Roads and Rashes -- Bicycle safety

Accidents in bicycling are an ever-present danger. Annually, in the US, there are over 500,000 emergency room visits and more than 700 deaths. The severity of bicycle accidents can be divided roughly into major and minor. Major accidents, including deaths and life-changing injuries, have been the impetus for the creation of, and the driving force behind, a variety of preventive task forces -- at the community, state, and national level. Beyond their paramount importance for safety and considering a broader view – including issues such as commuting, pollution, and the inactivity/obesity of Americans -- these initiatives are vitally important for the health of the nation. You are urged to learn more and to become involved.

Thankfully, minor spills are much more common than major accidents but exact statistics on them are lacking because many go unreported. For example, an athlete may self-treat a minor injury and thus the accident data is not captured. It should be noted, however, that despite the term "minor", falling off a bicycle and bouncing/sliding along the street, or ground, is never a fun experience. Regardless of how much they are disliked minor accidents are a very common part of cycling. This can been seen in the old adage, "There are two types of cyclists, those who have just fallen, and those who are about to". (Note: Runners may be tempted to skip this article. However, this would be a mistake. Runners do trip and fall, so it may be bring bad karma to scoff at or ignore the topic.)

The exact reasons for crashes – beyond the broad laws known as Gravity and Murphy’s -- are indeed numerous. Although not all crashes are preventable, it is important to learn as much as possible about traffic safety, training and race safety, and bicycle maintenance. Knowledge about the common situations that result in accidents is critical in reducing the types of crashes that are due to preventable errors. Through analysis, problem solving, and, especially, education we can collectively work towards making cycling safer.

With respect to direct health consequences as a result of a fall, a discussion about all of the potential injuries is not possible in this column. However, a brief description of two of the most common injuries is warranted. Road rash and muscular strains invariably result when one falls off of a bicycle. NOTE: For the injured athlete, specific details regarding appropriate medical care for bicycle accidents and other falls can only come from a visit to a qualified medical professional. The following descriptions about road rash and muscular soreness assume that the athlete has already sought and been given appropriate medical advice. They are included only for general descriptive purposes

Road rash refers to the skin abrasions that result from frictional contact with the ground. Abrasions may result from direct contact of skin with the road, or may be transmitted indirectly through clothing. Clothing offers protection against road rash but only up to a point, depending upon the physics involved in the crash. Although the following description regarding wound care is brief, it covers the basics. The most important step in initial treatment of road rash is to thoroughly clean the wound. Irrigation with water, and vigorous scrubbing using soap/water and a washcloth is essential to remove dirt and other debris from the wound. Rubbing alcohol and hydrogen peroxide are not necessary since they confer no advantage over soap and water. (Note: lacerations, puncture, or other more complicated wounds require different treatment.) Next a “non-stick” dressing, such as Second-Skin or a similar product, is applied to protect the wound and to help absorb blood and drainage. Abrasions require daily care – dressing changes combined with further cleaning – (gently with soap and water). An antibiotic ointment may be used prior to redressing, but ointments should not be used for too long a period of time since they may delay healing. A natural part of the healing process is scab formation. When the wound begins to form a “healthy” scab, dressings may be discontinued and the wound left to “air out”. This usually occurs several days after the initial injury, depending on size and severity of the abrasion. Further along in the healing process, the scab will progressively fall off to reveal new, pink epidermis. This skin has not yet fully healed and one must be careful about sunlight, which is damaging and may cause permanent pigment changes. Thus, clothing and/or sun-block should be used to protect against solar radiation. Additionally, some authorities recommend using a moisturizer (e.g. aloe)

Another common occurrence after a fall is referred to as delayed-onset muscle soreness. This type of muscular injury usually manifests several hours, or the following morning, after a fall. Those of you who have experienced this know the feeling well. It is typified in the expression, “sore all over”. This type of muscular injury accounts for the pain and stiffness that seems to be everywhere and involve areas not immediately apparent right after the accident. It occurs as the result of a protective, reflexive (involuntary) muscular contraction. For example, if one falls and the left side of the body hits the ground the muscles on the right side of the neck will contract to prevent injury to the head and spine. The discomfort usually peaks at about 48 or 72 hours post-fall. Treatment is primarily symptomatic. Ibuprofen or acetaminophen may be used to help reduce pain. Additionally, many athletes find that light, easy exercise helps work-out some of the stiffness. Studies into this type of muscular soreness have documented that those who heal the fastest are the ones who follow the advice, “do what you feel comfortable doing”. In other words, aggressive physical therapy or at the other extreme, bed-rest, prolong the process. Thus, the injured athlete is encouraged to do usual activities as tolerated, based upon how they feel.
Some starting points for bicycle safety education and safety

1. ALWAYS wear a helmet. This is a “must” for everyone but especially for children, because of their increased risk for serious head injury.
2. http://www.bikeleague.org/
3. http://www.usacycling.org
4. http://www.bicyclinginfo.org
5. http://kidshealth.org/parent/firstaid_safe/outdoor/bike_safety.html
6. Do a search for bicycle safety at http://www.nlm.nih.gov, and http://www.mayoclinic.com
7. http://www.sharetheroadsafely.org/
COPYRIGHT©2005 Mark Jenkins
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