Handle your crash like a pro - our team doctor’s ultimate tips and tricks for tumbles and tarmac touch downs

Crashes are inevitably part of the riders’ daily (race-)life. This includes painful nights, wounds that stick to clothing and bedsheets, fresh plasters every morning and a lot of work for the team’s medical staff. While pro riders enjoy immediate first-class medical treatment in case they hit the deck, it may look completely different when you hit the ground on your evening spin right after watching the finish of a Tour stage. For all the after-work heroes and weekend warriors that unfortunately take a tumble on their rides, follow the instructions of our head of medical Christopher Edler and you’ll - hopefully - be fine!

The legs are feeling great, you’re going fast on your local lap but suddenly you come across a greasy corner spiced up with a bit of gravel - front wheel slips, that uncomfortable sound of rubber sliding sideways and even before you realise what’s happening, you hit the tarmac. 

First things first

Most importantly, and as a very first step: Check yourself or your fellow riders to determine if there are serious injuries or if it’s just some lost skin. A heavy hit on the head or fractures are what we want to check for and rule out first.
But how?

• Check carefully if you can move your neck up and down and side to side without pain.
• Are you able to move your arms freely?
• Can you take a deep breath without feeling any pain?
• Is your abdomen free of pain when you touch it from side to side?
• Can you get up and walk around? 

If one of these is NOT the case, be sure to get checked by a doctor soon!

Did you hit your head?
A blow to the head is generally a bit more difficult to evaluate, especially when you’re on your own.

Here’s another checklist to see if you could have more than just a bit of a headache.

• Check your helmet for fractures or dents 
• Do you have a strong an unusual headache, dizziness or nausea? 
• Do you have a lack of balance? 
• Are you experiencing blurred vision? 

From the medical perspective, all of these are red flags. Call the emergency department, instead of hopping back on your bike! 

Fingers crossed there’s no need to call emergency and you’ve just come away with a bit of road rash and bruises. 

No bruises, no story

Bruises and contusions as well as abrasions or lacerations are the injuries that are most often sustained in a bike crash. The impact of hitting the ground usually creates bruises, while sliding on the tarmac with your body leaves you with so-called road rash. In most cases, you’ll be good to go again after a couple of days and your wounds will disappear, but the stories of crashing will definitely remain for some time with your bike buddies. 

For bruises and contusions, which are common injuries in a variety of sports, the PRICE regime is an easy to remember and adopt concept:

Protection: Mainly in the terms of protection from weight bearing, or loading with weight. In more severe contusions, this could be done through the use of crutches or certain braces. If it’s your elbow or shoulder, it could make sense to protect it with a sling, which you wear around your neck.

Rest: The injury needs time to heal, and therefore it requires rest. But rather see it as “relative rest”. It is not meant to entail lying in bed the whole time until you feel better, but rather resting the affected body part(s) from strenuous exercise. A certain amount of activation and movement is also good for recovery.

Ice: The effect of cooling the affected body region is to reduce swelling and pain. Especially in the first few minutes after impact, cooling has its strongest effect. Although you won’t probably have a sack of ice handy when riding your bike, still use it when you come home. Cooling periods of 10 minutes with ice or a cool pack every one to two hours seem to be a widely accepted regimen. Make sure that you wrap a thin towel around the cooling device to protect your skin from direct contact. The skin will turn red during and after cooling. This is normal and a reaction by the skin’s vessels, which is also desired. However, if your skin starts to hurt or gets mottled or raises where you applied the cooling, you should discontinue and perhaps use a bigger towel or allow the cool pack to get slightly warmer.

Compression: Mostly used with elastic bandages or compression socks to reduce the swelling as well. Using an elastic bandage, however, is not the easiest way because there are some pitfalls around it. Compression should always start a little further away from the injured region and then move towards the body’s centre, wrapping it spirally. You need to get a feeling of how much is too much compression. You should not see any discolouration of the skin in front or behind the bandages, also should you feel no tingling sensation or numbness. Loosening the compression should immediately relieve any of these sensations.

Elevation: To minimise the pooling of fluid in the affected limb or joint, you should aim to have it raised above the level of your heart. Especially in the first one or two days, this can decrease the amount of swelling and potentially increase recovery speed and ameliorate the range of motion.

The PRICE concept is a simple way of helping you at home to relieve pain, reduce swelling and potentially speed up recovery without the need for a lot of equipment.

If for a few days the pain and swelling doesn’t ease or even gets worse, be sure to see a doctor to have the affected body part checked for smaller fractures or injuries to ligaments and tendons.

Some skin on the road?

If your wound is actively bleeding and looks like a laceration, it is worth having it checked in the local Emergency Department. These wounds might need to be professionally cleaned and further stitched or glued together.

If it is the typical abrasion where the surface of the upper layer of the skin is damaged, it can usually be treated without medical assistance. It is very important, though, to clean it properly and take regular care of the wound so it does not get infected.

That’s why the most important step is to rinse it and get the superficial dirt out of the wound. 

• You don’t have to brush it all out, but you should at least gently wash it with a clean cloth.
• Afterwards apply an antiseptic spray, or even better, an antiseptic cream or gel. Ingredients like polyhexanide or chlorhexidine work quite well on wounds. There are still ointments available with Iodine as an active ingredient, but I’d suggest using one of the others mentioned. If Iodine is the only one available to you, it is still better than nothing!
• Use a sterile bandage or gauze to cover the road rash. Be careful to put a non-adhesive layer, for example, Adaptic or Lomatüll, between the wound and the bandage so it doesn’t stick when you remove it.
• Change the bandage often. If you use an antiseptic ointment, change it once a day or after sports activities.
• Look for signs of infection. If you see redness of the intact skin around the wound, feel a burning sensation in the wound after 2 or 3 days after an initially good recovery, or if you even can palpate swollen lymph nodes in your axilla or groin region, do seek medical assistance. In the rare case of developing a fever you should immediately see a doctor. You might need antibiotics.

If your pain or open wounds stay longer than a few days and you have the feeling that you are not making progress in recovery, please see a doctor.

Enjoy your ride and stay safe,
Christopher Edler