UBC study finds spinal cord injuries from mountain biking now exceed those in hockey, skiing, football. Now there are calls for change
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The fall that changed Stan Yee’s life forever was a fluke crash off a steep ramp on a North Shore trail that the veteran mountain biker had ridden many times before with ease.
This time, though, he landed in a rehabilitation hospital where he’s fighting to regain some movement in his limbs — and where he’s backing calls to improve education and gear that could reduce spinal cord injuries in his beloved sport.
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“It’s a dangerous sport, but it’s also rewarding, so take the extra precautions when you are out in the trails, and take nothing for granted,” said Yee, a vice-president in the BMO Financial Group mortgage department who suffered a serious spinal cord injury in September.
“I think it should start with awareness. All the mountain bike associations should share the numbers.”
The numbers Yee is talking about are from a new study released by a spinal surgeon, Dr. Brian Kwon, who noticed an alarming pattern in recent years: The majority of his athlete patients no longer come from the traditional sports associated with broken backs and necks, such as hockey and skiing.
Instead, Kwon said he has been “inundated with mountain bikers with catastrophic injuries” in his operating room at Vancouver General Hospital. The hospital is the provincial referral centre for all spinal cord injuries in B.C.
“We’re seeing this barrage of carnage coming off of mountain biking parks,” said Kwon, a Canada Research Chair in spinal cord injury at the University of B.C.
“Last year, we had four young quadriplegic men on the ward at the same time from mountain biking.”
Kwon wondered why the public wasn’t talking about this increasing spate of life-altering injuries among mountain bikers, perhaps the way Canadians might if the same number of hockey players were getting hurt.
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“It struck me that if there was one spinal cord injury in a junior hockey player it would be on TSN, it would be national news. And here we were with three, four, five, six, seven of these every season and nobody seemed to be talking about it,” Kwon said.
So he began an academic study, recently published in the medical journal Neurotrauma Reports, which found that between 2008 and 2022 in B.C., 58 mountain bikers injured their spinal cord, compared to three hockey players.
Although the study only examines those 58 patients, Kwon has since determined that in the past two years, from 2022 to 2024, another 21 B.C. mountain bikers received spinal cord injuries — a rate seven times that of skiers and snowboarders.
The findings point to an urgent need for change, said Kwon, who is director of the International Collaboration on Repair Discoveries, a spinal cord injury research centre affiliated with UBC and VCH.
That could include expanding risk warnings for riders, and encouraging more discussion among health workers, governments, mountain biking associations, bike parks and mountain resorts about how to improve safety.
“I think that we all have a very shared interest in trying to understand what it is that is causing the risk to be higher in some people, understanding what protective equipment is useful and what isn’t, how to message it to people so that they do the appropriate runs,” he said.
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“We want everybody that goes up on the hill to come off that hill, healthy and safe.”
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‘A lot of people will be surprised’
The results of Kwon’s study are “very sobering,” said Martin Littlejohn, executive director of the Mountain Bike Tourism Association, which represents bike groups, resorts and industry operators in B.C.
He agreed more could be done to improve messaging about risk.
“When a study like this comes out and identifies the consequences related to the activity, I think it is an opportunity for us to reinforce the need for people to really take their safety into consideration,” Littlejohn said.
“Maybe we can do a more concerted campaign or some effort to really raise the bar in terms of awareness for potential for injury.”
A lot of popular biking terrain is on land owned by the province. In response to questions about Kwon’s study, the Environment Ministry sent a statement saying it is conducting a multi-year project to update the difficulty rating system for trails. It is also creating a tool that will help inform users of the risks on land managed by the government.
Increasingly, ski resorts across North America use their chairlifts to carry bikers up the mountain to access downhill trails. Of the 58 injured riders in his study, Kwon said more than one third were hurt at the Whistler Mountain Bike Park.
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When Postmedia reached out twice to Whistler Blackcomb to ask about what role the resort could play in improving safety, a spokesperson for its parent company, Vail Resorts, said management was too busy getting ready for the ski season to answer questions about better protecting mountain bikers.
“Right now our team is focused on preparing for an early season,” said Vail’s Sara Roston.
Yee was not on Whistler when he was injured on Sept. 14, but was near another ski resort, North Vancouver’s Seymour Mountain.
On the challenging John Deer trail, Yee was videoing a group of friends coming off a steep ramp, a trick he had done many times. Once the last rider had gone, he hopped on his bike to catch up with them but, in his haste, he fell and was thrown over the handlebars.
“I goofed up,” said Yee, a thoughtful, friendly man who has been mountain biking since 1987.
“I should have been more cautious.”
He knew instantly it was a catastrophic injury. “I couldn’t feel my arms or my legs.”
After two months in Vancouver’s GF Strong Rehabilitation Centre, Yee is slowly regaining some movement in his arms, but cannot move his fingers yet and has no feeling below his chest. His spinal cord is broken at the C4/C5 level, just below his neck, which means he is expected to be in a wheelchair and to need some assistance with eating, dressing and showering for the rest of his life.
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Yee, who lives in Coquitlam with his wife, Emily, said he loves biking because it can range from a solo outing to decompress after work to a social activity with a large group.
“It’s such a beautiful sport to meet people,” he said.
Despite his nearly four decades of biking, Yee was taken aback by Kwon’s findings that the sport has had so many more spinal cord injuries compared to activities like skiing. For that reason, Yee said, the public needs to be alerted to the study’s conclusions.
“If I’m surprised, a lot of people will be surprised,” he said.
Mountain bike associations and other groups could share information about difficult trails and about the numbers in Kwon’s study so riders can make informed decisions, he said.
“Let people decide what they would like to do with the findings because if they’re surprised, then that might make them more cautious.”
The study, he said, could also inspire the development of new, easy-to-wear equipment to better protect bikers, like him, who are thrown over their handlebars.
“Anything could help, right? It’s no fun being in GF Strong,” he said.
More than three-quarters of the riders in Kwon’s study were thrown over their handlebars, with the rest injured by collision or other means.
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After seeing the mounting number of mountain bikers landing in his operating room, Kwon decided in June 2022 to start analyzing the data from the Rick Hansen Spinal Cord Injury Registry, which collects information on all patients in Canada with this type of injury.
Of the 58 bikers in B.C. who suffered spinal cord injuries over a 14-year period, 54 were male with an average age of 35.5 years. Nearly all had jobs, with only two listed as professional bikers. Half were married.
When the spinal cord is damaged, it can block messages from the brain to the rest of body about movement or feeling, and the severity of that loss depends on how high up the spine the injury occurred.
Half of the patients in Kwon’s study have been left without the use of their arms or legs or both, while the rest have some motor function — but in all cases the injuries are life-altering.
“You can be in an electric wheelchair with very little ability to use your hands, no ability to use your legs, no ability to control your bladder or your bowel, no sexual function,” Kwon said.
In addition to the emotional toll on their families, Kwon found the health and economic costs to B.C. for these 58 patients to be nearly $200 million over their projected lifetimes.
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Is it that mountain biking hasn’t necessarily adopted certain preventative practices, or is it that mountain biking is just inherently that much more dangerous?
Dr. Brian Kwon, spinal surgeon
All but 4.5 per cent of the 58 injured riders wore a helmet or protective gear or both. That safety equipment is important, Kwon said, but doesn’t eliminate the risk of a spinal cord injury.
That’s why, he argued, it’s crucial for people to realize these accidents can happen to anyone, regardless of experience or the difficulty of a trail. Some of the people in his study were doing extreme tricks, while others were recreational riders.
Kwon does not think the findings in his study are unique to B.C., and that the number of spinal cord injuries in bikers is likely high in other places with mountainous trail riding. He added that spinal surgeons in Quebec and in Vail, Colorado, have told him they’ve seen similar increases.
The reasons behind the rise in mountain biking injuries are unclear.
The popularity of mountain biking has grown, especially in the early years of the pandemic, so there are more new riders using steep jumps and ramps.
In other sports, including hockey, changes have been made to reduce spinal cord injures, such as putting “stop signs” on the back of children’s jerseys and adding protocols to reduce cross-checking into the boards. In football, there is also more education around safer tackling techniques, Kwon said.
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Those are possible explanations for why there are more spinal cord injuries in mountain biking, but it will take more research to be sure, said Kwon.
“Football is a highly violent collision sport, as is contact hockey. But we just see far fewer of those injuries,” Kwon said. “Is it that mountain biking hasn’t necessarily adopted certain preventative practices, or is it that mountain biking is just inherently that much more dangerous? I don’t know the answer to that.”
He hopes his study can be a catalyst to finding that answer.
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‘It is important to really understand the risks’
The risk associated with riding trails can never be removed entirely, but safety reminders could be increased, said Littlejohn of the Mountain Bike Tourism Association.
“To look before you leap. To be aware of the trail conditions and your own ability, which is the most important. To make sure your bike is mechanically sound,” said Littlejohn, a mountain biker for 40 years.
He noted that trail riding continues to grow in popularity, and that the bikes and their riders continue to evolve so the high-end athletes are attempting more and more difficult tricks.
“It seems to be a risk that many users are willing to accept, although I think when a study like this comes out, it does highlight one of the worst injuries anyone could ever imagine for themselves,” he said.
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“It’s certainly something to use as a focal point of why it is important to really understand the risks, and ride in a way that you can mitigate the potential for that type of injury.”
The industry has never tried to sugar-coat the inherent risks, Littlejohn added, but has made efforts to improve safety.
We all want to be able to come home safely at the end of the day.
Martin Littlejohn, executive director of the Mountain Bike Tourism Association
There are signs on official mountain bike trails that show the difficulty ratings, his organization has videos online with safety tips, and there is an app called Trailforks that describes the risk level of most off-road routes, he said.
Resorts like Whistler manage their own biking paths and have been leaders in developing the trail rating system that is in frequent use across the province today.
Trails on provincial land or private land are typically overseen by community volunteers who follow a similar rating system: black for hard runs, blue for intermediate and green for beginner.
Riders also need to be aware of trail conditions that can change due to a lot of use or extreme weather, Littlejohn said.
He has reached out to Kwon to speak with him more about his study, and will pass along the findings to organizations such as the Professional Mountain Bike Instructor Association and AdventureSmart, a national program that tells Canadians how to safely play outdoors.
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“A concerted effort is always important to try to help to get these messages out there,” he said.
“We all want to be able to come home safely at the end of the day.”
The provincial government started a new program to improve mountain bike trail safety in 2019.
This week, the Environment Ministry said its multi-year project involves working with First Nations, mountain bike clubs, provincial recreation associations and local governments.
“While the difficulty rating system and tool kit is still in development, we expect signage to be similar to what people would be familiar with at ski hills — green circle, blue square, black diamond, double black diamond,” the ministry’s statement said.
“There will also be information about the types of features a specific trail includes, ie. jumps, exposure, wood technical trail features.”
The new signs and tools are to be part of a pilot project in 2025 at eight areas of the province where mountain biking is popular. No timeline was provided for when the tools will be available to everyone across B.C.
Emily, Yee’s wife, said her husband plans to educate his biking friends as well as his contacts at a Coquitlam off-roading association about Kwon’s study, and to be involved in changes to reduce spinal cord injuries from the sport.
In the meantime, Yee remains focused on his recovery and on the positive things in their life.
“Stan is still with our son and I,” she said. “I can still look him in the eyes and laugh and cry together. And Stan is still Stan.”
lculbert@postmedia.com
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