In its many forms — from road to mountain bike to BMX — cycling and road rash go together like hiking and blisters. The former inevitably produces the latter. Because of their high speeds and close proximity, cyclists racing in a bunch are most susceptible to a tangle-up that results in a skin-burning slide across the road.
This past weekend, however, at the BMX Great Northwest Nationals in Redmond, medical staff from Desert Orthopedics in Bend treated some 50 riders for symptoms of what cyclists know as “road rash.” In BMX (bicycle motocross) or mountain biking, road rash is really a misnomer, as the skin abrasion can be the result of skidding across dirt or gravel as well as across pavement.
In any case, road rash is a painful but common part of cycling — as Michael Ryan can attest. Ryan, a doctor with Desert Orthopedics, has provided medical support at Central Oregon’s Cascade Cycling Classic stage race for some 15 years. He says he and his staff have treated as many as 100 riders in a single day for road rash during the CCC’s downtown criterium, where multiple circuit races are held over the course of one afternoon and evening.
Despite the frequency, most road rash is typically mild. In fact, it is not uncommon to see riders crash one day and be back racing in the peloton the next, with bandages covering their hips, shoulders and/or elbows.
“It’s pretty unusual for an abrasion to keep you off the bike,” says Mike Murray, an emergency-room doctor in Gresham who manages the Oregon Bicycle Racing Association’s first-aid program.
Bend bike racer Spencer Newell, 30, recalls how he “catapulted” off his bike in a local roundabout last year, scraping his hip, knee and elbow on his left side.
“I was close enough to my office,” he says. “I cleaned everything out, got back on my bike, went to Rite Aid (to purchase first-aid items), got bandaged up, and kept on riding for another hour.”
Unfortunately, not all encounters with road rash are quite that benign.
Five years before the roundabout incident, Newell was involved in a high-speed crash while racing during a stage of the Cascade Classic on the stretch of Century Drive that descends from the Mt. Bachelor parking area to the Sunriver cutoff road.
“We were going at least 50 miles per hour,” he recounts, “and some guy got the death wobbles (wheels wavering side to side uncontrollably) in the middle of the group. I got caught in it and went down, and slid on my right side for 150 feet. It felt like a Slip’N Slide. It was awful. I still can’t ride that hill without having an aversion to it.”
The road rash extended from Newell’s right calf all the way up his right side to his arm.
“I was on my back watching TV for five days after that,” he remembers. “It was three weeks for the bandages to come off, but I was on the bike in two.”
Know when to see a doc
Riders fortunate enough — one could say — to sustain road rash during a sanctioned bicycle racing event should by all means take advantage of the medical support offered at the race. Most OBRA races are staffed by at least one medical provider, while an entire team of well-equipped medical professionals is typically on hand at high-profile Central Oregon events, such as the Cascade Cycling Classic, road nationals or cyclocross nationals. Even for a minor case of road rash, racers should take advantage of the supplies, ease of accessibility and know-how offered at no charge to racers who are injured while participating in these events.
Those unlucky enough to be sent sliding across the pavement outside of a sanctioned race can, with the right supplies, treat most cases of road rash at home. That said, a trip to a medical clinic is recommended in some instances.
Deep-tissue lacerations, bleeding that will not stop, or a wound contaminated with dirt and debris that cannot be sufficiently cleaned at home are all red flags that a doctor visit is necessary, Murray advises.
Ryan recalls a pro rider who several years back sustained a deep abrasion when he was sent sprawling across hot pavement in a high-speed crash during the Cascade Cycling Classic.
“High-speed road injuries are the ones we watch a little more carefully,” Ryan explains. “We give them a good scrub and like to see them back in 24 hours and repeat the process.”
Clean early and often
A thorough cleaning of the abrasion is paramount. And the quicker, the better.
“If you’ve got a wound that’s been sitting there for hours, it’s going to get a lot more sensitive,” says Murray. “Soap and water is the most important thing. We generally use a saline solution at bike races because it’s less painful, but there’s nothing wrong with water.”
Leftover debris in the wound can lead to infection and scarring, says Ryan.
“If you’re doing it on your own, use a washrag or scrub brush to get the material out of the wound,” he instructs. “Mostly that’s uncomfortable, but people can get through it. After that, it’s daily cleansing.”
Keep it moist
Take care not to let the road rash dry out and scab over. Drying and scabbing, doctors say, will slow down the healing process and promote greater scarring.
While several over-the-counter dressing options are available at the local pharmacy, Murray says home remedies can also work in a pinch.
“It doesn’t have to be really high-tech,” Murray insists. “You can basically coat the wound with Vaseline, then put a piece of bedsheet over it and gauze to catch the goop, and that’ll work just fine.”
While it is best to keep the wound moist, it is important that the bandage covering the road rash allows the abrasion to breathe.
“Riders in the 70s used Saran Wrap (to cover road rash),” says Murray. “But sweat accumulates around the dressing and it gets white and the wound doesn’t heal.”
Supplies to have on hand
Riders with road rash should look for a breathable plastic dressing called Tagaderm, available at some local pharmacies. (Inquire with the pharmacist, as Tagaderm can be spendy — $9 to $13, depending on bandage size — and may be located behind the counter.) If Tagaderm is not available, look for a breathable, nonstick gauze, or any dressing that allows the wound to stay moist but not wet.
The dressing should act like a Gore-Tex rain jacket, Ryan says.
“The skin doesn’t weep underneath but allows the area to stay moist,” he says, describing how the dressing works. “Those (dressings) you can leave on for a week. That’s the ideal situation. (The road rash) will heal quicker and I definitely think the scarring is less.”
Other products to look for include petroleum gauze (prepared thin sheet of gauze coated with petroleum jelly), which can be topped with regular gauze and strapped in place with medical tape.
For more detailed instructions on caring for road rash, go to the Oregon Bicycle Racing Association Web site at www.obra.org and click on “Links” and then “Wound Care Tips.”