Inline Skating, Skateboarding, and Bicycle Motocross


  • Inline skating, skateboarding, and bicycle motocross (BMX) are relatively new sports that are often included in the category of adventure and extreme sports (AES). These sports have had increased participation and popularity in the last couple of decades, in part because of AES events (such as X-games); inclusion of some AES in the Olympic Games; and social media, Internet sites, sponsorships, television channels, and AES businesses.

    • Present unique challenges compared with traditional, team, or school- and club-based sports, including in terms of medical care.

    • Increased injury rates in new and inexperienced individuals and experienced athletes trying to push the boundaries of what is possible on their equipment.

    • Most injury data are from emergency department (ED) or hospital admission data, which do not account for injuries evaluated at urgent care or private physician offices.

Inline Skating


  • Inline skates date back to 1849; Louis Legrange crafted skates with wooden wheels to simulate ice skates for an opera

  • In the 1970s, inline skating was primarily limited to hockey players looking for ways to practice during summers.

  • In 2019, there were an estimated 4.4–4.8 million inline skaters in the United States according to the Sports & Fitness Industry Association (SFIA) and National Sporting Goods Association (NSGA), with the largest participation in the youngest age groups (6- to 17-year-olds).


  • Boots: Higher, firmer boots provide more ankle support and control; used by beginners and trick skaters. Lower boots allow more ankle flexion; used by speed skaters.

  • Frame: Shorter frames are more maneuverable; longer frames are faster and more stable. Most recreational skaters use four-wheeled frames. Speed skaters use five-wheeled frames. Artistic skaters use two- or three-wheeled frames.

  • Wheels: Wheel design: in a row for inline (rollerblades) compared with in side-by-side pairs for roller skates (“quads”). Wheel sizes vary by skating style. Harder wheels are faster and more durable, but soft wheels may have better grip.

  • Brakes: Some inline skates have a rubber brake built into the heel, creating friction against the pavement. Standard rear brake pressure does not allow efficient stopping. Older styles require the skater to lift the toe, causing loss of contact between the front wheels and the ground, reducing stability. Expert skaters, trick skaters, figure skaters, and speed skaters often use skates without brakes. Other braking techniques include spin stops, dragging the skate, or skating into grass.

Competitive and Noncompetitive Disciplines

  • Speed skating (sprint and long-distance events); roller speed skating was part of the 2018 Summer Youth Olympic Games

  • Team sports (inline and roller hockey, roller soccer, roller derby)

  • Aggressive inline focuses on tricks. “Big air competitions” rate competitors on jump height, trick execution, and artistic performance. In half-pipe (“vert”) competitions, tricks are performed at or above the pipe (ramp) rim

  • Street: tricks, grinds, and jumps on railings, curbs, stairs, and obstacles found in typical urban settings

  • Recreational (solo or group) skating

  • Others: Freestyle and freestyle slalom skating; off-road skating; free skating (urban skating or “riking”); inline alpine; inline downhill; artistic/figure skating; skate cross (multiple skaters racing an obstacle course)

  • Governing body: International Federation of World Skate (inline and skateboard)

Injury Patterns

Risk Factors

  • Male

  • Age: 10- to 14-year-olds account for a majority of injuries (according to Consumer Product Safety Commission [CPSC])

    • Inexperienced skaters are at increased risk of injury. Experienced skaters are also at increased injury risk related to performing tricks and dose-response skating (higher number of injuries the more hours per week spent skating, specifically >10 hours/week).

  • Skitching: hanging on to a moving vehicle, can lead to speeds of >70 mph. Deaths from inline skating usually involve motor vehicle collisions (MVCs).


  • Primarily from falls and collisions.

  • There was a significant downward trend in ED-treated inline skating injuries from 2005 to 2014 (CPSC). Medically attended injuries (which include ED, doctor’s offices, clinics, and school nurses) in 2014 were estimated at 29,857, and 2018–2019 national estimates of ED-treated injuries are <5000/year.

  • Severity: In a previous study, injury severity score (ISS) was 10.6 for inline skating compared with 10.5 for skateboarding and 12.7 for cycling.

  • Wheeled sports (roller skating, skateboarding, and scooter) had highest rate of traumatic brain injury (TBI) on computed tomography (CT) (12%) and clinically important TBI compared with all other sports; wheeled sports also had a TBI hospitalization rate 10 times that of team sports. Approximately half of inline fatalities in the Centers for Disease Control and Prevention (CDC) database are from head injuries.

  • Abdominal injuries are uncommon but may be significant. Five percent of clinically important intra-abdominal injuries (CIIAI) presenting to the ED were related to rollerblades, bicycles, or skateboards.


  • Upper extremity (UE, especially wrist and forearm) are the most frequent sites of injury, particularly more severe injuries (fractures and dislocations). Compared with other sports, skating sports have one of the highest frequencies of elbow dislocations.

  • Knee and ankle are most common lower extremity injury sites


You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here