Sooner or later
you will fall off your bike. Luckily, the majority of cycling
falls are not serious: You tip over coming to a stop; you
lose traction and slide out in a turn. Every cyclist experiences
these falls.
We usually cause our own crashes: Forgetting
to prepare for a stop, an overlapped wheel on a group ride,
going through a wet or dirty turn too fast, descending too
fast. It’s important to actively work on bike handling
skills to avoid these falls. Ride within your ability level.
Take responsibility for your own safety. The reality is,
if you fell off your bike, it was likely your own doing.
Owning the reasons you fell instead of blaming it on road
conditions, the course or other riders is the first step
toward learning better crash avoidance techniques. Prevention
of crashes is always the best idea.
Five time Tour de France winner Bernard Hinault
said it best, “In cycling you make your own luck,
until the rider in front of you crashes, then you inherit
their bad luck.” Eventually either you or something
else will cause you to fall. When you do, you need to know
what to do.
The most common injury from cycling crashes
is skin abrasions: “road rash”. Common road
rash may not be a serious injury if it is treated quickly
and consistently during the healing process. Failing to
quickly treat road rash can lead to serious infections and
illnesses. Road rash is, in medical terms, somewhat similar
to a burn that damaged or destroyed the outer layer or layers
of skin. Several factors affect how serious the road rash
is: The speed of your fall, the surface you fell on and
the force of the impact. Sliding crashes tend to produce
the most road rash whereas tipping over tends to not create
abrasions.
Cycling Hall of Fame Coach Mike Walden and
Wolverine Sports Club Vice President of Racing Mike Rabe
both taught strategies for trying to reduce road rash in
the event of a fall. Both coaches and experienced cyclists,
Mike Walden and Mike Rabe both recommended always training
with covered shoulders and some type of a base layer, even
in hot weather, underneath. Some modern base layers actually
serve to make you cooler on hot days so they enhance comfort
as well as provide a series of layers to reduce the affects
of sliding across pavement. Several fabric layers can slide
separately, momentarily reducing friction on your skin.
If you’ve ever seen a cyclist’s jersey after
a fall then you can picture the damage that would have been
done to bare skin. Especially on group rides, it is important
to keep your shoulders covered and wear a thin base layer
under your jersey.
Once you do fall your first concern needs
to be proper diagnosis and assessment of your injuries.
If you suspect anything more serious than minor abrasions
you need to go to an urgent care facility at once. Cycling
injuries can produce hidden fractures or abrasions too large
to correctly clean and treat at home. If a fall is anything
more than minor seek professional medical treatment immediately
following your fall.
If a thorough and immediate examination of
your injuries at the crash scene reveals nothing beyond
minor skin abrasions knowing how to treat them after the
crash can speed the healing process, reduce the chances
of infection and increase your comfort level during healing.
The first (and most important) step to road
rash treatment is assessment of the injury. It is critical
that you make the correct decision about getting care for
your injury. Use this decision making process to decide
if you need to visit urgent care: If you have any question
in your mind as to whether you should visit an urgent care
facility to examine a road rash injury: You should. In other
words, doubt defaults to the decision to go to urgent care.
If you cannot decide whether or not to go- then go. Do not
take chances. Some clinical studies (Basler, et al, 2001)
suggest that the traditional treatment for road rash used
by cyclists for years may, in fact, cause additional harm
to wounded tissues and slow the healing process. Practices
such as excessive scrubbing of the wound and/or the use
of hydrogen peroxide as a cleaning agent can compromise
the cellular regeneration needed for wound restoration.
Cells called fibroblasts act as a sort of scaffolding for
tissue and secrete matter that forms tissue. You must maintain
your fibroblasts to insure quickest wound healing. Excessive
scrubbing of a wound, improper dressing or the use of harsh
antiseptics can damage or destroy fibroblast cells. It is
important to clean the wound, but do not scrub too hard.
Only use hydrogen peroxide or other harsh antiseptics when
nothing else is readily available at the accident scene.
Assessment of the wound also means examining it for additional
injuries that may be concealed by road rash. These injuries
can include deep cuts caused by rocks, glass or bicycle
components that require suturing or contusions and even
fractures or soft tissue damage. If you even suspect these
conditions, immediately go to urgent care. Another important
consideration in wound assessment is the status of your
tetanus immunization. If your tetanus shots are not up to
date, get one while in the urgent care facility.
The second step in treating road rash is cleaning.
When you slide across pavement foreign matter becomes lodged
in the open wound. This matter includes fragments of your
disintegrated clothing, dirt and road debris such as small
rocks. A significant amount of bacteria can also be introduced
into the wound area. These injuries can be more dangerous
than third degree burns. Picture a third degree burn with
a handful of dust and road dirt ground into it. With road
rash, infection is a certainty unless the wound is treated
quickly and proactively.
Care must be taken when cleaning to not make
the wound deeper. If the wound involves a significant area,
is hard to reach, has a significant amount of exposed white
tissue inside it or bleeds significantly, go to the urgent
care facility. It may be too difficult and painful to clean
thoroughly on your own.
Your primary goal in cleaning the wound is
removal of foreign matter. Your secondary goal is to gently
remove any dead tissue from the wound. This second step
may need to be done by a medical professional if there is
a significant amount of dead tissue inside or surrounding
the wound. Dead tissue is the small ridges of skin torn
up inside and around the wound that will not heal. Sometimes
it is difficult to differentiate dead tissue from tissue
that will heal; if in doubt have a trained medical professional
examine the wound.
First, irrigate the wound. While cleaning
you should wear latex gloves to avoid further contamination.
If you have an assistant cleaning the wound, be certain
they wear sterile gloves such as latex exam gloves to prevent
the exchange of blood or other bodily fluids. This is a
common concern when two riders have crashed together and
both have injuries. Make disposable medical latex exam gloves
a part of your road rash kit. The best way to irrigate a
wound is with a syringe filled with nontoxic surfactant
such as contact lens solution or other weak (0.9% sodium
chloride) saline solution. The best wound irrigation solutions
are the brand name Carraklenz, Ultraklenz and Microklenz
from Carrington Pharmaceuticals- all available on line.
Tap water can be used as a substitute if you are in an area
where water can be trusted for purity. Once the wound has
been irrigated some of the foreign matter may simply be
rinsed out of the wound site. Since road rash frequently
occurs on joints there may also be some localized inflammation.
Using cold water helps prevent additional inflammation.
Cooler water, to quite cold, can also temporarily numb the
wound area to better facilitate cleaning. Especially on
elbows, if you run the wound under cold water for a few
moments to irrigate, reduce inflammation and numb the area
you will be able to clean the wound more effectively with
less discomfort.
Use care when cleaning. You must strike a
balance between removing debris and minor amounts of dead
tissue and further injuring the area. Use of a solution
specific to wound cleaning is important. Avoid fragrance
soaps or soaps with additives. Apply the cleaning solution
to the wound in a gentle stream and use a sterile gauze
surgical sponge or very soft, sterile brush to gently wipe
debris away. Do not scrub too deeply- you only make the
wound worse, create pain and could press foreign matter
into the wound. You must clean the wound site but not injure
it further.
Once the wound has been irrigated and cleaned
of foreign debris use a new, sterile gauze surgical sponge
to gently blot the area dry.
Using your sterile, surgical gloves open a
wound dressing package larger than the size of the wound.
Do not touch the surface of the dressing that comes in contact
with the wound. Perhaps the most effective dressings for
road rash are the type used for burn patients, such as gel
impregnated hydro-dressings tend to work best for road rash.
2nd Skin is among the most readily available. These dressings
are breathable and maintain a clean, moist wound environment.
Other moist, permeable dressings include the Tegaderm and
Bioclusive brands. 2nd Skin has been the best we’ve
used. This can be purchased from on-line medical supply
stores. You will need to change your dressing at least once
a day, but likely more than that when you consider showers
and other activities that can contaminate the dressing or
cause it begin to come off. Changing your dressing is critical
to the prevention of infection and to speed healing time.
For the first dressing of road rash, you
may want to use a topical wound treatment such as Neosporin
+ Pain Relief. This will assist in preventing infection,
help to stop the introduction and proliferation of bacteria
and exert a mild anesthetic affect. A liberal application
will help prevent your first dressing from sticking to the
wound. You can substitute a sterile gauze pad for the first
dressing but subsequent dressing changes are better done
with a non-stick, Moist Burn Pad such as 2nd Skin. The initial
burn dressing may only remain in place until you get to
the urgent care facility, hospital or better area for more
complete wound care.
Using your sterile exam gloves, do not touch
the area of the dressing with the topical wound treatment.
Gently apply the dressing to the wound area, covering it
completely with at least a quarter inch overlap of the dressing
surrounding the wound.
To hold the dressing in place on legs and
arms nothing is better than Tubular Elastic Dressing Retainer.
Surgilast is flexible, soft and breathable. It does not
use any adhesive that sticks to your skin. Surgilast is
a stretch fishnet covering that holds wound dressings in
place. If you use Surgilast dressing retainer you will never
suffer from the pain of removing tape or adhesive bandages.
This is especially important for road rash on your legs
if you do not shave your legs. Surgilast also works perfectly
for holding dressings on knees and elbows since it moves
with the joint.
For road rash on buttocks, back, chest and
face you will have to use some type of tape or adhesive
dressing. Be careful with the adhesive on these- it can
cause its own brand of skin problems and be painful when
removed. The use of hypo-allergenic adhesive bandages and
tape over gauze dressings that hold the hydrogel dressing
in place is the best arrangement. The problem with these
mild, breathable adhesive bandages and tape is that they
just don’t stick very well.
Once you have initially cleaned the wound,
dressed it and visited urgent care you need to monitor the
wound for signs of infection. An increase in pain, swelling,
red rings or streaks around the wound all signal an onset
of infection. No question: Go to the doctor quickly. Even
moderate sized road rash can cause deep infections quickly
that may result in serious problems. Almost every cyclist
knows other riders who have had serious medical problems
from infected road rash. If you even suspect infection,
immediately seek professional medical assistance. Do not
delay even 24 hours.
Frequent inspections for infection are an
additional reason to change dressings. A practical reason
is to take a shower. For showering with road rash it is
best advised to simply keep the current dressing in place,
wrap the area with Saran wrap and shower as quickly as possible.
Keep the wound dressing from being soaked. Once out of the
shower towel off and remove the Saran wrap. Gently remove
the dressings and blot dry with gauze surgical sponges.
Re-dress the wound using a burn specific topical ointment
that promotes cellular regeneration such as Carrasyn V hydrogel
wound dressing. This is amazing stuff. Using Carrasyn (formerly
Carrington Gel) a road rash can heal completely to new skin
in under 10 days. Carrasyn V also reduces scarring.
It is fine to exercise with mild road rash
but be certain your dressings are kept clean. Do not swim
with road rash. You may contract (or spread) an infection.
Road rash takes a significant amount of supplies
to treat and maintain. Since it is a certainty that you
will eventually get some road rash it is smart to have a
basic road rash treatment kit handy. You will quickly learn
it takes an enormous amount of supplies. You will use two
moist burn dressings per day per wound site and liberal
applications of Carrasyn. Additionally, you need to change
tape and bandages each time you change dressings and keep
the Surgilast wound retention fabric clean and fresh. Also
in your kit should be a good pair of bandage scissors, tweezers
for removing bits of debris from wounds, latex gloves for
initial wound cleaning and dressing, syringes for irrigation
and irrigation/wound cleansing solution, Saran wrap for
showering and gauze sponges as well as various sizes and
shapes of adhesive bandages and wound dressing tape.
We use a wound treatment kit based on military
kits that we assembled on our own. The kit is lightweight,
compact and travels around the world with us especially
to countries where sterile wound management may be difficult.
As with any medical condition you are always
best served to get trained, professional medical diagnosis
and treatment. This article is no substitute for qualified
medical diagnosis and treatment. Do not take chances with
road rash. Prevention is the best cure, but if it is too
late for prevention, it is still early enough to get help.
|
