Danilo Napolitano (Wanty-GroupeGobert) makes a grim face as his wounds are being disinfected at the 2014 Tour of Turkey.

Wound care for cyclists: How to bounce back from abrasions

A crash course in road rash.

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Road rash is close to an inevitability for cyclists – but while it might ruin your day, with appropriate treatment you will soon be back in the saddle and on your way to recovery.

VeloClub member David Maver prepared this guide for post-crash treatment. David is a registered nurse from Philadelphia, USA with a clinical background in critical care nursing, emergency medical services, and wilderness medicine. He has a particular interest in wound care in outdoor settings, and enjoys riding steel bicycles with rim brakes while exploring the rural roads west of his home city.


Hitting the ground while riding your bike is one of the worst aspects of a great sport. Tarmac, gravel and trail can all take their toll on our skin and the silly lycra we wear does little to avert injury.

At some point it will happen to you. You will find yourself on the ground with less skin than you had moments earlier. Abrasions – or ‘road rash’ in the cycling vernacular – occur when the layers of skin are scraped away by an abrasive surface.

Fortunately, road rash does not typically cause much more than pain and some time off the bike – but you can bounce back quicker. Knowing how to properly care for this type of wound can reduce discomfort, promote healing, prevent infection, and return you to your normal riding routine more quickly.

Here is the CyclingTips guide to caring for road rash.

Russian athlete with road rash on leg.

Before You Ride

While most riders will never need to give thought to carrying any wound care supplies, gravel, mountain, and adventure cyclists traveling far away from civilization should give this serious thought and include a first aid kit in their gear. The further away you are riding from outside help, the more prepared you need to be to help yourself.

Before leaving for an adventure like this, consider asking questions like, “What can go wrong? How will I get help? What will I bring with me to help myself?”

Later in this article, wound care supplies will be discussed and they should be considered for inclusion in a first aid kit. 

Initial Management

After a fall – once you’re off the ground – your first step is to make sure you’re in a safe place, away from traffic. Once safe, check yourself over and assess what wounds you have and what condition they are in. This is where wound care starts.

The initial priority for any wound is to manage bleeding through direct pressure on the wound. If after a few minutes of pressure the bleeding does not ease, consider seeking medical care. Profuse bleeding is an emergency, and medical care should be sought immediately. 

Next, consider whether you’re safe to continue your ride or able to ride back home. If you are in too much discomfort or can’t ride safely, consider calling a friend, swiping your way into an Uber, or jumping on public transport.

Jumbo-Visma rider after a crash. Torn jersey, arm warmer, bibs and lower leg.

Cleaning the Wound

After bleeding is controlled, cleaning the wound is the next step in care. Cleaning the wound is an essential step to promote healing and prevent infection, creating a suitable environment for new tissue to grow. Cleaning does not need to happen immediately after bleeding is controlled, but should be performed when safe and practical; once home or at your destination for the day.

For minor abrasions without any contamination, gently washing with soap and water will be all that is required.

Rider bleeding from knee being attended to by team doctor.
Ruslan Tleubayev (Astana) attended to on the roadside after a crash at the Brussels Cycling Classic.

For more severe wounds – especially those that are contaminated with dirt and debris – cleaning is best performed by irrigating the wound with water or saline. While sterile solution is not required, any solution used should at least be safe to drink. Using a saline solution will lessen discomfort while irrigating a wound. Saline can be purchased at a pharmacy or made at home by adding nine grams of salt to one liter of water (two teaspoons in four cups of water for Americans). 

Irrigation is best performed by flushing the wound with copious amounts of water or saline under pressure. Current guidelines recommend using 50 ml of solution per square centimeter of wound with a pressure of 10-15 psi. This pressure can be achieved using a 50 ml syringe or water bottle punctured with a 2 mm hole. Irrigation syringes can be found for sale in pharmacies.

All visible debris should be removed from the wound. Superficial debris can be lifted out of the wound with tweezers, but if the debris is deep and irrigation was unsuccessful, seek care from a medical professional. Once irrigation is complete and the wound is clean, lightly pat the wound dry with a clean cloth or gauze.

Dressing the Wound

Rider with road rash being covered by doctor.
Mads Pedersen (Trek-Segafredo) treated for road-rash by team doctor Daniele ‘Nino’ Gaetano at the 2018 Giro d’Italia.

Once your wound is clean, placing a dressing over the wound is essential to wound healing. A dressing will keep the wound bed moist, absorb excess fluid (exudates), and prevent infection. A moist wound bed promotes new tissue growth through the process of granulation. If the wound bed dries out, this process will be dramatically slowed leading to a delayed and less functional healing of the wound. A dressing also protects the wound from additional trauma.

Many options exist for wound dressings with varying properties, but they all work to achieve the goals stated above.

  1. Non-adherent dressings are gauze with properties that prevent them from sticking to the wound. This becomes significant when the dressing needs to be removed. A dressing that can lift cleanly away from the wound will cause less trauma to the healing wound and reduce pain. These types of dressings should be used on minor wounds with little to no drainage.
  1. Hydrocolloid dressings are made of gelatin, pectin, or caboxymethylcellulose and provide occlusive coverage of a wound. These dressings create optimal moisture in the wound bed for dry to moderately draining wounds supporting growth of new tissue. They act as a barrier to outside moisture and contaminants, preventing infection. Hydrocolloid dressings will also not adhere to the wound bed.
  1. Foam dressings are ideal for wounds with moderate to heavy drainage as the foam will readily absorb the excess moisture while maintaining a moist wound bed. They can be applied for up to seven days unless they become saturated with drainage from the wound. Foam dressings will not adhere to the wound bed. Foam dressings are not needed for wounds without drainage.
Maximiliano Richeze wearing foam dressings after a spill at the 2019 Vuelta a España.

The exact choice of dressing is largely determined by how much drainage and moisture is present in the wound with foam dressings best for larger amounts and simple, non-adherent dressings best for little to no drainage. Once a dressing is selected, it can be cut to match the shape and location of the wound. 

Topical antibiotics, such as bacitracin or Savlon, can be used to prevent infection. Topical antibiotics can be purchased from a pharmacy, usually without a prescription, and should be applied in a thin layer over the open wound. Your dressing of choice can then be placed over the antibiotic. Topical antibiotics also have the benefit of helping to keep the wound bed moist.

The dressing then needs to be secured to stay in place. The simplest method is to cover the dressing with gauze and use medical tape to secure everything to healthy skin. Transparent, adhesive films, like Tegaderm, are also excellent at securing the dressing. A final method of securing your dressing is to use roller gauze, self-adherent wraps, or tubular bandages. These work particularly well for extremities and at joints.

Tubular bandages being used in a race.
Rafał Majka (POL/BORA-hansgrohe) modelling tubular bandages after a nasty crash at the 2017 Tour de France.

Dressings should be changed weekly unless the dressing appears saturated or is visibly dirty. When changing a dressing, take time to observe the wound. A healthy wound should be pink, moist, and slowly decreasing in size. When showering, wound dressings can be covered using cling film with edges taped down to prevent the dressing from becoming wet. 

Look for signs of infection when changing the dressing. Signs and symptoms of infection include the presence of slough or pus in the wound; increased drainage; warm, reddened skin surrounding the wound; unpleasant odors; increased pain; and fever or chills. If you recognize signs of infection or the wound does not appear to be healing, immediately seek attention from a healthcare professional.

Once your wound is healed, use moisturizers to prevent scarring, and sunscreen to prevent sunburn on the new skin. 

Tetanus Prophylaxis

Tetanus immunization should be considered with an acute, traumatic wound. Tetanus immunizations prevent infection caused by the ubiquitous organism Clostridium tetani. Dirty, open wounds like those that can occur from a bicycle crash are at risk for Tetanus.

With minor wounds that are clean, a Tetanus immunization may only be recommended if your last immunization was greater than 10 years ago. For larger, more contaminated wounds, especially if contaminated with dirt or soil, a Tetanus immunization is recommended if your last immunization was greater than five years prior. 

Conclusion

After a bicycle crash, road rash is just one type of injury that can set you back from riding. With the care detailed in this article, that set back doesn’t need to be long.

Properly caring for your wounds will improve healing and reduce discomfort allowing you to return to your normal riding faster than you might think.

Disclaimer

Wounds have a wide array of severity and the care for many wounds will extend beyond the bounds of this article. If you have such a wound, you should seek the care of a medical professional. Deep lacerations, puncture wounds, wounds with profuse bleeding, and any wound that exposes deeper tissues or anatomic structures underneath the skin should be cared for by a medical professional.

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