Can cyclists actually avoid injuries and illness? Experts examined three years of UAE Team Emirates-XRG data to find out

Tadej Pogačar’s Vuelta a España challenge came to a crashing halt when the Slovenian appeared to clip an object on the road that sent him reeling to his right into the peloton. He flew over his handlebars, landed heavily, and suffered fractures of his collarbone and spine, plus a concussion, ending his 2026 season early. The incident was unusual. Not only was the Slovenian on a wide, innocuous road, but it was the first time in 46 stage races that he’d abandoned. Pogacar’s previous race-ending crash came at Liège–Bastogne–Liège in 2023, when he fractured his wrist.

Less unusual is an unusual fact: “There are significantly more crashes on the right side than on the left. We can’t explain why. We’re looking into it.” The words of Raaghib Fredericks, UAE Team Emirates-XRG doctor, at this July’s Science & Cycling conference in Barcelona, where the South African presented his provisional findings on the injury and illness rates at the world’s leading cycling team for seasons 2019 to 2021. That crash bias was a footnote to a fascinating hour that revealed why staying injury- and illness-free is the most significant (albeit unsexy) performance boost a team and its riders can enjoy…

Paucity of research

“What do we currently know about injuries and illness at WorldTour level?” asks Fredericks. “Very little. There have been nominal studies in this area, including terrific research entitled ‘Beyond the finish line’ by a team led by Dr Thomas Fallon [of Queen’s University Belfast]. We set out to add to Fallon’s work.”

Fredericks’ research covered 30 male cyclists and analysed injury and illness data from the team’s cloud-based medical database, which was updated weekly. He could then compare those rates against training data from TrainingPeaks, the idea being that by pinning down injury and illness rates against factors like training loads, UAE Team Emirates-XRG could integrate protocols and best practice in search of, if not preventing and eliminating, at least ameliorating the impact of injuries and illness, which are significant. “Over the three seasons analysed, we lost 1,920 racing and training days to illness and injury,” he says. “That equates to around two lost days per rider each month.”

That absence varied from one day to months, as in the case of Diego Ulissi, who the team announced in mid-December 2020 would stop training and racing immediately after an irregular heartbeat led to a myocarditis diagnosis. The Italian was given the green light to resume training the following February, before racing again at mid-April’s GP Miguel Indurain. The 37-year-old now races for XDS Astana after making the switch for the 2025 season.

From a team’s perspective, a broken rider is like a broken wheel: useless. His or her impact is felt by the team, with schedules changed and, depending on the rider, chances of victory diminished. The competitive impact is felt commercially, framed against cycling’s fragile business model. Losing your strongest riders equals fewer wins equals less media exposure equals a struggle to attract sponsors… It’s a domino effect of doom.

Injury has a real and quantifiable impact on a rider’s transfer or contract value, too. The European Sport Management Quarterly, Journal of Sports Economics and Applied Economics have all featured research that shows injury can impact market valuation by 10 to 20%, with that rising to over 30% for a serious or recurrent injury. It’s worse news for older riders, as this can approach 50% for those on the wrong side of 28 years old. Naturally, this drop in market value limits an athlete’s salary and earning potential.

Egan Bernal is a clear example. In 2019, the Colombian won the Tour de France at the age of 22. In January 2022, he signed a lucrative five-year extension with Ineos reportedly worth €2.5 million to €3.0 million annually. Later that month, he suffered over 20 broken bones, a punctured lung and chest trauma after hitting a parked bus at 62km/hr. Since then, though he’s shown glimpses of his past form, he’s not been the same rider. His contract with Netcompany Ineos runs out at the end of this year and, at the time of writing, though there are rumours of either another extension or a move to Movistar, his future remains unclear. What is clear is that his likely next deal will see a salary drop to €2 million or less. Still healthy, but a sizeable percentage drop.

The injury amphitheatre

Time off the bike has clear consequences, so the aims are prevention (the ideal) and limitation (the reality). In Fredericks’ analysis, those 1,920 lost days were broken down into 140 incidences of injury and 134 incidences of illness.

When it comes to injury, 68% occurred during racing (compared to 32% in training). That’s significant and even more so when you account for annual workload. While training volume nestles between 18,000 and 23,000km, racing is around 8,500km. All in all, a rider is four times more likely to crash during a race than training.

“About 80% of these injuries are classified as acute [happen suddenly], of which 88% were a consequence of a crash,” Fredericks adds. That includes the infamous opening stage team time trial of the 2019 Vuelta a España when a paddling pool split, leaked water onto the road and took down six of their riders.

No one was seriously injured, and all riders started the next day. “That was a positive,” says Fredericks. “But I’m just glad I wasn’t the doctor at that race. He had to dress and undress the injured six riders for up to 12 days, adding an extra two-and-a-half hours to his day. Injury has significant implications for the staff as well as the riders.” (The doctor clearly did a fine job. This was the Grand Tour where Pogačar introduced himself to the world, finishing third and winning three stages in the process.)

Jayco AlUla doctor Luca Pollastre agrees that traumatic injuries are the most common. “While the frequency of crashes is relatively stable, the severity of those crashes is rising, which can mean weeks or even months before an athlete can return to competition,” he says. “We feel this is due to the aggressive nature of racing.”

This was brought home recently at the UCI World Championships in Montreal, Canada, when Liv AlUla Jayco rider Caroline Andersson, competing in the road race for Sweden, was involved in a major crash on a downhill stretch of the finishing circuit that took down 15 riders. The 25-year-old suffered four brain bleeds, two facial fractures, a broken collarbone and a broken pelvis. She is recovering and in a stable condition, but her 2026 season is over.

The most common trauma in Fredericks’ analysis was what he euphemistically termed ‘superficial’, like the road rash Pogačar endured at La Vuelta. Then came damage to bones – fractures or breaks – which shines a spotlight on bone health, a hot topic in professional cycling. Fredericks revealed that a significant number of riders [over 50%] had low bone mineral density, and quite a few of them are actually osteoporotic. Treatment includes bone-strengthening medication, calcium and vitamin D supplementation, and weight-bearing exercise.

“But that raises an important quandary,” says Fredericks. “We want to protect the riders from the risk of a fracture, but will they be interested in running, which we know helps? And will they be happier for more weights if it adds weight? It’s tricky.”

Damage to muscles, tendons and cartilage followed, while in Fallon’s research, hand and head injuries, particularly fractures and concussions, were common, with head injuries the most prevalent for female riders.

Overuse injuries are far less common, says Fredericks, with the majority related to patellar tendinopathy and Achilles tendinopathy, which are the result of the repetitive load of thousands of pedal strokes outpacing the tendons’ ability to recover and adapt.

Arguably, their rarity is credit to bike-fitters, like Phil Cavell, co-founder of Cyclefit in London, who have worked with many professional riders, including the Lidl-Trek team. Cavell’s also an author, whose most recent book, The Cycling Addiction, has just come out.

“To be fair, bike-fitters are only one reference point WorldTour riders are triangulating off,” says Cavell. “There’s also advice from teams and, surprise, surprise, WorldTour trends. Sometimes riders make decisions not wholly based on bike-fit and physio-led opinion.”

Cavell says there are hotspots when working with WorldTour riders, most notably when myriad factors change, like the bike, shoes, saddle and pedals, which can happen if a team’s sponsors change or a rider moves. “That’s when team camps become dawn to dusk affairs,” he says. “There may be adaptations at the foot, knee, hip, back… These adaptations may express over time, so our job is to predict what’s going to happen and put in place mediations.”

READ: Pedal performance: How Matteo Jorgenson re-learnt the art of pedalling

“I remember working with a very good rider, recently retired, who started a particular Grand Tour with a 17cm drop from saddle to bars,” he adds. “It worked okay for eight or nine days until it didn’t. We were brought in to revise his drop with a bit more insight and data – saddle pressure-mapping, motion-capture. He could see his issues reflected in our findings.”

Impact of illness

Fredericks’ research also focused on the impact of illness, explicitly seen in February 2020 when the UAE Tour was abandoned with two stages remaining due to an outbreak of Covid-19 at the UAE Team Emirates’ hotel in Abu Dhabi. The Emirati team and three other squads were quarantined for two weeks while health authorities carried out tests. Soon after, the team’s lead sprinter, Fernando Gaviria, confirmed that he had contracted coronavirus.

Of the 134 incidences of illness between 2019 and 2021, Fredericks says that 41% of these occurred during racing, with the remaining 59% either in training or between races. “In that time, we had 11 recorded cases of COVID, resulting in a loss of 137 race days [out of 659 lost to illness as a whole]. That’s significant and came down to the minimum 14-day isolation period, plus a graduated return to racing.”

Obviously other teams suffered. Take Simon Yates at Jayco AlUla, who tested positive after stage seven of the 2020 Giro d’Italia, held in October, and withdrew. The Australian outfit’s staff members also tested positive at both the Giro and late August’s Tour de France. The pandemic’s impact is still felt by Jayco, albeit positively.

“We have systems in place that stem from that experience,” says Pollastre. “These range from the use of face masks to strategic room allocation for athletes and the careful assignment of therapists to individual riders, among many other measures.”

“At the beginning of each season, we strongly recommend influenza vaccination for both staff and athletes,” he continues. “During the season, the team doctors hold a weekly call to review the health status of all riders. Relevant information is then shared with coaches and sports directors to support performance-related decisions. Understanding wearable technology data, training loads and providing continuous education are key components in minimising risk.”

Still, despite best practice, it’s hard to avoid SAD (Seasonal Afflicted Danger). “We always expect more issues at the start of the season due to the weather and changes in environment, moving from Australia to the Middle East and then into the European season,” adds Pollastre. “Towards the end of the year, there can also be a spike in illness due to the cumulative fatigue of the season. Although we haven’t analysed it over seasons, at our team I believe that a loss of approximately 10% of training and racing days per rider per year is a realistic average.”

Pollastre says that upper respiratory infections are the biggest cause of time off the bike, which matches both the data from Fallon and Fredericks’ research: “Of the 134 incidence of illness, 60 were respiratory related, like upper respiratory tract infections.” That’s around 45%. Fallon’s study found that racing Grand Tours is associated with a spike, potentially due to “immunosuppression” through the three-week strain. Load management is one method to reduce the chances of falling ill, but that’s clearly more controllable in training than at a race.

Dermatological issues, like saddle sores, were responsible for 18% of lost days, with gastrointestinal issues close behind – ideally not too close behind – at 17%. Interestingly, in Fallon’s research, female athletes report a higher ‘burden’ of gastrointestinal symptoms than the males, although the reasons are not fully understood. A 2017 study suggested that this disparity could be down to hormonal changes affecting gut motility and sensitivity.

Prevention is… tricky

Looking ahead, Fredericks is planning to pore over more recent data in search of solutions. What those solutions are is highlighted by Fallon’s research, which ranges from the use of protective clothing, such as Dyneema-enhanced jerseys to help reduce the number of abrasion-type injuries to neck-strengthening exercises, particularly for female riders, to minimise linear and rotational acceleration of the head during a crash.

“Cycling should also embrace technological advances in the use of head-impact accelerometers that feedback to the race doctor’s car to improve care and assessment,” the paper reads.

The problem is that the root causes of injuries and illnesses are multifactorial and somewhat speculative, albeit speculation stemming from education. Cavell gives the example of those traumatic injuries. “Does the trend of a more forward centre-of-mass with narrower bars mean less reaction time if something does happen? And what about shorter cranks? They allow a rider to maintain a deeper drop without blocking the hip, but does this have an effect?” As for the right-side crashing bias mentioned earlier, “That almost certainly has to be correlation, not causation, unless a parcours is especially right-corner-focused.”

Ultimately, for all the sophistication of modern professional cycling, staying healthy may still be its simplest performance advantage. Crashes remain an unavoidable hazard, while illness and overuse quietly erode seasons too. Fredericks’ research shows how much time is lost, but also where gains might come from: better data, smarter load management and preventative care. The marginal gain could be staying upright.