Epidemiological data on injuries in paragliding are mainly from retrospective case series or cross-sectional studies: calculation of injury rates is difficult, since the precise number of paragliders is usually unknown. No studies on degenerative changes as a result of overuse are reported in paragliding, and all the available series are related to traumatic events [1–5]. A survey from Germany analyzed over 400 incidents over a period of 3 years and calculated yearly incident rates of licensed pilots of 0.58–1.01 %, severe injury rates of 0.32–0.5 %, and mortality rates of 0.03–0.06 %, all decreasing over time [6]. In Switzerland, 129 incidents were reported over 3 years, 9 were fatal incidents and 60 of those classified caused major injuries [7].

Incidents in paragliding most commonly occur as a consequence of deflation of the glider (32.5 %), oversteering (13.9 %), landing errors (13.7 %), collision with obstacles (12.0 %), and takeoff errors (10.3 %) [6]. Any disturbance of the chute’s profile results in a loss of height: if there is an adequate distance to the ground, such disturbances can be corrected by the pilot, and a stable forward motion can be obtained. A large unilateral collapse of the airframe results in a spin and helical flight path, a spiral dive where the vertical speed can easily reach 20 m/s (72 km/h). Due to the large pendulum of the pilot suspended 8 m below the wing, the centrifugal forces may accelerate the pilot to speeds of over 100 km/h. By vector addition, this results in velocities of over 120 km/h for the pilot relative to the land surface. An aerodynamic stall over the whole wingspread (e.g., abrupt braking maneuver) results in a nearly vertical plunge downward, with speeds of around 10 m/s. A unilateral aerodynamic stall leads to uncontrolled rotation around the vertical axis and downward velocities of around 6 m/s.

Due to the sitting or semi-recumbent position in the harness (Figs. 18.3 and 18.4), the crashing pilot first impacts with his feet or buttocks.

Accordingly, most injuries are observed in the lower extremities and the trunk (pelvis and spine): fractures, dislocations, distortions, and strains of the lower extremities account for 27–46 % of these injuries, with injuries to the spine and trunk representing 31–60 % of all reported paragliding injuries [2–5, 8, 9].

In the spine, the most common injuries (50–91 %) are severe compression-type fractures, requiring surgical treatment in two-thirds of patients, while one-third of patients present neurological impairment [2, 5, 7]. In a Swiss study, in 12 out of 37 patients with spinal cord injury, the level of the neurological damage and that of the vertebral fracture differed by two segments: the authors assume that the particular injury mechanism responsible for these injuries, involving mainly axial forces compressing or stretching multiple segments at once, explains this difference to the non-paraglider paraplegic patients [2]. There is a typical peak at the thoracolumbar junction, with L1 as the most affected vertebra (30–35 %), as compared to the fracture distribution in general trauma where another similar peak at the lower cervical spine and a third smaller peak at the mid-thoracic spine are described [2, 5, 8].

In paragliding incidents, injuries to the cervical spine (6–8 %) and head (5–16 %) are relatively rare, but the total frequency of spinal and pelvic injuries is far higher as compared to general and sports trauma and highlights the danger of the massive impact forces at deceleration [2–5, 9]. The spinopelvic junction has been identified as being at special risk in paragliding incidents: in a retrospective series, 8 of 144 severely injured paragliders sustained a spinopelvic dissociation, an injury also known as a “suicidal jumper’s fracture” [5] (Fig. 18.5). Compared to the normal trauma population, the injured paraglider has a 19-fold increased risk of sustaining such an otherwise rare fracture. One possible explanation may be the additional horizontal force vectors that occur during the paraglider’s landing, as the inertia of the axial and horizontal moved mass of the torso forces the lumbar spine into lordosis, resulting in flexion-type jumper’s fractures [5, 10].

Non-skeletal injuries are less frequent: severe thoracic, visceral, and vascular trauma are reported, often concomitant to injuries of the spine [9, 11]. Three cases of traumatic rupture of the descending aorta, associated with multiple injuries following a paragliding blunt trauma, have been attributed to the chest being crushed and the sudden brusque deceleration [12]. Cases of myocardial contusion, hematothorax, pneumothorax, and gut and urinary bladder rupture, as well as liver contusion with bleeding, have also been reported [13].

Musculoskeletal, ligament, and tendon injuries related to functional overload and to the specific patterns of movements required in paragliding are rarely reported, probably because more attention has been paid to injuries resulting from high-energy trauma injuries up to now; however they are probably underestimated. Shoulder dislocation, for example, is a common paragliding injury and may be a consequence of the particular movement required when pulling up the sail [18]. Schulze Bertelsbeck et al. [19] also reported the case of a pilot who sustained a bilateral partial rupture of the rectus femoris muscle during a paragliding landing maneuver. Rupture of the rectus femoris muscle is a rather uncommon condition: the rectus femoris is the only biarticular muscle in the quadriceps, making it prone to muscle strain injuries when undergoing eccentric contractions [20–23]. During a paragliding landing, the pilot absorbs energy through his legs [3], and the quadriceps exerts an eccentric contraction to counteract the impact: accordingly, the rectus may be subject to strains and ruptures during landings with a paraglider. Effective strategies to prevent such injuries, therefore, may include an appropriate flight technique (including a proper reduction of the speed during the approach phase), together with a workout focused on the specific types of efforts required.

Various non-traumatic, yet potentially life-threatening conditions are reported in literature: they are characteristic of this extreme sport and are associated with exposure to environmental agents. Although the data in question consists of isolated reports, it takes on greater importance in the absence of systematic sets of data. Physicians should be aware of the potential for these health problems and take them into consideration, both when formulating the primary diagnosis, which often needs to be done rapidly, and when considering suitable strategies for the prevention of these conditions.