Bike Crash, Road Rash, and Abrasion Wound Management

A bike crash as a result of unforeseen events is a fact of cycling (road and mountain).  Even the world’s best pro riders go down (see Jens Voigt) so sooner or later you will find yourself on the ground after having been thrown from your bike like you were riding a wild stallion.  Usually the damage is not so bad but you will almost always have to deal with some level of road rash from the friction of your skin sliding along pavement, crushed stone, or even a mountain bike trail.

Last year I had to deal with two incidents resulting in road rash and it took me a while to piece together the information I needed to properly take care of myself and ensure those who try to help are doing the right thing.  (I had race officials administer some pretty poor first aid when I crashed in a local criterium and in some cases that can be more dangerous than the crash itself.)

Recognizing the 3 degrees of Road Rash

First Degree: 
Reddened surface only, unbroken skin layer

Second Degree: 
Surface of skin is broken but with a good amount of healthy tissue under and surrounding the wound. This will allow the skin cells to regenerate and the wound to eventually heal.

Third Degree: 
Skin is entirely removed and possibly exposing underlying tissue such as bone, underlying fat, tendons, etc... DO NOT attempt to treat yourself if this is the case.  Instead, seek immediate medical attention.

Treatment
Here are my suggestions for a simple, safe, and effective method of treatment for basic First and Second Degree Road Rash:

*CAUTION: ALWAYS seek immediate medical attention for Third degree road rash (deep skin wounds where any underlying structure is exposed) or if ever you are in doubt about any of your wounds or your ability to properly look after them on your own.

Stage 1 - Initial Cleaning (ususally performed at the scene of the accident):

1. Spray or squirt saline solution or clean water all over the wound and pat dry with a gauze (you can rub a little but not vigorously or you may cause more damage)  *Forget hydrogen peroxide, alcohol, and iodine.  Not only do they add unnecessary sting but they can cause cellular damage that delays healing or leaves additional scarring.
2. Remove only the very loose debris such as rocks, glass, wood splinters, etc... Save the rest of the cleaning for the shower or bath as soon as you can get to one. (Sooner is definitely better)
3. Dab on a topical antibiotic cream like Polysporin, Neosporin, or Fucidin and cover with a sterile dressing until you can get home (or to the hospital emergency if required) for further treatment.

Stage 2 - Comprehensive Cleaning (usually at home in the bath or shower):

1. Get in the shower or bath, soak the wounds with warm water (not hot, unnecessary pain), and rub gently with a soft soapy cloth or just your hands.  Repeat this until the wound looks mostly clean and free of debris.
2. Pat dry with a clean towel or gauze
3. (If there is still some small debris that appears stuck like rocks or large grains of sand, and you can get an edge of it, you can try removing these one by one with sterilized tweezers.)
4. Spray or squirt saline solution on wounds again and dab dry, always with sterile pads or gauze.
5. Apply antibiotic cream and cover with sterile bandage. Note: In place of traditional sterile wound dressings, there are some breathable dressings on the market made by 3M, Smith & Nephew, and some others.  Consult your doctor or pharmacist for proper use of these alternative dressings.

*Plan on repeating the stage 2 steps at least twice daily for a few days and then at least once a day for another week or so.  

Important

Keep it clean and always monitor yourself for any signs of infection: 

The wound may be infected if it is red, hot, swollen, unusually painful, smells bad or has pus.

Signs of a systemic infection can be serious and you should seek immediate medical attention if you develop fever, change in appetite, red streaks/lines radiating out in any direction from any wound site, lymph nodes become swollen or tender, and if for any reason you are in doubt or generally do not feel well.

Quick note on sun exposure and scarring:  Keep the wound as clean as possible and always cover the wound, especially when outdoors to prevent exposure to the sun in order to minimize scarring and skin discoloration.

Happy Riding, Stay Upright, and Be Prepared for the inevitable... 

Your crash stories, comments, and questions on this blog are always welcome.

Top 6: Why do Men Shave Their Legs for Cycling?

The question of why men shave their legs for cycling comes up time and time again.  So here are the top 6 reasons why we do it;

1. Wound Management *(fact of cycling: it's not if, but when... your fault, or not... we sometimes go down and a clean wound is a lot easier to care for than a hairy mess)
2. The Culture of Road Racing (show that you have a serious commitment to the sport!)
3. Massage (a leg massage after a hard or long ride is not only for pro racers, it has many benefits for enthusiasts as well and it's far more pleasant for both parties if the legs are clean and not a shag carpet)
4. Sunscreen Application (easier to apply)
5. Speed (while aerodynamic improvement is absolutely a myth, there is a placebo effect: if you feel faster, you ride faster.)
6. Heat Management (sure feels nice to have the wind cooling the skin on hot days)

Please feel free to add any good reasons I missed...

*Additional note for point #1: If you have hairy shoulders and back, you may want to keep those cropped as well because road rash isn't limited to your legs in a fall! Do not shave your arms - sorry but that is just too creepy.