Little supervision, many injuries

As the popularity of motocross has grown, so have the number of sport-related injuries, especially among children and teens. "When you race motorcycles on a dirt track at 40 or 50 miles an hour, fly dozens of feet into the air, and are involved in multivehicle crashes, the potential for serious injury is high," says Amy L. McIntosh, M.D., an orthopedic surgeon and sports medicine specialist at Mayo Clinic in Rochester, Minn.

To find out exactly how high, Dr. McIntosh and colleagues performed a retrospective study of 249 pediatric motocross patients seen at Saint Marys, one of Mayo Clinic's hospitals in Rochester, Minn., from 2000 to 2007. The investigators reviewed the type, severity and mechanism of injury as well as the cost of care.

Results of the study, published in the December 2009 Journal of Pediatric Orthopaedics, revealed that nearly one-half of the patients — all 17 years of age and younger — required hospitalization and an additional one-third needed surgery, mainly orthopedic procedures. The average medical bill was $14,947.

"In spite of protective gear, we saw every type of fracture, especially of the femur and collarbone, as well as ligament injuries, concussions and some devastating spinal cord injuries," Dr. McIntosh says. "Unfortunately, we think this is just the tip of the iceberg because we only reviewed cases severe enough to be referred to a Level I trauma center."

Return-to-ride guidelines are key

Of all injuries, concussions are the most likely to go unreported and untreated. Twenty-five percent of patients in the initial study experienced loss of consciousness. In a follow-up survey study, 50 percent of those interviewed said they had concussion symptoms but continued to ride the same day and never sought medical care.

Dr. McIntosh points out that although return-to-play guidelines are now in place for most amateur and professional sports, this is not yet true for motocross, which has no coaches or trainers to monitor injured riders.

"To reduce the risk of second impact syndrome — which occurs when a second concussion occurs before the first has fully healed — and future cognitive problems, it's vitally important that injured riders undergo a medical exam and resume racing only when it's safe for them to do so," she says.

She adds that Minnesota recently joined 20 other states in placing legal restrictions on when young athletes can return to play.

Taking it to the track

Ultimately, though, Dr. McIntosh believes that the best way to raise awareness about concussions is through grass-roots education. Most weekends find her at the track, talking to participants, parents, local EMTs and the pro racers the kids idolize. "Some of our patients have turned professional and can be great role models for concussion management," she says.

Mayo Clinic also offers free baseline concussion testing — an important tool for guiding return-to-ride decisions. At Saint Marys, injured athletes are closely monitored through every step of the sometimes-lengthy recovery process.

Dr. McIntosh and fellow researchers are also conducting prospective studies on how to make the sport safer. One study compares riders undergoing a preseason training program with an untrained group. "We want to know if preconditioning has an effect on injuries," she says.

Dr. McIntosh stresses that the goal of her research isn't to discourage children from participating in motocross. "We try to reassure parents that we're not opposed to racing. We just want to find ways to keep kids from getting hurt."