Abstract Background Bicycling, skateboarding, and inline skating are popular recreational activities, with the potential of causing severe injury. Methods A retrospective, population-based, trauma registry analysis of severe injuries and deaths from nonmotorized wheeled vehicles (NMWV) over a 10-year period was performed. Results During the study period, 1475 cyclists, 141 skateboarders, and 112 inline skaters sustained injury meeting registry criteria (length of stay ≥3 days or death). The majority were male. Lone crashes were the most common mechanism of injury, although collisions with motor vehicles accounted for 63.6% (n = 44) of observed deaths. Thoracic trauma and head injuries were more common in nonsurvivors. Conclusion NMWV injuries pose a public health concern. We recommend enforcement of mandatory helmet laws and expansion of the existing law to include skateboarders and inline skaters. Education initiatives should also be expanded to include the adult population. NMWV should be separated from motorized vehicles as much as possible.