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Henrie's Recipes
Cycling injuries
Posted Tue, 30 May 2000
Compared with most other sports, cycling is remarkably free of non-traumatic injuries. However, traumatic injuries are probably more common than in, for example, running.
In a lot of cases this traumatic injury can be avoided by paying attention to basic cycling safety rules (see Cycling: the basics), in particular, wearing a helmet!
Traumatic injuries
Most cycling accidents are too minor to enter into the statistics, so there is an obvious bias when statistics concerned with cycling accidents are reported. This may make it seem that there are a high number of serious accidents involving bicycles, when in fact, as long as you are careful, it is a safe sport.
Of the cycling injuries which get treated in hospital, around 20% are fractures, 30% bruises or contusions and the remainder are lacerations and abrasions.
More than half of all traumatic cycling injuries are to the head and face, most often injured in a collision with a car.
Head injuries
According to an article by Tim Noakes, head injuries are present in about 80% of those cyclists who die in cycling accidents. Most of these cyclists were not wearing helmets at the time of their accident, and yet research shows that more than 90% of head injuries can be prevented by a good cycling helmet.
This is particularly the case in children, yet they are the group most often not wearing a helmet.
Choose a good helmet (see Cycling: the basics) and wear it. Make sure that your children always wear a helmet as well. There are plenty of good makes on the market which have interesting designs which should appeal to children.
Abrasions or grazes
These are probably the most common cycling injury and are usually minor, although very painful. They can also be nasty, sometimes resulting in the need for plastic surgery.
Try and minimise them by protecting vulnerable areas of the body by wearing gloves and never cycle with no shirt, or only a skimpy T-shirt. Some people wear a T-shirt under a cycling shirt for extra protection, but I find that too hot in the summer!
By their nature these injuries collect gravel, dirt and oil, so should be carefully cleaned. A local anaesthetic spray can reduce the pain, and an antiseptic spray will minimise the risk of infection.
Lacerations
About 10% of cycling injuries are lacerations where the skin is torn and there may be injury to the underlying tissues. You should always seek medical attention for these, since they may contain foreign bodies which must be removed, and they may be deep enough to need stitching. Always make sure that the doctor checks when you last had an anti-tetanus vaccination, since deep wounds are vulnerable to this particular infection.
Contusions
Contusions are bruising of deep tissue, particularly muscle, which often occur with other injuries. These result from bleeding of small vessels into the surrounding tissue and can be minimised by applying ice to the area for around 20 minutes. Firm bandaging will also reduce the area of damage.
If there is significant bleeding into the underlying muscle then a condition known as compartment syndrome can result when bleeding between muscle layers leads to reduced blood supply and tissue death. The main sign of this is exquisite pain, which is getting worse rather than better. The affected area feels rock hard and is extremely tender to the touch or on movement. Seek medical help immediately since this is an emergency.
Fractures
The most common fractures in cyclists are of the ribs and collarbone (clavicle). Fractures of the collarbone and ribs can sometimes result in a punctured lung. If the cyclist is having trouble breathing tell the ambulance when you call them, to stress the urgency of the situation.
Arm and leg fractures are also relatively common. The affected limb should be splinted immediately at the site of the accident, by any means possible (a newspaper or towel). This reduces pain and bleeding.
Always remember that if the head is injured there may be a neck or back injury as well. Do not take the injured cyclist's helmet off, stabilise the neck, and if possible the back, and do not move the person, unless there happens to be a doctor on the scene (plenty of us cycle!) who can direct the way in which the person is moved. Even then, only accept having the person moved if traffic makes it dangerous for them to remain in position until the ambulance arrives.
Any cyclist who is unconscious after an accident has a neck injury until proved otherwise.
Overuse injuries
Cyclists knee
Many cyclists suffer pain and discomfort in their knee(s), often at and just below the kneecap, although pain on either side of the kneecap is also common.
This is probably due to inflammation at the point where the kneecap attaches to the bones in the lower leg. However, other structures may also be involved.
The most likely cause is incorrect alignment of your knees and feet. I often see people cycling with their knees almost at right angles to the bike, which puts abnormal stress on the ligaments of the knee. This is caused by pointing your feet outward, pulling the knee with it. Similarly, pointing your feet inward will lead to ligament stress.
Overloading the muscles of your leg by pushing at a high resistance for long periods will also damage the ligaments surrounding the kneecap. Don't strength train every day!
Incorrect saddle height - too low - will cause your knee to remain flexed during the entire pedal cycle, which will cause ligament strain as well.
To prevent this pay attention to setting up your bike, making sure that your saddle is at the correct height, and that your feet are in a comfortable, neutral position when you ride.
Rest is the only cure for cyclists knee. We all know that no-one is going to stop cycling all together, so reduce the amount of training you do until the condition settles. If your knee is hurting you continually, then halve your training schedule until the discomfort has gone.
Pressure injuries
Pressure on the hands, the perineum and buttocks and the feet can be a problem, particularly on long rides.
If you bike is properly set up, you have good gloves and good padded cycling shorts and a decent saddle this will be minimised and should not lead to long term damage.
However, there are times when excessive, prolonged pressure can lead to nerve and tissue damage.
For example, pressure between the hands and the handlebars can lead to damage to the ulnar and median nerves, since they can be compressed between the bones of your hands and the handlebars. You have problems with the ulnar nerve if you have pins and needles and numbness in the ring and little fingers, and problems with the median nerve if the symptoms are in your thumb, index and middle fingers. If this occurs over a few days of continuous riding, check the set up of your bike.
You are probably putting too much weight on the handlebars, and/or your gloves may not be adequate or the handlebars insufficiently padded.
Don't ride long distances on successive days if your hands are constantly going numb. Sort the problem out.
Prevent numb feet on long rides by wearing shoes with a stiff sole, which fit properly and don't pull the laces or velcro too tight. Sometimes an inner sole helps to spread pressure over a wider area.
Saddle sores are painful lumps which can develop in people who put in long hours of heavy training. They result from prolonged and repeated pressure causing chronic changes in the subcutaneous tissues of the perineum. If neglected these will grow and become more painful.
Corn plasters placed over the nodule when it is first noticed will generally take the weight off the nodule when you ride, and allow it to settle. If it doesn't settle then stop riding for a few days. These can become a real problem if neglected, so don't ignore them.
Most new cyclist find that their rear end is painful and numb when they first start out. As long as you have well cared for, clean cycling shorts, this will diminish with training.
There are many makes of saddle on the market now which are designed for comfort with gel padding. They differ for men and women, and are well worth the investment.
Conclusion
Cycling is actually a very safe sport - contrary to what a lot of runners, who seem to be terrified of traffic, will tell you!
Pay attention to the basic safety rules, make sure that you have the correct clothing and that it is clean and well cared for, set your bike up properly and enjoy your riding.
