Inline Skating, Skateboarding, and Bicycle Motocross

Inline Skating


  • Inline skates date back to 1849; Louis Legrange crafted a pair with wooden wheels to simulate ice skates for a scene in Giacomo Meyerbeer’s opera La Prophète.

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

  • Its popularity exploded in the 1990s; it became the fastest-growing recreational activity of the decade.

  • In 2014, there were an estimated 4.7 million inline skaters in the United States (US) according to the National Sporting Goods Association (NSGA).


  • Boots: Higher and firmer boots provide more ankle support and better control and are used by beginners and trick skaters. Lower boots allow more ankle flexion and are 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 sizes vary depending on skating style. An average recreational skate has wheels that are 72–90 mm in diameter; smaller wheels (48–72 mm) are used for tricks and dancing; larger wheels (80–100 mm) are used for speed skating. Harder wheels are faster and more durable, but soft wheels may have better grip. There are elliptical and rounded profiles.

  • Bearings: Higher-rated Annular Bearing Engineering Committee (ABEC) scale bearings are better in overall quality and theoretically translate into faster and smoother rides with less friction.

  • Brakes: Most inline skates have a hard rubber brake built into the heel of one of the skates, creating friction against the pavement. The standard rear brake pressure does not allow quick or 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 behind the body, or skating into grass.

Competitions and Skating Styles

  • Competitive inline skating events:

    • Speed skating (sprint and long-distance events)

    • Team sports (roller hockey and roller derby)

    • Group skating as a social activity—one of the largest groups to skate city streets is the Pari Roller in France, involving up to 35,000 skaters in one night

    • Figure skating and dancing

    • Half-pipe or “vert” competitions, wherein the tricks are performed at or above the rim of the pipe

    • Slalom racing thorough cones

  • Recent growth has been observed in increasingly aggressive skating events such as “big air competitions” that rate competitors on height of the jump, execution of tricks, and artistic performance.

    • Street competition—tricks, grinds, and jumps on railings, curbs, stairs, ramps, and other obstacles found in typical urban settings

    • Free skating (also known as urban skating or free “riking”)—The objective is to reach from one point to another by the fastest possible route, negotiating obstacles with jumps and slides as needed.

    • Off-road skating on dirt trails while on skates using special “all-terrain” wheels

    • These more extreme forms of inline skating increase potential for number and severity of injuries.

  • There was a strong statistically significant downward trend in emergency department (ED)-treated inline skating injuries from 2005 to 2014 according to the Consumer Product Safety Commission (CPSC)’s National Electronic Injury Surveillance System (NEISS). Medically attended injuries (which includes ED, doctor’s offices, clinics, and school nurses) in 2014 were estimated at 29,857 according to the CPSC.

Injury Patterns

Risk Factors

  • Male: ratio of male-to-female injured skaters is 1.5–2:1

  • Age: 10–14-year-olds account for a majority of injuries

  • Inexperienced skaters are at an increased risk of injury; 25% of skaters in a small study were injured their first time out

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

  • Skitching, a dangerous practice of skaters hanging on to the back of a moving vehicle, can lead to speeds of >70 mph.

  • Deaths from inline skating usually involve collisions with motor vehicles.


  • Falls lead to numerous injuries. Most frequent site of initial impact after an unintentional fall was the hands and wrists (44.6%).

  • Approximately 50% of head injuries in youth and adolescent sports/recreational activities occur while skateboarding, skating, and bicycle riding.

  • 10%–25% of inline skaters have reported at least one injury.

  • 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.


  • Approximately two-thirds of injuries occur in the upper extremity. 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 the most common sites for lower extremity injuries.

  • Head injuries account for up to 5% of serious injuries. Approximately half of the inline fatalities in the Centers for Disease Control (CDC) database are from head injuries.


Protective Equipment (Personal Protective equipment [PPE])

  • American Academy of Pediatrics (AAP) and the American Acad­emy of Orthopaedic Surgeons (AAOS) recommend helmets, wrist guards, elbow pads, and knee pads. American Dental Association (ADA) recommends mouth guards.

  • Estimated that wrist guards and elbow pads can decrease upper extremity inline skating injuries by 90%

  • Failure to wear wrist guards may increase the relative risk of injury by 10.4; nonuse of elbow pads may increase the relative risk of injury by 9.5.

  • Cadaveric studies using high-speed impact loading suggest that wrist guards may reduce injuries.

  • Helmets have been shown to reduce the risk of injury in bicyclists; this may be even more important for skaters who can reach speeds >40 mph.

  • Fatally injured skaters universally seem to be nonhelmet wearers.

  • Helmets

    • Should be certified by one of these groups: American National Standards Institute (ANSI), American Society for Testing & Materials (ASTM), CPSC, or Snell Memorial Foundation

    • Recreational skaters can use bicycle helmets. Aggressive or trick skaters should use skateboard helmets. For more information, visit the CPSC website.

    • Should be professionally inspected or replaced after any hard helmet impact

Use of Protective Equipment

  • Actual use: unknown; wrist guards are the most commonly worn personal protective equipment (PPE).

  • Peer effect seemed to increase the use of PPE in observational studies.

  • Adolescent skaters were much less likely to use PPE.

  • Most influential factors for PPE use in adolescents: parents (40%), requirement of skating location (33%), friends (15%), and coaches (14%)

  • Common reasons for not wearing protective equipment: lack of perceived need (47.3%) and discomfort (37.5%); appearance was also a factor (cited by 25% of adolescent skaters)

  • Formal instruction in school-based program has been shown to have a small but significant positive effect in attitude toward and use of protective equipment.

  • PPE has the potential to transmit forces to areas away from the impact site, placing other areas of the body at a risk of injury (e.g., wrist guards may place skaters at a risk of “splint-top” fractures).


  • Safe age for inline skating is not known. AAOS does not recommend skating (inline or skateboarding) under the age of 5, and 6–10-year-olds should be closely supervised.

  • Skate parks: advantages are a smoother surface separate from traffic compared with roads; however, some have concern for increased injuries.

  • Beginners should consider lessons; learning how to fall can help decrease injury.

  • A small-scale study showed increased balance and strength in preteens in a 4-week instructional inline skating program.

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Jul 19, 2019 | Posted by in SPORT MEDICINE | Comments Off on Inline Skating, Skateboarding, and Bicycle Motocross
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