Which injuries occur most often in professional cycling and what are their effects on athletes?
For the first time in professional cycling at the UCI WorldTour level, a study on the topic of injuries and their nature, frequency, and effects has been published. Several doctors from BORA - hansgrohe played a leading role. In this interview, the author, Dr. Christopher Edler, explains the results of the study and its practical implications.
Hello Chriss. So tell me, how did you come up with the idea of initiating this type of study? What is the idea behind it?
Our daily work is all about looking after the riders’ health, so it’s also important to be able to understand which specific health problems are actually occurring. We can roughly divide them into two categories: internal problems (mainly infections) and orthopaedic-traumatological problems, which are mainly accidents. In most major sports, these incidents are quite well studied and well described in terms of injury and morbidity statistics, i.e. their epidemiology. In cycling, however, this has not been the case so far. Yet it is very important in order to understand injury patterns and, for instance, to be able to prepare accordingly as a doctor before the races. The quality of care depends largely on preparation.
So it's about finding out which accidents occur, how often they appear and what exactly happens – are there usually fractures or are there more abrasions?
First, one attempts to characterise the different types of accidents and injuries, right?
Exactly. It's about introducing a standard so that the data is systematically documented and comparable. Within cycling, but also with other international sports. In this way, it’s also possible to put cycling in context with other sports.
How did you go about it?
First of all, one must distinguish between an injury being caused by a fall or not, because knee problems, for example, can also have another functional cause. Muscle injuries can also occur without a fall. So, the first thing is to identify the different accident mechanisms. Then, subsequent to that, one must categorise the injuries that have occurred in each case, such as fractures, skin abrasions, bruising, etc. Thirdly, one looks at the location of the injury. So where is the injury - on the head, leg, arm, shoulder, etc.?
So the mechanism of the accident, diagnosis and localisation form the basis. Then, the severity of the injury is assessed, and what burden this injury places on the rider and the team, i.e. for how long does the injury lead to absences and how often does such an injury happen to an athlete overall.
To do this, one can look at the number of days that the rider is out of action. In the case of a fracture, it’s relatively easy to count the number of days the rider is in bed with a plaster. It’s more difficult with bruising, for example, which means that the rider cannot train properly for a few days, or training may be possible, but the rider is not yet fit for a competition. It’s not so easy to classify these periods, however, in our study we made a classification that captures these periods quite well. Taken all together, this provides a relatively good overview of what happens in a team with respect to injuries.
Were you surprised by the results?
In general, it has to be said that epidemiological data have fewer new findings than, for example, what’s found in basic research. However, it was surprising to see which injuries actually occur and how often they occur. When it comes to cycling, people usually think of fractures, and these are the predominantly described injury patterns. But deep abrasions, lacerations and bruising happen much more frequently, which are more difficult to grasp, yet still have a correspondingly high impact on the total injury load of a rider, in some cases even more so than a fracture. Days lost due to fractures are usually the highest, depending on the operation, but they occur less frequently than previously assumed.
So how often do injuries occur?
In comparison to other sports, cycling is fairly average. For example, there are fewer injuries in running sports, but slightly more in MTB sports. In team sports, the injury rate is generally higher, by comparison.
According to our results, on average, every 18th day of a rider's competition is an injury day, or an injury occurs with every 65 hours of competition. This means that during the Tour de France, there will be one to two injuries per rider, on average.
What conclusions can one draw from the investigation?
That we as a team must first of all ensure good wound care and treatment of bruising and haematomas, because this is where one can influence the time that a rider is out of action. People underestimate how many days of absence there are in total, and how much influence one can have on shortening this. From the team’s point of view, that's where the leverage lies. That is why physical therapies, such as ultrasound, laser or shock wave therapy, for instance, are very important. In the case of fractures, one can only have a very limited influence. However, fast and optimal trauma care should be standard in any case.
How would you assess the impacts of the study for professional cycling?
This is the first time that prospective data has been systematically collected in professional cycling, so it is something new that has never been done before in the sport. On the other hand, we have only published data from one season so far, which of course limits conclusions that can be drawn. However, we will definitely follow up and hope to motivate other teams to do the same. I think that we are in the process of introducing a type of standard in cycling and thereby advancing the sport. That's why we have already engaged in an exchange with the UCI. In other sports, teams receive access to the anonymised data of all other teams, for example, in order to be able to compare themselves. Something like that creates incentives to collect such statistics.
What would be the next step from your point of view?
I think that we need a similar standard for internal problems, i.e. typical illnesses. Because there, too, we may very well be underestimating some impacts and overestimating others. Overall, more teams should participate in such surveys and the UCI should be assisted in the collection of such data.
Thank you very much for the interview Chriss!
The study “Injuries in elite road cyclists during competition in one UCI WorldTour season: a prospective epidemiological study of incidence and injury burden" can be found online here: