving vehicles and traffic.