Follow this cycling physical therapist's approach for a safe, effective, and efficient return following a cycling collar bone injury.
The ominous phrase frequently heard around recreational and semi-serious cycling subsets is, “It’s not if you’re going to crash, but when.” A 2016 study of 140 amateur and professional cyclists showed that 13.5 percent suffered a clavicle fracture, compared to 2-6 percent of the general population, making it the most common traumatic cycling injury. Consistent with the adage above, a direct relationship existed between cycling collar bone injury and time spent in the saddle. On average, these fractures were responsible for five months of recovery off the bike.
A 2023 study published in The Physician and Sports Medicine followed 54 male UCI World Tour riders during the 2019 season and assessed the extent and characteristics of accidents and injuries during competition. The researchers found that most affected the upper body, and the shoulder and collarbone accounted for 11.4 percent of the reported injuries. Cycling collar bone injury posed the highest injury burden due to the extended time loss from training and racing.
The statistics and old saying support the facts that cycling injuries are common, and the chances are good for a cycling collar bone injury. Put the odds in your favor by taking an educated approach to a safe, effective, and efficient return following a cycling collar bone injury.
Signs That You Have a Cycling Collar Bone Injury
During a cycling crash or fall, a rider’s natural reaction is to extend their arm to brace themselves. Unfortunately, a two-meter fall on a cyclist’s shoulder or arm is all it takes to produce sufficient force for a collarbone break.
The collarbone, or clavicle, lies between the sternum (middle of the ribcage) at the sternoclavicular joint and the shoulder blade (scapula) at the acromioclavicular joint. The collarbone is a significant skeletal component because it is the bone that connects the arm to the body.
Approximately 80 percent of cycling collarbone injuries involve the mid-shaft of the bone. The bone can crack cleanly into two parts or break into many pieces causing a comminuted fracture. A simple clavicle fracture will remain aligned or complicated by the overlap of the bone and displacement of the fragments (displaced fracture).
The unwitting cyclist will often hear a crack on impact with associated acute pain. As the cyclist attempts to get up and brush themselves off, they’ll notice their shoulder is sagging forward and down. There will often be a deformity, bump, or tenting of the skin in the area of the break.
Failed attempts to raise the arm can be excruciating, and the cyclist may note a grinding sensation. Bruising, swelling, and tenderness will develop soon after the trauma.
A physician will confirm the suspicion of a cycling collarbone injury by taking an X-ray. The image of the bones will pinpoint the location and severity of the damage and help guide the subsequent course of treatment.
In addition, the definitive diagnosis will rule out other potential injuries, like a shoulder separation or humerus (upper arm) fracture, and involvement of nearby structures, like the ribs, lungs, neck, shoulder blade, and in rare instances, the nerves and blood vessels traveling beneath the collarbone.
What To Do Immediately Following a Cycling Collar Bone Injury?
If you suspect a cycling collarbone injury following a traumatic accident, getting an x-ray as soon as possible is essential. However, it’s vital to protect the affected region and begin measures to reduce inflammation and swelling.
Use your rain cape or a friend’s jersey to form a makeshift sling to support your arm close to your body. Begin the process immediately by following the PRICE principle—an acronym for Protect, Rest, Ice, Compression, and Elevation.
Then it’s off to get the opinion of a certified health professional and that x-ray. Resists the temptation to get back on the bike. It’s not a wise idea, and you risk worsening the injury or turning a simple break into a displaced fracture.
Treatment Options For a Cycling Collar Bone Injury
Once your cycling collarbone injury is confirmed to be a fracture, there are two treatment choices: conservative care or surgical fixation. Each option has positives, negatives, and possible complications that make post-injury management an individual decision. You and your healthcare team will weigh the type and severity of the cycling collarbone injury against your goals and the likely outcome before choosing.
Conservative (Non-Surgical) Treatment
Conservative treatment involves immobilizing the injured arm in a sling for about six weeks to allow time for healing or union of the fractured area of the bone. Physicians generally indicate a conservative approach for a two-part non-or minimally displaced fracture with a single well-aligned break.
While conservative treatment eliminates the inherent risks of surgery, the success rate is lower, and there’s a longer recovery time and cosmetic concerns. A 2019 meta-analysis published in Medicine found that patients undergoing surgical treatment following cycling collarbone injury had better results in all outcomes except for the complication rate.
Surgical Treatment
Physicians suggest a surgical approach for more complex cycling collarbone injuries or when the patient is motivated to return to cycling as quickly as possible. Cyclists with fractures that cause shortening of the collarbone, that involve multiple fragments of bone (comminuted fractures), are overlapping significantly or rotated (severely displaced), or poking through the skin (compound fractures) are candidates for surgery.
Surgery offers faster bone healing, a lower incidence of persistent pain, and an effective and efficient return to sports and normal function. A desire or need to return to sports as fast as possible is why athletes may opt to have a surgical fixation.
The surgeon will make an incision in the fracture region, realign the ends of the fractured bone, and secure the site with a plate and screws. The procedure is an Open Reduction and Internal Fixation (ORIF).
Surgical treatment for cycling collarbone injuries has a lower non-union rate and a more normal appearance. Although the ends of the bone may unite with conservative care, for some patients, it may heal with deformity, shortening, persistent pain, and weakness, which may prevent the resumption of some activities or sports.
The initial collarbone stability is higher following surgery, allowing athletes to return to sport on an accelerated timeline and for cyclists to resume pedaling on a stationary trainer sooner.
However, all invasive procedures have risks, and cycling collarbone injury surgery is no different, but they’re typically rare and manageable. Infection and damage to surrounding structures are possible with all surgical procedures and can be emergencies. Notify your healthcare professional immediately.
In cases where the plate fails or the screws back out, causing pain with pressure to the area, a second surgery is required for the removal of the hardware. There’s a refracture rate of 1 to 5 percent after hardware removal. Fortunately, the modern type of locking plates used in surgery today means this is rare.
After surgery for a cycling collarbone injury, you will have a scar and a bump from the plate, which is visible under the skin. In contrast, with conservative care, there may be a “droopy” appearance of the shoulder and a “bumpy” clavicle bone.
Preventing a Cycling Collar Bone Injury
An ounce of prevention is worth a pound of cure. The best way to avoid the bumpy path of recovery following cycling collar bone injury is to avoid the bumpy pathway. Be mindful of where you’re riding and aware of the experience of the riders you’re with. Avoid riding in slippery conditions when washing out a wheel will cause a crash commonly implicated in cycling collarbone injury.
Proper Fall Technique
When faced with an impending crash, how you fall could make the difference between a nasty bruise and a break. It’s easier said than done, but it may become a reflex if you have it in your mind and practice the steps mentally.
It happens fast, but as the bike goes down, try to rotate your upper body to face the direction your bike is falling. Take the hand on that side off the bars, but resist the urge to extend it out to break your fall. Instead, tuck your arm close to your side and turn your shoulder, allowing the back of your upper body to take the brunt of the impact.
Counteract Cycling-Related Bone Loss
A recent study of master cyclists showed that compared with healthy men, matched for age and body weight, the master cyclists had lower bone mass density (BMD) at the hip and spine. Of the master cyclists, 67% had low BMD at either or both the hip and the spine, 52% were osteopenic, and 15% were osteoporotic.
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Endurance cycling offers many health and psychological benefits but can harm your skeletal system if not done correctly, leading to a cycling collarbone injury. Ensure you’re fueling appropriately and maintaining bone mass by participating in a weight-bearing resistance program like this.
When is it Safe to Ride After a Cycling Collar Bone Injury?
Now’s the time to be clear that every cycling collarbone injury is different and individualized. Each case is different, and the following recommendations shouldn’t replace the authoritative orders of your healthcare provider.
With that in mind, a recent survey showed that orthopedic surgeons most commonly recommended cyclists return to training 3-6 weeks after surgery and competition after 6-12 weeks. Cyclists are routinely permitted to resume low-intensity riding on an indoor trainer when tolerated while maintaining the surgical arm supported and immobilized in a sling. Weight-bearing on the affected arm by putting the hand on the handlebars is not advised.
Of the orthopedic surgeons surveyed, the most common determinant for advising their patients to return to road biking was the presence of a stable union or healing of the bones determined through an X-ray. A stable union frequently occurs sooner following surgery than in cases treated conservatively. Therefore, cyclists return to riding more quickly than patients treated conservatively without surgery.
Cycling Collar Bone Injury Rehabilitation Program
While there are many factors to consider before returning following a cycling collarbone injury, rehabilitation is critical once your healthcare professional clears you. The timetable is often slightly modified depending on the post-injury treatment-surgery or conservative.
Use the following protocol as a guide and defer to your physician or physical therapist’s orders. However, if given the opportunity, seek the expert care of a professional physical therapist or athletic trainer.
Basic Cycling Collarbone Injury Rehab Tips
- Keep your arm supported and immobilized in a sling for six weeks.
- Do not elevate your affected arm above 90 degrees for four weeks.
- Do not lift objects over five pounds for six weeks.
- Avoid repeated reaching away from your body for six weeks.
Phase One—The First Two Weeks
During the immediate acute healing phase, protecting the injured region is critical. Maintain the affected arm in the sling when you are up and moving around. Remove your arm from the sling for short periods several times a day to perform the following range of motion and gripping exercises.
Phase Two—Two to Six Weeks
Physicians permit most cycling collarbone injury patients to initiate shoulder range of motion and isometric strengthening during this phase. Perform the following exercises two to three times a day. Notify your healthcare provider of any unusual pain, grinding, or instability to feel.
Perform the following isometric exercises for three sets of ten repetitions, holding for 10 seconds.
Phase Three—After Six Weeks
Often called the transition phase, athletes will work towards a full range of motion and initiate higher-level strengthening movements. Begin with the following set of baseline resistance exercises and progress to your tolerance according to the recommendation of your physician or physical therapist.
Don’t neglect your rotator cuff and scapular stabilizing muscles. It’s not only the larger deltoid (shoulder) muscle that gets weak with immobility.
Use the following set of resistance exercises as a beginning point and progress to your tolerance, ability, and according to your healthcare provider’s advice.
Conclusion—Prognosis
Cycling collarbone injury is common, and the recovery takes time, but there’s good news. If you follow this cycling physical therapist’s approach for a safe, effective, and efficient return following a cycling collar bone injury, you will fully recover and resume riding without any limitations.
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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!
