Guidelines for Returning to Training After an Injury
When you talk to people outside the sport of cycling, they are often surprised by the frequency and seriousness of injuries suffered by bike racers. Perhaps that’s because cycling is not a contact sport like football or ice hockey, we compete and train with minimal safety gear, and no one accuses cyclists of looking particularly tough. Yet, if you include road rash, the injury rate in professional cycling is nearly 100 percent every season. And the second most common injury to cyclists – after abrasions – is a broken collarbone. Cyclists skip over things like tendonitis and pulled muscles and go straight to broken bones. Coming back from injuries is part of being a bike racer, because no matter what level racer you are, you’re virtually guaranteed to get hurt at some point.
When an athlete gets injured, the strategy for recovering and returning to form depends greatly on the type and location of the injury. The specific injuries come in all shapes and sizes, but you can segment them into three main categories: head injuries, upper-body injuries, and lower-body injuries.
With head injuries, the recovery process should be conservative in both its pace and intensity, and supervised by the athlete’s physician. We know a lot more about concussions and closed head injuries than we used to, but there is still much that needs to be learned. What seems clear, however, is that biggest danger comes from re-entering high-intensity training and/or competition too early.
USA Cycling and The Medicine of Cycling Group developed a set of recommendations for the treatment of riders who have suffered head trauma, and their recommendations include a gradual, step-wise approach to returning to a pre-trauma training workload. The keys are monitoring the athlete for symptoms of concussion, restarting training only when athletes are asymptomatic, proceeding gradually so long as no symptoms of concussion are present in the 24 hours after training, and stopping training immediately when and if symptoms return. If you haven’t already, I highly recommend reading the USA Cycling recommendations.
Upper Body Injuries
Breaking a collarbone, arm, or one of the many bones in your wrist and hand is frustrating and painful, but in the grand scheme of things it’s the lesser of many evils when it comes to injuries. As long as your back, hips, and legs aren’t also injured, you can often get back to training quite quickly. Depending on the pain level and the severity of the injury, you may be able to ride a stationary bike within days of your injury.
The best thing you can do to help improve your outcome is to seek medical treatment from physicians and physical therapists who work with athletes. The outcome that may be acceptable to a sedentary person (limited range of motion in the wrist, for instance) can be a major obstacle for an athlete, and treatment decisions need to take your expected performance outcome into consideration right from the start.
Broken ribs are a different story. The most common treatment recommendation is to rest, and anyone who has broken their ribs can attest to the fact that anything above a restful breathing intensity can be excruciating. Being patient is the quickest path back to training.
Throughout the recovery process from upper-body injuries, it’s helpful to work with a physical therapist and/or massage therapist. You’re going to be compensating for your injury as you sit on the bike, in the way you distribute your weight and the way you produce power. This can easily translate into soreness and tightness in other areas (your back, shoulders, neck, hamstrings, etc.). Physical therapy and/or massage therapy can help keep these compensations from becoming their own full-blown injuries.
Lower Body Injuries
If there’s a silver lining to upper-body injuries it’s that they rarely affect the biomechanics of your pedal stroke. Lower-body injuries, however, affect a cyclist’s key power-producing infrastructure. And as with head injuries, the worst thing you can do is rush back to full-intensity training.
Patience and diligence are essential. Think of it this way: the fastest way back to full power is to heal correctly the first time. Too many athletes prolong the recovery process or make matters worse by pushing themselves too hard too early. They don’t want to lose too much fitness, so they push themselves when they are only marginally recovered, and then they suffer a setback and have to wait again through a new injury process.
When working through lower-body injuries, prioritize pain-free movement before power production. In other words, once your physician has cleared you to ride, train at a low intensity level (recovery rides or endurance pace, no hard efforts) until you are experiencing no joint or muscle/tendon pain. This may take 3-6 weeks, depending on your injury, but it’s important because cycling is a highly repetitive motion and lower body injuries can lead to temporary or permanent changes in the mechanics of your pedal stroke. Adding power to your pedal stroke too early can aggravate structures that are still healing, or increase the likelihood of an overuse injury. During this process, it’s also essential to incorporate physical therapy and/or massage therapy as well.
A Word on Confidence
Sometimes healing the body is the easy part, and the lasting impact of an injury is a loss in confidence. If the injury occurred in a crash, athletes may be hesitant or nervous returning to high speeds, busy roads, or big packs. Athletes returning from overuse injuries are often timid about hard efforts or long training blocks, out of fear of re-injury. In either scenario, a progressive series of positive experiences is a better path back to full confidence than a sudden plunge back into the fray. Start slow, riding with 1-2 friends, then a slightly bigger group on a mellow route. Move up to a faster/harder group ride you can bail out of if necessary, and then get back into competition. Hesitation causes crashes, so you’ll know you’re ready for competition again when you’re comfortable making assertive decisions in the group rides.