This article first appeared in the St. Louis Beacon, July 14, 2011 - It was a lovely day and Dr. Greg Luttrell was looking forward to a pleasant bike ride in rural Hamel, Ill. Unfortunately, upon turning a corner onto a newly chip-sealed road, the bike hit a patch of loose gravel and slipped out from under him, sending Luttrell on a painful 50-foot slide along the ground that gouged nasty abrasions along the left side of his body.
"To make the dents you see in my helmet, it would be similar to somebody taking a ball peen hammer to your head," he said. "If you are not wearing a helmet, that hammer is going to go through your skull and into your brain."
He believes he could have been left comatose or even died if it hadn't been for his pockmarked headgear. As it was, he merely went home, showered and let his wife dress his wounds.
But that wasn't the end of it. Luttrell, then a transportation engineering faculty member at Southern Illinois University-Edwardsville, began wondering how many other potentially serious cycling accidents are never reported.
"That sort of opened up the floodgates," he said. "It was really that personal incident that started me down the path of research."
Tip of the Iceberg
Like any activity, bicycling carries risk. It can even be deadly. Earlier this month, Dr. Jennifer Cole, a prominent pediatric anesthesiologist at St. Louis Children's Hospital, made local headlines when she was killed in an accident with a car while cycling in rural Jersey County, Ill. Media reports said the 52-year-old was a dedicated cyclist and a regular competitor in marathons and triathlons who didn't take up biking until her late 30s.
According to numbers provided by Trailnet, a local advocacy group, 69 bicyclists were killed in Missouri over a 10-year span ending in 2009. While significant, the figure is less than a tenth of the nearly 800 pedestrians killed on foot during the same period. Biking injuries are significantly more common. Trailnet reports more than 6,100 over the decade, though that still lags behind the number of injured pedestrians by a factor of more than two.
The data don't show any conclusive pattern, but numbers are generally lower in more recent years. Only three cyclist deaths were reported in 2008 and 2009 combined and the annual number of injured has fallen below 600 each year since 2007. By contrast, the average number of cycling injuries for 2000-2006 was 639.
But Luttrell said trends aren't reliable until they hit the three to five year range. Further, his research revealed that injury numbers may be heavily undercounted anyway since most accidents, like his, are never reported unless a motor vehicle or emergency room visit is involved. He believes that happens only 10 to 15 percent of the time. He said the official totals are just "the tip of the iceberg" and comparing it to pedestrian figures isn't like contrasting apples and oranges.
"I'd say it's more like strawberries and kumquats," he said.
Luttrell noted that it's hard to really know how many cyclists are even out at any given time since bikes aren't registered like automobiles.
He also feels that law enforcement is sometimes not trained to assess fault properly when a bike and car end up in a collision.
"A lot of time, the motorist gets off with, 'Well, you know, it must have been the bicyclist's fault,'" he said.
Peaceful Coexistence
It may be hard to say how many cyclists are on the road but there are more than in the past.
"The number of riders is certainly increasing," said Ann Mack, executive director of Trailnet, which promotes the concerns of walkers and bicyclists in the bi-state area. "I commute by bike 24 miles roundtrip to work and I've seen, over the past few years, probably four to five times the cyclists."
Mack said Trailnet has worked with as many as 20 municipalities to create bike/walk master plans and help create what she terms "complete streets" or roadways that take into account the needs of both automotive and non-automotive users. That can mean everything from wider sidewalks to better signage and road markings to curbs that extend further into intersections.
"The other part is education. Now (driver training) is focused on how you drive a car among other cars," she said. "We really need to shift that to how you drive a car among other users of the road."
Mack said that 90 percent of biking accidents don't even involve other vehicles, a fact that significantly reduces the chances of serious injury or death. Broken wrists, shoulders and collarbones are not uncommon.
When they do involve a car, the results often depend on the speed of the car. She said a bicyclist's chances of survival are about 80 percent when the motorized vehicle is traveling less than 20 m.p.h., but at twice that speed, the reverse is true.
Mark Ewers, owner and operator of STLBiking.com, said he believes motorists and bicyclists can coexist on the roadways.
"It's about mutual respect and understanding of each other," he said in an email to the Beacon. "I believe that if cyclists and motorists alike will identify with each other and acknowledge each others' reasons for being out on the road, the road will be a safer place for both."
Some years ago, St. Louis even popularized efforts to raise awareness over cycling concerns when Patrick Van Der Tuin, a local man, began to put out "ghost cycles," white painted bikes that memorialize the site of cycling accidents. Though no longer practiced here, the idea has spread. Since 2003, ghost cycles have popped up from Seattle to New York.
The Dangers...
Dr. Douglas Schuerer, director of trauma at Barnes-Jewish Hospital, said that he can't say if cycling accidents have risen or declined over the years.
"It's a steady but small portion overall of what we do," he said. "Frankly, people aren't injured as much per riding hour on bicycles as they are in cars or in other ways."
Schuerer, who is also an associate professor of surgery at Washington University, said many of the injuries he sees are indeed wrist and arm problems due to a human being's natural instinct to break their fall with their arms.
"The other one, unfortunately, is still head injuries," he said.
Dr. Julie Leonard, attending physician in the emergency department at St. Louis Children's Hospital, said that when it comes to biking accidents, she's seen it all.
"The patterns of injury are very diverse," she said. "Frequently, just from falling off a bicycle there are long bone fractures to the upper extremities. But then we also see, from falling without being hit by a car, more substantial injuries to the head or the abdomen where the abdomen strikes against the handlebars or the head hits the ground after being thrown off of a bike that stops suddenly."
There can be a difference in the damage suffered by children in biking accidents, though not a big one since the mechanism of injury is the same. The position of the handlebars in relation to the child's body presents a greater risk of harm to the midsection including possible impact on the spleen or liver. In addition, youngsters have smaller bodies that provide less of a cushion for internal organs.
"Children also ride a different style of bike frequently," she said. "Ten-speed handlebars, which are low and curved, are actually less dangerous than a mountain bike or dirt bike handlebar because what will happen is that the front wheel and the handlebars will turn and it will be like a spear and hit the abdomen."
But she said a bigger threat for children is the potential for an accident to happen in the first place.
"It's more difficult to see a child on the road," she said. "They are smaller and sometimes they are below the level of the car and the car's mirrors. They are also not as good at navigating their own environments or as aware of potential dangers."
... The Benefits
But everyone seems to agree on one thing: The good exercise provided by cycling outweighs the risks. The tumble that became the genesis of Luttrell's research on accident reportage didn't discourage his cycling. He still goes riding and even kept the scarred helmet that may have saved him from brain damage. He said the benefits of biking have been immense. He loses 20 lbs. each time the weather warms enough for him to hit the road. When he was first diagnosed with diabetes, he found his blood sugar was able to normalize without medication during biking season.
Children also see positives from biking, not all of them physical.
"Especially from a developmental standpoint, kids that get out and learn to ride their neighborhood have better cognitive skills," he said. "They develop better. They are better socially to be able to adapt because they are out exploring."
At Barnes-Jewish, Schuerer said he feels that cycling is an essentially safe activity as long as proper precautions are taken, such as not driving aggressively and wearing a helmet. He said driving motorcycles or those in automobile accidents represent a larger portion of the injuries he deals with.
"As with any other activity, something could happen, but the overall risk is minor," he said.
Leonard said she feels biking is a very healthy activity and is usually very safe.
"The risks of obesity-related disease and mortality are far greater in our society than structured exercise related deaths," she said.
Leonard said a helmet should always be worn. Ideally, long sleeves and pants are better as well though she admits that's understandably difficult during a St. Louis summer. She recommends wearing good shoes for proper pedal control, taking a cell phone along and being sure to monitor landmarks and street names in case you need to call for help.
"Everything is a risk in life," she said. "It's just a calculated risk in taking the proper measure to be safe."
She feels injuries may have dropped during the decade she's spent treating them.
"Definitely the region is working to improve both pedestrian and cyclist safety," she said. "In other areas of the country such as Oregon and Washington, where they've done this decades ago, it's very clear that it reduces your rates of fatalities."
She also happened to know Dr. Cole, the cyclist killed in Jersey County this month. She called her colleague an avid biker who was deeply committed to promoting the activity.
"She would never want the message to go out that it's a dangerous sport," she said.
David Baugher is a freelance writer in St. Louis.