Therapeutic magazine: Skin wounds in Road Cyclists

FOUNDATION

cycling issue1 2018

THERAPEUTIC MAGAZINE

SKIN WOUNDS IN ROAD CYCLISTS

THERAPEUTIC MAGAZINE

c ycli n g issue 1 2018

MAGAZINE BOARD

CONTENTS

GREET CLAES

EDITOR’S LETTER

M S c (D e n t i s t r y), D D s (D e r m a t o - Co s m e t i c S c i e n c e s) H e a d o f R & D N AQ I ® nv, B e l g i u m

ED GARD GE YSKENS,

GERARD GREEN

L E T ' S N OT N E G L E C T T H E C YCL I S T S T H E M S E LV E S A S A CO N T R I B U T I N G FAC T O R E I T H E R

M S c (M a n i p Phy s i o), M M AC P, M C S P, P G Ce r t H E d C l i n i c a l M e n t o r U n i v e r s i t y Co v e n t r y, M S c M a n u a l T h e r a p y St u d e n t s , H a r b o r n e Phy s i o N AQ I ® I n s t r u c t o r

JOOST MENTINK M S c (B i o l o l o g y) CEO of MSP education center and Massage Network

PAUL VAN LOON

E D I T O R N A Q I F O U N D AT I O N

TO M VA N DA M M E,

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P R E S I D E N T O F T H E R O YA L B E LG I A N C YC L I N G L E A G U E

M A N AG E M E N T O F T R AU M AT I C SKIN WOUNDS IN PROFESSIONAL ROAD C YCLISTS R O G E R PA L FR E E M A N ,

M . B . C H . B ( H O N S ), B . A

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I T I S O U R F I R S T TA S K T O A S S E S S T H E S E R I O U S N E S S O F T H E S I T UAT I O N D R . SE R VA A S B I N G É ,

M S c ( Phy s i c a l T h e r a p y) P a u l Va n L o o n S p o r t s c l i n i c s , St a b r o e k & A n t w e r p N AQ I ® M a i n I n s t r u c t o r

T E A M D O C T O R LO T T O -S O U D A L C YC L I N G T E A M

EDITOR

TO M C L A E S ,

EDGARD GEYSKENS

S C R A P E S A N D B U R N S C A N B E ACCO M PA N I E D

BY H I G H F E V E R

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AT H L E T E S R E Q U I R E A LO T O F AT T E N T I O N

M S c (E co n o my), M S c ( A p p l i e d Eco n o my & H e a l t h E co n o my) M S c (B u s i n e s s A d m i n i s t r a t i o n), M S c (Fi n a n c e) C E O N AQ I ® nv, B e l g i u m

WRITER WESLEY MUYLDERMANS Spor ts Journalist & writer

O R T H O P E D I C S U R G E O N

PAU L VA N LO O N ,

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S P O R T S P H Y S I O T H E R A P I S T

W I T H J U S T A S C R A P E , R I D E R S A R E B AC K O N THEIR BIKE IN NO TIME H A NS VA N H O U T,

H E A D S O I G N E U R LO T T O -S O U D A L C YC L I N G T E A M

ART DIRECTOR ISABEL VERELLEN Master of Ar ts A r t D i r e c t o r N AQ I ® nv, B e l g i u m

SUBSCRIPTIONS I N FO @ NAQ I FO U N DAT I O N .CO M

ADDRESS NAQI FOUNDATION - NICHOLAS HOUSE - RIVER FRONT ENFIELD, MIDDLESEX EN1 3FG - UNITED KINGDOM

www.naqifoundation.com

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F O C U S E N T I R E LY O N YO U R P E R F O R M A N C E A N N -S O P H I E D U YC K ,

P R O F E S S I O N A L C YC L I S T

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I T I S I M P O R TA N T T O M A K E S U R E T H AT T H E S K I N C A N A LWAY S B R E AT H E A N D T R A N S P I R E N I K G E Y SK E NS , I N T E R N AT I O N A L T R A I N I N G M A N A G E R N A Q I

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T H E N E C E S S I T Y O F E S S E N T I A L FAT T Y AC I D S GREE T CL AES,

H E A D R E S E A R C H & D E V E LO P M E N T N A Q I

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TESTIMONIAL JOLIEN D’HOORE,

P R O F E S S I O N A L C YC L I S T

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cycling issue 1 2018

EDITOR’S LETTER Skin wounds in professional road cyclists

EDGARD GEYSKENS Editor NAQI Foundation

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ycling is one of those sports with frequent accidents and falls.

Professional cyclists take road rash and fractures almost for granted as “part of the job”.

In this thematic issue of the NAQI Therapeutic Magazine, we present different views on skin wounds among professional cyclists.

We will start with the vision of Tom Van Damme, President of the Royal Belgian Cycling League and President of the UCI Road Committee. His vision is straightforward: everyone has to take his or her responsibility.

The basic article of R. Palfreeman presents a clear picture of falls, the phase of wound healing and the steps in the treatment process. What is the vision of the sports medical and paramedical care provider?

Lotto-Soudal’s team doctor, Servaas Bingé, rightly points out the need to, first of all, assess the situation. Tom Claes, orthopaedic surgeon, underlines that professional cyclists require a great deal of attention both before and after orthopaedic treatment. Paul Van Loon, sports physiotherapist and former cyclist, explains how physiotherapy can contribute during the aftercare period. Hans Van Hout, head soigneur of the Lotto-Soudal team, sees cyclists as hardened athletes who quickly jump back onto their bikes with ‘just’ a scrape. The experienced champion cyclist Ann-Sophie Duyck tells her story about how she, as an athlete, deals with falls and injuries. Nik Geyskens, NAQI international training manager, focuses on skin care and underlines how important it is for the skin to breathe and sweat. Greet Claes, head of R&D NAQI, tells us how and using which products scars and abrasions can be treated and, as a testimonial, Jolien D’Hoore, a bronze finalist at the 2016 Olympic Games, tells us about her personal experience with NAQI products after a severe fall in China. My personal experience: “Nothing but praise for the NAQI Repair Oil and NAQI Cica Gel. After a fall during a race in China, both my arms were scraped and I had ugly burns. After a few weeks of intense use of these products there was no sign of the injuries and everything healed for 100%.”

NAQI Foundation

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P R E S I D E N T O F T H E R O YA L B E L G I A N C Y C L I N G L E A G U E

“Let's not neglect the cyclists themselves as a contributing factor either” – Tom Van Damme –

T

om Van Damme (56) succeeded Laurent De Backer as President of the Royal Belgian Cycling League (KBWB/RLVB) in 2010. In 2014 he was re-elected for another four years in office. In addition, League President Van Damme is also President of the UCI Road Commission and the International Professional Cycling Council. In 2015 he also became vice-chairman of the Belgian Olympic and Interfederal Committee (BOIC) in 2015. Van Damme cares a great deal about safety in cycling, and he is more than happy to share his views on this topic with us.

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Mr Van Damme, unfortunately, cycling without falls seems to be impossible. Which measures can be put in place in the future to reduce the suffering of many cyclists?

I

d o n’ t reall y w ant to t alk ab o u t th e f u ture in this resp e c t . We are alrea d y d o in g a great d eal to day. T h e Fe d er atio n an d th e o rganis atio ns alw ay s s t ar t o f f by mak in g th e co ur s e as s afe as p ossib l e. T hat is n ot s o o bv io us to d o, b e c aus e ‘s t re et f ur ni ture’ is em ergin g ever y w h ere o n th e s t re et s - als o in Flan d er s . We c an t r y to s e cure i t by p osi tio nin g as many mar shals as p ossib l e w h o us e f la gs an d w his tl es to make c yclis t s aw are o f th e p res en ce o f an o bs t a cl e. All o bs t a cl es al o n g th e co ur s e are als o ef f ici entl y mar ke d . T h e s t ate o f th e ro a d is n ot alw ay s id eal, an d that is s o m ethin g to t ake into a cco unt w h en p l ot tin g th e co ur s e o f th e r a ce. It mus t b e as s afe as p ossib l e fo r th e c yclis t s . T h es e are th e thin gs we have to reall y co nsid er. An d l et s n ot over l o o k th e c yclis t s th ems el ves as a f a c to r. I f th ey t ake a co r n er at high sp e e d o r d o n ot co r re c tl y anticip ate an o bs t a cl e o n th e co ur s e, this co ul d s till result in a f all. Falls have alw ay s b e en th ere an d w ill co ntinu e to o ccur, i t ’s p ar t o f th e gam e o f c yclin g .

NAQI Foundation

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c ycli n g issue 1 2018

Do you talk to cyclists about their responsibility when it comes to safety?

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as t year we m et w i th a numb er o f p ro fessio nal c yclis t s , in clu din g To m B o o n en, Ma x im e M o nfo r t an d Ilj o Keiss e. T h ey a dmi t te d that cer t ain c yclis t s may s o m etim es t ake to great o f a r isk an d that i t is n e cess ar y to p o int this o u t to yo un g c yclis t s at th e s t ar t o f th eir c are er. T h ere is als o a b ig resp o nsib ili t y fo r th e team, w h o mus t make th e yo un g la ds aw are ab o u t h ow imp o r t ant s afet y is dur in g th eir di f ferent t r ainin g event s . A s a Fe d er atio n we o rganis e info r matio n s essio ns fo r junio r s an d make i t a re quirem ent fo r th em to p ar ticip ate. If th ey d o n’t , th ey w ill n ot b e all owe d to s t ar t in th e B el gian Champ io nship an d th ey c ann ot b e s el e c te d fo r th e natio nal team . D ur in g th es e s essio ns info r matio n is p rov id e d ab o u t d o p e tes t s , s afet y dur in g co mp eti tio ns , t ak in g resp o nsib l e r isk s an d th eir h ealth .

Do cyclists or teams often come up with proposals to make it even safer?

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t th e m e etin gs t ak in g p la ce at th e UCI p ro p os als are re gular l y p u t o n th e t ab l e. Bu t that is d o n e by di f ferent p ar ti es , n ot jus t c yclis t s an d teams . T h e o rganis atio n an d th e fe d er atio ns als o think o f s t r ate gi es to imp l em ent . R e du cin g th e numb er o f c yclis t s p er team is o n e o f th es e m easures that co ul d in creas e th e s afet y. T h e p a ck w ill b e small er, w hich au to matic all y re du ces th e r isk o f f alls . Unfo r tunatel y, th e teams think this s t r ate g y is over r ate d, an d that i t w ill n ot af fe c t th e s afet y. I d o n’ t un d er s t an d this p o int o f v i ew ver y well, b e c aus e i t is p ure l o gic that a p a ck o f 14 0 c yclis t s is mu ch s afer than a p a ck o f 20 0 !

“ A pack of 140 cyclists is safer than a pack of 200 ”

A top cyclist once said: “Organisers should keep seriously injured cyclists from starting the next day.”

Do you agree with this statement?

N

ot at all! I think i t is a ver y b o l d s t atem ent . T hat wo ul d shi f t th e resp o nsib ili t y to th e o rganis atio n . W hil e th e team is resp o nsib l e, th ere’s a team d o c to r an d s o ign eur s w h o t ake c are o f th e wel f are o f th e c yclis t s . T h e team d o c to r has als o s wo r n a m e dic al o ath an d sh o ul d n ot b e af r aid to t ake his resp o nsib ili t y. R ight b efo re th e s t ar t th e o rganis atio n d o es n ot have an id ea ab o u t a c yclis t ’s e x a c t m e dic al co n di tio n .

T h ey c an o nl y rel y o n th e co mp eten ce o f th e team d o c to r.

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NAQI Foundation

cycling issue 1 2018

But an injured cyclist on a bike may be a problem for the safety in and of the pack ‌

I’

m n ot g oin g to d eny that , n ot at all. Bu t a gain, i t is n ot o ur t ask - I m ean o f th e fe d er atio ns an d o rganis atio ns - to d eny a c yclis t th e r ight to s t ar t b as e d o n his m e dic al co n di tio n . Ever yo n e co nt r ib u tes to th e s afet y in th e co ur s e, ever yo n e has his ow n resp o nsib ili ti es . Als o th e c yclis t s th ems el ves , th ey fe el th e s t ate o f th eir ow n b o di es an d sh o ul d b e h o n es t w i th th ems el ves an d w i th oth er s .

There is no international association of cycling doctors, physiotherapists and soigneurs. Could such an association not contribute to a better exchange of information to intervene quicker and more efficiently in case of accidents?

T

h ere are l ot s o f oth er ass o ciatio ns an d o rganis atio ns , fo r e x amp l e th e A ss o ciatio n fo r Sp o r t s an d M e dic al Cer ti f ic atio n (SK A), an d s o m e d o c to r s wo r k fo r di f ferent sp o r t s . I am o f th e o p inio n that yo u c ann ot sp li t ever y thin g up. T h e team d o c to r s o f th e Wo r l d To ur teams als o re gular l y t alk to ea ch oth er an d e xchan g e all k in ds o f us ef ul info r matio n . It d o es e x is t , I m ean, i t is jus t n ot c all e d sp e ci f ic all y that . In a d di tio n, th e fe d er atio n als o o rganis es l ot s o f t r ainin g an d info s essio ns , w hich are all aim e d at mak in g c yclin g s afer. S o I think th ere is en o u gh co o p er atio n an d co h eren ce.

FOUNDATION

NAQI Foundation

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c ycli n g issue 1 2018

cycling issue 1 2018

SPORTS MEDICINE

MANAGEMENT OF TRAUMATIC SKIN WOUNDS IN PROFESSIONAL ROAD CYCLISTS – Roger Palfreeman –

c ycli n g issue 1 2018

SKIN WOUNDS

IN PROFESSIONAL ROAD CYCLISTS

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ro fessio nal ro a d c yclis t s n ot o nl y r id e at sp e e ds o f up to 8 0 k m / hr, th ey o f ten d o s o in a p el oto n o f up to 20 0 r id er s . T h ey als o have to co nten d w i th nar row ro a ds , to r tu o us d es cent s an d ‘ro a d f ur ni ture’ (su ch as t r af f ic islan ds , ro un dab o u t s an d b o llards). M o re re centl y, th ere have b e en a numb er o f signi f ic ant injur i es c aus e d by co llisio ns w i th m oto rc ycl e o u t r id er s c ar r y in g p h oto gr ap h er s o r T V c am er am en, ea g er to o bt ain cl os e up ima g es o f th e r id er s dur in g th e key m o m ent s o f th e r a ce. In a d di tio n, th e sup p o r tin g team c ar s t r avel in ver y cl os e p rox imi t y to th e r id er s an d f re qu entl y m ove thro u gh th e p el oto n at great sp e e d in o rd er to at ten d to m e chanic al issu es o r w h e el chan g es , s o i t ’s p er haps n ot s o sur p r isin g that cr ash es are f air l y f re qu ent o ccur ren ces .

Sk in wo un ds are th e m os t f re qu ent t r aumatic c yclin g injur y an d th e co mm o n es t o f th es e are sk in ab r asio ns (‘ro a d r ash’ ) an d sk in co ntusio ns . O th er t y p es o f sk in wo un ds are als o o cc asio nall y s e en ( la cer atio ns , in cisio ns an d p un c ture wo un ds). T h e injur y m e chanism is usuall y a co mb inatio n o f sh ear an d co mp ressio n fo rces , w i th th e ass o ciatio n b et we en th e t wo d eter min e d p ar tl y by th e sp e e d at th e tim e o f imp a c t , th e nat ure o f th e ro a d sur f a ce an d th e t r aj e c to r y as th e r id er hi t s th e gro un d . Injur i es c an als o b e c aus e d by co nt a c t w i th oth er r id er s , th eir b ikes , c ar s /m oto rc ycl es an d a v ar i et y o f ‘ro a d f ur ni t ure’, as allu d e d to p rev io usl y. T h e co mm o n es t si tes fo r sk in t r auma are over th e greater t ro chanter, sh o ul d er, up p er b a ck , k n e es an d elb ow s . Less f re qu ent si tes in clu d e th e m e dial an d later al mall e o li at th e ank l e, w hich c an b e ver y di f f icult to mana g e du e to th e minimal over l y in g sk in thick n ess , o cc asio nall y re quir in g sk in gr af tin g .

W hil e sk in wo un ds may ap p ear to b e o nl y a min o r issu e, th ey c an imp a c t h eav il y o n th e p er fo r man ce o f an in di v idual, as th eir p res en ce in th e t y p ic al l o c atio ns w ill o f ten imp air sl e ep in g an d th ereby re cover y. R e cover y is a key p er fo r man ce d eter minant in a 3 - we ek s t a g e r a ce su ch as th e To ur d e Fr an ce an d s ever al night s o f inter r upte d sl e ep are likel y to have a gr a dual at t r i tio nal ef fe c t o n th e r id er.

Cl othin g wo r n dur in g c yclin g r a ces / t r ainin g t y p ic all y o f fer s ver y li t tl e p rote c tio n f ro m sk in injur y, th o u gh that is b e ginnin g to chan g e w i th th e d evel o p m ent o f sp e cialis e d f ab r ic s in co r p o r ate d into th e gar m ent s (s e e b el ow). Light weight Lycr a gar m ent s are th e n o r m, p ar ticular l y w h en co mp etin g in h ot o r humid co n di tio ns .

W i th this in min d, th ere is cl ear l y p otential fo r r id er s to sus t ain mu ch m o re signi f ic ant injur i es , in clu din g f r a c t ures , h ea d injur i es an d dama g e to inter nal o rgans an d this sh o ul d alw ay s b e co nsid ere d f ir s t w h en ass essin g a r id er, n ot o nl y dur in g th e r a ce, b u t als o imm e diatel y fo ll ow in g w h en th ey s e ek m e dic al at tentio n .

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NAQI Foundation

cycling issue 1 2018

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e fo re dis cussin g th e di f ferent t y p es o f sk in wo un ds , i t is wo r th b r i e f l y rev i ew in g th e s t r u c t ure o f sk in; i t is co mp os e d o f thre e dis tin c t layer s – th e ep id er mis , th e d er mis an d th e hy p o d er mis (o r sub cu t an e o us layer).

SKIN STRUCTURE •

Hair Melanocytes

Epidermis

Nerve

Sweat gland

Dermis Fat layer

Blood vessels

Figure 1: Normal skin structure

• Epidermis: refers to the outer layer of the skin. It is avascular and just a few cells thick. It provides a barrier to infection and other injurious agents and also regulates water loss through the skin. It’s the first layer to be damaged in traumatic skin injuries, such as abrasions.

• Dermis: the layer below, consisting of connective tissue, nerves, blood vessels and specialised cells, including fibroblasts. This is the main site of inflammation when the skin is subject to trauma. It’s numerous nerve endings makes it highly pain-sensitive when injured.

• Hypodermis: the deepest layer, which is very variable in thickness, depending on location and the person’s degree of adiposity.

It consists of fat tissue, connective tissue and blood vessels.

SKIN Structure

“ The skin is composed of three distinct layers – the epidermis, the dermis and the hypodermis ”

c ycli n g issue 1 2018

CL A SSIFIC AT ION OF SK IN WOUNDS •

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i ve di f ferent t y p es o f sk in wo un ds are usuall y d es cr ib e d; ab r asio ns , co ntusio ns , la cer atio ns , in cisio ns an d p un c t ure wo un ds .

Ab r asio ns o ccur w h ere th e sk in is s cr ap e d o r r ub b e d o f f, usuall y du e to f r ic tio n .

T his is th e co mm o n es t t y p e o f sk in injur y s e en in c yclis t s , o f ten a cco mp ani e d by a co nt usio n . T h ey are s o m etim es f ur th er classi f i e d into

• 1st degree (involving only the epidermis) • 2nd degree (e x tending into the dermis) • 3rd degree (e x tending into the hypodermis) S e co n d an d 3rd d e gre e are th e m os t p ainf ul sin ce num ero us n er ve en din gs are e x p os e d, p ar ticular l y w h en a larg e area o f sk in is invo l ve d . T h ey als o ten d to h eal w i th a d e gre e o f s c ar r in g1.

Co nt usio ns are cl os e d wo un ds , c aus e d by b lunt t r auma, resultin g in dama g e to th e tissu es b en eath th e sk in, b u t w i th th e sk in sur f a ce s till int a c t .

L a cer atio ns o ccur w h en th e sk in is to r n o r cu t , resultin g in an ir re gular wo un d e d g e. T h ey are c aus e d by b lunt t r auma an d are s o m etim es s e en in ass o ciatio n w i th s evere ab r asio ns .

In cisio ns are cu t s c aus e d by shar p sur f a ces o r imp l em ent s . T h ere is a co n cer n that th es e may b e m o re f re qu entl y s e en i f dis c b r akes are int ro du ce d into th e p el oto n, as is cur rentl y un d er co nsid er atio n .

Pun c t ure wo un ds o ccur w h en a shar p o bj e c t p en et r ates th e sk in – th es e are tet anus- p ro n e wo un ds , s o i t ’s imp o r t ant to ass ess th e r id er ’s tet anus s t atus .

T h ey are s o m etim es s e en w h en a r id er co m es into fo rcef ul co nt a c t w i th th e b ike dur in g a cr ash, in p ar ticular th e f ro nt chainr in g w hich has num ero us p o inte d te eth aro un d i t s circumferen ce.

SKIN WOUNDS

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" Abrasions occur where the skin is scraped or rubbed off, usually due to friction. This is the commonest type of skin injury seen in cyclists "

cycling issue 1 2018

Inflammatory phase

THREE PHASES OF WOUND HEALING •

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h ere are thre e p has es o f wo un d h ealin g that n e e d to b e co nsi d ere d in th e mana g em ent o f t r aumatic sk in l esio ns , th e f ir s t t wo o f th es e b ein g th e m os t imp o r t ant f ro m a c yclis t ’s p er sp e c ti ve.

T h e f ir s t p has e is th e inf lammato r y p has e, w hich s t ar t s imm e diatel y af ter sk in injur y, w i th ha em os t asis an d co ntinu es fo r aro un d 5 to 6 day s . It ’s char a c ter is e d f ir s tl y by an inf lu x o f n eu t ro p hils in resp o ns e to ch em ot a c tic f a c to r s rel eas e d by dama g e d tissu e. T h eir f un c tio n is to cl eans e th e injure d area o f cell d eb r is , th eir a c ti v i t y p eak in g over 1 to 2 day s . Fo ll ow in g this , th ere is an inf lu x o f m o n o c y tes , w hich t r ans fo r m to ma cro p ha g es o n ce th ey l eave th e micro circulatio n – th es e p ro du ce num ero us grow th f a c to r s (su ch as t r ans fo r min g grow th f a c to r s , inter l euk in -1, inter l euk in - 6, t um o ur n e crosis f a c to r-alp ha, p latel et- d er i ve d grow th f a c to r), w hich p rep are th e w ay fo r f ib ro b las t p ro li fer atio n in th e fo ll ow in g s t a g e, as well as p ro m ote th e ini tial s t a g es o f an gio g en esis (grow th o f n ew b l o o d vess els).

T h e n e x t s t a g e is th e p ro li fer ati ve / gr anulatio n p has e, b e ginnin g aro un d day 4 an d usuall y las tin g a f ur th er 1 to 3 we ek s , d ep en din g o n th e t y p e o f wo un d . It ’s char a c ter is e d by an in inf lu x o f f ib ro b las t s an d subs e qu ent p ro du c tio n o f co lla g en t y p es 1 an d 3, as well as gl ycos amin o gl yc ans an d p rote o gl yc ans , co ns ti t u ent s o f th e mat r i x . An gio g en esis b e co m es m o re p ro min ent at this tim e an d th ere is als o ev id en ce o f re - ep i th elialis atio n, w h ere ep i th elial cells migr ate f ro m th e p er ip h er y o f th e wo un d to l eave a thin layer cover in g th e wo un d sur f a ce.

Finall y, th ere is th e mat ur atio n / rem o d ellin g p has e, w hich co mm en ces tow ards th e en d o f th e p re ce din g gr anulatio n p ro cess an d c an las t fo r m o nths o r even l o n g er. T h ere is co ntinu o us co lla g en t ur n over an d rem o d ellin g, an d p otential fo r wo un d co nt r a c tio n v ia th e a c tio n o f sp e cialis e d cells c all e d myo f ib ro b las t s , esp e ciall y i f th e wo un d has h eal e d by s e co n dar y intentio n . T h e ma x imal tensil e s t ren g th o f th e resul tin g s c ar is t y p ic all y rea ch e d af ter aro un d 3 m o nths .

Two di f ferent s cenar ios p res ent to th e team o r r a ce d o c to r.

Mana g em ent o f sk in wo un ds dur in g th e r a ce an d d ef ini ti ve mana g em ent in th e fo ll ow in g p er io d .

Begins when the wound develops, lasts 4 to 6 days Marked by oedema, erythema, inflammation and pain Healing process is triggered Immune system works to prevent microbal colonisation

Proliferative phase

Lasts another 4 to 24 days Granulation tissue flls in the wound Fibroblasts lay collagen in the wound bed, strengthening new granulation tissue Wound edges begin to contract Epithelial cells migrate from the wound margins

Maturation phase

Can last 21 days to 2 years Length of time depends on patientand wound-related complicating factors (e.g. duration of the wound, patient comorbidities, wound infection status) Filled-in wound is covered and strengthened Scar tissue forms Figure 2: The phases of wound healing.

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MANAGEMENT OF SKIN WOUNDS DURING THE RACE •

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n ce a r id er has b e en invo l ve d in a cr ash dur in g th e r a ce th ere are thre e p ossib l e imm e diate o u tco m es:

“ If a rider gets back onto their bike after the crash, they will often come over to their team car or race doctor for medical assistance while they continue in the race, usually as they hold onto the side of the moving car. ”

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They get up straight away and attempt to rejoin the race.

They get up more slowly with the potential to continue, often after a quick check by the race doctor or team doctor by the roadside.

They don’t get up and most likely abandon the race, needing more involved medical assessment.

t is ver y co mm o n fo r r id er s to g et s tr aight b a ck o n th e b ike i f at all p ossib l e. Any d elay makes i t l ess likel y that th ey w ill re gain th eir p osi tio n in th e r a ce. If th ey d o n’t g et up, i t su g g es t m o re s er io us injur y, in w hich c as e mana g em ent o f sk in t r auma is r arel y th e p r io r i t y.

I f a r id er g et s b a ck o nto th eir b ike af ter th e cr ash, th ey w ill o f ten co m e over to th eir team c ar o r r a ce d o c to r fo r m e dic al assis t an ce w hil e th ey co ntinu e in th e r a ce, usuall y as th ey h o l d o nto th e sid e o f th e m ov in g c ar. I d eall y, th e injure d sid e sh o ul d b e cl os es t to th e c ar, w hich may m ean s o m e c aref ul man o eu v r in g o n th e p ar t o f th os e insid e, in clu din g s w i tchin g f ro m f ro nt to b a ck s eat i f ro o m p er mi t s .

T h e f ir s t p r io r i t y is to ensure that th e r id er is s afe to co ntinu e an d, in this re gard, a r ap id s cre en fo r co n cussi ve s y mpto ms usin g m o di f i e d Ma d d o ck s qu es tio ns sh o ul d b e p er fo r m e d p r io r to ev aluatin g any injur i es . T h e d o c to r sh o ul d als o ask i f th ere is any p ain n ot relate d to si tes o f sk in wo un ds r id er s w i th clav icular f r a c tures usuall y aren’ t ab l e to co ntinu e, b u t i t ’s n ot unusual fo r r id er s w i th w r is t , elb ow o r sh o ul d er f r a c t ures to c ar r y o n r idin g, alb ei t in s evere dis co mfo r t .

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cycling issue 1 2018

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ontrol any bleeding by applying firm pressure with a sterile gauze pad. Consider cleaning the wound if it appears badly contaminated, in which case use a sterile gauze pad and copious amounts of water, which doesn’t need to be sterile – drinking water in a race bottle is fine for this purpose and it also allows for a jet of water to be squirted onto the skin to assist in wound irrigation. The main aim of in- race management is to cover the wound and prevent any further contamination by road debris – it is not possible to provide definitive wound cleaning and dressing.

Ab r asio ns o f th e up p er limbs are m os t easil y mana g e d by th e us e o f ap p ro p r iatel y - si ze d t ub ular b an da g e (usuall y n et tin g t y p e), cu t to an ap p ro p r iate l en g th . T his is quick l y ap p li e d to th e limb an d a n o n - a dh erent dr y dressin g sli d un d er n eath to cover th e wo un d, h el d in p la ce by th e elas tic ate d b an da gin g .

Wo un ds over th e sh o ul d er area , t ro chanter ic area o r k n e e are m os t easil y t reate d in a di f ferent mann er, by usin g a n o n -a dh erent dressin g, h el d in p la ce by a s e co n dar y a dh esi ve t ap e, su ch as H y p af i x . In o rd er to p ro m ote sk in a dh esio n, f ir s t quick l y cl ean th e sk in o f any ro a d gr im e an d s weat , th en s w ab th e sur ro un din g sk in w i th Fr iar ’s B als am o r p las ter sp r ay. Cu t a dh esi ve t ap e to si ze an d th en ap p l y a n o n -a dh erent dressin g to th e t ap e b efo re ap p l y in g th em to th e wo un d si te. T his is n ot alw ay s eas y, p ar ticular l y i f o ccur s w hil e n e g otiatin g s e c tio ns o f d ow nhill o r co r n er s!

I f th ere is a d elay in g et tin g up o r th e r id er is o n his fe et b u t n ot at temptin g to g et b a ck o n his b ike, ass ess fo r oth er injur i es f ir s t at th e ro a dsid e. Co nsid er th e p ossib ili t y o f a sp inal injur y, f r a c t ure o r inter nal injur y p r io r to a co n cussio n s cre en, w hich, in this c as e, sh o ul d als o in clu d e a quick b alan ce tes t . If th e r id er is d e em e d f i t to c ar r y o n r i din g any sk in wo un ds c an subs e qu entl y b e mana g e d at th e c ar. I f th e r id er remains o n th e gro un d, sk in is n ot a p r io r i t y. A signi f ic ant injur y is a real p ossib ili t y an d a m o re d et ail e d m e dic al ev aluatio n is w ar r ante d, w hich is b eyo n d th e s co p e o f this ar ticl e.

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DEFINITIVE MANAGEMENT OF SKIN WOUNDS POST-R ACE •

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n ce th e day ’s r a cin g has f inish e d, d ef ini ti ve wo un d c are c an t ake p la ce. It is b es t to a d v is e th e r id er to t ake his usual p os t- r a ce sh ower an d at th e s am e tim e, cl ean his wo un ds th o ro u ghl y an d th en p res ent fo r d ef ini te wo un d mana g em ent .

M os t p ro fessio nal r id er s are us e d to this p ro ce dure an d w ill cl ean wo un ds in th e sh ower o n th e team b us imm e diatel y af ter r idin g an d, w hil e this d o es p otentiall y r ais e issu es re gardin g th e t r ansmissio n o f b l o o d - b o r n e infe c tio ns , i t is highl y e f fe c ti ve. If cl eanin g hasn’ t t aken p la ce by th e tim e th e r id er is ass ess e d, an al ter nati ve m eth o d is to p la ce th e r id er o n a larg e in co ntin en ce b lanket an d emp l oy this to s o ak up th e w ater us e d in th e p ro cess . T h e key thin g is to us e co p io us am o unt s o f w ater to cl ean th e wo un d . In g en er al, this p ro ce dure c an b e qui te un co mfo r t ab l e an d is ma d e mu ch easi er by ana es th etisin g th e wo un d usin g l o c al ana es th etic (Lid o c ain e) g el o r sp r ay.

Cl eanin g o f co nt aminate d wo un ds c an b e f a cili t ate d by us e o f a s ter il e p lain surgic al s cr ub b r ush . If this isn’ t av ailab l e, a n ew b ath sp o n g e (t aken dire c tl y o u t o f i t s p a ck a gin g) is an alter nati ve. H owever, i t ’s imp o r t ant n ot to tr aumatis e th e wo un d any m o re than is n e cess ar y fo r a d e quate cl eanin g .

D o n’t fo rg et to ch e ck th e r id er ’s tet anus s t atus , th o u gh this is usuall y up -to - date an d n ot re quir in g f ur th er immunis atio n unl ess i t ’s a tet anus- p ro n e wo un d, in w hich c as e tet anus immun o gl o b ulin may b e a d vo c ate d .

M e dic al a d v ice sh o ul d b e s o u ght fo r wo un ds that ap p ear d e ep (af fe c tin g th e sub cu t an e o us tissu es an d /o r un d er l y in g s t r u c t ures) an d fo r la cer atio ns , in cis e d wo un ds an d p un c t ure wo un ds . Many la cer atio ns c an b e cl os e d w i th su tures o r s ter is t r ips , d ep en din g o n th e sk in si te an d th e d e gre e o f tensio n p la ce d o n i t .

O th er s are b es t l e f t to h eal by s e co n dar y intentio n, w h ere th e wo un d is kept o p en, du e to th e likel y di f f iculti es p os e d by sk in cl osure w h en th ere is signi f ic ant tissu e l oss . Highl y co nt aminate d wo un ds may n e e d surgic al ass essm ent .

O n ce th e wo un d has b e en th o ro u ghl y cl ean e d, i t an d th e sur ro un din g sk in c an b e dr i e d usin g a p i e ce o f s ter il e gau ze. If th e r id er w ill b e tr ainin g o r r a cin g a gain th e fo ll ow in g day, i t ’s ess ential to p rep are th e sk in to p ro m ote dressin g a dh esio n, oth er w is e i t ’s likel y that s weat , r ain o r th e m e chanic al s t ress o f jo int m ovem ent w ill c aus e th e dressin g to l o os en an d eventuall y d et a ch w hil e r idin g .

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SKIN WOUNDS

IN PROFESSIONAL ROAD CYCLISTS

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h ere are s ever al di f ferent w ay s to d o this , in clu din g th e us e o f sp r ay p las ter o nto th e sk in p r io r to dressin g ap p lic atio n . H owever, p ossib l y th e m os t ef fe c ti ve is to us e Fr iar ’s B als am (tin c t ure o f B en zoin), w hich makes th e sk in ver y t a ck y an d mar ke dl y imp roves th e a dh eren ce o f th e s e co n dar y dressin g . Alter nati vel y, a l en g th o f tub ular b an da g e c an b e us e d to cover th e dressin g an d h o l d i t in p la ce.

O n ce th e sk in is p rep p e d, th e p r imar y dressin g (in co nt a c t w i th th e wo un d ) c an b e ap p li e d an d th en covere d w i th a s e co n dar y dressin g (a dh esi ve dressin g t ap e, 10 cm w id th) to h o l d i t in p la ce. T h e e x a c t ch oice o f p r imar y dressin g d ep en ds o n th e nature o f th e wo un d, b u t th e m os t ap p ro p r iate o n e is usuall y a hydro p o l y m er (o r fo am) dressin g, du e to i t s c ap a ci t y to han dl e th e high e xu date l evels t y p ic all y s e en in c yclin g - relate d sk in t r auma . H ydro p o l y m er dressin gs als o h elp maint ain a m ois t wo un d env iro nm ent , w hich is th o u ght to p ro m ote sk in h ealin g an d re du ce p ain relati ve to dr y dressin gs .

OT HER DRESSING T YPES T HAT ARE USED ARE:

• Hyd r oco lloïd / hyd r oge l

• Hyd r o p o l y mer

T h es e co nt ain g el - fo r min g a g ent s (a g elatin o r s o dium c ar b ox y m ethy l cellul os e) h el d w i thin an a dh esi ve co mp o un d, o f ten laminate d to aw ater p ro o f o u ter layer. T his resul t s in a p re - fo r m e d dressin g that is w ater p ro o f an d c an b e us e d in i t s ow n r ight w i th o u t th e n e e d fo r a s e co n dar y dressin g to h o l d i t in p la ce. A s w i th hydro p o l y m er/ fo am p ro du c t s , th ey p rote c t th e wo un d f ro m infe c tio n w hil e maint ainin g a m o is t env iro nm ent .

T h eir main dis a d v ant a g es are that th ey d o n’ t co p e well w i th h eav il y e x u datin g wo un ds , n o r c an th ey b e easil y a dapte d to co p e w i th ab r asio ns o f di f ferent si zes an d shap es . T h ey may b e us e d s ever al day s fo ll ow in g th e ini tial injur y, at w hich tim e e x u date l evels are n ot s o high, b u t o nl y o n sui t ab l y -si ze d sk in l esio ns , as th ey are usuall y p refo r m e d .

Pa ck in g /al ginates (d er i ve d f ro m s eawe e d ) – us ef ul fo r d e ep c av i t y wo un ds , b u t o nl y af ter sp e cialis t ass essm ent . T h ey wo ul d usuall y b e p la ce d un d er n eath a s t an dard hydro p o l y m er dressin g, w hich is th en covere d w i th a s e co n dar y dressin g . T h ey are us e d to abs o r b th e e x u date that wo ul d oth er w is e fo r m w i thin th e wo un d c av i t y.

SKIN WOUNDS

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• Silico n d r e ssing s C an b e us e d to p revent wo un d a dh eren ce5, esp e ciall y w h en th e wo un d is gr anulatin g an d p ro du cin g l ess e x u date. It ’s imp o r t ant to minimis e any dressin g a dh esio n, sin ce i t disr upt s th e re - ep i th elias atio n p ro cess an d ultimatel y d elay s h ealin g .

cycling issue 1 2018

Photo Credits Cor Vos

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at r i x dressin gs – p roteas e - m o dulatin g mat r i x (co lla g en /ox idis e d re g en er ate d cellul os e) may b e b en ef icial in si tuatio ns w h ere h ealin g is likel y to t ake l o n g er, su ch as d e ep er, c av i t y - t y p e wo un ds . T h ey are usuall y p la ce d un d er n eath th e p r imar y dressin g . T h ere is ev id en ce to su g g es t th ey may p rov id e a b et ter env iro nm ent fo r th e fo r matio n o f gr anulatio n tissu e 6,7. T h e p r imar y dressin g is cu t to si ze an d ap p li e d to th e wo un d . T h e s e co n dar y dressin g is als o cu t to si ze, w i th a g en ero us am o unt o f over lap, s o that a reas o nab l e am o unt remains in co nt a c t w i th th e p rep p e d sk in .

Fo r wo un ds over j oint s (e.g . th e k n e e) i t is usuall y b es t to ap p l y th e dressin g w h en th e joint is p ar tiall y f l e xe d, to re du ce m e chanic al tensio n o n th e dressin g w hil e r idin g .

H ydro p o l y m er/ fo am dressin gs c an b e l ef t in p la ce fo r up to 7 day s . T his is n ot alw ay s p ossib l e o r p r a c tic al, p ar ticular l y i f th e dressin g b e co m es s o il e d by subs e qu ent day s o f r a cin g . H owever, i t ’s b es t to l eave i t in p la ce fo r as l o n g as p ossib l e, o nl y rem ov in g i t w h en i t has rea ch e d i t s c ap a ci t y to abs o r b e x u date o r w h en i t ’s v isib l y dir t y. T h e dressin g c an b e p rote c te d w h en sh ower in g by th e ap p lic atio n o f s ever al w r aps o f Clin g f ilm, s e cure d at i t s e d g es by a dh esi ve t ap e. If a dressin g n e e ds to b e reap p li e d, us e o f an oth er hydro p o l y m er/ fo am dressin g is a d v is e d . If th e wo un d is n o l o n g er p ro du cin g mu ch e xu date, a silico n dressin g c an b e ap p li e d un d er n eath to minimis e th e r isk o f wo un d a dh eren ce.

It is unusual fo r sk in ab r asio ns t reate d in th e ab ove mann er to b e co m e infe c te d . Signs o f infe c tio n wo ul d in clu d e sp rea din g re dn ess o f sur ro un din g sk in, in creasin g p ain, o f fensi ve wo un d dis charg e, malais e o r fever.

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MINIMISE INFL AMMAT ION •

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issu e inf lammatio n result s in p ain an d s ti f f n ess . It is qui te co mm o n fo r a r i d er ’s p er fo r man ce to b e imp aire d fo r s ever al day s fo ll ow in g a cr ash resultin g in injur y. T his may simp l y re f l e c t p ain inhib i tio n, ref l e c te d in altere d m ovem ent p at ter ns an d re du ce d fo rce p ro du c tio n . H owever, dire c t ef fe c t s f ro m a s y s temic inf lammato r y resp o ns e remain a p ossib ili t y, as C- rea c ti ve p rotein l evels are o f ten el ev ate d in th e day s fo ll ow in g injur y. In o rd er to re du ce th e d e gre e o f inf lammatio n, th e r id er sh o ul d b e a d v is e d to ap p l y an ice b a g to th e dress e d wo un d (ap p rox imatel y 30 minu tes ever y 2 h o ur s) an d a co mp ressi ve b an da g e at all oth er tim es – a co h esi ve b an da g e is id eal fo r this p ur p os e. T his sh o ul d b e d o n e fo r th e remain d er o f th e day an d fo r th e fo ll ow in g day p r io r to r i din g, at th e ver y l eas t . It is als o b en ef icial to el ev ate th e injure d b o d y p ar t , i f feasib l e. Pn eumatic d ev ices co mb inin g co mp ressio n an d co o lin g are av ailab l e an d are p o p ular w i th s o m e teams fo r th eir injur y mana g em ent . It wo ul d als o s e em p r u d ent to t ake a sh o r t co ur s e o f n o n -s tero idal anti - inf lammato r y dr u gs fo r s ever al day s , to f ur th er minimis e th e inf lammato r y resp o ns e.

S TR AT EG IES TO PRE V EN T OR REDUCE T HE SEVERITY OF SKIN INJURIES •

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e centl y, th ere have b e en s o m e n ew d evel o p m ent s in mater ials us e d fo r c yclin g cl othin g . Fo rem os t am o n g th es e is th e us e o f a sp e cial f ab r ic ma d e f ro m Ult r a High M o l e cular Weight Po l yethy l en e f ib res (UHMW PE ). T h e f ib res are 15 tim es s t ro n g er than s te el an d o f fer ma x imum s t ren g th w i th minimum weight . T h e f ib res are woven into a f ab r ic w hich is us e d to reinfo rce th e areas o n th e b o d y m os t co mm o nl y af fe c te d by ab r asi ve sk in injur y elb ow s sh o ul d er s , up p er b a ck an d later al thigh / t ro chanter ic re gio n . W hil e su ch te chn o l o g y c an’ t p revent all sk in injur i es , i t likel y o f fer s signi f ic ant p rote c tio n f ro m sh ear fo rces an d, to a l ess er e x tent , co mp ressi ve fo rces .

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cycling issue 1 2018

SUMMARY POINTS •

• Skin injuries are very common in professional road cyclists.

The ensuing pain and inflammation often leads to a reduction in performance over the following days.

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Definitive wound care can only take place after the end of the day’s racing.

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The commonest types of injuries are abrasions and contusions.

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The initial stage of management is to thoroughly clean the wound with copious amounts of water and a sterile scrub brush/sponge.

Use of local anaesthetic gels and sprays can facilitate this process.

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Foam/hydropolymer dressings, when used with a secondary dressing, provide the best combination of optimal healing environment and ability to cope with wounds of different shapes and sizes and at different locations on the body

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Promote dressing adhesion by the application of Friar’s Balsam to surrounding skin.

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Take steps to minimise the inflammatory response.

• Most dressings can be left in place for several days, providing they are

not contaminated or have exceeded their capacity to absorb exudate.

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New fabric technologies are now available that show promise in reducing the severity of skin trauma.

Source: Aspetar, Sports Medicine Journal, 2016 Dec, vol.5, p456-461.

References available at www.aspetar.com/journal Roger Palfreeman M.B.Ch.B. (Hons), B;A; (Hons), Dip. S.E.M., F.F.S.E.M.Clinical Liaison for Sports Science Aspetar – Orthopaedic and Sports Medicine Hospital Doha, Qatar Ex-teamarts, BMC Racing Team en Team Sky

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TEAM DOCTOR OF THE LOTTO-SOUDAL CYCLING TEAM

“It is our first task to assess the seriousness of the situation.”

– Servaas Bingé –

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s a general practitioner Servaas Bingé (37) has his practice in Hansbeke, but he

is also the team doctor of the Lotto-Soudal cycling team. Big shots like Tiesj Benoot, André Greipel and Tim Wellens count on him to keep them healthy, but also to get them back on their bike as soon as possible after a fall. We had an interesting and informative talk with the author of Nooit meer naar de dokter (Never see a doctor again) – a plea for less doctor’s visits – about skin lesions in cyclists and how to take care of those.

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Doctor BingĂŠ, which factors can cause skin problems when cycling?

F

r ic tio n is cer t ainl y a p ro b l em c yclis t s are re gular l y f a ce d w i th . Cer t ainl y tow ards th e en d o f th e s eas o n, w h en th e temp er atures are high er an d th e air humidi t y is high er to o. An d that f r ic tio n usuall y c aus es p ro b l ems w i th th e r id er ’s b um, r an gin g f ro m min o r ir r i t atio ns to s er io us abs cess es . Bu t I think that th e quali t y o f th e p avem ent a c t uall y p lay s a b ig ro l e. T hat , in co mb inatio n w i th e x t rem e h eat , is a d ea dl y co mb inatio n . We o n ce ha d a r a ce in Po lan d, w h ere th e temp er ature w as over 4 0 d e gre es at th e tim e, mak in g th e asp halt ver y h ot to o. In su ch circums t an ces b ur ns c an o ccur by jus t to u chin g th e ro a d . A r id er w h o f alls o n su ch a sur f a ce w ill su f fer sk in injur i es n o o n e’s w ai tin g fo r.

Is it possible to protect the skin in advance against such a fall?

N

ot a gains t a f all in i t s el f, b e c aus e th e imp a c t is usuall y qui te s evere. T h e m os t imp o r t ant thin g is g et to th e s t ar t in th e b es t p ossib l e co n di tio n an d to ke ep th e sk in as h eal thy as p ossib l e. Make sure that th e sk in is alw ay s p ro p er l y hydr ate d, f ir s t o f all by dr ink in g su f f ici entl y. In f ros t y weath er o r oth er e x t rem e co n di tio ns th e r id er s c an, fo r e x amp l e, us e a p rote c ti ve cream .

If a rider falls, what does the care of the skin involve immediately after the fall?

A

t th e cr ash si te we w ill a c t uall y f ir s t ass ess th e s er io usn ess o f th e si tuatio n, an d th en d eter min e w h eth er i t is a resp o nsib l e ch o ice to co ntinu e th e r a ce. T hat is th e f ir s t qu es tio n we are alw ay s g oin g to ask o ur s el ves . If th e r id er fe els up to i t , th ere is a c t uall y n ot mu ch that c an b e d o n e ab o u t th e wo un d i t s el f at that m o m ent . T h e wo un d is alrea d y dir t y - an d th erefo re infe c te d - an d w ill mainl y re quire c are af ter w ards . S o th ere is n ot mu ch n e e d fo r disinfe c tio n at th e cr ash si te, o r f ro m th e sup p o r t vehicl e.

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“ Wound care is always provided in three steps.”

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cycling issue 1 2018

Therefore, most of the ‘action’ takes place after the race ...

W

o un d c are alw ay s invo l ves thre e s teps , a s y s tem k n ow n by b oth th e r id er s an d th e c aret aker s . Fir s t o f all th e wo un d is cl ean e d . T his is th e b asis fo r p ro p er h ealin g .

Sto n es , dir t o r oth er mater ials in th e wo un d mus t b e rem ove d . T h ere is o nl y o n e w ay to d o this: by t ak in g a sh ower. T h e wo un d n e e ds to b e s cr ub b e d well, an d fo r tunatel y th ere are sp e cial b r ush es an d towels fo r that . N ever th el ess , this is usuall y a r ath er p ainf ul b usin ess . I have s e en cr ash es in th e To ur d e Fr an ce, w h ere th e si tuatio n w as s o b a d, that th e r id er s ha d to b e ana es th etis e d to cl ean th e wo un ds . I re gular l y have to g et in th e sh ower w i th r id er s b e c aus e th e wo un ds are s o m etim es in di f f icult-to rea ch p la ces , o n th eir b a ck , fo r e x amp l e.

Step t wo is disinfe c tio n . We us e a disinfe c t ant to k ill any b a c ter ia that may s till b e in th e wo un d . Af ter all, we have to avo id that all k in ds o f b a c ter ia enter th e b o d y thro u gh th e b l o o d . T h e m eth o d o f disinfe c tio n an d th e p ro du c t us e d d ep en ds o n th e t y p e o f wo un d . In th e f a ce we usuall y wo r k w i th co l o ur l ess disinfe c t ant s , w hil e s o m e co l o ur o n th e l e gs d o es n ot reall y mat ter.

Finall y, th e wo un d mus t b e p rote c te d a gains t f ur th er infe c tio n an d a climate fo r o ptimal wo un d h ealin g mus t b e create d . T his is d o n e by v ar io us t y p es o f cover in g b an da g es . T h ere are p assi ve dressin gs , w hich simp l y cover th e wo un d . Bu t th ere are als o a c ti ve b an da g es , su ch as a greas e b an da g e w h ere th e p ar af f in creates a greas y layer o n th e wo un d . We s o m etim es us e abs o r b ent b an da g es , b e c aus e th e wo un ds may co ntinu e to rel eas e f luids .

How to get a rider ready for action the day after a crash?

T

h e o bj e c ti ve is to b e ab l e to l eave th e wo un d ‘o p en’ as s o o n as p ossib l e, I m ean n ot covere d by any thin g . If yo u cover th e sk in, th e a cidi t y o f th e sk in w ill d e creas e a li t tl e, w hich is n ot reall y w hat th e wo un d n e e ds . O f co ur s e, i f yo u dr i ve in b a d weath er th e n e x t day, resultin g in dir t y ro a ds , we have n o ch o ice b u t to p rote c t th e wo un d . An d even w h en i t ’s hid d en un d er n eath th e cl oth es , like o n th e hip, fo r e x amp l e. T h es e wo un ds ten d to s t ay o p en fo r a ver y l o n g tim e, b e c aus e th ere is f r ic tio n c aus e d by th e c yclin g p ant s .

Is pain medication permitted and/or recommended?

A

wo un d that is well covere d an d c are d fo r usuall y d o esn’t hur t to o mu ch . Cover in g a wo un d well is in i t s el f an anal g esic . If p ain d o es o ccur, p ar a cet am o l, fo r e x amp l e, c an b e us e d, a t r a di tio nal p aink ill er. We p refer n ot to gi ve anti - inf lammato r y a g ent s b e c aus e th ey have a n e gati ve e f fe c t o n re cover y. We d o n’t us e p aink ill er s b as e d o n narcotic s , like Tr ama d o l, b e c aus e c yclis t s are a c tuall y dr i v in g a vehicl e. We have to rem emb er that ...

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Are there any other elements that have a positive impact on the healing of the skin?

D

i et is an imp o r t ant f a c to r. Yo u have to eat th e r ight ma cro - an d micro nu t r i ent s .

An athl ete’s b o d y n e e ds a l ot o f en erg y as i t is an d dur in g th e wo un d h ealin g p ro cess even m o re s o. An d w i th o u t any hard s ci enti f ic p ro o f, we c an d ef ini tel y susp e c t that z in c an d v i t amin C p lay an imp o r t ant ro l e in wo un d h ealin g .

A cyclist’s main task is to perform. Can scrapes have a negative impact on performance?

A

wo un d - o f any nat ure - d eman ds a l ot o f en erg y f ro m th e b o d y. An inf lammato r y p ro cess s t ar t s an d i f i t is qui te e x tensi ve, i t w ill d ef ini tel y have an imp a c t o n th e p er fo r man ce. T h e b o d y us es en erg y fo r th e h ealin g p ro cess , an d that en erg y c an n o l o n g er b e us e d fo r p hy sic al ef fo r t s . T his ef fe c t is o f ten un d eres timate d . A wo un d c an reall y d o s o m ethin g to yo ur b o d y.

And then there’s the psychological impact of it all ...

M

os t r id er s have ha d en o u gh f alls , mak in g th em n o l o n g er af r aid o f f alls , in th e li ter al m eanin g o f th e wo rd . Bu t i f yo u have a larg e ab r asio n s o m ew h ere o n yo ur b o d y, yo u w ill si t o n yo ur b ike di f ferentl y, an d this may t ake aw ay s o m e o f yo ur s te er in g ab ili t y. An d this makes th e r isk o f f allin g, af ter a p rev io us tumb l e, even b ig g er. An d this is n ot jus t ab o u t ro a d r ash, b u t als o co ntusio ns , fo r e x amp l e. R id er s w h o d o n ot g et to th e s t ar t in th e b es t o f co n di tio ns , have a b ig g er chan ce o f f allin g by d ef ini tio n .

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cycling issue 1 2018

ORTHOPEDIC SURGEON

“Athletes require a lot of attention, both before and after the treatment.”

– Tom Claes –

T

he name Claes will definitely sound like music to the ears of many cyclists, although when they meet him it’s often because they are in some kind of ‘miserable’ situation. It is almost impossible to find a Belgian rider who has never been to the orthopaedic ward of the hospital in Herentals.

With Toon Claes as the absolute pillar, and his sons Tom and Steven and 6 other colleagues as his lieutenants, Herentals is 'the place to be’ for cyclists with collarbone fractures, knee injuries and other locomotor problems. We had an interesting conversation with Tom, who told us that Greg Van Avermaet once told him: “Your father is not here, but you are a Claes, so you can do it!” No pressure, you know ...

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Doctor Claes, talking about cyclists, what are the most common injuries?

C

yclis t s su f fer m os t o f th eir a cu te injur i es o n th e co llar b o n e. W h en th ey f all, r id er s o f ten f all o n th eir sh o ul d er. H owever, we als o s e e qui te a l ot o f chro nic injur i es .

R i d er s d o a hu g e am o unt o f rot atio ns , w hich may c aus e s ever al t y p es o f f r ic tio n p ro b l ems at th e k n e e. T his c an c aus e s er io us p ro b l ems fo r p ro fessio nal c yclis t s .

What are the biggest challenges for you as a surgeon?

I

f a r id er is invo l ve d in a f all an d su f fer s an injur y, i t is imp o r t ant in th e f ir s t p la ce that h e c an rea ch us . We have to b e av ailab l e at all tim es , als o dur in g we eken ds .

D e cisio ns have to b e ma d e quick l y. Wai tin g o n e day l o n g er b efo re o p er atin g c an b e cr u cial fo r imp o r t ant r a ces that may have b e en s ch e dul e d . T hat ’s w h ere we t r y to make a di f feren ce. B esid es , athl etes re quire a l ot o f at tentio n, b oth b efo re an d af ter th e t reat m ent . T h ey c all us an d ask fo r a d v ice: w hat c an I d o, is this o r that s ens atio n n o r mal, etc . T h es e s e em to b e t r i v ial mat ter s , b u t fo r th e r id er s i t is ver y imp o r t ant .

An d we t r y to gi ve c yclis t s th e sup p o r t th ey n e e d .

At some point you were watching the Tour of Flanders at home when Greg Van Avermaet fell and broke his collarbone. And your first thought was: “That’s for me!”

I

n d e e d, I imm e diatel y t r ans fo r m e d f ro m a sp e c t ato r into a surg e o n . I k n ew th en that th ere w as a b ig chan ce that h e wo ul d co m e to H erent als an d I did in d e e d o p er ate o n G re g that s am e evenin g . T h e n e x t day th e r id er fe els b et ter alrea d y, an d that is ver y imp o r t ant m ent all y. T h ey have mu ch l ess p ain b e c aus e th e f r a c ture is s t ab ilis e d w i th a p late an d s crew s . S o th e p ain is l ess an d th ey c an s t ar t think in g ab o u t b uil din g up a gain an d fo rg et th eir mis er y. Af ter a day o r t wo th ey c an s t ar t r i din g o n th e ro lls , c alml y, mak in g sure th eir co n di tio n d o es n ot su f fer to o mu ch .

T his is n ot jus t th e c as e fo r c yclis t s , th o u gh, als o fo r s el f- emp l oye d p er s o ns , fo r e x amp l e. A s el f- emp l oye d b aker w h o b reak s his co llar b o n e c ann ot af fo rd to b e o u t fo r l o n g . In that c as e we als o have to a c t quick l y an d a d e quatel y.

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cycling issue 1 2018

Your father once said: “The result depends on the extent to which a patient gives his body the chance to recover.” What does a standard recovery look like for a cyclist/athlete ?

P

e o p l e w h o are n ot in to p sp o r t s s o m etim es co mp lain that th eir re cover y t akes l o n g er than that o f an athl ete. An d, o f co ur s e, yo u c an’ t co mp are ap p l es an d o r an g es . It o f ten co n cer ns di f ferent t y p es o f injur y, an d we w ill alw ay s ‘p ush’ c yclis t s m o re to th e limi t s . It ’s o f ten w alk in g o n a thin lin e, an d we t r y to avoid crossin g a cer t ain b o rd er. It is imp o r t ant to k n ow h ow th e r i d er fe els . We re co mm en d th em to lis ten to th eir b o d y at all tim es an d b uil d up f ro m th ere.

In c as e o f a co llar b o n e f r a c t ure we make i t ver y r igid by ap p l y in g a p late an d s crew s .

An d th en i t ’s up to m oth er nat ure to h eal th e f r a c t ure un d er n eath . B esid es , a fo rce is e xer te d o n that p late an d i f th e l o a d is to o h eav y i t c an als o s t ar t to f ail, an d even b reak . It ’s n ot s o b a d fo r c yclis t s , b u t i t ’s di f ferent fo r m oto rc yclis t s . If th ey g o thro u gh a h eav y f all a gain fo ur we ek s af ter th e p late w as p u t in p la ce, th e p late may b en d o r even b reak . We alw ay s e x p lain th e r isk s , b u t to p athl etes d o ever y thin g fo r th eir sp o r t , th ey s earch an d s o m etim es cross th e b o un dar i es .

“They have to listen to their body and build up on that basis.”

Mental strength is indisputably very important for a good recovery What is your role in this area?

W

e imm e diatel y t r y to anticip ate h ow th e r id er is co p in g, w hat his m ent al co n di tio n is . I f th e r id er in dic ates that th e r a ces w hich are co min g up are l ess imp o r t ant fo r him, th ere’s n o n e e d to p ush him . H e has ma d e a m ent al click at that p o int an d w ill t ake thin gs sl ow l y. Bu t th ere are oth er s w h o w ant to b e b a ck o n th eir b ike as s o o n as p ossib l e an d w h o w ant to b e r a cin g to th eir ma x imum c ap a ci t y in fo ur we ek s tim e.

We sup p o r t th e r id er in w hat h e w ant s , as l o n g as i t c an b e m e dic all y sup p o r te d .

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They say it’s important to apply the right treatment at the right time. On the basis of which factors is this decided?

M

y o p inio n is that , fo r m os t f r a c tures , a c tio n has to b e t aken as ap. If yo u w ai t a co up l e o f day s , s c ar tissu e w ill alrea d y s t ar t to fo r m . T h e m ot to is: th e f resh er, th e b et ter. T h ere are o f co ur s e s o m e grey areas , d o ubt f ul c as es . N ot s o l o n g a g o we ha d a yo un g c yclis t co m e to s e e us f ro m Wes t-V laan d eren, h e c am e to s e e us b e c aus e we have a cer t ain nam e in th e c yclin g wo r l d . T h e p ati ent ha d e x p e c te d that we wo ul d o p er ate o n him imm e diatel y b u t th e f r a c ture w as m ove d o nl y slightl y an d h e w as s till ver y yo un g . T h e p ati ent ha d co m e to s e e us to g et surg er y an d to g et b a ck o n his b ike as s o o n as p ossib l e. At su ch a m o m ent we are p u t un d er s o m e p ressure, b u t in m e dic al ter ms i t w as n ot a g o o d id ea . We e x p lain e d this to th e p ati ent , that i t h eals jus t as well an d jus t as f as t w i th o u t an o p er atio n, an d o f co ur s e th ey a ccept that .

Do you give advice to athletes about how they can avoid certain injuries?

W

e d o s o esp e ciall y w h en i t co n cer ns athl etes w h o su f fer f ro m k n e e injur i es . We are n ow a team o f nin e o r th o p a e dis t s , an d I am alm os t e xclusi vel y wo r k in g o n sh o ul d er s . Fo r chro nic injur i es - mainl y k n e e an d hip injur i es - thin gs are a b i t di f ferent . Yo u c an cer t ainl y t ake p reventi ve a c tio n, fo r e x amp l e by co r re c tl y p osi tio nin g th e cl eat s o n th e sh o es , co r re c tl y p osi tio nin g th e p e dals o r th e s a d dl e h eight .

“We don’t like cutting through damaged skin.”

Abrasions on top of another injury probably require a different approach from you ...

W

h en a c yclis t f alls o n his sh o ul d er, this may s o m etim es c aus e a larg e s cr ap e. If th e sk in is gr a ze d in th e e x a c t sp ot w h ere we have to o p er ate, we p refer n ot to d o i t .

We d o n’ t like cu t tin g thro u gh dama g e d sk in . Alth o u gh this d o esn’t hap p en ver y o f ten, b e c aus e th e imp a c t is a c tuall y o n th e sh o ul d er an d o ur in cisio n is usuall y m o re at th e co llar b o n e. D ur in g th e o p er atio n th e injur y is alw ay s c aref ull y covere d to make sure that we c an d o a cl ean jo b.

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cycling issue 1 2018

Let us have a look in our crystal ball ... Are there visions or new practices in this domain which may lead to new views on the matter or new approaches in the future?

W

hat we are alrea d y d oin g is 3D p r intin g . To day, we are c ap ab l e o f d eter minin g d e fe c t s b as e d o n s c ans , w hich all ow us to p r int t ail o re d imp lant s in 3D. We d o n’t d o this fo r athl etes , b u t fo r s er io usl y wo r n sh o ul d er s w hich n e e d a sh o ul d er p ros th esis .

B esi d es , th ere are s o m e o n g oin g d evel o p m ent s in th e area o f ro b otic surg er y, mainl y in th e f i el d o f k n e e p ros th es es . B y m eans o f ro b ot s th e co mp o n ent s are ver y a ccur atel y p osi tio n e d . Human assis t an ce is o bv io usl y s till re quire d, b u t th e p re cisio n o f a ro b otic ar m is m o re a ccur ate than a human ar m . In uro l o g y p ro ce dures this te chni qu e has l o n g p roven i t s wo r th .

Finall y, c an I make s o m e p ub lici t y? O n 20 O c to b er we are o rganisin g o ur sp o r t s co nferen ce, an d this year c yclin g - an d m o re sp e ci f ic all y c yclin g injur i es - are th e cent r al to p ic . T h e t arg et gro up o f this co nferen ce are sp o r t s d o c to r s , p hy sioth er ap is t s , s o ign eur s ... B esid es us , th ere w ill b e many interes tin g sp eaker s f ro m th e c yclin g p a ck , as well as s o m e r id er s . T h e to p ic s that w ill b e dis cuss e d in clu d e: co llar b o n e f r a c tures , chro nic k n e e injur i es , h ow d o es ever y thin g wo r k f ro m a b io m e chanic al p er sp e c ti ve, h ow c an injur i es b e avoid e d . Ever yo n e w h o is interes te d c an jo in us . Welco m e!

Photo Credits Michael Blann, Rouleur

Flanders International Congress on Cycling Injuries Herentals (Belgium) 27 November 2018 https://sportcongres.org

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SPORTS PHYSIOTHERAPIST

“Scrapes and burns can be accompanied by high fever.”

– Paul Van Loon –

T

he CV of sports physiotherapist Paul Van

Loon (40) looks impressive: owner of three private hospitals, main therapist at the Ballet of Flanders, physiotherapist with the Belgian national cyclocross and mountain bike team.

He also works as a physiotherapist for several cycling teams including Rabobank, Tinkof-Saxo & several individual athletes, including Mathieu van der Poel, NAQI head instructor for Europe and Japan … In short, he is one of the Belgian top therapists! Besides, Van Loon was a cyclist himself, so he knows the ins and outs of the world of cycling. That is why we are definitely interested in his vision on abrasions and burns - and their effects on 32

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motor skills.

cycling issue 1 2018

Photo Credits@byaksel NAQI Foundation

c ycli n g issue 1 2018

Let’s get down to business, Paul. What are the problems caused by abrasions and burns when moving?

I

f th e wo un ds are n ot p ro p er l y t aken c are o f, a cr us t w ill fo r m - a hard cover, as i t were - w hich w ill make i t m o re di f f icult to m ove. Cyclis t s o f ten have s cr ap es o n th eir hips , w hich makes p e dallin g hard er. H owever, n ot jus t th e res t r ic te d m ovem ent is a p ro b l em, th e athl ete’s sl e ep c an als o b e s everel y disr upte d . It is m o re di f f icult to f in d a g o o d l y in g p osi tio n in b e d, an d ab r asio ns an d b ur ns c an als o co m e w i th high fever. A b a d night ’s sl e ep is o f co ur s e dis as t ro us fo r a quick an d g o o d re cover y. T h es e sk in injur i es c an a c t uall y have an even m o re n e gati ve ef fe c t o n th e re cover y an d p er fo r man ce o f a c yclis t than any oth er t y p e o f injur y, fo r e x amp l e a s t ab ilis e d f r a c t ure. E sp e ciall y w h en i t co m es to reall y larg e ab r asio ns , w h ere larg e p i e ces o f sk in are g o n e, th e imp a c t o n th e b o d y sh o ul d n ot b e un d eres timate d . It is als o ver y imp o r t ant to k n ow h ow to t ake c are o f a cer t ain wo un d .

And with all due respect, but as a physiotherapist you are of course not immediately an ‘expert’ in the field of abrasions ...

I

t is p ar tl y in clu d e d in o ur t r ainin g, b u t yo u c an alw ay s in creas e yo ur sk ill thro u gh a d di tio nal t r ainin g . T h e m os t imp o r t ant thin g I have l ear n e d f ro m a numb er o f e x p er t s by e x p er i en ce, is to ke ep th e wo un d m o is t . O bv io usl y n ot w i th wo un d f luid, b u t w i th cur ati ve dressin gs su ch as silico n e dressin gs . T h es e w ill a c tuall y ensure that th e wo un d w ill cl os e w i th o u t fo r min g cr us t s , s o that th e sk in remains f l e x ib l e. An d a f l e x ib l e sk in ensures sm o oth m ovem ent , w hich is my t r a d e.

Can we speak of a multidisciplinary approach?

W

e c an all l ear n f ro m ea ch oth er an d ever yo n e’s e x p er i en ce an d e x p er tis e is imp o r t ant an d us ef ul. T h e f ir s t co n cer n is a quick re cover y o f th e athl ete. Fo r e x amp l e, in c as e o f ver y larg e ab r asio ns an d b ur ns , i t may b e us ef ul to s e ek h elp f ro m sp e cialis t b ur ns cent res . I o n ce ha d a s er io us f all an d th e sup p o r t I re cei ve d f ro m th em af ter w ards w as reall y imp o r t ant fo r m e. H owever, i f we are in th e To ur d e Fr an ce, fo r e x amp l e, an d esp e ciall y in small er r a ces , yo u w ill n ot have a b ur ns sp e cialis t at han d . An d w i th all du e resp e c t fo r th e f ir s t aid p e o p l e w h o are p res ent o n th e sp ot , th ey d o n ot usuall y have any sp e cialis e d k n ow l e d g e ab o u t this k in d o f s er io us sk in dama g e. It is th erefo re imp o r t ant that yo u, as a s o ign eur o r p hy sioth er ap is t , c an a d e quatel y a dminis ter th e f ir s t c are.

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NAQI Foundation

c ycli n g issue 1 2018

Do you often have to deal with abrasions in practice?

O

f co ur s e, athl etes w h o have a s cr ap e o r a b ur n d o n ot ini tiall y g o s e e a p hy sioth er ap is t . H owever, th es e sk in l esio ns o f ten co m e w i th an oth er injur y that we c an t reat . S o we d o co m e a cross th es e k in ds o f injur i es .

Ini tiall y n ot to h elp w i th th e sk in wo un d, b u t to h elp w i th th e oth er injur i es . W h en this o ccur s i t is o f co ur s e us e f ul to als o have s o m e k n ow l e d g e ab o u t sk in l esio ns .

“ Skin injuries of ten come with other injuries. And that is our trade”.

So most of the time you are dealing with other physical problems athletes may be faced with. Do you notice that some injuries seem to have more of a mental impact than others?

W

h en i t ’s a f r a c t ure o r an oth er s er io us injur y, that ’s usuall y th e en d o f i t fo r a r id er, w h o w ill have to res t an d l et th e f r a c ture h eal. T his is a co mp l etel y di f ferent m ent al p ic t ure. T h e ab r asio n is t aken c are o f, af ter w hich th e r id er c an, in m os t c as es , r id e a gain th e n e x t day w i th o u t f ur th er a d o. T h e t r ick y thin g ab o u t this k in d o f injur y is that th e p ain an d th e oth er ‘af ter- ef fe c t s’ o f ten sur f a ce af ter a few day s . O f co ur s e, this d o es n ot m ean that ab r asio ns c ann ot have a m ent al imp a c t o n a r id er. Yo u s e e an d fe el th e wo un d, w hich c aus es yo u to si t a b i t cr amp e d o n yo ur b ike. S o m etim es yo u s e e th e s am e r id er f all a co up l e o f tim es in a r a ce. Pe o p l e ten d to s ay that h e has a b a d day o r that h e is n ot fo cus e d . Bu t all to o o f ten i t is simp l y th e f ir s t f all af fe c tin g his entire r a ce an d even th e reas o n fo r m o re f alls .

“ Sur viving the night is crucial for a c yclist with abrasions.”

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cycling issue 1 2018

T h e s am e r id er s o f ten f all an d th ey are n ot n e cess ar il y th e l eas t sk ill e d c yclis t s . In c yclin g yo u have to make re gular d e cisio ns in jus t a f r a c tio n o f a s e co n d . D e cisio ns w hich w ill result in f allin g o r n ot f allin g, w innin g o r l osin g . B ein g cr amp e d o r s c are d, fo r any reas o n w hat s o ever, may have dis as t ro us co ns e qu en ces . Yo u w ill r arel y s e e a sp r inter w h o fell o n day o n e o f a s t a g e r a ce throw in g hims el f in th e mass sp r int o n day t wo. O nl y C aven dish is an e xceptio n to that r ul e, b e c aus e h e s o m etim es s e ems n ot to fe el any p ain o r fear.

As a movement specialist, what do you advise a cyclist to do the day after a crash?

S

o m etim es we w ill l et th e c yclis t r id e o n th e ro ll er s b efo re a r a ce, o r we l et him r i d e th e b ike a b i t , s o that h e c an m ove aro un d an d fe el h ow well o r h ow b a d thin gs are g o in g . It w ill h elp g et th e f l e x ib ili t y b a ck a b i t . R es tin g is , o f co ur s e, ver y imp o r t ant fo r a g o o d re cover y, s o we t r y to limi t this . N ot ever yo n e w ill a gre e w i th w hat I am g oin g to s ay n ow. W h en i t co m es to ab r asio ns o r b ur ns , co o lin g is o f ten n ot a g o o d t reat m ent . It w ill imp air th e wo un d h ealin g . If, in a d di tio n to th e wo un d, th ere is als o inf lammatio n, that ’s an oth er s to r y.

Riders are tough guys. Grit your teeth and back on the bike ...

O

f ten th ey d o n’ t have an oth er ch o ice. In a s t a g e r a ce th ey have to g et b a ck to i t th e n e x t day. Mak in g th e r id er rea d y to s t ar t is w hat is n e e d e d . A s p rev io usl y m entio n e d, th e f ir s t thin g to d o is cl ean an d disinfe c t th e wo un d . T h en make sure that th e r id er c an g et thro u gh th e night co mfo r t ab l y. Sl e ep in g well is cr u cial an d a d di tio nal p ain co nt ro l may b e re quire d . If h e ‘sur v i ves’ th e night , th e r id er w ill b e rea d y to s t ar t th e n e x t day. An d th e main thin g w ill b e to dress th e wo un d c ausin g as li t tl e b oth er as p ossib l e fo r th e c yclis t .

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c ycli n g issue 1 2018

HEAD SOIGNEUR OF THE LOTTO-SOUDAL CYCLING TEAM

“With just a scrape, riders are back on their bike in no time.”

– Hans Van Hout –

A

s the head soigneur of the Lotto-Soudal cycling team, Hans Van Hout coordinates and manages the other soigneurs in the team. The average cycling fan associates soigneurs with massaging muscular cyclist legs, but their tasks are much more diverse in real life. They are often the first persons to see the injuries of the riders, while also being some sort of confidant. Things told on and next to the massage table - at least ... stay on and next to the massage table. But Hans didn’t mind talking to us about how he deals with and treats abrasions ...

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cycling issue 1 2018

“Not many cyclists have beautiful knees and thighs.”

Hans, what are the biggest problems/challenges with scrapes?

I

t is imp o r t ant to f ir s t s e e w h ere e x a c tl y th e sk in injur y is l o c ate d . Is i t o n a jo int , un d er n eath th e j er s ey, o n th e sh o ul d er fo r e x amp l e? In th es e p la ces i t is n ot alw ay s o bv io us to disinfe c t an d ap p l y a dressin g . If th e ab r asio n is in an oth er p la ce, n ot un d er n eath cl oth es , fo r e x amp l e, i t is n ot alw ay s eas y ei th er to ap p l y a dressin g that w ill als o s t ay in p la ce. M o re than chall en g es en o u gh!

How do you go about it in practice, on the spot, immediately after the fall? Is there actually anything you can do at that moment?

I

f i t is jus t a gr a ze, m os t b iker s w ill jump b a ck o n th eir b ike in n o tim e. A s f ir s t c are yo u co ul d ap p l y s o m e disinfe c t ant , fo r e x amp l e. T h e res t w ill b e t aken c are o f af ter th e r a ce, b e c aus e th ere’s n o tim e to l os e dur in g th e r a ce. Pain m e dic atio n is hardl y ever a dminis tere d . If th e p ain is reall y b a d, th ere is usuall y s o m e oth er injur y w hich w ill ke ep th e r id er f ro m co ntinuin g in th e r a ce.

You must work closely together with the team doctor ...

I’m

sure th ere’s s o m e s o r t o f co nsult atio n b et we en yo u . T h e m e dic al asp e c t is a c tuall y th e d o c to r ’s resp o nsib ili t y, b u t w h en i t co m es to ab r asio ns , we are o f ten th e o n es to t ake c are o f i t . T h e d o c to r w ill alw ay s have a (f inal) s ay : h ow s er io us is th e injur y, co ul d i t b e co m e infe c te d, w hat t y p e o f dressin g n e e ds to b e us e d ...? In th e en d, h e is th e o n e w h o k n ow s b es t .

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c ycli n g issue 1 2018

A soigneur is usually some kind of confidant, someone for the riders to pour out their hart to. Do they often talk about injuries?

W

h en th e r id er s are o n th e mass a g e t ab l e, we d o sp eak ab o u t ‘ro a d r ash’ an d oth er ‘min o r ailm ent s’. T h ey d o ask fo r o ur o p inio n s o m etim es . I have th e imp ressio n that r id er s o f ten f ir s t t alk to us an d o nl y th en g o s e e th e d o c to r. May b e th ey d o n’ t w ant to l o o k like fo o ls ... A s cr ap e has a di f ferent m ent al imp a c t than, fo r e x amp l e, a f r a c t ure. I o n ce ha d to d eal w i th a r id er w h o b ro ke his co llar b o n e dur in g o n e o f th e f ir s t r a ces o f th e year. S e co n ds af ter his f all h e k n ew imm e diatel y that his sp r in g s eas o n w as over. T hat ’s a h eav y m ent al b l ow. M os t r id er s k in d o f lau gh ab o u t a few s cr ap es . I d o n’t think many r id er s s till have ‘sm o oth’ k n e es an d thighs .

H ow th ey d eal w i th i t m ent all y o f ten d ep en ds o n th e t y p e o f r a ce dur in g w hich an d th e m o m ent w h en i t o ccur s . Is i t a r a ce th ey t r ain e d hard fo r an d reall y li ve d fo r? R id er s s et cer t ain g o als fo r th ems el ves dur in g a s eas o n . G et tin g injure d w hil e t r y in g to rea ch th os e g o als is o bv io usl y e x tr a p ainf ul an d c aus es great dis ap p oint m ent . A slight f all dur in g th e f ir s t day o f a multi - day r a ce is usuall y n ot a dr ama .

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Photo Credits Photonews

“A rider is more cautious, but more quickly distracted as well. It’s quite a tricky thing!”

cycling issue 1 2018

During a stage race a rider who fell must get back on his bike the next day. How are you going to get him ready to race?

I

n th e f ir s t p la ce we are g oin g to c aref ull y ch e ck that th ere is n o (threat o f ) inf lammatio n, an d we p re fer ab l y d o this a few tim es a day. If th ere is an inf lammatio n, i t is usuall y ‘gam e over ’ an d th e r id er wo n’t b e ab l e to co ntinu e. In r a ces like Par is- R o ub ai x th e r id er s are co mp l etel y covere d in dir t an d i f that en ds up in a wo un d, th ere is a b ig chan ce that a p ro b l em w ill ar is e. If n e cess ar y, a di f ferent t reatm ent o r dressin g sh o ul d b e us e d .

Does a rider who falls on day 1 behave differently on his bike on day 2?

A

bs o lu tel y. An d that ’s mainl y b e c aus e r id er s have to a djus t th eir p osi tio n af ter a f all. B e c aus e th ey su f fere d an injur y, th ey are n o l o n g er ab l e to m ove cer t ain p ar t s o f th eir b o d y like b e fo re. T h ey w ill reli ve th e f all o f th e p rev io us day in th eir min ds a few m o re tim es . Was i t th eir ow n f ault? D id an oth er r id er make a mis t ake? In f un c tio n o f th es e qu es tio ns a r id er w ill b e co m e m o re c au tio us , as i t were, an d s till b e m o re quick l y dis t r a c te d f ro m his main t ask . It ’s t r ick y. T h e r id er s als o k n ow that i f th ey cr ash a gain i t c an b e all over an d o u t , o r th ere may b e even m o re di f f icult day s ah ea d . T hat ’s qui te h eav y to d eal w i th ps ych o l o gic all y.

Finally, let's be the devil’s advocate ... It is sometimes argued that soigneurs do not always have the right background and training to treat abrasions - and by extension, other injuries. What do you think of this statement?

I

am cer t ainl y n ot g oin g to d eny that this is , o r c an b e, th e c as e in yo u th an d wo m en’s c yclin g, w h ere vo lunte er s are a cco mp any in g th e r id er s . In th e c as e o f a p ro fessio nal team, s oign eur s mus t b e ab l e to p res ent cer t ain quali f ic atio ns , b e c aus e th ey have to ap p l y fo r a p er mi t . Fo r e x amp l e, we have a b asic t r ainin g in anato my, f ir s t ai d an d even resus ci t atio n . Many s o ign eur s have als o co mp l ete d a sp o r t s d e gre e, fo r e x amp l e a mas ter in p hy sic al e du c atio n . We als o t ake re gular ref resh er co ur s es to s t ay up to date, in clu din g at Na qi. S o w i th m e an d my co ll ea gu es th e r id er s are cer t ainl y in g o o d an d s afe han ds!

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c ycli n g issue 1 2018

PROFESSIONAL CYCLIST

“The trick is to focus entirely on your performance and not on the ‘exterior factors’...”

– Ann-Sophie Duyck –

A

nn-Sophie Duyck (30), from West-Vlaanderen, rides for Cervélo Bigla Pro Cycling, and has been an active member of the women’s pack for some years. In 2012 Ann-Sophie became more dedicated to time trial. She is the four-time Belgian champion in this discipline. In 2017 she earned a silver medal at the European Time Trial Championship. In the same year she was outsider favourite in Gent-Wevelgem, but unfortunately she had to give up after a severe fall. She knows better than anyone what it is like to crash on asphalt as a cyclist, and what the painful consequences are.

We asked her how she deals with skin lesions and how they affect her performance.

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NAQI Foundation

“Just seeing the wound is sometimes enough to induce fear.�

Photo Credits: http://hanswarreyn.photography

c ycli n g issue 1 2018

Ann-Sophie, as a cyclist, what are - apart from falls the biggest problems for your skin?

M

any o f us are su f fer in g f ro m p ro b l ems to o ur b u t to ck s . T h ere’s th e p ressure f ro m th e s a d dl e, th e s weat an d th e f r ic tio n o f th e cl othin g, w hich easil y c aus es ir r i t atio n .

Fo r tunatel y, I have relati vel y li t tl e f r ic tio n p ro b l ems . W h en I wear a tight- f i t tin g shir t un d er my j er s ey I may have s o m e p ro b l ems in my ar mp i t s . T h e weath er is als o a b ig f a c to r in this , o f co ur s e. Cyclin g in th e p o ur in g r ain fo r an entire day is n ot mu ch f un fo r yo ur b um, b u t n ot fo r oth er b o d y p ar t s ei th er.

Are there certain things you do before a training or a race to protect your skin better against a fall?

B

esi d es yo ur cl oth es , th ere’s n ot mu ch yo u c an d o to p rote c t yo ur s el f a gains t a p otential f all. Bu t , to g et b a ck to th e b um p ro b l em, I p er s o nall y us e th e NAQ I B o d y S cre en, fo r e x amp l e. If yo u us e this p ro du c t in th e l o n g ter m b efo re a r a ce, yo ur sk in w ill b e ‘ t r ain e d ’ to b et ter resis t ir r i t atio ns . W h en yo u d o this dail y, even o n day s w h en yo u d o n’ t r id e, i t w ill have a p osi ti ve ef fe c t o n th e sk in .

You mentioned the cycling clothes earlier. Are there any developments in that domain which may have an impact in case of falls?

A

bs o lu tel y. T h e D u tch f ir m DSM , a c ti ve wo r l dw id e in h ealth, nu t r i tio n an d mater ials , d evel o p e d a n ew f ab r ic w i th D y n e ema® f ib res , w hich is a c tuall y a k in d o f s e co n d sk in layer. T his t ro us er f ab r ic o f fer s e x t r a p rote c tio n fo r th e thighs , a c yclis t ’s m os t v uln er ab l e p ar t s o f th e b o d y. It signi f ic antl y re du ces th e r isk o f s er io us injur i es .

Which skin injury do you experience as the most troublesome/painful?

I

t may n ot b e a sk in l esio n in th e m os t li ter al s ens e, b u t I o n ce l os t my f in g er nails in a f all. T hat is reall y aw f ul an d p ainf ul, als o af ter w ards w h en fo r ins t an ce yo u have to t ake s o m ethin g o u t o f yo ur t ro us er p o cket . S er io us ab r asio ns , w hich are als o p ar tiall y b ur ns , are reall y n ot eas y to co p e w i th . A s s o o n as yo u have an injur y w hich e xcretes f lui ds , yo u’re in t ro ub l e. T h ey are n ever nice wo un ds to l o o k at ei th er. I ’d r ath er have s o m e b r uis es .

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cycling issue 1 2018

Do these scrapes affect your performance in any way?

I

t has a s er io us p hy sic al, as well as a m ent al imp a c t . Jus t s e ein g a wo un d c an c aus e a cer t ain fear o f g et tin g invo l ve d in a f all a gain . L as t year, af ter my s evere f all in G ent-Wevel g em, that is e x a c tl y w hat hap p en e d to m e. Yo u are a c tuall y sp en din g to o mu ch en erg y o n to this m ent al asp e c t . O f co ur s e, all r id er s have a di f ferent w ay o f co p in g w i th this . T h e t r ick is to fo cus entirel y o n yo ur p er fo r man ce an d n ot o n th e ‘e x ter io r f a c to r s’. B esid es , a wo un d that is covere d by cl othin g o r a dressin g dur in g th e r a ce w ill alw ay s c aus e yo u to fe el an ir r i t atio n . An d all th es e li t tl e thin gs w ill dis t r a c t yo u f ro m th e ess en ce o f th e mat ter : w innin g th e r a ce.

Do you actually have a say in the care of a wound or do you leave it entirely to the doctor/physio?

I

n wo m en’s c yclin g we d o n ot (yet) have a team d o c to r at o ur disp os al dur in g th e r a ces . S o yo u are p ar tl y at th e m erc y o f th e g o o d c are o f th e s o ign eur s . Natur all y, n ot ever yo n e has th e r ight b a ckgro un d o r t r ainin g to ap p l y a d e quate wo un d c are. In p r a c tice, yo u w ill o f ten t ur n to th e m e dic al s t af f w hich th e o rganis atio n p rov id es .

H owever, th ey mainl y ch e ck fo r f r a c tures , b u t p ay l ess at tentio n to ab r asio ns . S o yo u are als o larg el y s el f- reliant . Yo u g o h o m e an d t ake c are o f i t th ere o r yo u l et s o m e o n e els e t ake c are o f th e wo un d . W h en I l os t my f in g er nails in that o n e f all, I b o u ght d ozens o f dressin gs an d b an da g es an d oth er quick f i xes . Per s o nall y, I c an’t co mp lain b e c aus e I am sup p o r te d by NAQ I an d I c an us e th eir p ro du c t s . Af ter my f all in G ent-Wevel g em las t year, NAQ I s ent m e th e NAQ I R ep air O il, am o n g oth er thin gs , w hich has a p osi ti ve e f fe c t o n th e s c ar tissu e an d that wo r ke d reall y well.

Are there other factors that have a (positive) effect on the healing of the skin?

I

have alrea d y n otice d that weath er co n di tio ns have a hu g e imp a c t . If i t is to o h ot o r to o co l d, th e h ealin g p ro cess sl ow s d ow n .

D i et is als o an imp o r t ant f a c to r. W h en yo u g o b a ck to c yclin g af ter an injur y, o r yo u have su f fere d an injur y, i t is imp o r t ant , fo r e x amp l e, to t ake in en o u gh p rotein . Yo u may have to t ake a few day s res t af ter a f all, w hich w ill re du ce yo ur int ake o f c ar b o hydr ates . H owever, yo u have to to p i t up thro u gh fo o d o r sup p l em ent s to p rov id e su f f ici ent en erg y to yo ur b o d y fo r th e re cover y p ro cess .

“Bad weather conditions slow down the healing process.”

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c ycli n g issue 1 2018

I N T E R N AT I O N A L T R A I N I N G M A N AG E R N AQ I

“It is important to make sure that the skin can always breathe and transpire.”

– Nik Geyskens –

T

he NAQI skin care products are much appreciated by athletes and sports associations in a wide array of disciplines. Even more: the athletes’ wish is NAQI’s command! The products are made tailored to the needs of and in cooperation with those who have to use them on a daily basis in order to perform at top level. Nik Geyskens is Account Manager and International Training Manager at NAQI. We asked him what the challenges are with regard to the skin and why NAQI is the ideal skin care partner.

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NAQI Foundation

cycling issue 1 2018

Nik, what do sports physicians have to take into account in terms of skin care and is there anything they can do preventively?

T

hat ’s qui te a b ro a d qu es tio n an d th ere’s a l ot th ey c an d o, a c tuall y. T h e sk in is ver y thin an d is sup p os e d to p rote c t us in all k in ds o f circums t an ces an d a gains t di f ferent f a c to r s . A b ig ‘p ro b l em’ w i th athl etes is that th ey sh ower a l ot an d that h ot w ater an d s o ap diss o l ve th e p rote c ti ve f at layer o f th e sk in . B esid es , many athl etes wear cl os e d sh o es w hich are n ot su f f ici entl y ventilate d an d w hich d o n ot gi ve yo ur fe et th e chan ce to g et s o m e air an d d o n ot l et th e s weat dr y up quick l y. B e c aus e o f this th e ‘b ar r i er ’ (th e sk in layer), w hich sh o ul d p rote c t us , c an g et dama g e d an d micro - o rganisms g et th e o p p o r tuni t y to grow. T h ere fo re, th e aim is to s t ren g th en th e sk in in that resp e c t . T his c an b e a chi eve d by sh ower in g w i th a mil d s o ap - f re e s o ap o r sh ower g el, dr y in g yo ur s el f o f f th o ro u ghl y als o b et we en th e to es an d l et tin g th e sk in hydr ate af ter sh ower in g . T his is usuall y a b i t m o re di f f icult fo r m en than fo r wo m en, b e c aus e th ey d o n’t usuall y have th e hab i t o f ap p l y in g a cream o r t ak in g c are o f th eir sk in .

Cyclists obviously often have to deal with friction ...

T

hat ’s t r u e, o n e o f th e p ar t s that su f fer is th e b um . T hat ’s o n e o f th e p la ces w h ere s t ren g th enin g th e sk in is ver y imp o r t ant - to p rov id e c are an d hydr atio n . T h e f un c tio nali t y o f th e b ar r i er layer mus t b e res to re d . It has b e co m e s o thin that ever y imp a c t i t un d erg o es is a k in d o f dama g e. It is ver y imp o r t ant n ot to us e Vas elin e, al th o u gh i t is p o p ular l y k n ow n to b e a g o o d p rote c ti ve p ro du c t . It d o es gi ve s o m e s o r t o f p rote c tio n, b u t i t wo n’t all ow th e sk in to b reath e, th e ev ap o r atio n o f w ater is b l o cke d . If th e m o is ture is t r ap p e d w h en yo u are d o in g sp o r t s , th e sk in b e co m es b lan d .

E x tr a l o a d o n that b lan d sk in w ill dama g e th e sk in . It is als o imp o r t ant n ot to us e antib a c ter ial p ro du c t s w hich dis t ur b th e n o r mal sk in f l o r a o r p ro du c t s w i th a high co ntent o f eth ereal oils w hich c an ir r i t ate th e sk in .

Photo Credits: Eva Synnestvedt Hansen cyclingmemories @ebbehastng

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c ycli n g issue 1 2018

Are there NAQI products that could help with this?

T

h e NAQ I B o d y S cre en c an b e ver y us ef ul in th es e c as es . It c an b e ap p li e d p reventi vel y, an d cer t ainl y n ot o nl y to th e b um . Cyclis t s s o m etim es su f fer ab r asio n c aus e d by th e h elm et b u ck l e un d er th eir chin, o r by a shir t that c aus es f r ic tio n in th e ar mp i t s o r at th e nip p l es . In th es e c as es th e B o d y S cre en c an als o b e ap p li e d . Athl etes w h o su f fer f ro m ab r asio ns du e to f r ic tio n sh o ul d us e th e B o d y S cre en re gular l y as a k in d o f day cream o n th e s ensi ti ve areas . It w ill h elp th em p rep are, p rote c t an d s t ren g th en th eir sk in in th e r un - up to a co mp eti tio n .

Let’s talk specifically about abrasions. How are they treated and which NAQI products can be used?

A

n imp o r t ant remar k to b e ma d e is that we d o n ot o f fer wo un d c are p ro du c t s , b u t sk in c are p ro du c t s . We c an wo r k aro un d th e wo un d to s timulate th e h ealin g p ro cess .

Fo r e x amp l e w i th th e NAQ I Mass a g e O il R ep air we have a p osi ti ve ef fe c t o n sk in rep air by ap p l y in g ess ential f at t y a cids w hich are n ot p ro du ce d by th e b o d y. In a d di tio n, i t a c t s o n th e sk in’s elas tici t y. O n ce th e wo un d is cl os e d, th e s c ar s that are g en er ate d have an imp a c t o n th e elas tici t y. Jus t ima gin e a c yclis t w i th a s c ar o n his k n e e. It w ill d e f ini tel y af fe c t his m o b ili t y an d limi t i t . T h e s c ar w ill th erefo re sl ow d ow n th e m o b ili t y. T h e sm o oth er th e sk in, th e m o re co mfo r t ab l e yo u c an m ove o r th e f as ter rehab ili t atio n c an b e s t ar te d .

Are there any other elements, other than the care products, that have a positive influence on the recovery of the skin?

I

b eli eve that th e imp o r t an ce o f g o o d an d su f f ici ent res t an d a b alan ce d, h ealthy di et sh o ul d cer t ainl y n ot b e un d eres timate d . An athl ete has to lis ten to his b o d y an d resp e c t w hat i t ask s fo r. T his w ill h elp th e re cover y.

“Most of our products are the result of a demand from the market.”

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How is the collaboration between you and athletes, doctor, soigneurs... ? Do they sometimes ask specific questions about the development of certain products?

I

f we l o o k at o ur sp o r t s r an g e, i t is t r u e that m os t p ro du c t s are th e result o f a d eman d f ro m th e mar ket . Cyclis t s wo ul d o f ten have sp e ci f ic re qu es t s , b e c aus e i t is an en dur an ce sp o r t o f ten t ak in g p la ce in e x t rem e co n di tio ns . Bu t we als o wo r k cl os el y to g eth er w i th all k in ds o f sp o r t s ass o ciatio ns , w h o us e o ur p ro du c t s an d re co mm en d th em to th eir athl etes .

Cyclis t s s o m etim es ask fo r a w ar min g p ro du c t w i th a di f ferent d e gre e o f w ar min g . It may b e to o co l d o r to o h ot . T h ey c an als o in dic ate, fo r e x amp l e, that in cer t ain circums t an ces a re f reshin g mass a g e p ro du c t is m o re p l eas ant than a co nventio nal p ro du c t . T h eir w ish is o ur co mman d!

Photo Credits: gruberimages

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c ycli n g issue 1 2018

HEAD R&D NAQI

“The necessity of essential fatty acids” T

he epidermis and the dermis constitute the two principal layers of the skin. The horny layer of the epidermis serves as a barrier preventing water loss and invasion of microbes and irritants, while the dermis provides physical and nutritional support to the epidermis. The horny layer provides a unique structure of dead cells embedded in a hydrolipidic film, where the presence of Linoleic Acid in the lipids is necessary for an intact barrier with a well hydrated, smooth skin surface as result.

– Greet Claes –

L

in o l eic Acid imp roves th e co h esio n o f th e cells an d natur all y p rote c t s th e sk in s t r u c t ure f ro m a g gressio ns . T h e ess ential b uil din g b r ick s Lin o l eic Acid (O m e ga - 6 Fat t y Aci d ) an d Alp ha - Lin o l enic Acid (O m e ga -3 Fat t y Acid ) are n ot p ro du ce d in o ur b o d y even th o u gh th ey are an abs o lu te n e cessi t y fo r th e s y nth esis o f cell m emb r an es an d p ros t a glan dins , fo r d e fens e an d grow th m e chanisms an d fo r th e p hy sio l o gic al an d b io ch emic al p ro ce dures o f cell re g en er atio n . T h ey are als o anti - inf lammato r y, s o th ey h elp c alm an d s o oth e sk in co n di tio ns .

I f Lin o l eic Acid is la ck in g dur in g th e h ealin g p ro cess o f th e sk in oth er av ailab l e f at t y a ci ds w ill rep la ce i t , b u t this w ill result in an in creas e d sk in p er m eab ili t y an d s ensi ti v i t y, o f ten l eav in g th e sk in dr y an d i tchy.

Ad din g ess ential f at t y a cids thro u gh di et has a limi te d an d tim e co nsumin g ef fe c t o n sk in h ealth . T h e ep id er mal layer s o f th e sk in d o n ot co nt ain b l o o d vess els to sup p l y th e cells w i th nu t r i ent s , as b l o o d vess els are o nl y fo un d in th e d er mis . Ad di tio nall y th e s t r u c t ure o f th e ep id er mis p revent s th e circulatio n o f e x t r a cellular f luids . T h erefo re, th e o u ter layer s o f th e ep id er mis are p rov id e d w i th l ess nu t r i tio nal sup p o r t than th e un d er l y in g cells . S o h ow e f fe c ti vel y sup p l y th e ess ential f at t y a cids th en ? Fo r tunatel y th e sk in is dire c tl y af fe c te d by th e us e o f to p ic al ap p lic atio ns . To p ic al ap p lic atio n has b e en p roven to b e ver y ef f ici ent in sup p l y in g ess ential f at t y a cids to th e sk in .

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To strengthen the skin and improve the skin regeneration NAQI offers a variety of solutions: BOOSTER NAQI REPAIR OIL NAQI® REPAIR OIL contains 80% pure Omega-3 and Omega-6 Fatty Acids to boost skin cell regeneration and intensify the skin healing process. ● Apply this booster twice a day during 2 to 3 weeks. Massage a few drops gently into the skin.

After 2 to 3 weeks of using The NAQI® Repair oil , it is recommended to reduce the percentage of Omega-3 and 6 Fatty Acids to avoid overstimulation of the skin cell renewal and scaling.

MAINTENANCE PHASE NAQI MASSAGE OIL REPAIR To continue the skin care NAQI® Massage Oil Repair is advised. NAQI Massage Oil Repair combines Omega-3 and Omega-6 Fatty Acids in the form of Rose Hip Oil with other nourishing oils. NAQI® Massage Oil Repair optimizes the water holding potential of the natural barrier, improves the smoothness and moisturisation of the skin and reduces the appearance of scars. ● Apply daily by massaging a few drops into the skin.

CREAM NAQI ® CICA CREAM For those who prefer creams to oils, NAQI recommends the NAQI® Cica Cream or NAQI® Cica Gel . Both are anti-oxidant rich emulsions, containing Omega-3 and Omega-6 Fatty Acids with a soft, light feel and high penetration to reinforce and moisturise the skin, strengthen the skin barrier and accelerate the skin renewal.

To ensure optimal skin care, it is best to alternate the NAQI® Massage Oil Repair and the NAQI® Cica Cream or Gel. This way the skin recieve all necessary nutrients and essentiel fatty acids.

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PROFESSIONAL CYCLIST

“Nothing but praise for the NAQI Repair Oil and NAQI Cica Cream!”

– Jolien D’Hoore –

" After a fall during a race in China, both my arms were scraped and I had ugly burns.

After a few weeks of intense use of these products there was no sign of the injuries and everything healed for 100% ! ”

Photo Credits: MVH/vrouwenpeleton.be

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“ After the fall, Jolien started using the NAQI Repair Oil for two weeks. In the maintenance phase she switched to the NAQI Massage Oil Repair and alternated this with the NAQI Cica Cream. "

May 8, 2017

After the fall May 16, 2017

May 21, 2017

After 2 months July 5, 2017

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All rights reserved. No part of this publication may be reproduced in any form or by any means without permission in writing from the editor of the NAQIÂŽ Therapeutic Magazine.

FOUNDATION

HYPOTHESIS: The hypothesis of the NAQIÂŽ Therapeutic Magazine is that the quality and the outcome of therapeutic care and sports performance will substantially increase if treatment is supported by skin therapy/care.

The condition of the skin (ao scars, dry skin) can negatively influence therapeutic care and sports performance, even to a degree that skin care becomes a necessity before any other treatment.

W W W.NAQIFOUNDAT ION.COM NICHOLAS HOUSE - RIVER FRONT ENFIELD, MIDDLESE X EN1 3FG UNITED KINGDOM

C YCLING ISSUE 1 2018: 28€

FOUNDATION