What Body Parts Will You Most Likely Injure In A Motorcycle Crash?

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What Body Parts Will You Most Likely Injure In A Motorcycle Crash?

Background photo by Franc

ATGATT. It stands for All The Gear, All The Time and is a war cry made by safety-conscious motorcyclists as they tackle a dangerous world on two wheels. But, do you really need to protect all your body parts all the time? Which body parts will you most likely injure in a motorcycle crash? The Center for Disease Control, World Health Organization, National Highway Traffic Safety Administration and Association For The Advancement Of Automotive Medicine has the answers you need. What can they tell us about motorcycle safety?

The CDC studied the 1,222,000 people who were treated in U.S. emergency rooms for non-fatal, motorcycle-related injuries between 2001 and 2008, then recorded their injuries by location on the body.

The CDC found that 30% of all non-fatal motorcycle injuries happen to the legs and feet
The CDC found that 30% of all non-fatal motorcycle injuries happen to the legs and feet

Photo by Elvert Barnes

Surprisingly, the largest percentage of injuries occurred to the leg and foot area — 30 percent of all non-fatal motorcycle injuries were recorded on the lower extremities.

The CDC found that 22% of most common motorcycle crash injuries occurred to the head and neck
The CDC found that 22% of most common motorcycle crash injuries occurred to the head and neck

Photo by Sarah Nichols

Next most-common were head and neck injuries, making up 22 percent of the total. Those were closely followed by “upper trunk” (i.e. chest, shoulder and back) wounds, then arms and hands, then “lower trunk” (i.e. hips and pelvis).

What the CDC information doesn’t tell us is how severe those injuries were or whether or not they were influenced by the wearing of appropriate safety gear.

Enter the AAAM study. While it set out to determine differences in injuries between young and old riders, it also tracked injuries related to helmet use. It tracked all injured motorcycle operators in the state of Maryland from 1998 to 2002, using both hospital discharge records and police reports. It also goes a little deeper than the CDC report, breaking injury locations down into nine areas — head, chest, abdomen, spine, neck, face, upper extremity, lower extremity, and external skin — and ranks them according to severity.

Distribution of Injury Severity Score (ISS) By Age and Helmet Use
Distribution of Injury Severity Score (ISS) By Age and Helmet Use

As you can see in this graph, helmeted riders were shown to have a greater number of less severe injuries and a smaller number of more severe injuries.

Distribution of Injured Anatomic Region by Age Group
Distribution of Injured Anatomic Region by Age Group

This graph shows the distribution of injuries and correlates with the CDC data showing that lower extremities represented the most common injury location. This table is not controlled for helmet use, unfortunately. Maryland is a helmet law state, so we can assume a high rate of helmet use though and the relatively low rate of injuries to the head, face and neck reflects that.

Injured Anatomic Region By Age and Helmet Use
Injured Anatomic Region By Age and Helmet Use

But that’s what is tracked in this table, which shows the location of the most severe injury experienced by a given rider, tracking them across helmet use. What’s interesting here is that, while younger riders do show a greater occurrence of that most severe head, neck and face injuries among those who weren’t wearing helmets, the trend among older riders is the reverse. Lower extremities again make up a majority, even when we consider that these are the locations of only the single most severe injury on the rider’s body.

Rate ratios and 95% confidence intervals (CI) for death by body region among hospitalized motorcyclists
Rate ratios and 95% confidence intervals (CI) for death by body region among hospitalized motorcyclists

This table tracks the location of the injuries that resulted in death. Keep in mind, these were the deaths that occurred at the hospital, not at the accident site. Causes of death there were not reported in this study, but likely do include considerable instances of head trauma. Regardless, deaths-at-hospital were most commonly caused by thorax injuries, closely follow by head, then abdomen.

So far, this is good data. The CDC gives us the big picture of injury locations to riders nationwide, then the AAAM shows that data is not greatly influenced by helmet use. Let’s go more granular into the specific injuries with the information provided by the WHO.

In this study, motorcycle accident victims who wound up in the Jinnah Postgraduate Medical Centre in Karachi, Pakistan were surveyed to determine the precise nature of their injuries. Those with head injuries requiring neuro-surgery were excluded, as were those with only soft tissue damage, who didn’t break any bones.

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  • William Connor

    In my two accidents my only serious injury was a broken ankle. The rest were some bruises, both times I had full face helmet, leather jacket, boots, and jeans. The broken ankle occurred in some pretty nice street riding boots with ankle protectors. Now I wear over pants every ride. I find they are more comfortable than just plain pants on my current bike. The seat is very grippy which is nice but it tends to bunch up the material which is not nice.

    • Davidabl2

      I’d bet there are times when a full-on racing boot would prevent ankle fractures that a “street boot” wouldn’t.

      • Stuki

        Or an MX boot

        • Davidabl2

          Actually a MX boot will probably protect you from fractures that a road racing boot wouldn’t, as it’s more impact-oriented i.e. more heavily armored, and stiffer than a GP-style boot.

          • Piglet2010

            I have been using Alpinestars Scout WP boots for most off-road and quite a bit of street riding. A little too stiff and bulky for track use, and a little too hot for summer urban commuting, however.

      • William Connor

        It may have. These were race styled but street oriented so not as much protection as a true race boot. The impact I had it probably would not have mattered as it was a direct impact with the guard rail with enough force to knock me off of the bike. It was like bracing for a hit on the ground with your hands out, except it was my foot.

    • eddi

      I’m going back to that boot review that was done earlier this week. I have to revise my opinion from “ugly boot” to “better protection than style”. I love my skeletal system just as it is. And now that I’m older, that could be harder to maintain in a crash.

  • Michael Howard

    “Surprisingly, the largest percentage of injuries occurred to the leg and foot area — 30 percent of all non-fatal motorcycle injuries were recorded on the lower extremities.”

    Surprising? Not when even “professional moto journalists” can’t get over their “jeans are good enough” addiction to style.

    • Gonfern

      Yep! Even wearing jeans, I will wear icon Stryker leg protection. The tyny knee protection that comes in riding jeans and most textile pants offer very little protection. a simple tip over can turn into a broken leg

      • Piglet2010

        I wear knee armor under reinforced jeans while riding around town or off-road – unlike the author, I usually land on my knee and elbow on one side in a low-side fall.

        • gregory

          Exactly. Knee and elbow, and, if too fast, your head snaps down and hits the ground, too. But it’s knee and elbow that take the normal toll from whoopsidoos.

          -g

    • taba

      “Is this data a reflection of that fact [least likely protected] or is it simply indicative of just how exposed our feet and legs are?”

      This.

      • Michael Howard

        In either case, wearing less protection on your legs than the rest of your body makes a lot of sense, yeah?

        • taba

          It is a hassle wearing leg protection, yeah?

          • eddi

            It is, really. On the bike it’s fine but if you need to walk around, they are heavy and awkward. That said, the problem is mainly stowing a pair of overpants.

          • Michael Howard

            Eh, I wear a Roadcrafter and getting into or out of it takes about as much time as pulling on just a jacket. Yadda yadda Aerostich yadda yadda Roadcrafter yadda yadda ‒ it’s all true.

            As for having a place to stow it, I ride a maxi-scooter with a small studio apartment beneath the saddle, so that’s not an issue for me either. And there are options for riders of “real” motorcycles, too (I have a 55-liter trunk when needed), if wearing full gear is actually important to you.

            • Jai S.

              The tibia and fibula are most likely to be broken in an accident, and incidentally I had a friend in full armor go down and break those. Is there any thing for the Roadcrafter to protect those?

              • aquatone

                There are many ways to break a leg and although armor may not prevent a fracture, it could make a fracture less serious. Although I don’t know of anything that works with a Roadcrafter specifically.

            • Piglet2010

              Well, a Roadcrafter is less of a pain that putting on a jacket and knee armor under reinforced jeans, but slightly less of a hassle than typical two-piece zip-together jackets and pants – the only real advantage I can see for getting the two-piece Roadcrafter would be jacket in one pannier, pants in the other, and lid in the top-box.

              • Michael Howard

                One of the things I like about my 2-pc is being able to take off the jacket during a stop without having to also remove the pants. Plus, I have the option to “mix and match” jackets and pants. By the way, I don’t care for the Roadcrafter “bib” conversion piece – I use my own suspenders.

            • I Have the Hat

              “…small studio apartment beneath the saddle…” made me chuckle.

  • Scott Otte

    I guess I’m in good company when I broke my tibia. Though not because of it’s “exposed position”, but because it’s what I landed on first after flying through the air.

    http://wp.me/p3y1Rt-eo I still don’t remember much, can’t imagine how bad it could have been without gear.

    • socalutilityrider

      Dude. Just read through many pages of your site. Glad to hear it wasn’t worse. Why did the bmw’s rear wheel lock up?

      • Scott Otte

        I was looking into going after BMW for a while, so I never wrote about it in my blog. That time has since passed I’ll write something up soon and fill in the blanks.

        • socalutilityrider

          Thanks, I will read it. Just curious how a bike could have such a sudden catastrophic failure, especially one with such a high perceived build and engineering quality to it.

          Also, this article is right. I am still recovering from a pretty bad ankle injury (thankfully not broken or torn all the way through) from a decent off a month ago. No other injuries, just ankle and leg. I had Vendramini Marathon Steels on.

          • Scott Otte

            I hope you heal up quickly… I was wearing good Sidi boots, and well you can’t stop some forces.

            Here’s the link to the details on the accident that I know. I doubt it will satisfy your questions… I still have many.

            http://motocynic.wordpress.com/2013/12/27/what-i-think-happened-that-day-my-bmw-tried-to-kill-me/

            • socalutilityrider

              It’ll be fine, that small off was my fault, total rider error-thanks for good thoughts.

              Just read your article and all the links. Wow. First of all, your insurance company: really? Rider is going in a straight line and they think you just locked it up randomly? It is amazing how great of an effort they will go to avoid paying out a justified claim. I’m no expert, but based on the links you provided, there is an issue on that bike, a scary one at that. I would of figured BMW wouldn’t have these sort of issues due to their long pedigree, but seems like the Japanese have it more figured out on the reliability spectrum.

        • aquatone

          I’m wondering the same thing. Between that and your friend being attacked by a condor there are a few things that really do just happen.

  • Jason

    “Helmet use is only reported as a “yes” or “no,” but in the real world, a great difference exists between even DOT-certified, street legal helmets. A crash in a $700 Schuberth will not have the same results as a crash in a $25 half-helmet.”

    Yes, a full-face helmet will provide better protection that a half-helmet. However, higher price does not necessarily correlate to better protection. Motorcyclist’s helmet test found that inexpensive DOT only helmets protected better than more expensive DOT / Snell M2005 helmets.

    • http://RideApart.com/ Wes Siler

      Which is why we wear ECE 22.05, the same standard used by every motogp rider.

      • Jason

        So why didn’t you mention that in this story? This story implies that if you want to protect your head buy an expensive helmet. It is the old adage: “If you have a $100 head buy an $100 helmet”. Dexter Ford’s “Blowing the Lid Off” article turned that old adage on it’s head by lab testing helmets and showing that an $100 DOT helmet performed better than $500 Snell helmets. Snell got mad, the helmet manufacturers got mad, Ford got fired, and the article disappeared from Motorcyclist’s website.

        • Stuki

          What “lab tests” did Ford conduct? Unless he lined up volunteers to slam into stuff in all manners of realistic ways; who is to say his tests are any more accurate than Snell’s? Or the DOT’s? Generally, what higher prices buy you, is more comfort; lighter weight, better visibility removable liners, better venting, less fogging………. Which does contribute to active safety, since someone in a fogged over helmet with tunnel vision with sweat running down his eyes while he struggles to keep his heavy lid from breaking his neck, probably aren’t the safest rider out there.

          For any kind of simple “crash test”, simply slapping layer upon layer of fiberglass, and inch upon inch of padding, around the wearers head, is highly likely to yield better results. The whole point of standardized testing of the DOT, Snell and ECE kind, is to set some minimum requirements for certain tests, and then let engineers try to come up with the best compromises that still meet those standards. Exactly which standard to follow, as long as it is rational (i.e. not just some feelgood rubber stamp), and updated as more information is available; is less important than that there is some standard, so optimizing for all the feelgood parts don’t go too far.

          • Jason

            Motorcyclist Magazine hired a lab (Collision and Injury Dynamics) to do the tests. They compared helmets that conform to DOT, BSI, ECE, and Snell standards and measured the G force applied to the headform. The helmet that transferred the lowest number of G’s (176) was $79.95 DOT only Z1R. The helmet that transferred the highest number of G’s (243) was a Snell rated Arai. The scientific paper with the helmet manufacturer’s names removed can be found here: http://media.wix.com/ugd/0ff0f8_dc6e3ef7247f18891d1f6770b8a62f0b.pdf I can’t find the original Motorcyclist article, just a bunch of references to it with broken links to Motorcyclist’s website.

      • Stuki

        The most common street crashes are so far removed from infinite runoff MotoGP crashes, as to make one wonder why? Also, MotoGP helmets are designed to be very light, and have a minimal aerodynamic footprint. Inevitably compromising passive safety of the bang your head into a sharp curbside corner or firehydrant kind (a childhood friend died doing the latter, unhelmeted at <30mph, being a teenage idiot on a dirtbike. Sans any helmet, MotoGP or otherwise, of course.)

        I'm sure MotoGP helmets are very good, as in no corners cut; but they aren't necessarily (nor necessarily not, I just don't know) all that optimised for street use. Of course, then again "street use" ranges all the way from urban messengers, to guys who do play MotoGP on the weekends, so some street use cases are probably better served by MotoGP kit than others.

    • Piglet2010

      Supposedly, Snell M2010 was revised from M2005 partly in response to this article (but of course, an official admission will not be made).

      • appliance5000

        This is true – and I’ve a;ready been in a dogfight on this one. I trust snell 2010 ratings. And f there were errors in the past they were errors made based on safety assumptions of the time. Oh lord why don’t I stop typing now…

        • Jason

          My wife and I have Snell M2010 rated Shoei helmets but I don’t buy the argument that the M2005 standard was a good standard for the time. Snell insisted in their open letter that lower G forces don’t reduce head injuries:

          “All the standards, Snell M2000 and M2005 included, presume a threshold model of injury. That is: so long as a threshold G limit is not exceeded, there will not be a serious injury. A corollary conclusion is that any G exposure not exceeding this G limit is no better or worse than any other G exposure not exceeding this limit. If a G exposure below this limit is safe, another 40 G’s lower cannot be any safer.”

          I’m sorry but there is a huge difference between a 100 G, 200 G, and 300 G hit to the head. That was well know in 2005.

          I also don’t agree with Snell continuing to certify helmets to the 2005 standard until the end of 2012. I’m personally bitter about this because I bought a helmet in 2011 thinking that it was certified to the M2010 standard. Only when I took out the liner for the first time did I see the Snell M2005 sticker.

          • Piglet2010

            Most racing and track day organizers will no longer allow Snell M2005 (or earlier) lids to be used.

      • Jason

        That is correct. Snell published a letter attacking the methodology of the test used in “Blowing the Lid Off” and defended the use of one weight headform for all size helmets and 300 g’s as an acceptable maximum. Then they updated their standard for 2010 and switched to different weight headforms and a maximum of 275 g’s. However they never admitted that the 2005 Snell standard was wrong and continued to certify helmets to the 2005 standard even after the 2010 standard was released.

    • atomicalex

      You need to choose the standard that will best reflect the impacts you are likely to face. A daily commuter will likely find that the ECE standard more closely matches their general risk profile. The 2005M Snell standard was biased toward impacts, which is different from USDOT and ECE which are biased toward sliding. The 2010M standard reflects that change. The USDOT standard focuses on top-of-head impacts, the ECE distributes the impacts more widely. AND… the head forms are different – so you might even want to pick a standard based on what shape your head it.

      It’s no small effort to get the best helmet for your head.

  • DragosStefan

    I keep wondering why manufacturers of motorcycle jackets keep providing serious protection for the back/spine and none for the chest. This is not the first statistics to show a high percentage of thorax injuries. Of course, many of them are caused by the lack of protection, but also by the fact that the chest is at least as vulnerable as the back.

  • http://metabomber.com/ Jesse

    Short answer: Body parts that you are very attached to, and probably like the use of.

  • Mike McCall

    Is Pride considered a body part?

    • eddi

      Yeah but it heals rapidly. As long as the rest of you is relatively intact.

  • aquatone

    There are a number of studies that examine the effect of gear on injuries:

    “This study demonstrates that motorcycle protective clothing is associated with a significantly reduced risk of injury in crashes, particularly when body armour is fitted. While the most substantial effect was observed for open wound injuries, crashed motorcyclists who were wearing motorcycle clothing were also significantly less likely to require admission to a hospital.”

    http://www.georgeinstitute.org/sites/default/files/documents/motorcycle-protective-clothing-protection-from-injury-or-just-the-weather-the-gear-study.pdf

    “In one recent NZ study, riders wearing any reflective or fluorescent clothing had a 37% lower risk than other riders. Riders wearing white helmets had a 24% lower risk than those wearing black helmets. The study was conducted in mainly urban areas of Auckland (Wells et al, 2004). By comparison, a summary of European research into safety measures for motorcyclists concluded that florescent clothing is effective during daylight, but not against a bright background. They also found that retroflective clothing gives little improvement at night (Noordzij et al, 2001).

    http://www.roadsafety.mccofnsw.org.au/a/84.html

    “This study showed that loads, and the subsequent risk of fractures, can be reduced efficiently by foam-plate systems. Benefits were established for using a laminate of hard and soft materials for protection against soft tissue injuries both in the accident analysis and experimental tests”

    http://www.ncbi.nlm.nih.gov/pubmed/12361520

    • gregory

      Reflective vests save lives. I’d say: more important than a full face helmet or any other sort of armour. Wear a bright horribly green/ yellow reflective vest. Upper frontal visibility, as per the Hurt Report, is critical.

      -g

  • Davidabl2

    The death stats would seem to confirm what some S.F. paramedics told me many years ago: that chest compression and head injuries were the two most common causes of death. Note that lethal “Thorax injuries” exceed head injuries in all categories. Perhaps because very,very few street riders wear any kind of chest protection V.S. a large proportion wearing helmets.

  • Davidabl2

    I would not go out without wearing knee protection any more than I’d go out without a helmet,gloves and eye protection.
    And a jacket that protects shoulders and elbows. Even if the weather is so hot that it has to be a mesh jacket.
    The back protector is at the bottom of the list,and sometimes I will wear workbooks instead of full race boots.
    Although I DO feel a little naked if I’m doing “MGST” (Most Gear Sometimes) instead of ATTGAT..

    • Jorn Bjorn Jorvi

      Regarding the back protector, it seems we can agree that they don’t do much. Sure they’ll protect you from direct impacts, especially from pointy things like curbs and clip ons, but those kind of impacts are uncommon.

      However, I choose to wear mine. I have an astars jacket with the snap in back protector. The back protector mounts to the jacket and then holds my body with a 4-5 inch wide strap around my waist. This does wonders in keeping the jacket from shifting around as I effectively have a giant waist belt built into the jacket.

      • Stuki

        Also, those cases when a back protector DOES do something, not having that something done can likely lead to paralyzation; which is about as high on the scale of nasty as it gets…

        • NOCHnoch

          Precisely. All my jackets have back protectors built in. Why go without it when it can protect from such a horrific injury?

          • Michael Howard

            Back protectors make my back look fat. ;)

  • Davidabl2

    “We routinely watch as motorcycle racers walk away from 200 mph+ crashes while wearing head-to-toe protection”
    It should be noted that they haven’t usually hit any hard objects except the pavement and the dirt. And they (usually) haven’t been directly struck by another vehicle.
    Realistic street protection will be different, because while speeds are far lower, those typical long racetrack slides don’t happen because the rider typically hits something solid before sliding very far. Or GETS HIT by something typically typically very large and has four wheels.

    Road conditions would seem to be somewhat more like MX racing conditions (or Motard?) than like GP. Although in truth it would be best to develop really effective street protection based on street conditions where shock protection may be more important than sliding protection.

    How about a ventilatedRroadcrafter suit with a terminator-style exoskeleton & airbags? :-)

  • DerekB

    Two words – rotator cuff

  • stever

    Hearing loss is an injury that will happen every single time you ride unless you protect yourself.

    Fortunately, earplugs are the cheapest gear you can buy by a factor of at least 100.

    • Jai S.

      Every single time I’m going above 50, I’m using ear plugs. It’s so much more comfortable.

      • Piglet2010

        Or even for around town on a noisy bike such as a bone-stock TW200, ear-plugs are needed.

  • grindz145

    Thorax?

    • eddi

      The chest between collar bones and bottom ribs. Below that is the abdomen. Real medical types may feel free to correct this as necessary.

  • ThinkingInImages

    Great article and it pretty much aligns with the injuries I’ve had – with one exception: my leg was damaged by the motorcycle itself. A tiny piece of engine fin. It snapped off and nailed me right in the knee. To this day, that still spooks me. I’ve been looking at better leg protection now that I’m older and wiser.

    I’ve always been a level headed rider and I take riding very seriously. I think that’s a small part of how I’ve survived riding for so long without major injuries. The other part is I’m “compact” and limber. I learned a long time ago from sports that if the ground is coming up at you to not tense up.

  • AHA

    Focussing just on the data for serious injuries & death at hospital (& extrapolating for the roadside) it seems clear that the head, thorax & abdomen are the key danger areas which is pretty obvious. I’m struck by how little protection is available for the chest and almost nothing for the abdomen as far as impact protection is concerned. Does anyone sell a waterproof, abrasion resistant jacket with integrated , all round armour similar to an off road harness?

    • Mitchel Durnell

      Many A* and Dainese jackets have chest armor pockets now. You can buy and wear a Forcefield back protector that has a chest protector attached. Or a motocross roost rig, technically.

  • taba

    Any chance you’ll be reviewing any of the Alpinestars jeans anytime soon, Wes?

    I’ll get a couple pairs of the Hellcat if you believe they are meaningfully protective.

  • Maverick Moto Media

    You left out the most common broken bone for road racers: the collarbone.

    • Mitchel Durnell

      The track community here in Socal has a pretty good collection of broken collarbones. Most say to spend the extra coin and have it fused.

  • gregory

    I thought the Hurt Report said that your jaw was the most likely injury area. God bless full face helmets.

    But sturdy boots (as this study suggests) make sense, too. I guess I can’t ride in Chuck Taylors any more.

    -g