10 Most Common Bicycling Injuries


Hypothermia happens a lot in the bicycling community and directly or indirectly, it is also responsible for a significant amount of bicycle accidents. On several occasions, I have had the unpleasant task of telling a bicyclist that they can no longer ride (not fit to ride) due to hypothermia. The primary issue being that they still had several thousand feet of descending to complete and everybody knows that most bad accidents happen on the way down the hill. Further, throw in the symptoms of the later stages of hypothermia and to allow the PT to continue was to ask for a serious accident.

About hypothermia – there are five stages of hypothermia and they are based upon core body temperature. However, any PT that has gone to stage three needs to be in a hospital or on the way to a hospital. Typically, a bicyclist on a tour or just out riding that is suffering from hypothermia will be in the first or second stages of hypothermia. Symptoms include: uncontrollable shivering for an extended amount of time; skin feels cold; PT feels very cold; cyanotic or pale skin, numb hands, butt, and face/etc. Usually this is a result of being caught in the rain on a hot Colorado summer day that turned nasty – or afternoon crack and boom as we locals call it. On one particular tour, hundreds of cyclists were caught in a downpour/thunderstorm with sleet while they were descending from 12,000-11,500ft to 10.000 – 9,000 feet. There were hundreds of shivering cyclists. However, the PT that still had blue lips and bluish skin but STOPPED shivering was the PT that I kept my eye on (shivering is the body’s method of warming itself). These are the PTs going into the next stage (third) of hypothermia, the symptoms include: the PT STOPS shivering – serious symptom; cold skin; glassy stare; loss of motor coordination (stumbling or cannot walk correctly); all the symptoms of first and second stages except much worse; and probably the worse indication – they cannot carry on a conversation or are Alert and Oriented x2 or less. Confusion is a major symptom: PT has difficulty remembering or does not know who is president/where they are/what they are doing/ what ride they are on/ etc or decreased level of consciousness. When a hypo PT gets to this stage – time to call 911 and/or get them to a hospital.

The Treatment – The first thing is to get the PT out of whatever is causing the hypothermia. If they are getting it from being wet and riding their bike down a mountain with high winds and sleet. Standard rewarming by putting the PT in a dry place that is warm. If possible, try to get them out of the wet clothes and put blankets around them. Let them sit next to a heater. For the stage 1 and 2 hypo – this is probably enough. Just give them an hour in a warm dry place with dry clothes – maybe some warm drinks and they will probably be fine. Keep them in this place at LEAST until they quit shivering (easier said than done – keep them longer if they will let you but usually they will start riding again). However, for the folks that are getting worse instead of better, start doing a full workup and consider calling 911. If all possible treatment has taken place: you dried them out, got their wet clothes off and put them in a warm environment but his/her condition continues to go downhill. Be on the alert – you will PROBABLY have to call 911 wait and see situation. If the PT becomes unresponsive (unconscious) – DO NOT HESITATE – CALL 911 and/or GET PT TO A HOSPITAL

Third stage + hypo – standard treatment: Do vitals every 3-5 minutes; O2 if you have it; and KEEP THEM WARM. If they are having serious issues with A & O – call 911. This PT needs to be in an ER and your job is to keep them stabilizied and track the PT’s progress until the ambulance arrives. Again, we are not doctors and this is first aid. If the PT is getting worse instead of better, get the PT to a higher level of medical care.


There are basically three stages of this illness: First Stage the PT presents sweating profusely, probably has a headache, slightly confused, may have some difficulty with balance, drinking large amounts of water; may have cramps, etc. Second stage or Heat Exhaustion – same as first stage but worse –more cramps, weak and/or exhausted, rapid shallow breathing, weak pulse, and a VERY serious symptom – if the PT is NOT sweating anymore – PT’s body has lost the ability to cool itself – pretty serious stage. Third stage – heat stroke – this is a life threatening condition – GET PT TO A HOSPITAL ASAP. However, except in extreme circumstances, a bicyclist first aid provider will probably not run into a full heat stroke. Typically, the hyperthermia PT is a bicyclist that forgot his/her water bottle on a hot sunny day. PT then develops the symptoms of both hyperthermia and dehydration at the same time. It is surprising how many times I have come upon a PT in a small accident and when I started doing the assessment, I realized the reason the PT had the accident was due to the symptoms of dehydration and first stages of hyperthermia.

Treatment is pretty simple. Get the PT out of the heat and sun. As simple as finding a shade tree or the shade of a building – whatever you can find – get them out of the direct sun. Also, try to get them out of the heat. A building close by with air conditioning or at least a fan is good. However, usually this is not a luxury available and we have to cool them down. Common sense rules, loosen clothing, take off the helmet, and start watering down the PT (again use their water). Cool off by using wet cloth/dressings/gauze/whatever is available. Cool off with damp cloth the head, neck, arms, torso (as much as possible), and legs. If there are additional people available, have them fan the PT. Continue cooling them down as you examine the PT. Check vitals – increased respiration is normal at first but should start calming down after a few minutes of cooling. Keep track and time the vitals. Drinking fluids is a mixed bag. I have read 1st Aid Manuals that stated drinking liquids is not a good idea and then 1st Aid Manuals where it recommends giving them water or electrolytes. I personally do NOT immediatlely give PT liquids simply for the reason that nausea is a typical symptom of the first stages of heat exhaustion. If the PT was dehydrated prior to treatment, if they throw up whatever liquids you give them, I assure you the dehydration will become significantly worse. Usually, I wait on the water/liquids until AFTER they start cooling down significantly. Typically, the PT will be sweating profusely. However, after 30 minutes under a tree, and being cooled down with wet cloth and being fanned the entire time, usually the PT will feel significantly better and able to keep water down. At that point, give them very small amounts of liquids. If they keep it down, increase the amount. As stated, you do not want a dehydrated PT to vomit and lose even more hydration.

If the PT starts demonstrating symptoms of heat stroke – DO NOT HESITATE – call 911 and/or get them to a hospital ASAP. If you cannot get them to a hospital – keep them in a cool place, treat the symptoms, check and keep record of vitals until the ambulance arrives. Again, heat stroke is a life threatening condition – always keep that in the back of your mind – even as you treat the 1st and 2nd stages of heat exhaustion.