Beyond the Crash – Health, safety and recovery time for athletes who have experienced significant trauma

Pro cycling has an unfortunate association with crashes. High speeds, a big peloton, and very driven athletes taking every chance to win does result in some riders exceeding the limits of grip and space available, resulting in crashes. There, of course, have also been concerns about course design and safety, with riders and rider unions calling out what they deem to be unsafe racing conditions that have led to crashes. It’s not just in the races as well, but out in training, sometimes crashes happen and can have serious ramifications.

But how do riders recover from these, sometimes very serious, crashes? We’ve seen incredible cases of riders winning races just days after fracturing an elbow, completing a Grand Tour with a fractured back, and riders returning from crashes most medical professionals would deem as career-ending, in less than a year.

The damage that these crashes can do

Injuries in sports are certainly not uncommon. We see in football various ligament injuries or muscle strains that can take athletes out for weeks, while tennis star Andy Murray was plagued by injuries and hip problems in the latter stages of his career. High-impact sports like rugby have become almost synonymous with concussion incidences, while track and field athletes are commonly plagued with tendon, ligament, and muscle issues. However, there are not many sports, outside of those deemed on the more extreme end of the spectrum, where there is quite such a common occurrence of broken bones as road cycling. More than 150 riders jam-packed on roads, sometimes one lane wide, racing at average speeds of 40-45kph and exceeding more than 80kph on descents, all jostling and fighting for position to continually move up.

The only protection they are afforded, some wafer-thin Lycra that covers half their body and a helmet on top of their head. An inevitable result of this is that almost every single race features a crash, and in those crashes, it is not uncommon to see a high incidence of broken bones along with bruises, cuts, road rash, and concussions. In the most serious of cases, riders can suffer truly horrific and traumatic injuries, known as Polytraumas, which not only put their careers at risk, but also their lives.

Recently, a new scientific research paper looking into polytrauma in professional cycling was published, assessing the impacts of these significant injuries on riders both in the short and long term. Though the cyclist in question is not specifically named, the identifying details confirm that the rider in the study is Egan Bernal (Ineos Grenadiers), who suffered a horrific crash while out training in 2022 that very nearly put an end to his already stellar, but still very much young, career.

In this paper, the full extent of Bernal’s injuries are looked into in quite incredible detail. An Injury Severity Score (ISS) is also given, with a total score of 41. To put that into context, ISS scores are determined from 1 (minor injury) up to 6 (incompatible with life). This is then applied to nine regions of the body: “head, face, neck, thorax, spine, abdomen/pelvis, upper extremities, lower extremities, and unspecified.” This means the maximum score that can be given is 54, so a score of 41 averages 4.5 for each region, putting this rider mostly in the category of Severe to Critical injuries across the body.

As for the term ‘polytrauma’, this has been defined in the paper as “injuries suffered from a high-energy trauma which affects two or more organ systems accompanied by an ISS of more than 16 points, successfully predicting a mortality rate of >10 %.”

This puts into haunting perspective just how terrible these injuries can be. Just a few of the injuries Bernal sustained included a fully displaced patella fracture, a clean break of the femur, eleven fractured ribs, along with broken vertebrae and spinal disc herniations.

This is one of the worst-case scenarios when a crash occurs in cycling. Most commonly experienced are broken collarbones due to putting the arms out to break a fall, with contusions, road rash, and concussions also being not uncommon in cycling injuries. What is most astounding in the case of this polytrauma study and Bernal is that after just ten weeks of recovery, he was able to cycle again. Then, seven months after suffering this list of extensive and highly severe injuries that were genuinely life-threatening, he returned to competition.

How do riders recover from these injuries?

So just how do cyclists recover so quickly from such horrendous crashes and injuries? To get some more insight into this, we spoke with Jan-Niklas Droste, then Director of Health and Performance at Red Bull-BORA-Hansgrohe. He explained that the process starts from the moment the crash occurs, where, along with the first aid provided by the race organisation, the team also rely on their own medical team with extensive traumatological training and experience for on-site care.

“It is important for us that we can provide the best possible support for the athlete and the necessary care at a very early stage with our internal expertise and network.”

This requires not just internal staff within the team, but also relying on a network of expertise to determine, in each specific case, what is required for the individual and the injuries that they have encountered. It may be covered by the on-site team provided by the race for lesser injuries, or team staff may be required for further checks and care. In cases where surgery is required then a balance is determined between how rapid a response is required, or if further travel for more specialist treatment that will result in a faster and safer Return to Sport (RTS).

It's well known that after these injuries occur, there is then a far longer process of recovery from them. Initially, while the bone is healing, it is common that riders feel more lacking in energy. This is due to an increased metabolic demand as the healing process begins. There is an inflammatory response, an increase in cellular activity, greater nutrient demands, and the formation of new blood vessels in the afflicted area to increase blood flow and healing. All of these increase energy demands based on the severity of the injury and can increase levels of fatigue as well as energy requirements. This is why it then becomes essential for riders to work with team dieticians to best determine a diet that will enable adequate recovery while meeting the new demands of their healing body.

Beyond that, there is a process of strength and conditioning (S&C) to make sure that the body can repair itself in the best way possible. The issue faced with broken bones, and especially immobilisation of any sort, is that it is often then followed by muscle atrophy and imbalances, especially with unilateral injuries. For example, breaking one leg can result in greater muscle loss in that leg while the other still takes on forces and becomes relatively stronger. A proper rehabilitation programme is then required to address these imbalances and also strengthen the afflicted part of the body. In fact, Droste did confirm that off-bike work is used to speed up the rehabilitation process after an acute injury.

Another strong benefit linked with S&C work is injury prevention. Although this is sometimes a difficult one for teams and athletes to buy into, since there are old-school and evidence-based approaches that can’t necessarily determine if it prevents an injury that might never occur. Did it not occur due to S&C, or did it just not occur? In a sport where time is an investment, investing this time in something that does not actively show results for injury prevention can be a hard sell.

“Prevention is such a big topic and is definitely very important. What makes it so difficult to organise prevention efficiently? Because good prevention means that we minimise the risk of something negative happening. So if we do good prevention, nothing happens. That is psychologically difficult. Precisely because prevention usually means doing ‘more’ or doing things ’differently’. The structure of many sports is often very experience-based and tradition-driven,” added Droste.

He followed this up with a fairly comprehensive support of S&C, though, “Is off-bike work important: yes.”

Can different recovery methods rush the recovery rather than allow full healing?

Sometimes, however, it can almost seem like these recoveries happen far quicker than would be expected. Uno-X Mobility's Jonas Abrahamsen, for example, was nearly a non-starter for the 2025 Tour de France due to breaking his collarbone just three weeks before the Grand Tour. In this situation, he had the fracture pinned or plated – it was only confirmed that he had surgery – to keep the bone structure in place and allow it to heal without the need for a sling. After seeing an expert in Manchester, he was deemed to be making an exceptionally fast recovery. Some of this could even be to do with his confirmed adequate fueling, as insufficient energy and nutritional intake can slow the repair of broken bones. It also worked out brilliantly for the team, with Abrahamsen delivering a first Grand Tour stage win on stage 11, likely bringing in greater return on investment for current sponsors as well as great bargaining power for additional sponsorship down the line.

However, there are risks to this rapid recovery approach that have to be balanced and weighed up. Droste again provided very useful insight in regards to this, as their motto for recovery is: “as quickly as possible without taking uncontrolled risks.”

That’s where things become a bit more difficult to assess. The best way to heal a broken bone is to have it placed in the right position in the event of a displaced fracture and allow it to heal in its own time. This process normally results in a stronger area of the bone due to an increased deposit of bone mass in the fracture site. However, it takes time, more often than not at least six weeks, which in the WorldTour is a lengthy period of time to not be able to train to your best potential or compete. There can be pressures for both riders and teams to get a rider back in action as quickly as possible. A very saturated race calendar with team rosters stretched thin can provide pressure on teams to have riders ready to race, while contract insecurities and a drive to win can also pile pressure onto the riders.

Surgery for broken bones has been used within cycling very successfully, but there are risks. In the event of a second crash and damage to the fracture site, the potential impact to the area will be significantly greater if the bone is still pinned, plated, and healing. This itself then has potential complications for long-term recovery. Does the risk outweigh the reward, or is it worthwhile?

Is there pressure, internally or externally, that riders race on with broken bones?

This brings us on to another interesting discussion, about who makes the decision of what processes and steps to take, and whether there is any pressure on the rider to make a rapid return to racing.

A good example of the rapid approach paying off is Annemiek van Vleuten, who in 2022 at the World Championships crashed in the team time trial and fractured her elbow. She then lined up for the road race a few days later, elbow heavily bandaged up, and went on to win the title with a searing attack in the last kilometre. It was a heroic victory and a true feat of grit and determination, but only because it worked out. Had she crashed and caused further damage, there would likely have been an onslaught of online discussion around the decision.

To get an opinion on the matter, I asked Droste about who makes the call on a decision to race with an injury like this and if there is any pressure on the rider from the team or vice versa to race? He was very open in stating that in these situations, he has never experienced it being one-sided and that at the team, they put a heavy emphasis on gathering as much information as possible and then considering that to make the best decision possible. A lot of elements need to be considered, such as how tolerable the pain is, whether it will have long-term negative effects, and does continuing to ride create risks for not just the rider, but other riders as well.

“It is crucial that all parties involved have the best possible information available to make a good decision that is right for this case.”

What long-term effects can these crashes have?

Going back to the rider in question and the specific injuries that they suffered raises the question about what long-term effects these injuries can have. Bernal has been fortunate to return to a competitive level in the WorldTour, although arguably not the same level that he once was. Chloe Dygert (Canyon–SRAM zondacrypto) is another example of a rider back winning at the highest level in the Women's WorldTour following her crash that saw her sever her quadriceps muscle during the 2020 UCI Road World Championships time trial in Imola, Italy. However, she is still hampered by this injury, notably needing to withdraw from the 2025 Tour de France Femmes due to the pain she was experiencing.

Meanwhile, Chris Froome (Israel-Premier Tech) has not come close to the form of his glory days, which won him four Tour de France titles, since his 2019 crash. In recent weeks, the 40-year-old was involved in another serious crash whilst out training, suffering broken bones in his spine and ribs as well as a life-threatening rupture to the lining around his heart.

The paper on polytrauma paints a fairly bleak portrayal of return to competition and form after severe injuries. Looking at 207 athletic individuals, although they were deemed ‘athletic’ by achieving a Tegner Activity Score of more than five, which is still far lower than the score of 10 deemed for elite-level competitors, it was found that after suffering traumatic injuries, most did not return to sports. In this case, the average ISS score was 22.8 compared to Bernal’s 41, and out of those 207 individuals, 59.1% did not return to sport at all, while 53% felt they did not return to pre-trauma levels of performance.

However, looking at the spinal injuries that Bernal suffered, at present, there is no documented case of an athlete ever making a competitive return to sport after injuries of that severity level.

What is the mental toll from these crashes?

Another element to these crashes and the recovery from them is the mental toll and effect that they have on the athletes. Ellen van Dijk retired in 2025 with immediate effect, citing fears of crashing and sustaining further injuries as a factor in her decision. German 21-year-old rider Louis Kitzki also made this decision to retire, after the deaths of Samuele Privitera and André Drege in races. For riders who suffer these horror crashes themselves, it can be a long road back to recovery and being able to put themselves in a situation where they may be susceptible to further crashes.

A study by Peter Hudson in 2021 looked into the impacts of crashes on cyclists, both physically and mentally. The key findings actually suggested that the greatest barrier for these cyclists when it came to a return to competition was a psychological one, with anxiety, sense of vulnerability, and a fear of crashing again as the main concerns, rather than the physical injury itself preventing a return to performance. A fear of cornering too fast, what other cyclists might do in the bunch, unknown road conditions and hazards, and not wanting to experience the pain of crashing and the labour of the rehabilitation process were all considerations when it came to why these psychological boundaries existed. It was determined that the best approach for these riders would be to seek psychotherapy.

This approach is also echoed by Droste: “I am a great advocate of providing athletes with psychological support in the event of injury,” although it depends on a case-by-case basis, as is much of the recovery process from crashes.

A good example of how this mental aspect of crashing can impact riders is Thibaut Pinot. After his breakthrough at the 2012 Tour de France, much was expected of Pinot, but one area where he lacked performance was his cornering. He was visibly cautious around corners due to a worry of crashing, and even went through the process of getting advice and instruction from racing drivers on how to improve his cornering. At the 2025 Tour de France Femmes, Sarah Gigante also showed that descending at speeds and cornering were not among her strengths, despite her exceptional climbing prowess.

This is mirrored by demon descenders such as Tom Pidcock (Q36.5 Pro Cycling), Matej Mohoric (Bahrain-Victorious) and others who appear able to descend far quicker than other WorldTour riders while using the same equipment, having the same grip, but able to push themselves closer to that limit with less fear of what might happen if they cross it.

Do riders have any contract security around crashes?

This is an interesting one, as the CPA (Cyclistes Professionnels Associés), who work to safeguard professional cyclists, have a document which details certain safeguarding measures for cyclists in the event of a crash. The minimum requirement from teams that employ athletes as riders for the team is to offer 3 months of full pay, followed by 3 months of half pay, as long as it does not dip below the minimum salary. This minimum wage for employed riders is €44,150/year and €35,721 for neo-pros – €38,000 for a Women's WorldTour pro and €31,768 for the equivalent neo-preo – but the injury pay for different riders at different teams will vary based on the contract. This is a minimum requirement to protect the riders.

But there is an important consideration here, and that is the term ‘employed’. The reality is that quite a lot of professional riders are actually self-employed and contracted by the team. This comes with a higher minimum salary of €72,404 and €58,582 for neo-pros in the men's top-tier, with self-contracted female riders earning €62,320 and €52,000 respectively. The reason for that higher salary, however, is due to riders needing to then cover their own salary if they can’t ride, and also needing to take out personal insurance in the event of an injury. In a sport such as cycling, where crashes and broken bones are not uncommon, this insurance will not be cheap.

However, if a rider is coming to the end of their contract, there appears to be no securities in place for these riders save for their insurance, either from the team or personal. A team is under no obligation to offer a rider a contract extension if they are injured during the final few months of their contract, but equally, there are no clauses under which a team can terminate a contract based on a rider's injury. It would require an amicable agreement between both parties. Additionally, insurance for the rider provided by the team is required to cover a minimum of €100,000/year of medical fees, along with a minimum of 12% salary for pension, and a €250,000 payout in the event of an injury that causes permanent disability or death.

Where does this leave us?

In a sport where such traumatic injuries occur, to the extent that they would be medically classed as life-threatening, it is truly incredible to see recoveries where riders can return to such a competitive level, over the span of comparatively short spaces of time. It’s a true testament to the healthcare professionals and medical expertise at the disposal of WorldTour cycling teams.

However, it does beg the question from a longer-term perspective, as well as a mental health one, of how these rapid returns impact a rider. Protections are in place for riders who are within the span of their contract, but for those nearing the end of their term, there are worries to be had. Add to that an increasing race calendar, relegation battle for points stretching teams thin, and a continual search for sponsors mainly reliant on race results, and there are pressures placed upon riders externally and internally to return to sport possibly quicker than would be medically recommended.

Teams take a rider well-being approach first, but there is a distinct lack of long-term studies looking at the effects of these rapid returns to sport after injury. Certainly, the mental component of the risk of these crashes has been a contributor to the retirement of several riders just this season.