Feature

Mon 19 Oct, 4:00 pm UTC

Health: How to deal with road rash

By Nik Cook, Cycling Plus

If you’ve come off your bike at speed, you’ve probably experienced road rash, that burn/skin abrasion that results from contact with the ground.

In most cases it’s not too painful straight after the fall, but get home and the suffering really starts. It’s painful because of the number of nerve ends that become exposed.

Clothing offers a degree of protection, but thin Lycra is little help. You can protect your hands, however, by always wearing gloves.

Treatment

The first step for treating road rash is to be properly prepared for it:

Shave: Cleaning debris out of wounds is an awful lot easier without hairs in the way. It’s one of the main reasons for cyclists shaving their legs.

Treatment kit: Keep a stock of the basic kit at home (see the list below). All of the items can be bought at a decent chemists or online suppliers.

If you get a dose of road rash, assess the severity of the wound and if it’s larger than your palm, consider a trip to an A&E or Minor Injuries Unit.

Dr Prentice Steffen is the physician for Team Garmin-Slipstream and he warns that road rash, although painful, should be low on a rider’s list of priorities.

“Don’t let road rash divert attention away from potentially more serious injuries such as head, spine or internal damage,” he says. “Skin comes last in the evaluation of an injured cyclist.”

If you’re treating yourself, the first step is the most important – clean the wound as thoroughly as possible. Do this by both ‘jetting’ the syringe/saline solution over the wound and using sterile wipes.

Once you’ve got rid of the visible muck, clean the wound generally using a mild antibacterial soap, a washcloth and lots of water. Then pat the wound dry.

Dr Steffen agrees: “In the vast majority of cases, it’s a myth that road rash needs to be scrubbed. Betadine and peroxide are too harsh; soap and water is sufficient. Gels and sprays do little.

"There are rare cases where debris becomes embedded in the wound and thus needs more attention; this should be done in an emergency department with pain medication, the proper equipment and experience.”

Dressing the wound

If using a healing hydrocolloid dressing, apply it and leave in place until healing has occurred. It’ll drop off in a week or so to reveal new pink skin. You do not need to remove the dressing or reclean the wound.

If you’re using more traditional dressings, apply a thin coating of antibiotic ointment once the wound is clean, followed by a non-adhesive gauze pad and then hold that in place with a combination of micropore tape and Surgifix tubular bandage. Then monitor the healing process, cleaning and re-dressing the wound daily.

Dr Steffen sums up: “There are three phases to road rash care. The first is to be bandaged 24/7. Phase two is covered during the day and open-to-the-air at night. Third is unbandaged 24/7, dried up and scabbed over.”

Keep an eye out for spreading redness, swelling, an increase in pain, pus or foul smelling drainage. All of these are signs of infection and if they’re present, you should consult a doctor immediately.

Once the scab has come off, new pink epidermis will be revealed. This skin has not yet fully healed and over-exposure to sunlight can cause permanent pigment change. Protect it with sun block or clothing and apply a moisturiser. Also bear in mind that you and your road rash are individual, and what works for you might not work for a mate. 

Treatment kit

  • Phials of saline solution
  • Syringe
  • Sterile wipes
  • Anti-bacterial soap
  • Antibiotic ointment (Neosporin)
  • Dressings (Hydrocolloid dressings such as Duoderm make the healing process much easier. A cheaper alternative are non-adhesive gauze pads, but you’ll have to clean and redress the wound daily)

Road rash isn’t pleasant, but you can limit your pain by being prepared: road rash isn’t pleasant, but you can limit your pain by being prepared

User Comments

There are 14 comments on this post

Showing 1 - 14 of 14 comments

  • Good information to get people started. It's really shocking how many cyclists don't know this stuff.

  • Useful article. Not living up to my nickname I found out all about this yesterday! I also found out why I have been using a crash hat for so long. You dont appreciate them until your head whacks against the tarmac with enough impact to crack a nut. It saved a trip to A&E at the very least. I have also started carrying a Boots 1 day first aid kit on longer rides.

  • Can I also suggest from recent experience that the stretchy cohesive bandage (the stuff which sticks to itself), not wrapped particularly tightly, can be a good way to keep a dressing in place and/or protected from the elements (such as the mud of a cross race)

  • Had a front wheel blow out at 45mph once leaving a huge amount of meat on the road.

    My mate behind went to find help and found a Surgeon, a GP and a Neuro Surgeon in the next 10 minutes. What a lad!

    Wasn't impressed with cars who passed by; slowing passing and oggling out of the window. Did anyone ask if I was ok with all my blood and guts hanging out? NO!

    BLOODY CAR DRIVERS!!!

    A small snap shot of the Great British public there.

    -Jerry!

    PS- Smashed my Helmet in two so I agree with "careful".

  • One more item - OLIVE OIL

    After you have scabbed over and it is not "coming off" by itself week or two and your pretty sure its healed.

    Put on some OLIVE OIL. It'll be off in a day or so.

    Use best judgement on when to put it on.

  • Very useful article - thanks. As a relative newbie, I'm not looking forward to the first time I need this info for real!

  • I carry sterile wipes and TCP spray plaster.. clean it with the wipe spray the plaster on, wait for it to dry and get back on the bike and off you go.

  • The FastAid+ range of hydrocolloid dressings (you can get them at Boots) are fantastic. They're made by Robinson Healthcare. Boots do a private label version, too.

  • Very good info. Although surprised with the comments about gels and sprays being of no use ? ...being a mtber through and through made it v hard to go down the hairless route ! but as if by magic ...smooth legs at the ready off i went on my usual epic roadie route unfortunately the chain snapped half way round ...again no helpful car drivers to assist ! but when I finally got home I was pleasantly surprised with the ease of cleaning tarmac out of the hairless wound ... So first and foremost if you're gonna do the roadie thing then get rid of those hairs !!!

  • In my experience don't use the spray on plaster or second skin type stuff!! I did .... big mistake. I had to scrape myself off the bathroom ceiling (just like someone setting fire to my leg!)

    ++ for hydrocolloid though.

    Best advice ... don't fall off ;-) Watch for slippery corners and look out for drain & man-hole covers, wet leaves and diesel spills. Best to slow it down around corners especially with colder weather on its way.

  • Another tip from when I worked in ED was to clean the wound with normal saline (salty water) ,but soapy water as described above is fine, and then apply 'fixomull' or 'hypofix' conformable adhesive tape directly to the wound. I know this sounds bizarre but fixomull is a conformable tape in a wide roll that is very breathable. The principle is to apply the tape and wipe off the exudate when it appears through the holes in the tape. Leave the tape on for a week, remove after soaking in olive oil as described above. Note that the advantage to this method is that the tape is water resistant (it doesn't come off easily) conformable and provides a skin like barrier. It is not as effective in healing as a hydrocolloid; but stays on. Hydroclloids are overkill for most superficial grazes like road rash; also expensive and not durable for large joints.

    I base this advice on practice in an ED department in Australia 2 years ago. I am a crit care nurse not a wound nurse so take this advice on it's merits. I definitely echo the advice above: for large areas or if it develops purulent exudate(smelly pus), progressive surrounding redness and concurrent fever go back to your doc.

  • +1 for TCP spray plaster, stings like a bar steward but keeps the wound clean and dry

  • (Rock) Climbers suffer from this regularly - but in climbing parlance it's called gritstone rash. Check out ClimbOn. Comes as a bar or a cream. Fantastic stuff - mildly antiseptic. I get really badly cracked fingers from winter riding. If I remember to use ClimbOn I don't, if I do it fixes it quickly. Works really well at healing grazes - feels like it heals faster, but can't prove that. Cream is best for big, sore patches. bar works best on smaller patches. (Cream also works really well on burns and nappy rash)

    If you google needlesports (based in Keswick) they stock it and last time I looked they offered free postage. In the Peak you can get it in Outside and Jo Royles in Buxton.

  • ...and at 18 Bikes in Hope

  • 1

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