Physiotherapy after a cycling crash - what happens and why you should get help

So, you’ve had a crash. Welcome to the club. Now that you’ve finished sobbing over your broken bike or ripped jersey, it’s time to get yourself mended. Physiotherapy can be a very useful tool, but how do you decide when you need help and what happens when you go for treatment? We spoke to a physio to find out.

While the initial pain of a crash can be high, the days and weeks following a big ‘off’ can be incredibly frustrating. Muscles can tense up and leave you unable to move as you could before.

This is currently a subject very close to my heart. After an awkward landing in a hedge left me unable to twist, a trip to see Bryan McCullough MCSP, a specialist sports physio and bike fitter at The Bike The Body, has got me started on the road to full recovery. To make something useful out of my current backache, we chatted to Bryan to get his take on recovering from a crash.

There are seemingly countless causes for crashes and the resultant falls are equally varied. Aside from the most common bruises and road rash injuries, Bryan says that the upper limb takes the brunt of the musculoskeletal injuries that he sees:

“This will mainly be fractured collarbones, damage to the AC joint (where the collarbone attaches onto the shoulder blade - ‘shoulder tip’) or fractures to the wrist and hand (most commonly scaphoid bone). The other areas that take the impact are the side of the hip, rib cage, elbow and the head either directly or indirectly.”

If you’ve broken something, then you’ll likely know about it pretty quickly and will have been attended to by paramedics or medical professionals. If this isn’t the case, then Bryan says that there are a few important things to be aware of in terms of whether you may need any follow-up.

> What to do if a riding buddy crashes

Bryan adds: “If you are unable to weight bear on your leg or can see visible deformity (beyond swelling) around the injured area then you really should consider attending a Minor Injuries Unit if there is one available locally to you, otherwise you may have to attend an A&E where there are likely to be longer waiting times as critical medical conditions and injuries will be prioritised.

"If you are experiencing headaches, nausea, dizziness, or excessive drowsiness then you should also consider calling 111 (in the UK) as these are signs that you may have suffered a concussion from your crash. The signs of concussion can also be more subtle and it is for this reason that you should return to riding cautiously and gradually after any crash.”

In my case the concussion took a week of solid rest to recover from, and after another week of limited mobility, I was starting to think about when would be best to seek out physiotherapy.

Bryan suggests: “Minor crashes will result in road rash, a few bruises and nothing more. In those cases, you just need to listen to your body and gradually return to riding as able.

"However, there are circumstances where further problems emerge only when you do get back on the bike and start to build the mileage back up. At this point, it would be worth checking in with a physio if you are experiencing a new pain that you were not having prior to the crash.

"In more significant crashes it is well worthwhile having an MOT or once over from a physio experienced in dealing with cycling injuries to be able to ascertain whether it is safe to get back on the bike or whether any treatment or rehab might be indicated."

Before getting treatment, you’ll need to actually find a physio and doing so can be a bit of a challenge. Cycling is rather unique, so Bryan also suggests: “It really helps if your physio has a good understanding of cycling and the demands it places on the body whether you enjoy a leisurely Sunday ride or are training for a challenging sportive or racing.”

> Hit by a driver? The 9 vital steps you should take next

Once you’ve found a suitable physiotherapist, you might be wondering how many sessions will be needed to get you fixed up. It's worth remembering that, just like a power meter won’t give you amazing climbing abilities straight away, physio is a service that will aid your recovery rather than provide an instant magic fix. 

How long you have to spend receiving treatment is very individual and down to the injuries suffered from the crash.

Bryan says: “In some cases, just one or two sessions are all that is needed to give some advice and treatment. Whereas in other cases it can be a long road back to fitness. We only need to look at examples such as Chris Froome who is still recovering from the after-effects of his injury almost 2 years on.”

After deciding to use a physio and having found one, you might be wondering what will happen at your first session. When we asked Bryan what he is looking for when a new patient walks through the door, he said: “The most important elements to prioritise at a first session are observation and listening. It is vital to get a detailed history not only of the presenting injury but also a more in-depth history of riding, previous injuries, job, upcoming events or competition. These factors shape how we then plan rehab, recovery and timescales alongside the injury itself.”

> How to maximise your recovery and build your fitness

To give you a little bit of context, my initial session began with some questions, then we moved to assess my range of motion at the point of the injury before manipulation of the surrounding muscles. Bryan then spent the remainder of the session teaching me the stretches that would help to improve the movement around the injury. Like a good lad, I’ve been doing them every day... honest! 

The session was very hands-on; so would Bryan say that virtual physio sessions are good enough?

“If this last 18 months has taught us [physios] anything it's that we can still provide an incredible amount of help through virtual means for patients who are struggling with pain or injuries.

"The pandemic forced this move on the profession but I like to think that it has also presented a great opportunity to be able to spread our ability to support further. Over the last year and a half, I have consulted and helped cyclists recover from injury all over the world which has been a new and rewarding experience.

"Having said all that, when we can, face-to-face appointments do still provide the best setting to get the maximum out of what physio assessment, treatment, rehab and management can offer.”

Just like your school days, a trip to the physio is likely to result in you leaving with a bit of homework to do. That is likely to include some exercises that you’d usually do in the gym, so we asked Bryan whether he sees gym work as a useful recovery tool:

> Strength training for cyclists

“I’m a big advocate of cyclists training in the gym, not only to maximise performance but also to minimise injury risk. It is why such a large proportion of my clinic is given over to being a dedicated gym rehab space.

"In terms of recovery from injury specifically, it really depends how long the injury has or is keeping you off the bike. If you have been able to get back on the bike relatively quickly then the need is less, but if you are facing a longer period off the bike then it really starts to become incredibly important to maintain muscle strength and conditioning in other ways.”

While that might sound like you need a host of extra kit to do the work, Bryan says: “A cheap set of mini resistance bands would be the number one thing on my list. They are inexpensive, take up no space and can add an incredible amount diversity and challenge to your rehab and also general strength training off the bike.”

Ideally you’ll never need to see a physio, but we asked Bryan if there is anything that we, as riders, can do to help minimise damage if we do crash:

“This is really a multi-faceted issue. The best way to minimise your own risk of crashing is to ensure your bike fits you well and is in good working order - chiefly the brakes but also the steering and headset.

"A very common complaint I hear in the clinic is that of a rider who is scared or tentative on descending - this often has a large bike fit component to it as the downhill slope can change our ‘balance point’ on the bike causing excess pressure on the bars, which results in a tight grip on the bars, which in turn compromises steering and braking control.

"When it comes to actually crashing, the problem is that they are inherently unexpected and happen in the blink of any eye, so there is little practical advice other than trying to roll on impact rather than the instinct to stick an arm out.”

But what about your favourite road.cc writer? I'm doing fine, thanks for asking. With each trip to see Bryan my back is easing a little, my range of movement is getting better and I come away with a new list of stretches to do in the front room. Crashing again in my final road race of the season probably wasn't the best idea, but now I have a good bit of time to fully recover before cyclocross season starts and I can crash in the comfort of a muddy field.

thebikethebody.com