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Injury Prevention Is the Sole Responsibility of Each Cyclist, Says Traumatologist

When he hits the track of Masiv, a Czech stage race, he wears a helmet not just because of the strict rules. An orthopaedist and traumatologist at the Bulovka Hospital in Prague, Dr Pavel Cinegr has seen hundreds of injured cyclists. Especially head injuries occur very often and are extremely dangerous, as they may result in severe and permanent damage. What risks do we take once we get in the saddle? Let the doctor have his say.

“Cycling is my favourite sport, so I don’t want to moralize and discourage anyone from biking. Even I myself break the rules of safe cycling sometimes. Nevertheless, I must mention the risks involved in this beautiful sport.

“Every sport has its specific injuries. Because of the high speed and the risk of colliding with a solid object, cycling ranks among the most dangerous sports, and the spectrum of potential injuries is quite wide-ranging. Luckily, the majority of cases is minor injuries, such as clavicle fracture, fracture in the shoulder, the wrist area, the ribs, and vertebral compression fracture. The higher the speed, the bigger the risk of sustaining a severe injury. However, even at zero speed, a fall on the side can cause serious fractures in the hip joint area.”

Pavel Cinegr with his friend Gaspi at Masiv.

Since 2002, Dr Cinegr’s office at one of Prague’s clinics has seen a triple growth in the number of injuries sustained during leisure activities. The majority of cases consists of cyclists, inline skaters and pedestrians injured by a cyclist or an inline skater.

“Other frequent kinds of cycling injuries are spinal and rib fractures. Luckily, spinal fracture mostly has the form of vertebral compression fracture, which means that the vertebrae get compressed without bursting and injuring the spinal cord. Nevertheless, cyclists with such injuries still have to wear a corset for three months and sometimes need to undergo a surgery. Even though it ranks among “minor” injuries, it’s no bed of roses.

“The most severe injuries are usually sustained during traffic collisions, which pose a high risk of life-threatening injuries of the head, the rib cage, the abdomen, or a combination of these, termed polytrauma. With regard to imminent threat to life and potential permanent damage, head injuries are the most dangerous. They can occur after a collision with a solid obstacle, such as a tree, a pole, or a car, but also after a seemingly harmless fall off the bike. I remember a case of a helmetless cyclist who hit his head against a rail at minimal speed, which resulted in brain haemorrhage and permanent disablement. A helmet is not a solution to everything, but it gives you a high chance of preventing certain kinds of injuries or at least reducing their consequences.

Road cyclists are the most endangered group.

“The most endangered group is road cyclists. With regard to the mechanism of the injury, head-on collisions at high speeds are obviously the most dangerous. Such patients often end up in specialized departments of traumatology. If they don’t die on the spot or shortly after their arrival at the hospital, the patients are often left in a persistent vegetative state. This severe brain damage makes them unable to move purposefully, speak, communicate and eat independently, which makes them dependent on life-long care at specialized intensive care units.

“Children are at risk when sustaining dull blows in the abdomen area, which can occur if they fall over the handlebars. It may seem that nothing serious happened because children tend not to complain and sometimes feel guilt, and as a result, are unwilling to admit that they are in pain. However, a hit in the abdomen with the handlebars can cause an unnoticed liver or spleen injury. Especially a ruptured spleen can result in extensive bleeding into the abdomen, and without medical attention the consequences may be fatal.

“Cyclists rarely realize that they can severely injure others. This may have not only moral but also serious financial and legal consequences. I know of patients who had to face both their own injuries and the criminal consequences of their mistakes. Suspended sentences for bodily harm and high financial compensations are not so rare.

I’m not a fan of system orders. Everybody is responsible for their own health. Cyclists with their helmets on protect their cranial vaults, which reduces the risk of skull fracture and direct brain injury when hitting a solid obstacle.

“What I see as a dangerous trend of the last few years is creating segments for comparing speed in Strava at places with high concentration of people, such as cycle paths. Apart from cyclists, inline skaters, families with children, joggers, and mothers with prams spend their weekends there. Cyclists trying to break records in their immediate proximity are a threat to both themselves and the people around them. Creators of the segments and Strava users should think again and restrict the potentially dangerous segments in Strava. I am sorry to say that I too tend to get carried away by the quest for records, but it is advisable to always think twice.

“Sometimes I witness or take part in discussions about the compulsory helmet law. I’m not a fan of system orders. Everybody is responsible for their own health. Cyclists with their helmets on protect their cranial vaults, which reduces the risk of skull fracture and direct brain injury when hitting a solid obstacle. On the other hand, concussion of the whole head and the related negative consequences occur, which leads some people to the heretical idea of helmet refusal. I grew up in a time when it was common to ride without a helmet, so it took me some time to get used to helmets. Anyway, as my job involves seeing the consequences of severe head injuries, wearing a helmet on the bike is a must for me.

“Another much discussed issue is drinking and riding. I oppose zero alcohol tolerance for cyclists. I can’t imagine going on a longer ride on a beautiful day without having a pint at a beer garden. However, I’ve seen a lot of unfortunate cases of people cycling home from a pub to the neighbouring village without lights. So drink responsibly. To conclude, I would like to say that falls and injuries are part of cycling and are the adrenalin-endorphin essence that makes this sport so much fun. Nevertheless, it can help to think about potential consequences from time to time. I wish all your readers many happy kilometres without injuries.”