10 Most Common Bicycling Injuries

Failure to Unclip / My Knee Hurts / Cramps / How Much Further

Failure to Unclip

If bee stings are the most common injury that I see as a bicycle medic. The most common bicycle incident that I see is a fall due to failure to unclip. On tours – failure to unclip is like people yawning – when one does it – several end up doing it. As PTs, failure to unclip victims almost always state they are not injured – even if they are injured. The most common injury associated with failure to unclip is EMBARRASSMENT. I am serious, it takes a couple of minutes to calm the PT down due to their embarrassment – to get to the point that I can actually communicate with them about injuries associated with this sort of fall. There are several injuries – and they can be serious – associated with this sort of fall.

The most common injury is chipping/bruising/cracking/fracturing bones in the hip area. The injury could be to the femur/femur head/pelvis/ilium/etc. Technically a “hip fracture” is a fracture of the proximal femoral, not the pelvis. However, we do not have x ray vision and we are doing First Aid. So, for our purposes – any bone in the hip area that is injured should be treated as a suspected hip fracture. As stated – especially if the PT is embarrassed – they jump back up and get back on his/her bike and try to act as if nothing happened.

As a First Aid person – make your way over to them and after they have said they are ok – a couple of times – let them know that there are some injuries associated with this sort of fall and that you would like to check them out (obtain permission). Also, while standing there – look at their helmet to make sure they did not crack it or that there are scrape marks – indicating blunt force to the helmet/head. Then – with the PT’s permission – press slightly on the hip of the side of the PT that hit the ground. If there is pain – do a full work up. If no pain on the slight press – use more force and push on the hip. If painful – do a full workup – if no pain – then probably the bicyclist will let you know that they are ok and they want to ride (or more simply stated – they want you to leave them alone). Technically, the PT has had a fall and you should do a head to toe/primary/secondary assessment. However, good luck on getting the PT to even stick around long enough to do the pressing on the hip area much less a full workup. This is First Aid, so at least check out their hip area to make sure that nothing is chipped/cracked/broken/etc. However, when the PT demonstrates considerable pain when you press the hip area – they are hurt and should be treated. DO NOT LET THE PT CONTINUE RIDING HIS/HER BIKE.

Again – we do not have x-ray vision and we do not know what is going on in terms of a chipped/cracked/broken bone. Very large arteries (like the femoral artery)/veins/nerves pass thru this part of body and an injury to this area should be treated seriously. A bone chip floating around the area – can nick the femoral artery. Not likely but if it does – you have a very serious – life threatening – medical emergency on your hands. So, if the PT is having pain – slightly probe the area for pain – put the PT in a position of comfort and then attempt to convince the PT to go to the hospital or possibly call 911. I personally would call 911. The ambulance crew knows how to board the PT as well as wrap them in such a manner that it will be as safe as possible to move them into the ambulance. The PT should NOT walk so putting them into a car can be tricky. As stated, I would call 911 and yes you will probably be given a hard time – be told that you are over reacting. The reality – if PT is presenting with pain upon examination – it could be a chipped, cracked, or fractured bone in the hip area. PT needs to get an x ray and be at a place they can receive a higher level of medical care.

Other injuries associated with failure to unclip: broken wrist; broken arm; broken humerus; dislocated shoulder; head injury; spinal injury; etc. Again, this is a very common accident and usually the PT is just embarrassed and trying to act as though nothing has happened. Do the best you can on obtaining permission to treat. I have discussed how to treat the injuries listed above in other parts of the website. I have seen PT’s that fell due to failure to unclip that acted as if nothing was wrong but when I started probing their arm/wrist – suddenly they had pain. Again (and for the last time), the PT will be embarrassed and the embarrassment can mask an injury. Check them out.

My Knee Hurts

My knee hurts – I have heard this way too many times. Usually, when a PT comes to an AID Station and states those words – they are done for the day – especially if they are on a tour and they expect to ride the next day. Most knee injuries are pulled/strained/exhausted muscles/tendons. PT’s knee is not going to get better if they ride – the knee needs massage and RICE – rest, ice, compression, and elevation. Of course – the primary portion of RICE is REST! Like I said, if a PT shows up at an AID Station saying their knee hurts – IT IS NOT GOING TO GET BETTER – attempt to convince them to SAG for today in order to ride tomorrow. As far as treatment at the AID Station – massage and RICE.

Then there is the true athlete that has chronic knee issues but usually they do not come to us (medics) – these folks usually know what to do.

One scenario that is particularly un-nerving is when the patella (kneecap) moves to the side of the knee (dislocation). Usually this can be resolved by relaxing the muscles in the calf/thigh with massage and usually the PT will explain that this is NOT the first time this has happened. Attempt to get them to go to a hospital – or at least SAG for the day. The First Aid treatment is to massage and put slight pressure on the patella to move back into the correct position. Check CMS before and after you start the massaging. However, even before massaging – if you are in an environment where you can get PT to a level of higher medical care – do so!


Pretty much the same thing – PT is done for the day. Cramps can be a symptom of hypo/hyperthermia/exhaustion/dehydration/loss of electrolytes/etc. – – take your pick. When presented with a PT having cramps – be on the lookout for all the conditions I mentioned above – cramps are usually a symptom of something else. When riders present with cramps – TRY to convince them to stop riding and call it a day. The cramps are NOT going to get better.

Having said that – there are always exceptions but basic First Aid – when the PT shows up at an AID Station or is on the road and has to stop the cramps pain is so bad – they SHOULD call it a day. Call them SAG. If they simply will NOT stop riding – massage and hydrate. If they are also presenting with hyperthermia symptoms – be cautious about the hydration (see hyperthermia).

How much further

Call them SAG. PT is probably too tired/exhausted to be riding safely.

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