Anatomy of cycling injuries, for a stronger recovery

After he hit the deck hard, was knocked unconscious and spent four days in hospital in September 1969, discomfort became a constant companion of Eddy Merckx’s career. If you look at the numbers alone, it seems like Merckx didn’t suffer much – the year after the crash in the Blois velodrome in France, he raced 18 more days than in 1969 (and 2,000km more than the year prior) and won 36 races (up 11 year on year).

However, in the Cannibal’s own words, winning had become more complicated. His hips and back had been twisted by the crash (in an accident that killed his derny pilot Fernand Wambst), and his legs would eventually lock in pain during races.

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More recently, Chris Froome’s Dauphiné crash in 2019 has changed the former Sky and Ineos rider’s career forever and likely ended his chances to win a record-equalling fifth Tour de France. And what level will Froome’s former teammate, Egan Bernal, reach after his January crash in Colombia?
 
They’re extreme examples of crashing. But no matter the severity of the incident, it leaves many questions requiring an answer. What actually happens to our body when we’re injured? What are the biomechanical and physiological effects of traumatic crashes that we face when we start cycling again? Why do some athletes, like Merckx, come back with no apparent issues, whereas others cannot keep up the quality of their former exploits?

Gravity of injuries

“Some injuries are easier to recover from than others,” says former British Cycling and Team Sky physiotherapist Phil Burt. “When you have catastrophic injuries, your body almost has to learn a different way to work again.”Former Team Sky and British Cycling physiotherapist Phil Burt. Photo: Burt archive

All bodies are affected by pathologies, degradation and decay when we age and grow older, Burt continues, but when these happen over a long period of time, bodies find ways of coping with them. In other words, if changes happen gradually, we notice them less and we have time to catch up with them. But when they happen suddenly, as with Froome and Bernal, the comeback is more challenging. For cyclists, what also changes is how the body interacts with the bike. And that's not an easy problem to solve even when everything else is going well.

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“All human beings are asymmetrical, and we're all slightly wonky and twisted,” adds Burt. “But obviously, when you have crashes like that, it becomes even more dysfunctional [to push your pedals and the bike]. So what might have been really optimal before, now is harder to do.”
 
And if a new position on the bike after a crash is uncomfortable, the adjustments to solve the discomfort could lead to a cascade of other issues like saddle sores and joint aches.

Effects on the human body

But on top of the effects on our physical structure, can severe injuries also have an impact on our ineternal physiology, that is our metabolism pathways? Aitor Viribay, lead performance nutritionist for Ineos Grenadiers and researcher in exercise physiology, says the limitations after a traumatic injury are less severe on the metabolism than on the body’s structural components.

“The main limitations are often related to neuromuscular function and to the relationship between muscles and bones," he says.

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Depending on the gravity of the injury, some motor neurons can be switched off and stop working, so it’s more complex – if not impossible – for the nervous system to function. The other issue is connected to bone injuries, as bones have a harder time healing than muscles.
 
“It’s easier for you to break that bone again after an injury,” says Viribay. “The bone quality’s often compromised and the bone-muscle crosstalk [the action of muscle-derived factors on bone and bone derived-factors on muscle] can be compromised, too.”Aitor Viribay, Lead performance nutritionist for Ineos Grenadiers. Photo: INEOS-Grenadiers. 

Viribay also discusses a hypothesis that connects bone health and the immune system. However, he says studies aren’t extensive in this area. “After these big traumas, the immune system is highly compromised and we know bones play a key role in the immune system. So, probably, this could be one reason why athletes aren’t able to recover again or to be at their optimum."

Psychology impact of crashing

Of course, anyone who’s ever had time off the bike injured knows it’s not only a physiological or biomechanical tunnel that we ride through when we’re injured. There are also the psychological effects of riding after traumatic experiences. 
 
“Sometimes it’s the mind that struggles to heal and riders aren’t able to take the same risks they used to take before,” says Burt. He refers to the central governor theory, which suggests our brains control and regulate exertion so that we never put ourselves in a dangerous situation.

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"I suspect that if you have a severe injury, that capacity is even more affected,” continues Burt. “If you can’t go as deep as you did beforehand, because with the trauma your ‘body protection’ level is even higher, mentally it's harder to get into that place.”
 
Viribay also agrees on the psychological effects of crashes and elaborates on the connection between mind and movement.Chris Froome is among those riders who has not been at the same level after the 2019 crash at the Critérium du Dauphiné. Photo: Dario Belingheri/Getty Images

“The mind has some activations that could feel scarier after a crash,” he says. “And these activations from the central command [central nervous system] through the peripheral nervous system can be compromised. And we know that the central nervous system plays a huge role in performances and muscle contractions.”

A comeback is always possible

Reassuringly, as Merckx and numerous other riders have proven, athletes can come back even after the most severe injury. Burt cites Ed Clancy's example. Clancy, a former track cyclist who won three Olympic gold medals, had severe back issues and underwent surgery six months before the 2016 Games in Rio.

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"He had a massive disc prolapse and we had to operate. Unbelievably, within six months he’d returned and won Olympic gold."
 
Merckx, on the other hand, after crashing in Blois, always travelled with an Allen key to move things around on his bike and feel better in the saddle. The tinkering was part as a direct result of the crash, and part an obsession to find a perfect bike position. His search never really stopped and he continuously changed things around. However, from the outside, it seems like he did, as he went on and became the most successful cyclist in history.

What to do to come back

When recovering from a crash, your most important attribute is patience because there are more or less standard healing times for tissues and structures.
 
“It’s six weeks for initial healing, then 12 weeks for long tissues to heal. But different structures like bones take six to 12 months to go through what’s called the remodelling phase,” says Burt.

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However, the silver lining for cyclists is that compared to other sports where landing forces on joints, bones and muscles are more severe (like running, for example), it’s easier and quicker to recover from injuries. “And you can train your lungs and heart without much pain or cost for your body,” says Burt.
 
Of course, the sooner you can move after an injury, the better for the body in terms of neuromuscular function and avoiding muscle-mass loss. Still, different criteria and approaches depend on the severity of the injury and, of course, the person involved and their reaction to it. In the cases of Froome and Bernal, there’s a whole team dedicated to their rehabilitation. Most of us can only rely on the doctor and the physiotherapist we decide to consult.Finally, whether we are amateurs or professionals, note that nutrition has a massive impact on our recovery. “Ensure that you have everything to optimise your immune system and to reduce inflammation. Proteins are important to keep muscle mass, but also make sure you have enough energy to sustain the immune system because recovering from an injury has a huge cost in terms of energy expenditures. So we spend a lot of calories in trying to recover from big traumas,” says Viribay. 
 
If you’ve recently been injured, don't despair. As you can see, it's possible to come back from the most traumatic crashes, providing you take time and let your body heal. However, there’s a final nugget of advice from Burt not to forget: “The ability to know when not to train is probably more valuable than being able to push yourself. Some people don’t know when to stop and then are injured or ill. So knowing when to push and when not is also a way to limit injuries in the long term.”