Introduction Downhill Mountain Biking (DHMTB) is one of the more spectacular sub-disciplines of mountain bike (MTB) cycling. The primary aim of our study was to prospectively document the injury rate, severity, aetiology, location and type during official training and racing by elite DHMTB riders during the 2023 UCI Cycling World Championships.

Methods The participants of this prospective, observational study were elite male and female cyclists competing at the UCI DHMTB World Championships located in the Nevis range in Fort William, Scotland, in 2023. This study followed the injury reporting guidelines established by the International Olympic Committee (IOC), which include the STROBE-SIIS and the cycling-specific extension.

Results Throughout the championships, 10.4% of riders sustained one injury, with 4.3% of riders injuring more than one location per injury event. The overall injury incidence was 3.3 injuries per 100 rides. The incidence rates were higher in the training group (6.4/100rides) than in the race group (2.3/100rides). There was a greater incidence of injury in females in the training 5.7/100 rides and racing 4.4/100rides compared to male riders. Female athletes experienced more severe injuries, with double the estimated time lost to injury. Additionally, female athletes were found to have a significantly greater risk of head injuries and concussions than males.

Conclusion Overall, injuries are more prevalent in training than in competition. Compared with male DHMTB athletes, female DHMTB athletes are more at risk of injury and show a greater incidence of injury within official training and competition as well as more severe injuries.

Downhill Mountain Biking (DHMTB) is one of the more spectacular subdisciplines of mountain bike cycling and has been shown to have high injury prevalence.

There is a lack of methodological homogeneity amongst the prospective injury surveillance studies conducted within DHMTB and across competitive cycling.

No Study has currently reported injury incidence within elite DHMTB as per the International Olympic Committee (IOC) cycling extension recommendations.

Within DHMTB injury incident rates were higher in training (6.4/100rides) compared to racing (2.3/100rides).

Overall Injury incident rate was significantly higher in females (5.1/100rides) compared to males (2.3/100rides).

Female athletes have a 2.89 higher risk of Injury compared to Male DHMTB athletes.

Female athletes have significantly higher risk of head/neck (RR 9.5) injuries and concussion (RR 6.34) compared to their male counterparts.

The IOC Cycling Extension should acknowledge that when reporting injuries per 100 rides, the number of rides completed prior to injury should be collected to improve reporting accuracy.

Female athletes may benefit from an extra official training ride to ease pressures during course familiarisation and reduce racing injury incidence.

Female athletes may benefit from neck strengthening and resistance training to reduce the number of head and neck injuries.

The authors have declared no competing interest.

TF is funded by the Department for Education (DfE). No other funding was received for this study.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval for this study was obtained from the Medical Faculty at Queen University Belfast, Northern Ireland (Faculty REC Reference Number MHLS 23_97).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors