Electric bikes + middle-aged riders = more injuries

As an emergency room physician, Dr. Ali Raja is among the first to witness new injuries mundane and exotic that land people in the hospital. One of the more notable recent trends is the rising number of middle-aged road warriors hobbling in after accidents on electric bikes, often looking sheepish.

E-bike sales have soared since the early days of the pandemic when legions of cooped-up souls were searching for outdoor activities, and with that has come a spike in injuries, recent research shows.

Since early 2021, riders between the ages of 45 and 64 — Gen-Xers and the youngest of the Baby Boomers— suffered the fastest growing rate of e-bike injuries, according to a new study from researchers at Columbia University’s Mailman School of Public Health.

Raja, who is executive vice chair of emergency medicine at Mass General Brigham, said injured older riders he treats often spontaneously decided to rent an e-bike.

“They will walk out of a building and see a rental and say, ‘I will use one of these,’” he said. “That spontaneity means they don’t have a helmet or much experience.”

E-bikes have lured many with aching or rebuilt joints back to the great outdoors, allowing them to be active once again. They’ve enticed former couch potatoes to put down their TV remotes and take up trail rides. The devices are also championed by environmentalists for helping ease traffic congestion and pollution as urban commuters choose to leave their cars home and e-pedal in to the office. Plus they don’t require scrounging for a parking space.

But experts are concerned about the rising number of injuries, especially among older riders, and say city planners and riders should make changes.

“There’s a need for attention because of how close these e-bikes are driven in proximity to cars,” said the study’s lead author, Katie Burford, a post-doctoral fellow in the Department of Environmental Health at the Mailman School.

Burford and her team studied more than 1.9million injuries involving e-bikes, powered scooters, and other 2-wheeled devices that hospitals reported to a national injury database from 2019 through 2022.

They found total injury rates across the age groups spiked for power scooters by 88 percent and for e-bikes by a stunning 293 percent. While powered scooter injuries appeared to be tapering off among most age groups, the rate of e-bike injuries kept climbing.

Raja, the Mass General Brigham ER doctor, said the speed and weight of e-bikes play into such high numbers of injuries, with the fastest ones able to reach nearly 30 miles per hour and often weighing twice or more that of a typical road bike.

“The heavier batteries and the equipment and the speed make it harder to control,” he said. “People, when they come in and I ask what happened, they say ‘I didn’t ride the bike that fast but I couldn’t stop it from hitting the pole.’ Or they hit a car.”

The bikes come in three basic tiers: Class 1 with a top pedal-assisted speed of about 20 mph; Class 2, also with a top speed of 20 mph but including a throttle so users aren’t required to pedal; and Class 3 that are heavier and faster, reaching speeds of 28 mph, but users are required to pedal to activate the motor. Some e-bike riders modify their devices to ride at speeds well above 30 miles per hour, approaching those of a motorcycle.

Two popular ride-sharing companies in Greater Boston, Bluebikes and Metro Mobility, offer Class 1 e-bikes.

Mark E. Salomone, Jr., a personal injury attorney who handles cases across Massachusetts and Connecticut, said his phones are ringing more often about e-bike injuries. Typically, he’s found that e-bike riders don’t wear as much protective clothing as those who ride motorcycles.

“So the injuries we see with e-bikes are more severe,” Salomone said. “They’re striking the pavement without proper protective gear. A lot of people are wearing shorts and T-shirts, as opposed to something you would wear on a motorcycle,” like helmets, pants and long sleeves.

Molly Jennings, who moved with her husband earlier this year from Iowa to Dorchester, was intrigued by all the people she saw renting electric Bluebikes at the subway stop on her way to work. At 56, and with two new knee replacements, Jennings decided to join their ranks.

“After surgery, my knees are not strong enough, but e-bikes have allowed me to start rebuilding my muscles, and I have lost 30 pounds,” Jennings said.

One of the trickiest parts as a new rider, she said, was finding her balance on the heavy bikes, especially while turning a corner in traffic. She’s had a few spills, but no serious injuries.

“Just bruised and embarrassed,” Jennings said.

She carries a helmet in her backpack because ride-sharing e-bikes stations, like Bluebikes and Metro Mobility, do not stock helmets at their rental docking stations, though they both encourage helmet use with notices on their bikes and in their mobile apps.

Massachusetts law requires helmets for motorized bikes that travel faster than 25 mph.

But Jennings may be in the minority of e-bikers when it comes to helmets. Just 44 percent of injured e-bicyclists reported wearing a helmet, with proportionately fewer wearing helmets each year, researchers from University of California San Francisco found in a nationwide study.

The incidence of head trauma from e-bicycle accidents in 2022 reported by hospitals was approximately 49 times higher than in 2017, increasing from approximately 163 reported head injuries to approximately 7,922 nationally.

Helmet laws for e-bikes vary widely among states. Burford, the Columbia University researcher, said mandating universal helmet laws for e-bikes might decrease ridership. A more productive approach, she said, is to focus on infrastructure changes that make it safer for riders, which could reduce injuries. She said adding more protected bike lanes and bike boxes, an area where cyclists can stop in front of cars while waiting for a light at intersections, are promising.

“They’re kind of like a crosswalk for cyclists because intersections are very dangerous,” she said.

E-bicyclists are passionate about their hobby. A Globe post on the Facebook group E-bikes For People Over 50 asking about injuries prompted more than 100 responses and emails.

“I am a rider over 50 (64) who broke her elbow on an ebike,” replied a retired teacher from West Virginia. “The reason I broke my elbow on my Ebike is because I wasn’t sitting on the couch, which is what I would’ve been doing previously.”

Another shared that she just got an e-bike at age 57 and “I freaking love it!!,” she wrote. “I fell off my bike unto a curb and no cars stopped!! Thankfully it was just bruising. I always wear a helmet and have front and back lights for safety. None of my friends will even try to ride because they are afraid.”

Bill Lucas, a 60-year-old from western Pennsylvania, was a longtime rider of traditional bikes, but he took up e-cycling this past spring after having been bed-ridden for more than a year with various health issues, including severe balance problems.

“It’s life-affirming,” Lucas said. “It’s giving me control of myself in ways that represent freedom.”

He’s riding much more challenging routes than he ever did with a road bike, flying over rocks and tree roots.

As a result he’s had several crashes and injuries.

“At the age of 60,” he said, “I have wrecked more than I did at any other time in life.”

Jennings, the new e-bike rider in Dorchester, is hooked as well. She hopes to buy her own in the spring.

“I have a pretty chaotic work and home life,” she said. “Being on the e-bike is like a recharge for me.”

This story has been updated to clarify that Massachusetts law requires helmets for motorized bikes that travel in excess of 25 mph.

Kay Lazar can be reached at [email protected] Follow her @GlobeKayLazar.

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Electric bikes + middle-aged riders = more injuries