Too many cyclists walk away from a crash thinking they're fine, only to later realize they've actually broken a bone, suffered a concussion, or needed stitches. Nobody wants to bail on a great ride, but delaying treatment can lead to fractured bones misaligning, unnecessary scarring, and long-term brain injury. So how do you know if you should continue down the trail or head toward the nearest hospital? Follow this guide from three doctors who love to ride.
In the moments after you crash, take a minute to compose yourself and do a self-inventory. Check your helmet for cracks, and then any areas on your body that hurt or hit the ground when you fell, says Dr. Robert Klitzman, M.D., a sports medicine orthopedic surgeon with Indiana University Health. If there are any areas that are bleeding, make sure there are no obvious signs of a fractured bone — immediate, often misshapen swelling, loss of function, and pain under pressure. When you get to your feet, make sure you have full range of motion in all of your limbs. If one shoulder sags and you can't move your arm higher than your chin, you've got cycling's trademark injury, the broken collarbone.
Check Your Head
"If you're with another rider, talk to them so they can determine if you're making sense," says Klitzman. "Sometimes with a head injury you're not the best judge of your current state. Even if everything looks fine, but if you have a headache or your partner thinks you're acting strange, get to a physician to be checked for a possible concussion." Are details of the accident hazy? Err on the side of caution and visit the emergency room, says Dr. Darren Markland, M.D., a cyclocross racer and intensive care physician in Alberta, Canada.
If you have the wind knocked out of you, check for severe injury, says Markland. Progressive abdominal pain, shoulder pain after abdominal trauma, and shortness of breath that persists or worsens could be signs of intra-abdominal bleeding, which can be life threatening. Handlebar injuries can also cause liver and spleen lacerations. The best rule of thumb? "If you can't walk on it, don't remember it, or it gets progressively worse afterward, then you definitely need to see a doctor," says Markland.
If You're the First Responder
If you're giving assistance to a riding buddy who's on his back, first check to make sure he's breathing and his airways are open, suggests Dr. Richard Burgett, M.D., a surgeon at the Midwest Eye Institute and competitive road racer with Team Heroes. Then make sure he has a strong pulse. From there, follow the steps of the self-checklist, making sure not to move the injured rider if he reports any pain in the neck or back.
Lumps You Can Take
Luckily, most injuries on the trail or road are going to be of the soft-tissue variety — bumps, bruises, strains, and road rash, none of which necessarily mean visiting a doctor, at least at first. "Road rash is dramatic, but heals well if attended to," Markland says. That means cleaning the area thoroughly with water and antibacterial soap, slathering on antibiotic ointment, and covering with a bandage (change daily until healed).
"Broken ribs suck, but as long as you don't have too many, they heal up well on their own, too," says Markland. To be safe, have a doctor check your breathing if you suspect broken ribs, but time and painkillers are the only treatments. "Most sprains and strains get better on their own," he adds. "These most common injuries tend to respond well to conservative therapy: rest, ice, and anti-inflammatories. But if they aren't improving within a couple of days, see your doctor."
Super Glue and Stitches
A bleeding injury may seem serious, but unless it's deep and needs to be held to stop the flow, you can flush it with water and get stitches after the ride. Many mountain bikers stash a tube of Super Glue in their first-aid kit for just such an occasion. If you think the gash does require stitches, make sure you do so within 24 hours, Burgett says.
Inspect Your Bike
After declaring yourself fit to pedal on, check that your bike is still in working order. "You don't want another crash due to missing a problem with your equipment," says Klitzman. Look for cracks in the bike frame and fork — steel and aluminum often fails near the joints, carbon frequently breaks mid-tube. Check that your wheels are true. If they're bent, but not completely tacoed, try bending them back to at least ride home. In the case of a broken rear derailleur, shorten your chain (you carry a chain tool, right?) to convert your drivetrain to singlespeed.