What Happens After A Crash At The Tour de France?
We hate to admit it, but Tour de France crashes are sometimes just as memorable as a sprint finish or the winning attack in the final kilometres on Alpe d’Huez. (Who here is also guilty of having searched “cycling crashes” on YouTube?) While we never want any cyclist (pro or not) to get hurt doing the thing we love most, it’s no surprise that crashes garner lots of attention in a don’t-want-to-look-but-can’t-look-away sense.
But what happens after a crash in the Tour de France is something we rarely get to see. After the bikes hit the pavement and the bottles go flying, the peloton pedals on, taking the TV cameras and motorbikes with it. Seldom do we know what happens to a crashed cyclist unless they’re in the yellow jersey or a serious race contender.
If you’re Lawson Craddock, who suffered a particularly gruesome crash in the 2018 Tour de France that resulted in a fractured scapula and a deep cut above his eye requiring stitches, you go for some hamburgers.
After a hard fall on stage one of @LeTour in which you sustain a broken scapula (ridge) and a handful of stitches in the right eyebrow, you stop for a burger. cc @lawsoncraddock pic.twitter.com/zZlFt707ij
— Matthew Beaudin (@matthewcbeaudin) July 7, 2018
To get a better inside look at what happens after a crash, we tapped the EF Education First Pro Cycling Team’s Head of Medicine, Kevin Sprouse, who was on the scene after Craddock’s infamous crash, and cyclist for EF Education First Pro Cycling, Nate Brown, who finished 43rd in the 2017 Tour de France, to answer all of your burning questions. As you’d expect, what happens after a crash is highly circumstantial, but here’s a rough breakdown of the events.
What Happens Immediately After a Crash?
As we often see on the coverage, riders and team members spend the very first moments following a crash assessing the damage. Is the rider okay? Is the bike okay? “The first thing is a scan for any catastrophic or immediately life-threatening injuries, and though such injuries are fortunately uncommon in pro cycling, they are not unheard of,” says Sprouse. “This consists primarily of a visual assessment, informed by many years in cycling, sports medicine, and emergency medicine.”
This visual assessment includes observing how the rider is positioned, if there are any obvious injuries, if the rider is conscious, and if conscious, if they’re talking and making sense. Usually by the time the team car arrives on the scene, the rider is already up and collecting himself, so Sprouse has to get an idea of what happened, and if there are any injuries to be concerned about including concussions.
“Of course, assessment of possible head injury is very high on the list,” says Sprouse. “Our riders are aware of this priority and are very good at participating in a quick roadside screen—answering questions about the current date, stage of the race, race situation, etc. —while we simultaneously untangle bikes and get them back on the road if appropriate. A quick examination of the helmet is a part of this evaluation as well.”
Normally the team car is the first one to a crashed rider at the Tour de France, but if it’s a huge crash and multiple teammates go down, then neutral support might help out. For the most part, though, the doctor rides in the team car and assists on the scene. Some stages require the doctor to watch from the bus, since the roads can be narrow and the race is often split into multiple groups. If this is the case, the rider is brought to the bus or is met at the hospital if needed.
“ There is also an ambulance that follows the race, and if the injury is serious enough and you can’t continue, you will go to the hospital in the ambulance,” adds Brown.
If the rider isn’t seriously injured, he looks for his bike, gathers himself, and tries to continue riding. If the bike isn’t in working order, he’ll wait for the mechanic or support car to arrive to swap a wheel or an entire bike. If the team leader crashes, though, it’s the domestique’s job to support the leader.
“If he is good to continue, then it just depends when the crash happened. If it’s in a very critical moment of the race, and he needs to get going as fast as possible, you give him whatever he needs,” says Brown. “If his bike is broken, you give him your bike, if he needs a new wheel, you give him your wheel. If it’s at a relaxed moment of the race, you just wait for the team car to bring him whatever he needs, and then you help pace him back to the group.”
How Do Riders Decide to Abandon or Not?
There’s no one-size-fits-all decision when it comes to whether a crashed rider should continue or abandon the race – the decision to abandon depends on the situation. It’s usually a group discussion and decision between the team doctor, the directeur sportif, and the rider himself. Sometimes it’s acceptable to push through the pain and continue riding, like in Craddock’s case, but the rider’s health and safety come first.
“Ultimately, a rider can abandon any time they feel it is necessary. If the doctor feels that it is medically necessary, then it is our decision, even if the rider and DS [directeur sportif] want him to continue,” says Sprouse. “In such situations, I can honestly say that I have never had a DS or team administrator give me any pushback. That is a testament to this team!”
Brown reiterates Sprouse’s statements. “When it comes to concussions, normally it’s the doctor who makes the call for you to stop. Sometimes you are caught up in the moment, and you don’t want to stop. If the doctor sees signs you hit your head or has concerns about a serious internal injury, he won’t let you continue. With most other injuries, it’s up to the rider – I’ve known some riders continue on with broken bones.”
Do Teams Monitor an Injured Rider?
While all teams have different processes, Sprouse was the team doctor present during last year’s Tour when Craddock crashed. After being examined and undergoing a series of x-rays and ultrasounds, the team decided he could carry on since he suffered no head injury. We’ve all seen the iconic images of the blood dripping down his face after the stage (an obvious cause for concern), but after being monitored for 24 hours, he displayed no concussion symptoms.
“From a musculoskeletal standpoint, primarily with regard to his shoulder, he worked with our entire medical team at the Tour on a daily basis,” says Sprouse. “Our team chiropractor, Matt Rabin, was able to do some fantastic physio work with Lawson on a daily basis. The soigneurs continued their daily massage, but with added focus on the muscles around the shoulder that would fatigue after each stage. We all kept a close eye on his range of motion and functional limits of the shoulder, as that dictated his ability to handle the bike safely. This was a daily assessment pre- and post-ride.”
Though medically unnecessary, the team continued to monitor Craddock’s fractured collarbone by ultrasound. “While I knew the fracture was stable and nothing was going to change its appearance, I think Lawson liked having visible confirmation of this. It was understandably reassuring. And with the imaging technology so readily accessible, there was no reason not to look.”
When Is It a Race-Ending Injury?
With Craddock completing the rest of the Tour in visible pain, there’s a bit of a blurred line between what warrants a rider to abandon the race, and when it’s acceptable to continue. Both Sprouse and Brown are in agreement: Concussions are grounds for mission halt.
“‘Always’ is a difficult parameter,” says Sprouse. “We always pull riders who have a concussion or other serious injury, but there’s generally no argument or discussion in these cases.”
“Head injures for sure,” confirms Brown. “Any other injury, it’s up to the rider and doctor to see if the pain is manageable to continue – normally any sort of broken bone, you won’t continue.”
How Do You Manage Riders Who Want to Continue, But Shouldn’t?
It’s difficult, since the decision makers are not only impacting one rider’s personal goals, but also the goals of the entire team. Every rider’s contribution is critical in a 21-stage race like the Tour, but keeping the rider’s career in context is key.
“It’s hard,” says Brown. “You never want to drop out of a race. You have to remember that dropping out of a race might be the best for you in the long run.”
The doctor’s recommendation arguably holds the most weight when deciding to pull a rider. The doctor travels with the team, stays with the team and gets to know each rider over the course of a season (and sometimes multiple seasons depending on the rider), so it’s a conversation between two colleagues, rather than an outside opinion.
“Having built a relationship with the athletes, this conversation is much easier,” says Sprouse. “I think most riders truly understand and appreciate that our ultimate priority is their health, and not just their health today or this week! We try to impress upon them that the goal is to ensure that, when they are 40, 50, 60 years old, they don’t regret a health decision they made while racing. We want them to have long, healthy, active lives after cycling as well. Knowing this, they seem to respect our input in situations where they might rather keep racing, but we tell them they shouldn’t.”