OHSU bike commuter injury study released

Eastbank esplanade ramp-4

(Photo © J. Maus)

Back in February we shared a sneak peek at a study done by Oregon Health Sciences University (OHSU) that tracked bike commuters and monitored the types and severity of injuries they received during a one-year period. That study has now been published and is embedded at the end of this post.

The study is titled, Bicycle Commuter Injury Prevention: It Is Time to Focus on the Environment. It was published in the November 2010 issue of The Journal of TRAUMA® Injury, Infection, and Critical Care.

Here is the background:

Few data exist on the risk of injury while commuting to work or school by bicycle. The proportion of commuters choosing to travel by bike is increasing in the United States, and information on injury incidence and the influences of rider characteristics and environmental factors may suggest opportunities for prevention actions.

When they say “environmental factors” they mean the built environment or the quality of the bikeways and streets and facilities used by bike commuters.

And here are the conclusions:

Approximately 20% of bicycle commuters experienced a traumatic event and 5% required medical attention during 1 year of commuting. Traumatic events were not related to rider demographics, safety practices, or experience levels. These results imply that injury prevention should focus on improving the safety of the bicycle commuting environment.

[Please note that in this case “traumatic event” is a scientific term meaning an event that led to an injury.]

This study should be of great use to advocates pushing for a higher quality, more refined and comfortable bike network. It also struck me as something that has a lot to do with the idea of tolerance we shared a few months back. If you are trying to appeal to the much-ballyhooed “interested but concerned,” a stressful riding environment with high potential for injury might be just enough to keep them from giving bicycling a try.

I hope planners, engineers and electeds take note of this study and allocate more resources to improving the quality — not just the quantity — of our bikeways.

UPDATE: Read a good Q&A with one of the doctors behind the study over at the Mercury blog. Also, see an embed of the study below:
OHSU_bike_injury_Study

Jonathan Maus (Publisher/Editor)

Jonathan Maus (Publisher/Editor)

Founder of BikePortland (in 2005). Father of three. North Portlander. Basketball lover. Car driver. If you have questions or feedback about this site or my work, contact me via email at maus.jonathan@gmail.com, or phone/text at 503-706-8804. Also, if you read and appreciate this site, please become a paying subscriber.

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are
are
14 years ago

can’t really fault their sampling, i guess, but a 20 pct injury rate seems awfully high. the fact that 52 pct of those surveyed use clipless pedals might also suggest that the sampling is skewed.

what strikes me, though, is that the conclusion — we need more and better facilities — seems somewhat belied by the fact that reported injuries occurred “mostly on bike lanes/wide shoulders and residential streets.” but as they say, this could be “exposure.” portland has a lot of facilities already, and this is where people ride, so this is where they will be when they get injured.

bruce
bruce
14 years ago

I would be very interested in a different look at a similar question. In the most recent 8 years of solid cycle commuting I’ve had no injuries and almost zero illnesses (colds, flu etc.) While I suppose I’m damning myself to a whopper of a cold in a couple of days, I’ll bet that I’m not alone in the perception that cycling cures many ills. A serious study of this type of benefit would be fascinating.

Eileen
Eileen
14 years ago
Reply to  bruce

I’m willing to bet your lack of illness has more to do with how often you wash your hands and how much time you spend around young children.

April
April
14 years ago
Reply to  Eileen

Yeah, I think my reduced number of colds since I started riding has more to do with spending less time on the bus!

When I get a cold, it’s just as bad as before I started biking everywhere.

Bomber
Bomber
14 years ago
Reply to  bruce

Bruce, this is also my own observation. I’m much healthier all together when I bike commute. When I do get a cold or similar, I have noticed that my recovery time tends to be quicker than people my own age I work with who do not ride as often or at all. Further, I need to heal from cycling related injuries, quicker too, so long as allow more time to go slower on my rides. -Bomber

Richard Masoner
14 years ago

Participants were recruited through websites, says the study. I wonder what the advertising looked like, which might impact self selection bias.

Since the study authors point out a correlation between helmet use and traumatic event rate, I’d like to look at the raw data to see if there’s a correlation between helmet use and lower limb injuries, as some other bike injury meta-studies have shown.

Jonathan Maus (Publisher/Editor)

Richard,
They recruited folks through BikePortland.
Here’s a post I did about it in 2007.

Carl B.
Carl B.
14 years ago

I was a participant, and the only injury I’ve ever suffered while commuting happened during the study period (it was minor). I conclude, based on 100% correlation, that study participation caused my injury. They made up for it by giving me a coupon for Ben and Jerry’s. Maybe injuries cause ice cream. I seem to remember observing that as a child.

PdxMark
PdxMark
14 years ago

“Approximately 20% of bicycle commuters experienced a traumatic event and 5% required medical attention during 1 year of commuting.”

My first inclination was that 20% seemed awfully high, until I flipped it around to the corollary that once every 5 years a bike commuter could expect to have a traumatic event. That somewhat fits my commute history. It also means that the odds of a serious traumatic event for a rider is about once every 20 years.

Tonya
Tonya
14 years ago

Richard (#3) – I was in the study too. I seem to remember hearing about it here. Not sure how else the advertised the study.

f5
f5
14 years ago

I was in the study, and I’m pretty sure I heard about it on BP.org.

Greg
Greg
14 years ago

I was also in the study. I received an invite from a friend of a friend at OHSU who knows I bike.

#1 are – I agree that a 20% injury rate does seem high, though the 52% clipless seems to match the 50% of respondents being “advanced riders”.

Of course, all the data in the survey is self reported. We filled out a survey form monthly, so keep that in mind.

spare_wheel
spare_wheel
14 years ago

~50% clipless sounds about right during the winter. i suspect that comfort bikes were also under-represented.

😉

cyc
cyc
14 years ago

“…that once every 5 years a bike commuter could expect to have a traumatic event.”

Yes, this “feels” right to me. What is a similar rate for operation of a car?

Bjorn
Bjorn
14 years ago

The study was in Portland, I would say that more than 50% of the people I ride with ride clipless… My knees hurt if I try to ride flat pedals for long distances, if you ride a lot you eventually find that floaty clipless pedals are more comfortable and prevent injuries… Sure in other places I have been people don’t ride clipless pedals, but here I would say it is pretty much the norm.

Zaphod
14 years ago

Carl B #4…
Very well done. I salute you with a cup of Gelato.

are
are
14 years ago

goes to show, i guess. i use toe straps, which seem more than sufficient to address the knee issues.

resopmok
resopmok
14 years ago

I am really not sure what construes a traumatic event if only one quarter of them required a trip to the hospital. If it includes a number of near misses, I had a traumatic event attempting to walk across the street with a walk sign this evening. While I am surprised there are not more accidents out there given the way some people drive, I do agree with the conclusion we need safer streets that also _feel_ safer. The general lack of common courtesy and caution on the roads for vulnerable users can be quite intimidating at times. As good as our network is, too, there are still gaps that require one to ride in the same lanes as autos, which when combined with the intimidation is surely a barrier for the “curious but timid.” I suppose this study more or less simply reaffirms this regardless of what a traumatic event is, as I think a 5% injury rate is too high.

The biggest barrier we face is how we want to approach this education based issue in order to help make the streets safer.

Stig10
Stig10
14 years ago

I predict the # of cyclists going to hospital will keep going down. Little to do with safety improvements though.

It’ll be people refusing treatment due to their employer’s healthcare plans punishing them for getting sick or injured.

are
are
14 years ago

re comment 14, the published report does not make this clear, but i would have assumed that “traumatic” meant something involving a physical “trauma.” a skinned knee or something.

Evan
Evan
14 years ago

I experience a traumatic event every time I ride, when I look at all those people who think there is no other way to get around than by car. What is even more traumatic is the number of parents who put a car on the road to drive their kids to school, because it is unsafe to walk to school because of all the cars on the road.

PdxMark
PdxMark
14 years ago

Actually, the report defines a traumatic event “as a cycling event leading to injury,” and a serious traumatic event as “a traumatic event requiring medical attention.” So, yes, a skinned knee is a traumatic event, but not a bruised ego…

Peter Buck
Peter Buck
14 years ago

I definitely agree that infrastructure is the problem. I crashed hard on RR tracks in Beaverton Tuesday that were aligned poorly for cyclists. Fifteen minutes later I encountered a nylon mesh bag of woodchips keeping construction run-off from going down the storm drain in the bike lane on Beaverton-Hillsdale Highway. The repaving lip at the drain is too large to actually ride over the drain even if the woodchip bag wasn’t there. Further along I had to share the auto lane to avoid deep leaves in the bike lane.

I read the report and the statistic that stood out is the injury rate of 15/100,000 miles. Assuming an annual commute distance of 3000 miles this suggests a commuter cyclist will sustain an injury on average once every two years. I looked up some NHTSA traffic data (2008 Traffic Safety Facts & 2008 FARS) and calculate that an auto injury occurs only 79 times per 100 million miles or roughly 200 times less frequently than cycle injuries on a per-mile traveled basis. Assume an annual auto mileage of 12,000 and you’d expect on average an injury in a car once every 105 years. No wonder more people don’t cycle.

resopmok
resopmok
14 years ago

If it’s a skinned knee or bruised hip or scraped palm, then I’ve probably sustained more trauma as a result of accidents unrelated to automobiles in my time riding a bike. Darn clipless just don’t want to release sometimes, ya know? Maybe that’s the skewing statistic, since ~50% of participants used them.

KJ
KJ
14 years ago

I have toeclips. I have had three traumatic incidences in the last 3 years, I fell over at a stop sign while getting used top the toe clips in front of a 3 yo and his mom, fell over at a red light while using the time to put something in my bike bucket and i once went right instead of left after a stop sign with my BF and skid out to avoid hitting him. all had very minor abrasions and the last one I smacked my head on the pavement(thanks helmet!) and gave myself minor whiplash instead of a concussion.

All user error at very slow or no speeds and no cars involved. Some loss of pride maybe. =) was not in the study but thought it might help disambiguate meaning of trauma in the article to offer some non auto crash related examples.

ahhh language and semantics.

Dave Thomson
Dave Thomson
14 years ago

Cycling is less forgiving of operator error than is driving a car (as far as injuries to the operator). Low speed events such as forgetting to unclip at a stop sign or crossing RR tracks incorrectly can easily cause injuries from minor scrapes on up. There really isn’t anything similar when operating a car; low speed crashes rarely injure someone surrounded by metal, with airbags, and restrained by seat belts.

The cure for this is comprehensive training for cyclists starting in grade school. You can’t engineer facilities that will prevent untrained riders from hurting themselves.

Peter Buck
Peter Buck
14 years ago

#22Dave,
The study did not find any significant difference in injury rates between experienced and beginner cyclists which suggests training won’t solve the problem. I think there is a lot that can be done to improve infrastructure – design rail crossings to not catch bike tires; design storm drains that do not impact bike lanes; stop using bike lanes for garbage pickup, construction signs, etc.; clean leaves from bike lanes; put green boxes at all intersections instead of just some of them. Finish connecting bike infrastructure to mass transit – for instance, it’s not possible to get to the Beaverton Creek Max station by bike lane. There is a lot of low-hanging fruit out there.

BURR
BURR
14 years ago

Once again, the logic that the solution requires a new separated bikeway network, rather than simply reeducating motorists to operate in harmony with other modes, escapes me.

Kt
Kt
14 years ago
Reply to  BURR

This. Definitely.

Better biking facilities are always nice, but if the DOTs of our various jurisdictions could figure out how to educate everyone about properly sharing the road, that would go a long way to making the roads better for biking. And walking. And skateboarding.

Safer drivers make for safer roads.

Also, I find the study’s definition of “trauma” to be a little unrealistic. As Ian Cooper pointed out, the need for a band-aid over a paper cut could be seen as “trauma” by the study’s authors. But most people would not consider it trauma, by the common definition of the word.

Stig
Stig
14 years ago

I like bike lanes but when they’re only 2 inches wide after factoring in wheel eating storm drains, how are they doing anything other than causing injuries and discouraging cycling?

There are bike lanes like this all over East Portland and Gresham.

BURR
BURR
14 years ago

the bike lanes do have a whole lot of hazards in them, from being too close to parked cars, to being to the right of right turning traffic, to drainage grates, to manholes and other utility vaults, to poorly repaired utility cuts, to leaves, glass and other debris in them.

We really do need a new bike lane standard for both the width of the lane (>6′), it’s placement w/r/t parked cars and right turning traffic, the quality of the pavement surface, and routine maintenance.

fred
fred
14 years ago

I would believe this. I have biked for 35 years – am a middle aged very careful biker. My goal is not speed; my goal is to get home alive. This past summer, while wearing yellow, having flashing headlights, traveling as the last bike in a pack, and entering a cross walk only when all cars were stopped, I STILL got hit while one of the cars went from stationary to driving. It was one of those cold experiences of realizing that you can do everything right, and still get hit. I pretty much only ride now where there is separation between me and cars – I dont want to be any where near those 1 ton metal death traps
.

spare_wheel
spare_wheel
14 years ago

“Darn clipless just don’t want to release sometimes, ya know? Maybe that’s the skewing statistic”

http://www.youtube.com/watch?v=Q0O8ZzFuMkQ

David Wiley
David Wiley
14 years ago

I can’t tell you how much I hate this statement being in the conclusion:

These results imply that injury prevention
should focus on improving the safety of the bicycle commuting environment.

Personally I believe we should ask for all the improvements in biking environment we can, but this wasn’t implied at all. The study made no attempt to address this issue.

Greg
Greg
14 years ago

One of the most interesting aspects of the research is that the rates of traumatic and serious traumatic events are ~2.4 times the yearly average rate in December and January. Put another way, 38% of the traumatic events occur in 17% of the year. Interestingly, February has the lowest rates of the year.

This doesn’t seem to be discussed much in the research, but it does make me wonder. Is there a correlation with reflective clothing? Is there something else going on?

Eileen
Eileen
14 years ago
Reply to  Greg

I don’t think there is any wonder why there are more injuries in December and January. A lot of rain and any ice will be in those months. Most people are commuting both ways in the dark. And I bet all the raingear and bundling up can affect people’s ability to respond quickly. Not to mention response times slowed by winter blues. Why February is the lowest, I don’t know. Since it’s data from only one year, it could just be a fluke. It seems like February is when a lot of people are just about beat by the winter and so maybe overall commuter rates are lower. Maybe it’s just all the love in the air.

Greg
Greg
14 years ago
Reply to  Eileen

My point is that I’d like to see the data mined to determine which factors are most important. We might not be able to do anything about wet roads, but if the survey could show that Nov/Dec rates drop to normal for people with lights & reflective gear, that is worth knowing.

Sarah Sharp
14 years ago
Reply to  Greg

I wonder if gravel added by the city for traction is a contributing factor to the increase in tramatic events in Dec. and Jan. After all, we only really get snow in late December and early January. I know it’s hell to travel in bike lanes when they’ve swept all the gravel from the road into the bike lane. That hypothesis would correlate nicely to the statistic that most tramatic events occured in bike lanes or on residential streets, on dry/clear days.

mello yello
mello yello
14 years ago

I remember a few years ago a young lady on a bike tour of the oregon coast with some friends who, unable to clip-out in time at a stoplight, fell over head-first into the oncoming traffic lane.

are
are
14 years ago

re comment 30, crap on the roads december, january. by february a lot of people have just hung it up for the season (and the injured riders have been thinned out).

Ian Cooper
Ian Cooper
14 years ago

The study gives a bit of a false impression. Heck, I often have injuries that require medical attention – last month I got a paper cut that required a band aid. It really hurt, and while, technically, it was trauma that required medical attention, I don’t consider it noteworthy in terms of injury prevention.

Greg
Greg
14 years ago

Peter Buck
#22Dave,
The study did not find any significant difference in injury rates between experienced and beginner cyclists which suggests training won’t solve the problem.

I’m not so sure about this conclusion. Just because a rider has been commuting for 3 years (qualification for advanced in the survey) doesn’t mean that they are learning that whole time.

I used to ride a motorcycle. After 10 years of riding, I took the MSF’s Advanced Training course, and I learned a number of useful concepts and practices. Also, explicit discussion of safety practices helped my awareness of them on a regular basis.

http://www.msf-usa.org/index_new.cfm?pagename=RiderCourse%20Info&content=46838086-A0CC-53D5-64FEBDC6C7B0B42F

I think a similar training class would be helpful for cyclists as well. Does anyone know of such a program?

Bomber
Bomber
14 years ago
Reply to  Greg

Greg is exactly right here, this is true of a NUMBER of disciplines including bicycling, operating vehicles, almost any activity with an element of danger. When I was in the Army, even the most experienced took regular training on the basics with weapons & vehicles to reenforce good habits, push out bad habits that begin to form.

David
14 years ago

Having read through the article closely, I agree that this study does not support its conclusions.

There is certainly a category error in the assumption that skill correlates with months of commuting experience. (agreeing with @Greg)

Further, the data seem to offer conflicting evidence that investments in the environment will reduce injuries. (agreeing with Wiley) The number of events on bike boulevards seems to clash with their statement.

One notable error in the article, is that it refers to John Pucher as John “Puncher” both on the first page of the text and in the references. Considering that Pucher is one of the top names in bicycle planning, this error undermines my confidence that the study was well-informed or reviewed by planning researchers.

This study’s short-comings are not the end of the world–it would be great if the researchers re-ran their analysis in collaboration with the stand-out PSU faculty who are experts in bicycle transportation.

Adams Carroll (News Intern)

This study should be seen as a public health study, not a transportation/planning study. The researchers are all doctors and nurses and do not have professional expertise in transportation infrastructure. That being said, I feel that their conclusions are valid… and I base that completely on my own gut opinion. Even without a study, I know (because I hear about them via email, etc..) that a lot of injuries people get while riding bikes occur because of these environmental factors like potholes, slippery leaves, poorly designed speedbumps, drain grates, poorly signed street projects, etc…

David
14 years ago

The challenge here is that Public Health professionals’ don’t have much in the way of tools to recommend that are not closely related to transportation planning (traffic safety education included). Beyond recommendations to wear helmets and obey traffic laws (e.g., use lights), almost any recommendation gets into the complexity of transportation planning and analysis. Public Health tends to be much better trained and funded to do evaluation work, they have much to bring to the interdisciplinary field of planning.

Of course, there is no doubt that much greater investment in *both* systems of education and of transportation environment are called for. Where to place the priority remains an open question–even after reading this publication.

McKinley
McKinley
14 years ago

Maybe I am mistaken, but I think the authors of the study might have underestimated the number of miles each participant rode. They took the average number of days per week that each participant report each month and multiplied that by the initiallly reported roundtrip commute distance to get the average weekly distance and then multiplied that by 4 to get the monthly total. So for the year-long study, they got 4×12 weeks of mileage, not 52 weeks worth. Would this change the results? I don’t know, but it might lower the # injuries/miles ridden numbers.

April
April
14 years ago

Things that have caused me to fall in my four years of bike commuting: wet tracks (twice, and now I usually walk my bike across unless I’m perfectly perpendicular to the tracks), wet brakes + user error, a wet wooden bridge, forgetting as I stopped that one pannier was full of canned food, standing on my pedals in slippery shoes….oh, and I got sent to the hospital a month ago because of a badly made/unmarked speedbump.

I’m a clumsy person in general, though. And except for that last crash, they’ve all been minor–scraped elbows and knees, bruised dignity. Yeah, I’m probably never going to ride clipless. Scares the crap out of me. I’ve had toe cages though, both with and without straps, and I love those.

spare_wheel
spare_wheel
14 years ago

“Yeah, I’m probably never going to ride clipless. Scares the crap out of me.”

if you learn how to track stand going clipless becomes a lot less frightening.

April
April
14 years ago
Reply to  spare_wheel

I can tell you right now, that is probably never going to happen. My sense of balance is awful, and I’m just a clutz. In yoga I’m the one flailing, trying to stay standing on one leg. I took longer to learn to ride a bike, than either of my brothers. I’m the kind of person who walks into doorjambs in my own house. Plus, I find it easier to keep my balance on a bicycle while sitting. I’ve never understood the people standing on their pedals as they brake (and these aren’t people who are doing track stands).

In other words: Even if I learned to track stand, I would never ever depend on my ability enough to do it in clipless pedals. I fall off my bike enough without them.

spare_wheel
spare_wheel
14 years ago
Reply to  April

April, its a myth that the trackstand requires “standing”. A slight tile of the wheel and a slight rocking motion is all that is necessary. I taught my “better half” how to hold a track stand for minutes in one half hour practice session. Like most motor learning… its just requires a little practice.

April
April
14 years ago
Reply to  spare_wheel

Did you miss the part where I said my balance was terrible? I appreciate that you’re trying to be encouraging, and I’d love to learn track stands, but I would never depend on my ability to stay in one enough to do it while wearing clipless pedals.

Greg
Greg
14 years ago

I see SF is doing bike training – http://www.sfbike.org/?edu

Anything in Portland?

are
are
14 years ago

there are at least seven LAB certified instructors in the portland area.
https://members.bikeleague.org/members_online/members/findit.asp?action=search

Bomber
Bomber
14 years ago

Not a Portland person but I think this applies US wide; I get that the ability to “track stand” is useful and a worthy skill. BUT, at intersections with red lights and cars present, I don’t do it. I put a foot down, why? Because it demonstrates that I am stopping, and is a sign of good faith that yes, “I take the stop light seriously”. There are 3 or 4 motorists watching you and this sign of good faith, takes only a couple extra seconds. If the area is deserted and rural, and we’re talking about a stop sign, sure I’ll slow to the speed of a very slow walk, make sure I’m looking carefully back and forth and go. Little things like this help demonstrate to the motorists that at least some of us take the laws seriously. A trackstand to the non-cyclist looks like a stunt and like you are doing a bit of showing off IMHO. Drivers are often stressed and reactionary because driving is stressful psychologically in very subtle ways that not even I totally understand. I little demonstration on the part of the cyclist, helps a lot IMHO.

John Mayberry, OHSU
John Mayberry, OHSU
14 years ago

Thanks for all your comments, I have enjoyed the discussion! BIggest congratulations go to Red Hoffman, ND, MD who approached me as a first year med student wanting to do a research project. She is a bicycle commuter herself and I felt she had the moxy to plan and complete this ambitious of a project. It took several months to design and plan and get all the approvals and a huge amount of work mostly by her and Ellen Peck, my research assistant. Bill Lambert of our Public Health dept was an enormous help on design and statistics. Thanks also to Ben & Jerry’s, Bike Gallery, Flex Car, City of Portland, OHSU Transportation Planning, Jonathan Maus and BikePortland.org, and BTA for sponsoring the study and helping Red with recruitment. It took Red nearly a year to analyze the data which she presented at a national trauma surgery meeting. She won the Templeton Injury Prevention Research award among a very competitive field.

The short-comings of the data as mentioned above are all somewhat valid but honestly there is nothing as comprehensive as this in the published literature. We have certainly raised the bar for future studies!

One criticism mentioned above I would like to rebut is our inclusion of minor injuries in traumatic events. We really had to do that to get statistical power in the analysis. Our premise was that any traumatic event could have been serious and therefore correlated with serious traumatic events. Fortunately most bike crashes only result in skinned knees or elbows, but it only takes a few millimeters difference in trajectory or a few more Newtons of force to convert a sprain to a fracture or a contusion to a ruptured spleen.

Thanks again and best wishes and we’re glad so few bike commuters were actually injured! JM

bill bethurum
bill bethurum
14 years ago

11 years and 17,000+ miles of commuting in Fort Collins Colorado and so far no trauma. Knock on wood!! I likes bikes and an occasional New Belgium beer.

Barbara
Barbara
14 years ago

What I miss in this study is some perspective on how biking LOWERS certain risks. Bikers get more exercise so they have a lower risk of heart attacks, obesity, diabetes etc. It also lowers stress levels. My problem with studies and articles like that is that it scares people away from biking because they are afraid of a scraped knee next year, but don’t think about the heart attack in 10 years when they just sit in their cars all the time. The editorial in the Oregonian said that more bikers make for safer roads because cars are more used to them. So if we scare people away from biking, we don’t get that safety in numbers.
There was an intersting article in the Times that we should live more dangerously to be healthier (http://women.timesonline.co.uk/tol/life_and_style/women/families/article4418620.ece). They argue that even biking without a helmet is safer that being a coach potato and die of a heart attack.

q`Tzal
q`Tzal
13 years ago

And now we see even this study being misquoted, misinterpreted and misrepresented by our “leaders” to justify nanny state policies.

I miss Vance ranting about this sort of thing: I could just chime in and go “Yeah!”.

Rob
Rob
13 years ago

Dr. Mayberry’s comment leaves logic behind. Essentially, he said “We counted every injury, no matter how small, because they COULD have been bad.”

Yeah, and a skinned knee from hopscotch could have been a broken spinal cord. Get real.

The purpose of the study was to make biking sound dangerous. It failed. A tiny injury every 6,700 miles is not dangerous. A small injury (like a skinned knee) that gets shown to a physician is NOT “serious.” And again, if that kind of “serious” injury happens only once every 25,000 miles, this is not dangerous.

Why is everyone so eager to pretend biking is dangerous? It’s benefits are way bigger than its tiny dangers. Are you trying to scare more people into cars and onto couches???