10 Most Common Bicycling Injuries

Road Rash

Road rash is also referred to as a cherry or a strawberry. They are all basically the same type of injury and they fall under the category of abrasions. I have treated a lot of these and the patient’s (PT) level of pain is not always equal to the depth and area of the abrasion. Sometimes an abrasion the size of a half dollar results in a PT that is crying and will not let you touch the wound. Then there was the guy on a ride outside San Francisco that had a cherry the size of a grapefruit and he had almost no pain. He allowed me to clean his would with alcohol soaked gauze. Typically using alcohol results in screaming (I am not joking). This example of the different level of pain that you may encounter with this injury is something to consider when treating abrasions/road rash.

Treatment. Almost always, road rash is caused by a crash of some sort. Anytime you have a PT that has been in a bicycle crash, it is necessary to do a head to toe exam (primary and secondary assessment) to determine the extent of the injuries. Assuming that the abrasion is the only injury, the next step is to clean the wound as best as possible. If you have sterile water with you, now is the time to use it. However, water is weight and not many bicyclists have sterile water. The next best substitute is to use the PT’s water bottle. For obvious reasons, when cleaning the PT’s wound, the PT’s germs are better than your germs. Therefore, so use his/her water bottle when you irrigate the wound. Use a lot of water and try to clean it as best you can. Depending upon how deep and how much dirt is in the wound. I usually just take a sterile dressing (3X3 or 4X4) and soak it with water and start scrubbing out as much dirt/gravel/asphalt/blood/etc. as you can get. Use water liberally. Squirt it onto the wound and clean as much of the foreign bodies out of the wound as you can. If it is really bad, I will use a roller bandage and use it like a scrub brush to get the deeper stuff.

You are not a doctor and you are just doing first aid. So, do as good a job as you can and then dress and bandage the wound. All that water and you are NOT going to be able to use tape. I usually put on a sterile dressing and then wrap the wound with roller bandages. Tie them off then check for CMS. According to the books, they advise NOT to put Neosporin on the dressing prior to placement on the wound. I have heard doctors and nurses say different. However, you are doing first aid and I strongly recommend that you just clean the wound as best you can and then put a sterile dressing on the wound and wrap. Convince the PT to visit his/her primary care doctor, Emergency Room or an urgent care facility. At the ER, they can numb up the wound and clean it like it should be cleaned. Your first aid to the wound is a temporary measure and the PT should always be advised to see an ER/Urgent Care facility and/or their primary care doctor. Try not to let them continue riding, which is not always as easy as it sounds. Frequently after the adrenaline of the crash wears off, the PT will feel like riding again, especially after the dirt is cleaned out of the wound. The enemy in this matter is infection. Obviously, with significant foreign objects inside a large wound/road rash/cherry an infection can happen fast. The PT needs to get to get to an ER/Urgent Care Facility or at least to the next AID Station if you on an organized ride. At that point, medics have the tools to properly treat the wound for infection. So, clean it –wrap and then get them to a higher level of medical care. That is the standard care. Again, any time there is a cherry/strawberry; usually there was a fall/crash/bike accident. Do the head to toe exam, including checking the helmet.