In cycling, crashes are an inevitable part of the sport. Ride your bike for long enough and at some point you’re going to fall off either from pushing the limits of tyre grip, a mechanical failure or something completely outside of your control.
A study by Eley et al. (2019) which aimed to characterize the patients presenting with bicycle related injuries to A&E departments showed that fractures accounted for over one-third of injuries. When they looked at how falls occurred more than half were attributed to bike-handling errors. A meta-analysis by Rooney et al. (2020) which explored similar areas found that abrasions, lacerations, and haematomas accounted for 40-60% of injuries, while fractures accounted for 6-15%. Head injuries made up 5-15% with musculotendinous injuries accounting for 2-17.5%. The upper limb was more frequently affected by injuries than the lower limb, with amateurs appearing to be at higher risk of injury than professionals. The clavicle was the prevalent fracture.
The old adage of “you’re not a proper cyclist until you’ve broken your collarbone” might be true here.
While the above makes for some grim reading it’s not the topic of this blog. We’re all too aware of this often-unacknowledged aspect of return to sport. In cycling it’s often characterized by decreased descending speed, cornering confidence or confidence riding in groups. More often than not it’s highlighted when you’re exposed to similar situations which may have pre-empted a previous crash. So, what we want to focus on is, once these injuries have healed, how do we get back to our baseline performance, not from a physical standpoint, but, from a psychological one.
Fear of Re-Injury & How it May Interlink
While we’re now aware that sport’s injuries cause physical impairments, they are also known to cause psychological ones (Crossman, 1997). One such psychological impairment following an injury is the fear of re-injury (Grossman et al., 1995). In their work, Crossman and colleagues suggested that coupled with a physical return to play rehabilitation programme a psychological one is also needed. They suggest that the psychological trauma following an injury is often more difficult for the affected athlete then the physical trauma itself. Fear of re-injury or not returning to preinjury levels of performance is very common in athletes. When we look at the topic of this post in terms of a crash causing an injury it is only natural for the athlete to be fearful of similar situations again.
Other Responses of The Injured Athlete
The 3 main emotions athletes report shortly after being injured are frustration, depression, and anger (Pearson & Jones, 1992). Smith et al. (1990) suggested that the more severe an injury sustained the more severe the psychological trauma will be. These emotions are not conductive to an efficient and timely return to play and often rebound to acute post injury levels prior to return to sport (Clement, 2014). Hsu and colleagues (2016) refer to this as a “U” pattern of recovery. More than likely this is due to our ability to prioritize rehabilitation and recovery in the middle of the return to sport process interlinking with our process orientated behaviour as athletes.
From these varying responses to injury, we can see that we’re not set up for successful return to sport with high confidence to take on that next descent. We also know from a basic causational relationship that the emotions above cause stress, stress is characterized by high levels of cortisol which then effect our ability to recover. This means both our physical and psychological ability to return to baseline is compromised.
A Quick Word on Athlete Identity
While diving into athlete identity is beyond the scope of this article it is worth briefly touching on it as a precursor to some of the emotional responses to your sport being taken away from you. Athletic identity is the degree to which an individual identifies with the athlete role and looks to others for acknowledgement of that role (Brewer, Van Raalte, & Linder, 1993). We can deduce from this that once the “athlete” part of your identity is taken away via injury psychological impacts can ensue. Self-esteem is one such aspect that is majorly affected (Chan & Crossman, 1988). So, a quick word of warning, ensure you have developed healthy relationships and hobbies outside of sport to fall back on when sport cannot happen.
Let’s get back on topic..
Confidence on a bike is a feeling, it’s subjective to each individual. A downhill mountain biker may not be confident in descending an alpine road climb at 80 kilometres per hour but be perfectly confident in hitting a 20-foot jump. The Oxford English dictionary defines confidence as “the feeling or belief that one can have faith in or rely on someone or something”. Via the mechanisms highlighted previously confidence is often lost in a crash.
Strategies to Overcome Fear of Re-Injury
Oftentimes, it is the fear of injuring oneself again that knocks this confidence out on the open road. While drawing direct parallels with the research linked to fear of re-injury has its limitations due to it being mainly based within the musculoskeletal and soft tissue injury domain we can use it to guide our thinking. Hsu et al. (2016) provided some practical applications found from their meta-analysis of the area. These interventions included (among others) education around fear-avoidance beliefs, goal setting, imagery, self-talk, graded exposure, and social support.
Wertli et al. (2014) looked at fear avoidance beliefs in patients with low back pain and found that fear avoidance beliefs are associated with poor treatment outcomes in this specific population. It is fair to draw parallels from the fear avoidance model (below) into our advice for return to sport here. Athletes returning to sport should be educated on fear avoidance beliefs to catch themselves if this form of behaviour is present.
Goal setting can provide direction for the athlete in their return to sport. Goals should be specific and measurable to aid in monitoring of achievement. We refer back to the beginning of this article here in relation to the “U” concept discussed by Hsu and Colleagues (2016). It is fair to assume that the decreased emotional distress during the recovery period is, in part, related to process-based goals. There is no reason why we cannot carry this over into our return to play and increased confidence out on the road.
Imagery is a common psychological skill used by successful athletes. Imagery has been shown to have a physiological effect in reducing stress hormones (McKinney et al. 1997). We referred to stress hormones earlier and their ability to negatively impact recovery. Here, you may imagine yourself nailing that sweeping bend with great technique or riding close to your clubmate beside you.
Self-Talk is something we’ve touched on in our blog before. Simply put self-talk helps athletes identify and challenge negative thinking patterns. Giving a real-world context this could mean you’re nervous of a car reversing out on to the road as you have previous experience of being knocked off in this situation. In this context you may adopt a better road position which is positive, but, you may also engage in negative self-talk suggesting that “this always happens to me, maybe I shouldn’t ride this road again” or decrease my speed substantially. The positive self-talk here would go like: “I’ve adopted a better road position, I’ve made eye-contact with the driver and adjusted my speed – I have done all that I can do in this situation”.
Woods & Asmundson’s (2008) work on graded exposure in patients with chronic low back pain ties in with the above on the fear avoidance model. They suggest graded exposure to movements and tasks that were previously known to cause pain can have positive outcomes on a patient’s recovery. Patients in this study who underwent the intervention showed significantly greater improvements on measures of fear of pain/movement, fear avoidance beliefs, pain-related anxiety, and pain self-efficacy. For our return to baseline following a crash example we can draw some conclusions here in practical terms. One such example could include building speed progressively through a corner that you are fearful of falling off on due to your tyres slipping out in line with a previous crash. This can help build confidence in a similar way to the goal setting mentioned above.
Lastly, social support can play a big role in overcoming the fear of re-injury. We may find solace in the fact that others have gone through similar journeys before and can help us. Key here also is a good coach-athlete relationship to ensure preinjury baseline is not expected too quickly and both parties acknowledge the processual nature of this. As always communication is key.
I hope you enjoyed this deep dive into cycling injuries, crashing, and regaining one’s confidence. While our bones may heal quickly, or our cuts and scrapes fade away it’s so important to recognize the psychological impact crashing can have on performance. Simply recognizing this presents us with the first step to rectifying it. Hopefully the 5 steps above and accompanying information can go a long way to helping you on your path to recovery. As always if you feel injury or fear of reinjury is affecting your psychological state please talk! A friendly chat, a consultation with a qualified coach or a workshop with a qualified psychologist can really put you on the right path here.
Thanks for reading you can find a full list of cited works below if you’re that way inclined!
Brewer, B. W., Van Raalte, J. L., & Linder, D. E. (1993). Athletic identity: Hercules’ muscles or Achilles heel?. International journal of sport psychology.
Chan CS, Grossman HY. Psychological effects of running loss on consistent runners. Percept Mot Skills 1988; 66: 875-83
Clement D, Arvinen-Barrow M, Fetty T. Psychosocial responses during different phases of sport-injury rehabilitation: a qualitative study. J Athl Train. 2014;50: 95-104.
Crossman J, Gluck L, Jamieson J. The emotional responses of injured athletes. N Z J Sports Med. 1995;23:1-2.
Crossman J. Psychological rehabilitation from sports injuries. Sports Med. 1997; 23:333-339
Eley, Robert, Vallmuur, Kirsten, & Catchpoole, Jesani (2019) Value of emergency department triage data to describe and understand patterns and mechanisms of cycling injuries. EMA – Emergency Medicine Australasia, 31(2), pp. 234-240.
Hsu, C. J., Meierbachtol, A., George, S. Z., & Chmielewski, T. L. (2017). Fear of reinjury in athletes: implications for rehabilitation. Sports health, 9(2), 162-167.
McKinney CH, Antoni MH, Kumar M, Tims FC, McCabe PM. Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. Health Psychol. 1997;16:390-400.
Pearson L, Jones G. Emotional effects of sports injuries: implications for physiotherapists. Physiotherapy 1992; 78 (10): 762-70
Rooney, D., Sarriegui, I., & Heron, N. (2020). ‘As easy as riding a bike’: a systematic review of injuries and illness in road cycling. BMJ Open Sport & Exercise Medicine, 6(1),
Smith AM, Scott SG, O’Fallon WM, et al. Emotional responses of athletes to injury. Mayo Clin Proc 1990; 65: 38-50
Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear avoidance beliefs—a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14:2658-2678
Woods MP, Asmundson GJ. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomized controlled clinical trial. Pain. 2008;136:271-280.