"how tos"
race schedules
event reports



Road Rash.
By Tom Demerly

There are two types of cyclists: The kind that have fallen and the kind that will.
Knowing what to do when you fall is a mandatory cycling skill.

Step one in treating road rash is assessing the extent of the injury. If in doubt, go to urgent care.

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.

You can treat small, minor road rash yourself but be careful: nasty infections can result.

Injuries on the hand can conceal soft tissue injuries. You need professional medical help with these.

E.R. staff can find hidden injuries that may require sutures or an X-ray for diagnosis and treatment.

Debris can cause cuts deep enough to require stitches. this wound needed to have road fragments removed from it.

Following the cleaning of the cut it was then closed using a series of sutures.

Medical professionals are the best at assessing the extent and proper treatment of wounds. If in doubt, get medical care.

If you clean a wound yourself, do not scrub too hard. Hard scrubbing damages tissues and makes the wound worse.

Once the wound has been cleaned it should be free of road debris, dirt and all foreign matter. Now it is ready for dressing.

Initial dressing of the wound can be done with a topical wound ointment like Neosporin + Pain to relieve discomfort and reduce the chances of an infection.

Apply a liberal amount of anti-bacterial ointment to the dressing. Do not contaminate the area by touching it.

Use surgical gloves to handle dressings and be certain your work area is as clean as possible to prevent infection.

Carrasyn V, available from on-line medical supply stores, is an excellent wound dressing for fast healing and minimal scarring.

Moist, permeable dressings such as 2nd Skin allow rapid regeneration of tissues and speed healing.

For some areas the 2nd Skin must held in place with an adhesive bandage.

Surgilast tubular elastic dressing retainer is also available on-line and is the absolute best solution for cyclists who need to hold moist dressings in place without adhesive.

Surgilast is available in a number of sizes and stretches to fit legs, arms and even your head.

Once in place the Surgilast will hold dressings without adhesive and move without binding. It is perfect if you continue riding.

We use a military first aid roll from Tad Gear for compact carrying of road rash treatment supplies around the world. The kit contains adequate supplies to treat four road rash sites on a person for ten days duration with two dressing changes per day.

Especially if you travel, it is important to carry necessary supplies on your own for wound care.

Typical adhesives bandages of various shapes and sizes are carried to cover wounds on fingers, knuckles and small facial injuries.

Carrying a variety of these for various wound sites on the body. Be sure you have enough to facilitate frequent changes after showering or exercise.

Moist burn dressings tend to be the most frequently used in abrasion wound care.

Be sure your kit is well stocked with moist burn dressings such as Bioclusive or 2nd Skin. You will likely be changing this part of the dressing every day

Notice the cotton swaps for removal of debris from wounds.

Gauze wrap and a military style tactical trauma pack are very useful and compact. The gauze wrap is versatile for hard to bandage areas. It can be secured with tape on area where Surgilast elastic dressing retainer will not work.

The small trauma packs available from Tad Gear on-line are self contained first aid kits that fit in a pocket. Brave Soldier also sells small, single use road rash kits from their website.

Other essential components of your road rash kit are the Carrasyn V wound dressing gel and Neosporin + Pain antibiotic ointment.

Various types of hypo-allergenic surgical tape can help hold dressings in place in awkward areas such as thighs, buttocks, and other hard to bandage areas.

Temporary adhesive sutures such as butterfly closures from Band-Aid are another important part of the road rash kit.

Tools for cleaning and dressing wounds include bandage scissors for cutting Surgilast and surgical tape and shaping 2nd Skin to fit wounds.

Tweezers are for removal of small debris from wound sites. Be sure to keep these sterile.

Treating road rash can require a significant amount of supplies. This is the contents of the full kit we keep on hand to treat several riders over 10 ten days who have been involved in a crash and sustained four wound sites per rider.

It generally takes ten full days for healing to be complete so planning for supplies should take that into account.

The travel kit fully packed and unrolled.

This travel kit is available on line from Tad Gear, a supplier of military equipment.

When closed it can be transported in the bottom of a bicycle flight case.

© Tom Demerly, Bikesport Inc.
Site Designed and Maintained by: Intuitive Business Solutions.