What’s more dangerous, road cycling or mountain biking?

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Sep 29 2025

A one-year study reveals that road cyclists face more severe injuries than mountain bikers, with older riders at the greatest risk, reshaping how clinicians and public health experts view cycling safety.

Study: Road cycling causes more serious injuries than mountain biking. Image Credit: Real Sports Photos / Shutterstock

In a recent study published in the journal Scientific Reports, researchers investigated the specific risk associations of cycling's two most popular disciplines, road cycling and mountain biking. The prospective study utilized data from 149 cyclists treated at a trauma center over a one-year period.

Study findings revealed that while mountain biking accidents were more than twice as frequent, road cycling crashes resulted in significantly more severe injuries, as measured by the Injury Severity Score (ISS) metric. Road cyclists sustained more severe head injuries, and the cohort’s only death occurred in a road cyclist with head trauma. Motor vehicle collisions were also more common among road cyclists. Furthermore, the study identified a positive association between age and injury severity (older riders suffer more severe injuries), particularly for road cyclists, highlighting a key risk factor for this growing demographic.

Background

Cycling has been scientifically validated to offer several health and environmental benefits, including improved cardiovascular fitness, reduced carbon emissions, and reduced traffic congestion. Cycling has consequently witnessed a substantial surge in global popularity, particularly following the recent COVID-19 pandemic.

However, as cycle adoption grows, so do concerns about safety and injury prevention. Cycling's two most prominent disciplines, mountain biking and road cycling, present distinct environments and challenges. The former involves navigating unpaved trails with technical obstacles, such as rocks and roots, at lower speeds. Road cycling, in contrast, takes place on paved roads at higher speeds, often alongside motor vehicle traffic.

While previous research has identified common injury patterns across general cycling, few studies have directly compared the frequency and severity of injuries between these two very different cycling styles. Understanding these differences is crucial for tailoring medical responses to specific injuries, improving road and trail safety protocols, and educating a rapidly expanding community of riders.

About the study

The present study addresses these knowledge gaps by conducting a prospective observational study (one year) between November 2020 and October 2021 in Barcelona, Spain. The study enrolled all adult cyclists (18 to 77 years) who presented to their emergency trauma department with a cycling-related injury, resulting in a final study cohort of 149 samples (12% women; mean age, 44.8 years).

Study data collection included each participant's sociodemographic data, medical health records, and cycling information. Cycling information comprised detailed reports on the type of cycling subdiscipline (road or mountain), the mechanism and events of the crash, and the use of safety equipment (helmet, lights). Simultaneously, the ISS, a standardized anatomical scoring system that ranges from 0 (no injury) to 75 (fatal), was used to quantify the severity of each participant's injuries clinically.

Statistical analyses were conducted in accordance with the International Conference on Harmonisation (ICH) Topic E9 (CPMP/ICH/363/96) principles, and included both descriptive statistics (for quantitative variables) and multivariate regression models.

Study findings

Study findings demonstrated a clear, subtype-specific divergence in both injury frequency and severity. When considering only injury frequency, mountain biking accidents were observed to be far more common, accounting for 67.1% (100) of the 149 cases, more than double the 32.9% (49) from road cycling.

The findings were reversed when investigating injury severity, with analyses estimating the median ISS for road cyclists to be 6 (interquartile range, 3–10), statistically higher than the median ISS of 4 (interquartile range, 2–7.5) for mountain bikers (p = 0.039). Together, these findings establish that while more mountain bike injuries are presented to this trauma center, when they do happen, road cycling may result in substantially more harm than trail riding.

Finally, the study elucidates a positive correlation between age and injury severity, particularly for road cyclists. These variables demonstrated a positive correlation, meaning older riders sustained more severe injuries. For each additional year of age, a road cyclist's ISS increased by an average of 0.20 units, more than double the 0.09-unit increase seen in mountain bikers.

There were no significant differences between the two groups in triage level, need for surgery, or emergency department length of stay. The upper extremities were the most commonly injured body region in both groups.

Conclusions

The present study helps inform emergency first responders, clinicians, and the growing cycling community of the specific associations observed in cycling's two most popular subdisciplines, highlighting that while more mountain bike injuries were seen at this center, they were rarely as detrimental or life-threatening as the less frequent but more severe road cycling accidents.

The findings underscore the importance of recognizing the distinct profiles of different cycling disciplines in emergency medicine and public health. The positive association between older age and injury severity among road cyclists is a particularly critical finding, highlighting a vulnerable and growing population of riders.

Particularly for clinicians, the present research emphasizes the need for a higher index of suspicion and enhanced scrutiny for severe trauma in road cyclists, especially those occurring in older individuals, to ensure this high-risk population receives the appropriate level of care.

These findings represent associations from a single-center study without exposure data and may not be generalizable to other populations. Comparative risk between cycling disciplines cannot be inferred from this dataset.