Walking a dog is a time to unwind and bond with your furry best friend. But it can also raise the risk of injuries, especially among women and older people.

Researchers at Johns Hopkins University did a deep dive into two decades of injuries related to walking leashed dogs. More than 420,000 U.S. adults sought emergency room treatment from dog-walking accidents between 2001 and 2020. Nearly half the patients were 40 to 64 years old and three-fourths were women. The top three injuries were broken fingers, traumatic brain injuries and sprained shoulders.

Traumatic brain injuries included concussions and non-concussive head trauma, including bruised brain tissue and bleeding around the brain’s outer membrane.

Most of the injuries stemmed from falls after being pulled by a dog or getting tangled in or tripping on a leash. Women were 50% more likely than men to break a bone. Older dog walkers had three times more risk of falling than younger people and were twice as likely to break a bone.

Why study dog-walking injuries? Not only is dog ownership pervasive —53% of U.S. households have at least one — researchers say little is known about the extent of dog-walking injuries. Also, injuries more than quadrupled during the two-decade review period, something researchers attribute in part to rising dog ownership rates and the growing popularity of dog walking as a fitness activity.

The researchers hope their findings will make dog owners more aware of potential risks and encourage doctors to discuss those hazards.

So, stay aware of the dog’s leash and your surroundings when em-BARK-ing on your next dog walk.