No one likes to crash, but it is a part of cycling and most of the time your pride is all that gets hurt, plus a few tears in the Lycra. Your clothing helps prevent injuries, but sometimes you get cuts and scrapes, so is important to learn how to carefully assess and care for your cuts and scrapes if you fall. Most race venues have a first aid station and often EMTs or paramedics to provide assistance. They will likely have the materials to clean and dress your wounds, but not all races and events provide this service. One of my crashes occurred at a course in the middle of nowhere. I had no supplies with me and when I went to registration to get help, a guy gave me a band-aid out of his wallet. I had to drive 30 miles to an emergency department with a make shift dressing using napkins from a drive through restaurant and a t-shirt. I wasn’t prepared and I won’t make that mistake again. Be prepared and don’t count on others to take care of you.
The first step in deciding how to take care of a skin injury is making an assessment as to the type of wound. ‘Road rash’ is a generic term generally referring to an abrasion. Abrasions, loosely defined as a skin injury that grinds away layers of skin, are often very painful. The most superficial layers of skin are removed and this can expose the sensitive underlying nerve endings. That is why a small abrasion often hurts more than a deep laceration. Usually there isn’t much bleeding associated with an abrasion because few of the small blood vessels are exposed and those that are may actually be cauterized by the friction forces of the crash itself. What ever bleeding does exist should be controlled with direct pressure. If the bleeding continues, it is likely that the wound is deeper than you initially suspected and evaluation by a physician is important.
The next step is wound cleansing. At the race site, I recommend that you use clean tap or bottled water with some sterile gauze and gently rinse and clean the wound. The cleaning process is usually more painful than the actual crash. Over-the-counter medications like acetaminophen (Tylenol) and ibuprofen (Advil) can help with the pain. Then at home it is very important to clean the wound thoroughly. Although this is often the most painful step, it is definitely the most crucial. The skin serves as the barrier to harmful bacteria between the outside environment and our bodies. Once the skin is damaged via an abrasion, that barrier has been breached. The healing process will be delayed and scarring more prominent if the wound is not clean. The shower is a great opportunity to clean the wound. You must push through the discomfort and scrub away the dirt. If you cannot do the cleaning process yourself then be sure to have someone help scrub. The cleaner the wound, the less the chance of infection and the sooner the wound will heal.
Once the wound has been thoroughly cleaned you are ready to apply a dressing. It is important not to apply a dry dressing, like dry gauze to the wound because this will dry and stick to the tissue, removing healing tissue when it is changed. A non-stick dressing such as Telfa or petroleum impregnated gauze such as Xeroform will work very well. These are available over the counter and should be a part of your race kit. If you do not have these you can saturate dry gauze with an antibiotic gel. It is important to keep the wound covered and moist. Not too moist however. When a dressing gets wet from seeping fluid from the wound it should be changed. If the wound becomes too moist it will delay healing. If the surrounding skin looks like you’ve been in the bath tub too long, the wound is too wet.
You should change the dressing 2-3 times per day in the first 48-72 hours. This allows you to keep the wound and dressing clean. If an infection starts it will likely develop in the first day or two. Signs of infection include swelling, redness, warmth, increased pain and discharge or pus. After the first 72 hours you can usually apply a dressing after a morning shower and leave it open to air in the evenings if you are in a clean indoor environment.
The best dressing for road rash on the legs and arms when riding is telfa or xeroform gauze held on with Band-Net (looks like white fish-net stocking). One of the most challenging components to any dressing is getting the supplies and often you have to make do with the materials you have available. Also, every cyclist should have a tetanus booster at least every ten years.
Road rash supplies are an essential part of a medical kit that is imperative for all competitive cyclists to have their own kit. (We will have more on medical kits later.)
Supplies for a Road Rash Kit
- Your name, health insurance information, contact names and numbers
- Normal saline or bottled water
- Betadine or hydrogen peroxide
- Dry sterile gauze
- Non-adhesive dressing material, both telfa and xeroform gauze
- Medical bandaging tape
- Polysporin antibiotic ointment
- Non-latex gloves
- Band-aid type bandages of varying sizes.
- Ibuprofen or Tylenol (know appropriate doses and safe use)
Remember, the ultimate goal is to prevent infection and allow the tissues to heal. When in doubt, see a physician.