Racing a bike down a mountain is a risky sport. In fact, this is one of the attractions for a lot of racers – just how far can they push the boundaries? How fast, and high, can they go?
Unfortunately, there are consequences when things go wrong. Coming off a bike at speed, onto a track formed by granite boulders or lined with trees, often results in broken bones and damaged ligaments.
As a coach to downhill mountain bike and motocross athletes, it's important to try to protect them and reduce their likelihood of injury. However, it also involves helping to rehabilitate them and return them to the bike, ready to compete, as quickly as possible.
Let’s take a look at the areas that are most at risk of injury.
1. Shoulders
Being ejected over the bars straight towards the ground often means that the shoulders and head make contact first.
What are the most common shoulder injuries?
Dislocations: Helmets do a good job of protecting the skull, but the ball and socket joint of the shoulder is left susceptible to dislocation and impact injury. If you consider the head of the upper arm to be like a golf ball, and the socket of the shoulder like a golf tee, you can see that it doesn’t take much to unseat this.
Breaks: Broken clavicles (collarbones) are also very common as the bone is only covered by a thin layer of skin. Brook Macdonald drove his shoulder into the dirt of Lošinj during finals at the first round of the World Cup and broke his clavicle, but while this put him out of action for a while it was a relatively simple four week recovery.
Separations: Acromioclavicular (AC) joint separation injuries – at the top of the shoulder – are common, too. If you land on your shoulder, it can be easy to tear the ligaments which hold together the collarbone and shoulder blade.
How do you recover from these injuries?
Rest: The word no athlete likes to hear! Bones take time to heal. Without displacement, most bones will heal within four to six weeks, and this timeframe is rarely altered.
Surgery: If there is a bad dislocation or break, repairing the joint may be necessary. For the shoulder, this can involve re-establishing the nice shallow ‘cup’ of the shoulder joint, or repairing ligament damage. Greg Minnaar went through a period of time where he suffered from his shoulder ‘popping out’ during a run, and repair to the joint was necessary. Collarbone injuries can sometimes require metalwork, which is inserted to line up broken pieces of bone and hold them together.
Laser treatment: This is viewed as either a miracle treatment, or complete quackery – depending on who you speak to. This treatment essentially aims to help the bone regrow and repair faster. It is popular among speedway riders and cyclists, who often make a trip to one of the popular clinics to try and speed up their recovery. I have spoken to many athletes who say they have returned to their sport almost immediately after a few treatments. Surgeons are more sceptical to say the least.
Rehab: Following any of the above treatments, a period of rehab is necessary to recover movement and strength around the joint.
2. Ankles
If you ride with clip-in pedals, your shoes probably have a stiff sole with a cleat attached, and if you ride a BMX style flat pedal, your shoes probably resemble a simple trainer. Neither of these offer much in the way of ankle protection – especially when you compare them to the solid, plastic and hinged boots our Motocross brethren wear when they compete.
What are the most common ankle injuries?
Breaks: Riders often land feet first from a height, breaking bones in the ankle and foot. In fact, junior silver medallist Joe Breeden suffered such an injury this off-season in this way, and the injury was akin to what I have seen with a builder who fell from a high height from scaffolding.
How do you recover from these injuries?
Rest: Reducing swelling, pain and soreness can be sped up with equipment such as a game ready, which compresses the ankle and pumps cold water around it. Raising the foot will also speed up this process.
Surgery: To reduce further problems or pain, pins can be inserted or bones fused together, but fusing bones can make it difficult to walk on rough ground. This means that even taking part in an integral track walk could put you out of prime race condition for a number of days.
Rehab: This is important for regaining control of the foot and ankle - ensuring you're able to land on it, hop on it and flex it, which is vital for movement and balance.
3. Wrists
Outstretching your hand to protect your face as you approach the dirt is simply instinctive, but leads to many broken wrists and damaged thumbs.
What are the most common wrist injuries?
The leverage of landing on your hand through the wrist often leads to broken wrist bones, breaks of the lower arm, damage to the thumb or damage to the ligament attachment to the thumb. Plaster casts are used to immobilise the joint, and although effective they can reduce the range of movement in the wrist, meaning grip strength drops quickly.
Breaks: Bones such as the scaphoid - below the thumb - can be tricky to heal if they're not dealt with correctly, alongside breaks in the bones of the arm. A pin can be used to hold bones in place, but many riders are impatient to return to riding and don't allow full healing time. For the scaphoid bone in particular, this can be catastrophic, and has been the cause of premature retirement for more than one rider.
Ligament Damage: The thumb is at risk as it's often forced backwards during an impact to the ground. The ligament at the base of the thumb can be damaged or actually pulled away from the bone, which is not only painful but greatly reduces the ability to grip the bars.
How do you recovery from these injuries?
Surgery: This is often needed in order to pin the scaphoid together and give it the best chance of healing. One of my athletes recently dislocated and fractured his wrist, requiring three surgeries to replace the bones, pin them, and restore good blood flow to the hand. Complicated work!
Rest: A simple plastercast is often enough to hold the bones in place and allow recovery of ligament damage. However, patience is key! Cutting off a cast to ride is not uncommon, but if the bones have not healed fully it can result in months or even years of further discomfort or surgery.
Rehab: Recovering grip strength, strength in the arm, and then control on a bike can take time. Using single arm exercises and cable machines, dumbells, and kettlebells can help to regain good balance.
Above are just three areas that cause mountain bikers problems – and taking time off from racing is the most frustrating thing. Very few riders complain of the physical pain, but the psychological distress is often long lasting – missing the competition, normality of day-to-day life and ability to train can cut deeply.
Returning riders to competition in a healthy state – and stronger than before they were injured – is a key motivation and goal for me. Before long they are back to speed and, incredibly, looking to push those limits once again!
Alan Milway has over 13 years experience coaching professional bike athletes, find out more about his training sessions here.