In-line skating has remained a popular recreational activity all over the world. The number of injuries seemingly reached a plateau in the late 1990s. However, there are still more injuries caused by in-line skating than from skateboarding, hockey or lacrosse and rugby. In 1997, the estimated annual cost of medical treatment for these injuries in the US was over $US4 billion.Adolescence still represents the largest group of skaters, both in participation and injury. Although 10- to 14-year-olds account for 60% of injuries, in 1996 the US Consumer Product Safety Commission reported nearly 1500 injuries in individuals 65 years and over. Risk factors for injury include inexperience, aggressive skating and amount of time spent skating. There are also more recent data to suggest that self-reported expert skaters are more likely to sustain an injury.Reluctance to use personal protective equipment (PPE) by in-line skaters remains high. The general consensus is that PPE is effective in reducing the incidence and severity of in-line skating injuries. Therefore, efforts should be made to increase awareness of risk factors for injury in all skaters; to increase use of safety equipment; to provide safe environments for skating; and to legislate skating laws that will protect skaters from injuries.