Leave the Governor On: Dr. Chaim Arlosoroff on E-Bike Injuries in Kids

Somewhere along the way, a lot of us filed the e-bike under bicycles. It has pedals, a kickstand and a basket, and a 13-year-old can ride it to school. Dr. Chaim Arlosoroff, M.D., files it somewhere else. He is an orthopedic trauma surgeon at St. Mary’s Medical Center, and on this episode of Pain 2 Power he told Dave and Mike what the e-bike boom looks like from the trauma bay.

The short version is that the bikes coming through his emergency room are often not the bikes that left the store. A small part called the governor is supposed to keep them slow. Kids are taking it off. If you have a child or grandchild who rides one, or who has one on a gift list, this conversation is worth half an hour of your Saturday.

By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.

What a St. Mary’s trauma surgeon is seeing in Palm Beach County

Dr. Arlosoroff has done orthopedic trauma at St. Mary’s for the past 30 years. He explained that his group also covers the pediatric and adult emergency rooms there, and that St. Mary’s is a level one trauma center taking referrals from across the region. So when injuries change, he sees it early. Up until a few years ago, he said, the bad ones were motorcycles.

Dave opened the topic with a national figure: ER visits for e-bike injuries in the United States up more than 400%. Dr. Arlosoroff said he had done a little research of his own on the counties around us. “Palm Beach County from ’23 to ’24, 130% increase,” he said. “Broward, 180% increase.” Miami-Dade, counting Nicklaus Children’s Hospital, came in at more than 500% by his count.

Then came the two numbers that made Mike groan out loud. About 83% of the injured riders were not wearing a helmet. And the average age of the injured rider was 13.

Why the hospital count is only the floor

He was careful about what those figures include. “And remember, these are serious injuries,” he said. They are the cases that reach the emergency room, come in as a trauma alert, or get admitted. In his words, there’s a “gazillion of people who never make it to the hospital or go to urgent cares,” and none of them show up in the statistics. Every sprained wrist that gets iced at home and every road rash cleaned up at an urgent care sits outside the count.

Dave added a story from his own clinic. A few weekends back, Dr. Arlosoroff came by looking like he was having a bad day. That one weekend, Dave said, he had treated a 14-year-old with a spinal cord injury who was not expected to walk again, and a 13-year-old who did not survive. Dave said the age twice. Thirteen.

The governor, a small part built to hold a bike at 15 or 20 mph

The single most useful thing in the hour is a word most parents have never heard. An electric bike ships with a governor, a limiter on the motor that caps its top speed. Dr. Arlosoroff put the factory range at 15 to 20 miles an hour. The trouble starts when someone changes it.

“It’s really scary that 13-year-olds can buy or get an electric bike, change something in the engine,” he said. With the governor gone, he told Dave, “they can fly at 50, 60, or maybe more.” That is car speed on a frame built for a bike path, ridden by a kid who usually has a bicycle helmet on, if he has one on at all.

Mike’s math: 15 versus 50

Mike put it in a line that has since become one of the episode’s clips. When people hear the word bike, he said, they picture something you can’t go too fast on. Plenty of kids ride without helmets, and when he was a kid nobody wore one. “Going 15 versus 50 is the difference between a scrape and a cracked skull,” he said. In his view people take it very lightly and don’t understand the real responsibility of handling that piece of machinery.

Later he compared it to the golf carts kids drive around some neighborhoods. A 13-year-old on a golf cart is still a worry, he said, but at least it won’t be going 50, and there’s a little more protection somewhere. On an e-bike there’s nothing between your head and the concrete.

Sidewalks, wheelies and fire hydrants

Speed was only part of it. Dr. Arlosoroff described riders who ignore almost every traffic rule, partly because they are 13. They hop on and off sidewalks, ride against traffic, merge into it without looking. Dave added wheelies to the list. Dr. Arlosoroff said he has treated people who simply hit a utility pole or a fire hydrant, or caught a curb and went over the handlebars. “We’re talking about major, major injuries,” he said.

Dave raised the other side of the sidewalk problem: the people the riders hit. Pedestrians get hurt too. Dr. Arlosoroff said they see a lot of skull fractures, along with a lot of very serious injuries that carry severe consequences for the kid and for the family.

Pedal assist in Park City and Sedona, and Dave’s case for pedaling

None of this made Dr. Arlosoroff anti e-bike. He is an avid cyclist. Here in Florida he rides a road bike and a mountain bike under his own power. He said the e-bike comes out only when he travels to steep country like Park City, Sedona, or Italy, where he rode this past summer, because it lets him reach places he would never get to otherwise. He also noted, with a smile, that he is getting a little older than David.

The key difference is that his rentals are pedal assist. “Even with help, you are working hard and you’re getting tremendous amount of exercise,” he said. In South Florida, he said, it has become a fad, and for some people it is simply how they get around, because money is tight, they have lost a license, or for a variety of other reasons.

Flat land and the hour a day

Dave was blunter. He said he doesn’t believe a kid in Florida, on flat land, needs an e-bike at all. His reason had nothing to do with crashes. “Only 20% of the kids in the United States get enough exercise, get an hour of exercise every day,” he said, and he compared that with the early 1970s, when by his figures most kids got that hour in. He tied the change to rising rates of fatty liver disease and type 2 diabetes in children. His suggestion was simple: get the kids on bikes they push themselves.

Mike told a story from a bike shop. He went in wanting to burn a few calories, and the salesman kept steering him toward an e-bike, pitching how nice it would be to just cruise the trail and take in the scenery. Mike admitted that does sound pleasant. It also seemed to him to be missing part of what makes a bicycle a bicycle.

If a fall has already happened, our physical therapy page explains how an evaluation and a plan of care work.

What a parent can actually do before the next ride

Mike closed the e-bike segment by speaking straight to the parents and grandparents listening, especially anyone looking at gifts. An e-bike is a motor vehicle, he said, and it can be modified into something you would never expect. Dr. Arlosoroff added that he believes Florida has a helmet law for bike riders under a certain age, though he wasn’t sure of the age and said it is obviously not enforced. Dave said there are efforts to tighten the rules.

Pulling together what the three of them said on air, the practical list is short:

• Put a helmet on the rider every time. Dave said a parent who skips it is endangering the child.
• Leave the governor in place, and check that it is still there. Mike’s words: “Make sure that they’re not modifying these things.”
• Talk about sidewalks and traffic. Riding against traffic and hopping curbs came up again and again.
• Treat the purchase like a motor vehicle, with the rules and supervision you would give one.

Dave also mentioned that some parents are now suing e-bike makers after their kids were hurt riding too fast without a helmet. He was skeptical. In his view the responsibility starts at home.

Most fractures never need an operation

Dave had a second reason for inviting his friend on. If your kid comes off a bike and you aren’t sure whether the elbow is broken, he said, you may not need the ER. Dr. Arlosoroff treats injuries from the foot and ankle up through the knee, back, neck and shoulders, and he takes elective patients as well as the trauma cases at the hospital. Dave asked whether he favors a conservative approach when one is possible.

“Most can be treated non-surgically,” Dr. Arlosoroff said of fracture care and musculoskeletal injuries in general. He listed what fills his week: shoulder sprains, rotator cuff injuries, ankle sprains, and falls in older adults that end in a fractured wrist or hip. A lot of them, he said, are not serious. Many still land in the emergency room because injuries happen at all hours and people aren’t sure what they are dealing with.

From the ER splint to the therapy gym

He walked through the usual path. If he sees a patient in the hospital while on call, the first treatment happens there: splinting, crutches, whatever is needed. Then the patient comes to his office for follow up. “And eventually, a lot of time in your hands,” he told Dave, “and you help us look good,” by getting people back to their regular activities.

That last stretch is the part we handle on US-1. Our post surgical rehab page covers what happens after an operation, and the same careful progression applies when a fracture heals without one. If the injury is a wrist or hand, a shoulder, an ankle sprain or a hip, those pages explain what therapy involves. Our post on what to expect at your first physical therapy visit answers the questions most people have before day one.

Dirt bikes to the west, propellers to the east

Dr. Arlosoroff said the variety is what he loves about the work. Think where we live, he said. There are the ordinary car, bicycle and motorcycle crashes. Head west and you get dirt bikes, ATVs and side by sides. To the east is the water, with boating injuries, jet skis, and propeller injuries he called devastating. He even mentioned shark bites, which he said he sees more of now that diving and spearfishing have become so popular. Some of these patients end up in surgery and some do not.

A combat medic, a world ranking of 283, and a scholarship to Duke

Before any of the e-bike talk, Dave made his friend of more than 30 years tell the story of how he got here. It started in 1973, when Dr. Arlosoroff was a high school sophomore in Israel and the Yom Kippur War closed his school for three or four weeks. The men were called to the reserves. His mother, a retired operating room nurse, volunteered at a local community hospital taking war injuries and brought him along to help.

He worked as a kind of orderly, cleaning operating rooms and wheeling patients in and out. One of the orthopedic surgeons there was the father of a boy he played junior tennis with, and that connection got him into the room to watch surgery. He expected to hate it. Instead he found that blood and guts didn’t turn his stomach, and he was amazed watching bones put back together with pins, rods and plates.

Three years as a combat medic

At 18, like everyone in Israel, he went into the army, and he was selected to be a combat medic. He described an intense course of about six months followed by two and a half more years of service, seeing everything from a head cold to gunshot wounds. Through it all he kept playing tennis seriously. He was always one of the top four juniors in Israel, played on the Israel Junior Davis Cup team, and traveled to Miami to play the Orange Bowl.

Sight unseen

After his service he played the smaller futures and satellite tournaments for about a year. “My highest ranking was 283 in the world in 1981,” he said, adding that it sounds great but wasn’t going to be his future. American players he met on tour told him about playing for a university, and a connection led to the tennis coach at Duke. “I got an offer to get a, a four-year full scholarship, sight unseen. I mean, he’s never seen me play,” he said. There were no videos or smartphones then. The coach went on his ranking and results and took a chance, and it worked out well for both of them. Dave made sure listeners knew he was later inducted into the Duke Tennis Hall of Fame.

Mike connected the two halves. The focus it takes to reach that level as an athlete, he said, is the same focus Dr. Arlosoroff now brings to fixing bodies, and he still sounds curious about the human body as a machine.

Next door on US-1, and a joke with no leg to stand on

The practices sit close together in North Palm Beach, and the referrals run both ways every week. Dr. Arlosoroff described an orthopedic group that covers pretty much every subspecialty, with First Rehab “literally right next door.” “It’s a great setup.” Dave added that the surgeon walks over to check on his own patients, and had done exactly that the day before the taping.

Dave’s joke of the week came dressed as a serious story about an avalanche, a skier, a wrong-site amputation and a lawsuit. It went on long enough that both Mike and Dr. Arlosoroff admitted they were buying it. The skier sued the doctors and lost. “He didn’t have a leg to stand on,” Dave said. Mike said it may be the best one Dave has ever done.

Listen to the full conversation on the Pain 2 Power podcast page, watch it in our video library, or read more about Dr. Arlosoroff on his guest page. The show airs live Saturdays at 8:30 AM on 100.3 Legends Radio. If you or your child is recovering from a fall, a fracture or a sprain, call us at 561-624-4263 or request an evaluation, and we will help you plan the way back.

This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.