People riding e-bikes or illegally modified bikes are 41 per cent more likely to suffer head or neck injuries in a crash than other cyclists on non-electric bikes, a new study examining cycling-related visits to a hospital emergency department has found.

According to the study, published this month in the Journal of Emergency Medicine, the increased likelihood of “significant injuries” among ‘electric bike’ riders stems from higher average alcohol consumption and lower reported use of helmets than their pedal cycle counterparts.

However, though described as a “wake up call” by one personal injury lawyer, the study’s findings were questioned by former West Midlands cycling and walking commissioner Adam Tranter, who pointed out that hospitals and emergency services “often use ‘e-bike’ as a catch-all term”, thereby conflating people riding illegal machines, and the injuries they suffer, with those on legal e-bikes.

Conducted by researchers from Queen Mary University of London and Homerton University Hospital, the study examined cycling-related visits to the emergency department of a hospital in northeast London between September 2022 and August 2025.

These visits were identified from the electronic patient record and categorised by the researchers as “e-bike” or “non-e-bike.”

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Of the 5,529 cycling-related visits during the three-year period under assessment, 564 (almost 10 per cent) were categorised as involving e-bikes. The research also served as an unintended barometer of the rising popularity of e-bikes in recent years, revealing that only 3.8 per cent of cycling emergency department visits were e-bike related in 2022/23, compared to 16 per cent in the study’s third year.

Compared to “conventional” bike injuries, ‘e-bike’ riders were 41 per cent more likely to suffer a head or neck injury and 33 per cent more likely to sustain a lower limb injury. However, they were 36 per cent less likely to experience damage to their upper limbs.

Meanwhile, alcohol involvement was more common in ‘e-bike’ cases (eight per cent of all incidents compared to three per cent for non-electric bikes). Where documented, 81 per cent of ‘e-bike’ riders were also reported to not be wearing helmets at the time of their crash. Three per cent of injured ‘e-bike’ riders (a total of 17) required surgery.

Deliveroo rider’s illegally modified e-bike
Deliveroo rider’s illegally modified e-bike (Image Credit: All-Party Parliamentary Group for Cycling and Walking)

“These accidents were frequently associated with alcohol use and a lower reported use of helmets than in non-e-bike accidents and potentially resulted in more significant injuries,” the researchers said.

“These findings support targeted injury prevention and public health interventions as e-bike use continues to rise.”

Speaking to the Times, one of the study’s authors, Adam Stoneham, said: “What our study demonstrates is two things: that there is a greater number of patients presenting to A&E following e-bike accidents but also the severity of this trauma is greater than we were seeing with conventional bikes in the past.”

Stoneham, a consultant trauma surgeon and associate professor of social policy at Homerton University Hospital, continued: “E-bikes have been a total gamechanger; they make cycling much more accessible to people of all health and ages and they greatly increase the distance you can commute. But of course this comes at a cost.

“London infrastructure is not set up to deal with the volume of bikes we are currently seeing and it has already caused major problems in terms of parking as well as the health ramifications we are witnessing.”

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Another co-author, James Siswick, a foundation doctor at Queen Mary University of London, said the study’s findings provided further evidence that authorities need to clamp down on fast, heavy, illegal bikes.

“Trauma is all about energy. E-bikes are normally much faster and heavier than conventional bikes so transmit greater magnitudes of force. The brakes and steering are normally not proportional to meet these demands, all of which is reflected in the pattern of injuries that are treated,” he said,

“Add into that the fact that riders are much less likely to wear a helmet [and] are much more likely to be intoxicated and you have a lethal combination.

“The popularity of self-modified, unregulated e-bikes which can travel in excess of the 15.5mph speed restriction is of particular concern, not least because they are difficult to apprehend and completely untraceable.

“Collaborative working by the government, local authorities and bike hire companies could improve safety measures, resulting in a positive impact on public safety as well as reducing the consumption of NHS resources on e-bike related accidents.”

Female cyclist in London on Lime hire bike
Female cyclist in London on Lime hire bike (Image Credit: Simon MacMichael)

Adam Tranter, the former West Midlands commissioner for walking and cycling, urged caution, however, when it comes to using the study’s findings for policy or policing purposes, noting that hospitals tend to conflate legal e-bikes with their illegal counterparts, muddying the road safety picture.

In the UK, legal electric bikes, classified as electrically assisted pedal cycles (EAPCs), must have pedals that can propel the bicycle, have an electric motor with a maximum continuous rated power not exceeding 250 watts, and cut off electrical assistance when it reaches 15.5mph.

However, the use of modified bikes, which do not cut off assistance at 15.5mph and can reach high speeds without pedalling, has become an increasing issue on the UK’s streets, leading to widespread confusion with their legal counterparts.

These machines are instead classified as motorbikes and mopeds and do require a licence, registration, Vehicle Excise Duty, and the rider to wear an approved motorcycle helmet to be used on a public highway.

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Tranter also noted that the rise in e-bike injuries is to be expected given the increasing popularity of electric-powered vehicles, illegal or otherwise.

“It is unremarkable that e-bike injuries appear to have risen as a share of cycling injuries, given how e-bike use has grown in the capital,” he said.

“The bigger issue is that hospitals and emergency services often use ‘e-bike’ as a catch-all term, including illegally modified machines that are electric motorbikes in law.

“Better data collection, including in police STATS19 records, would give the full picture. We shouldn’t conflate heavy, fast, illegal bikes with the legal, regulated e-bikes that sustainable transport depends on.”

Nevertheless, Lucie Clinch, senior associate in the personal injury team at Stewarts Law, described the research as a “wake up call”.

“E-bikes are not simply bicycles that happen to have a motor – they can be heavier, faster and capable of generating considerably more force in a collision than a standard pedal bike. When things go wrong, the consequences can be catastrophic,” she said,

“The data is of no surprise – that traumatic injury from e-bike accidents often arise where alcohol has been consumed and where the riders were not wearing helmets. Use of e-bikes across London is growing and the risks of e-bikes should not be underestimated. Public education is still required to protect users.

“Accidents frequently result in concussions, skull fractures and broken bones, but some victims can sustain life changing injury. More regulation is needed, to include micromobility generally, to ensure that the ever-changing landscape of transport the UK, does not result in reduced road safety for all.”