Like many of you, as an avid hater of public transport (especially when it can't cope with a bit of snow and ice) and someone who definitely gets cabin-fever when I can't ride my bike, I have been guilty of taking the bike out on the roads when common-sense really should have prevailed. So, with ice and snow still lying on some of the roads outside, I thought it quite topical to write about a traumatic injury that cyclists ofter sustain - a broken collarbone. Whilst overuse injuries far outweigh traumatic injuries in non-competitive cyclists, hiting the ground at this time of year is not entirely uncommon.
But firstly, in an attempt to keep us safe, here are a few simple tips for riding on icy roads courtesy of road.cc:
- Use a slightly wider tyre and lower your tyre pressure.
- If you have a fixie, use it. You can slow a fixie down on ice without using the brakes whilst maintaining power and traction to the back wheel.
- Keep to the main roads - they will be much clearer of ice than quiet back roads.
- Stay away from the kerb.
- Give yourself longer to stop, gently using the back (not front) brake.
- Choose your line carefully.
- Watch out for roads with cambers.
- Keep your pedalling smooth. Sometimes a harder gear than normal will help you to maintain traction.
Should this fail to keep you upright, an unfortunate consequence may be that you land directly on your shoulder or on an outstretched hand and fracture your clavicle (collarbone.) Fractured clavicles are the most common type of fracture suffered by cyclists, with 70-80% breaking the narrow middle-third of the bone, which lacks the muscular and ligamentous attachments of the ends. An X-ray will diagnose your fracture, so the first stop should be your local A&E department!
If your clavicle proves to be intact, other sources of shoulder pain from this type of fall can be acromioclavicular joint (ACJ) sprains, rotator cuff tears or shoulder disloactions/subluxations just to name a few. Your Sports Physiotherapist will be able to help you in these cases.
Conservative Management and Physiotherapy
For minimally displaced fractures, the injury is usually managed by immobilisation in a sling for 4-6 weeks. In the past, a figure-8 bandage has also been used although it is less common these days. During this time, it is very important to begin an early supervised exercise program to prevent secondary complications such as stiffness ("frozen shoulder") poor postures and compensatory movement patterns. This program will be gradually progressed to improve strength and flexibility of the shoulder as the injury heals.
When can I get back on my bike?
Riding a bike places significant loads upon the arms and shoulders and your bone needs to have healed sufficiently for it to take this load i.e. >4-6 weeks. A turbo trainer is the most sensible place to start and riding should be relatively pain free with no increase in symptoms afterwards. You may need to alter your riding position (raising the front end) and it may also be a good opportunity to work on getting those core muscles to do some more work to offload your arms! Returning to the road carries far more risk as another fall could re-break the clavicle before it has fully healed. Your orthopedic surgeon will advise you on this, but it will not be less than 12 weeks, usually more.
Do I Need An Operation?
There are advantages and disadvantages to having your fracture managed surgically. We've all seen Tour De France riders breaking their collarbones and being back on their bikes in a matter of weeks. However, they ARE professional cyclists! An early consultation with a shoulder specialist should determine whether it is appropriate for you. They will consider factors such as your age, activity level, personal preference, fracture type, damage to blood vessels/nerves and other injuries sustained.
Early fixation of clavicle fractures has some advantages, such as:
- Earlier return to work and activities.
- Less pain (if the fracture is stabilised)
- Better chance of healing (as the bone ends are lined up together.)
- Less chance of deformity and mal-union.
However, there are potential complications, which include:
- Risk of infection.
- Risk of numb patch below scar.
- Possible scar problems (which could be cosmetically unattractive)
- Failure of fixation.
One final point on bone healing - Both NSAIDs (e.g. ibuprofen, naproxen etc) and smoking have been shown to retard bone healing, so it may be an idea to lay off the anti-inflammatories (paracetamol can be used as a painkiller) and cigarettes until you are healed!
By Nicole Oh - Pearson Physiotherapy