Do the Facial Injuries of Three Over-50 Cyclists Constitute an Epidemic?


Older Woman Bicyclist


Anti-bicycling sentiment has found its way into all facets of society. Cyclists do not just face discrimination while riding their bicycles. Negative, preconceived notions about cyclists follow them everywhere – even into the doctor’s office when seeking medical care for an injury.

This became acutely obvious when the Chief of Craniofacial Surgery at Massachusetts General Hospital wrote an article, “Cycling Injures: A New Epidemic?”, on a Huffington Post blog. The doctor started out in typical medical fashion by showing a Computerized Tomographic (CT) image of a patient with a fractured cheek bone. He listed several causes of facial fractures including motor vehicle accidents, physical altercations, and sports injuries.

Then, he went on to introduce a “new injury demographic, amounting to almost an epidemic: bicyclists over the age of 50.” This “epidemic” was based on his observation that he used to treat older patients with bicycle accident injuries once or twice a year. But the week before he wrote this article, he evaluated three such patients.

It’s difficult to understand how seeing three over-50 bicyclists with facial injuries in one week is tantamount to an epidemic. We don’t know who these people are, whether they are experienced or novice cyclists, and whether this occurrence is a fluke or a trend.

A clue to why the doctor drew these conclusions comes later in the article. He talks about how young and old are encouraged to ride bicycles in Boston to save on gas and to promote a healthy lifestyle. He blames the installation of bike lanes on Massachusetts Avenue and Commonwealth Avenue for their rank as the streets with the largest number of bicycle accidents.

In the middle of this seemingly scientific piece on facial injures in bicyclists over 50, he sneaks in the crux of why he sees older cyclists as incapable of riding without sustaining injury:

“My daily observation tells me that bicyclists (young and old) while slowing motor vehicle traffic on Commonwealth Avenue rarely stop for red lights or stop signs, frequently ride outside of the bike lane and often ride on the wrong side of the street.”

Again, we see the old stereotype of all cyclists as red light runners who disobey all traffic laws, inconvenience drivers, and ride recklessly. Could this “observation,” which the doctor applies to all of the cyclists he does not see on a daily basis, have clouded his judgment about the ability of older cyclists to ride without sustaining injury?

He quotes a newsletter as proof of numerous inadequacies in people over 50:

“People over 50 have slower reflexes, less strength, less coordination, less aerobic capacity and lower bone density. (See “Exercise and Aging: Can You Walk Away from Father Time?” in the December 2005 issue of the Harvard Men’s Health Watch… These unfortunate realities make older riders less likely to avoid a bike accident — and if they have one, it’s more likely to be severe. Presumed superior intelligence, good judgment and decision making are not protective from bike accidents and injury.”

Unfortunately, the online version of the newsletter only goes back to 2008, so there’s no way to determine why the doctor deemed this newsletter superior to research studies on the subject. During my rides, I see quite a few cyclists who appear to be over 50. I don’t see across-the-board evidence of the deficiencies the doctor lists as a given. And, not to be overly critical, but the newsletter is written specifically for men. Do women suffer the same deficiencies at the same age as men? Apparently, in addition to stereotyping cyclists as scofflaws, the doctor doesn’t believe in the existence of female cyclists.

The conclusion of all of this cyclist stereotyping is the most shocking part of the article:

“While being dangerous, city bike riding also has a limited exercise benefit. If you weigh 150 lbs and walk two miles to work at four miles/hour you will burn 150 calories. If you ride your bike that distance at 10 miles/hour, you will only burn 75 calories.

If you are over 50, think twice before you get on a bicycle, especially if you plan on riding in busy traffic. The benefits just don’t outweigh the potential consequences.”

Oddly, he concludes by denying all of the health benefits of cycling and advises people over 50 not to ride a bicycle —  because the benefits don’t outweigh the consequences. This conclusion is ageist and patently false with respect to the health benefits of cycling. Every cyclist knows the truth about cycling’s many health benefits, having experienced them firsthand.

The doctor’s anecdotal evidence for a facial injury epidemic among bicyclists over 50 wasn’t convincing, so I decided to do a little research into various physical activities and age-related facial injuries. I found an interesting research paper entitled “Craniofacial injuries from slip, trip, and fall accidents of children” (J Trauma. 2007 Jul;63(1):70-4.).

The background of the study:

“Slips, trips (STs), and falls are frequent events in childhood. As a child is likely to impact head-first in these events, craniofacial injuries are the most common trauma. We retrospectively surveyed our experience with pediatric craniofacial injuries and investigated the distributions of wound type and injury site, severity, and mechanism.”

From the outset, we can see that, due to the lack of coordination, skill, and judgment of early childhood, young children have a tendency to slip or trip and fall on their faces, resulting in craniofacial injuries — just like cyclists over the age of 50.

This study used a sample of 750 children, much larger than the doctor’s sample of 3 patients. The result was:

“Peak incidence of ST-type childhood craniofacial injury occurred at toddler age, whereas falls tended to occur when the children were younger than 1 year old; most of the patients were preschool.”

The study’s conclusion:

“The incidence of childhood craniofacial injury appears to be associated with the level of development irrespective of event type. The home is a potentially dangerous environment for children, especially during the preschool years. Padding the hard, acutely angled surfaces of housing structures and furniture around children’s activity zones is an effective method of reducing the risk of childhood craniofacial trauma.”

Given the unquestionable risk of craniofacial injuries in this age group, children must be advised about how to avoid the inevitable consequences of childhood.

As a precaution, children under the age of 3 ought to be removed from their (“dangerous”) homes and housed in foam padded cells – for their own protection. Children under the age of 1 should be discouraged from attempting to walk. Crawling burns more calories than walking, is just as efficient a form of locomotion, and significantly reduces the risk of facial injuries. Should a baby mis-crawl and fall on its face, the distance to the floor will be much shorter than when walking, so the injury will be less severe.

Babies and toddlers are less capable of walking properly than their older counterparts. It’s simply a fact of life. Therefore, they should think carefully before attempting the skill of walking, lest they fall on their faces and sustain serious craniofacial injuries. The benefits just don’t outweigh the potential consequences.

Fortunately for the children of the world, most expert cyclists don’t draw conclusions about the safety and benefits of specific activities by judging the accidents of a few. Nor do they recommend eliminating beneficial and enjoyable physical activity based on age alone, and the assumption that one’s age —  and shortcomings due to that age —  makes one more prone to suffering accidents and injuries.

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