(electronic music)
- Well, here we are in Chambery
the morning after the Roubaix stage
of the 2018 Tour de France
and we've been lucky enough to grab half an hour of time
with Dr. Kevin Sprouse,
who is the team doctor at Team EF Drapac.
Kevin, thank you very much for you time.
Could you tell me,
what are the five most common injuries you see in riders?
- I think number one is road rash,
and that, unfortunately, we saw yesterday
and is something that we're working on continuously now.
It's hard to rank them in terms of how common they are
because there's some subtleties there
but I think I'll run through the five
that I think I see most commonly.
So, road rash, clavicle fractures, wrist injuries,
concussions unfortunately, and then knee problems.
Those are usually chronic overuse things.
- And so let's start with road rash if that's okay.
So road rash, when I was a rider
we used to joke about it being trivial and superficial
and it, I mean, it literally is superficial
but it can be a really serious problem,
especially if it's a large area
and if it causes significant discomfort,
it can change riding styles.
And can you tell me, just roughly,
how you deal with a large area of road rash?
- Sure, so when treating road rash, this is kinda the,
this is the bag of tricks that I carry with me,
we use a porous surgical tape to hold it on.
Omnifix is the one I have with me, but we kinda grab
what's available in the pharmacies when we run out.
But this is a tape that I use.
Telfa dressings are just a nonstick gauze,
something you can just get at your local pharmacy.
You've probably seen it before, kind of a shiny coat to it
so it doesn't stick to the wound.
On top of that, we'll put just a triple antibiotic ointment.
In the US, we call this Neosporin,
this is a generic version, but you just put it on there
and that'll go directly on the wound.
And then occasionally we'll use
what you have probably seen on the riders,
this burn netting.
So this is something that my seven-year-old loves cycling
and he's gotten to where when he falls off
he insists that I put this on his knees and his elbows.
But you've probably seen this on riders in the Peloton,
just holding bandages on.
We'll often use it on the knee and the elbow,
those areas that are moving consistently
over the course of the four-to-six-hour stage,
otherwise this stuff will start to shift and migrate
as it gets sweaty, and you'll end up with the bandage off
and just being irritated.
So this is a good way just to put on top of all that
and hold it in place.
And all this is stuff that you can get from the pharmacy.
You don't need a special medical license or anything
to get it, it's pretty straightforward stuff.
- So clavicles, we do joke as cyclists
that you're not a real cyclist
until you've broken your collarbone, which is not true.
But it is a very-- (laughs)
- Still have mine.
- It is a very common cycling injury, though, isn't it?
- [Kevin] It is.
- [Interviewer] Can you first tell us a bit about why?
Is it something to do with the force transfer
when someone...
- Absolutely, it's how cyclists fall.
And so when then hands are on the bars
and they're going at a relatively high speed,
oftentimes what you'll see is,
sometimes they go straight over the bars
but more often than not,
there's a maneuver to try to avoid a crash,
and the wheel turns, and then they're going down sideways,
and the kind of innate tendency, the reflex,
is to throw your hand out, and that force is transmitted up,
and often the clavicle, being kind of an S-shaped bone,
has the weak spot in the chain and it snaps.
- Yeah, and you're about to show me
this incredible ultrasound device.
Talk me through this, so--
- Yeah, so it's great, at the Tour, we're very lucky
to have an X-ray machine at the end of every stage.
They don't do that at many races.
The Giro does it, but I think it's only those two races,
so a lot of times, if we're worried about a fracture,
then we're really left looking
for an emergency department, a hospital.
It's logistically demanding.
It can take a long time out of the rider's recovery
and everything they have to do in the evening.
So we've got the added benefit now of having these devices,
ultrasound device, which can take a look
at superficial bones like the clavicle very easily,
can take a look at the wrists, hand, foot.
So what do we wanna take a look at?
Wrist. - Scaphoid?
- Scaphoid, we'll kinda look at the distal radius
and down into the scaphoid here.
And so it's, this gel allows the sound waves,
which is what's coming out of the transducer here,
to kinda be transmitted to the skin,
down through the bone, or to the bone,
and give us a picture of the cortex there.
And you can see that it's nice and continuous
and I can kind of move back and forth across it.
And we go down, if you were to have a fracture
then we might see that right there
where that line is real continuous
there'd be a step-off, a quite noticeable one.
- [Interviewer] Right, Kevin, can you talk us through
wrist injuries and hand injuries, please?
- Sure, so we talked about clavicles and how the reason
why riders end up kinda twisted
and going down with the hand out
and the clavicle tends to take the brunt of that
but as you can imagine, the wrist and the hand are,
I mean, they're making impact with the ground.
And so you're at risk for a skin injury, of course,
but the bones of the wrist
and the small bones in the base of the hand,
kinda where the hand meets the wrist,
oftentimes are victims to these falls, as well.
The radius is the bone here on the side of the thumb,
the side of the hand that has the thumb,
and then the ulna is over here.
The scaphoid is a little bone
that sits right down in this divot.
- [Interviewer] Yeah.
- And that's one that is often injured, as well.
So when a rider goes down, a lot of times we're looking
at those bones, at the cartilage and tendons--
- Yeah. - That surround there,
and then the bones there in the base of the hand.
- [Interviewer] Yeah.
- But some of these are difficult to heal,
and so this is not something that someone would ride with.
They'd be out of a race.
But this little scaphoid bone,
because of the way the blood comes into it,
it actually comes, the blood supply goes down,
it passes the bone, and then comes backwards toward it,
so you can, when you fracture the bone,
you can actually cut off the blood supply,
which obviously makes it difficult if not impossible to heal
so sometimes these little fractures become surgical,
so you wanna catch them early.
- [Interviewer] So tell me about knees.
It's one of the few things I didn't have wrong with me
on a bike, so... (laughs)
- Perfect!
No, knees, obviously there's traumatic injuries to knee,
so you fall off the bike, you hit your knee,
that's a problem that comes up,
but honestly, what I see more often is
that the knee is the victim of chronic overuse injuries.
And what that means is that there's
maybe a muscular imbalance or a positioning issue.
Usually it's both.
The treatment of it is gonna depend on the cause.
And so, a lot of times, that means taking a step back
and looking at their movement,
looking at their strength patterns, looking at their fit.
Did they change their cleats?
Did they change their saddle height?
Oftentimes maybe they didn't do those things on purpose,
so they've been traveling
and they get back on their bike at home
and the seatpost has slid a little bit
and we have them measure it and it's like,
ah, it's down two centimeters, or a centimeter, or whatever.
And so, looking for kind of a root cause there
often involves going away from the knee
and looking at fit, hip strength, core strength,
and seeing what is stressing the knee
and what's causing it to hurt.
- Kevin, concussions, I remember this all too well.
It's very unpleasant.
Talk us through, one, diagnosis,
and then what you do with a rider with a concussion.
- So concussion is something that certainly affects cyclists
and is something that we see
throughout the course of the year,
and something that, over the last five to 10 years,
we've really learned as a medical community
that we probably need to take more seriously.
In my training, concussion diagnosis and management
was a very big piece of the educational puzzle
and something that we focused a lot on.
And I think you see in cycling that that's mirrored,
that we're starting to have these protocols
that are implemented, we're starting to recognize it
and just be aware of it a lot more.
It can be difficult because the diagnosis of concussion
is a subjective one, which means that there's no test
that tells us someone has a concussion.
You can't scan them, you can't do blood work,
and so then it's very much looking at their balance,
it's looking at their recall and their memory,
and it's looking at the symptoms that they relay to us.
So we're kind of at their mercy
in some regards with what they tell us.
- It's hard for me to imagine how, as a doctor, you can,
it must be so hard making that kind of diagnosis,
or trying to, at least the initial diagnosis,
under time pressure, because while it might sound, maybe,
to our viewers like better safe than sorry,
what about if you pull someone out on day three
of a Grand Tour and they don't have concussion?
Just because they might have hit their head,
you can't do that, it's not fair on the team or the rider.
- No.
- And so you have to give the benefit of the doubt
to keep riding to start with, I guess.
- I would err on the side of better safe than sorry.
- Yeah. - If I've got a concern--
- Yeah.
- If there's something that's just not right, done.
- Yeah.
- And if I end up pulling somebody without a concussion
when I shouldn't have, I'd rather make that decision.
Now it will eat at me. (laughs)
- Yeah.
- Like if we get back to the hotel
and they're perfectly fine, everything,
I'll be kicking myself but I would rather that
than put them back in and be kicking myself
for other reasons. - Yeah.
- The other tricky thing with concussion is symptoms
usually present over time. - Yeah.
- It's actually pretty uncommon in my experience
that a rider goes down, hits their head,
and is standing there with the bike
and immediately has concussion symptoms.
- Yeah.
Kevin, thank you so much, that's been fascinating.
And to recap for the viewers, so the most common injuries
that pro riders see are probably road rash,
broken collarbone, wrist injuries, concussion, and knee pain
and I think that's probably the same
for most recreational cyclists, too.
So I hope you found this interesting.
Kevin, thank you again,
and good luck for the rest of the Tour.
- Thank you.
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