After the crash: what to check, when to ride again

Most riders crash eventually, and most crashes end with road rash, a bent lever and a bad mood. Some do not. This post is about the hour after the impact and the weeks after that: what to check, in what order, and how to decide when riding again is sensible rather than merely possible. One rule sits above all the others, and we will repeat it because it matters: if you hit your head, or you cannot remember whether you hit your head, you see a doctor before you ride again. Nothing below replaces that.

The first ten minutes: head, then neck, then everything else

Concussion is not rare in cycling. The UCI puts sport-related concussion at somewhere between 1.3% and 9.1% of injuries across its disciplines, and adopted a cycling-specific concussion protocol from the 2021 season because the standard sideline tools were not designed for a rider on the road. The awkward part is that a concussed rider is often the last person able to judge it. The UCI's guidance for non-medical staff lists the signs to watch for in someone else: looking stunned or dazed, trouble with balance, headache, slurred speech, changes in vision. If you are the one on the ground, the questions are simpler. Do you know where you are, what the date is, and what happened? Is your helmet cracked or dented? Did you black out, even briefly?

The NHS guidance on head injury is explicit about what needs an ambulance rather than a lift home: loss of consciousness or trouble staying awake, a seizure, problems with vision or hearing, clear fluid from the nose or ears, new numbness or weakness, difficulty walking, balancing or speaking, or a high-speed impact of the sort a bike crash at road speed plainly is. Vomiting, dizziness, or being on blood thinners are reasons to get urgent advice even without the red flags. Riders on anticoagulants should treat any head impact as a hospital visit.

Then the neck. Pain in the neck, or pins and needles in the arms, after a crash means you stay still and someone calls for help. Only after the head and neck are cleared do you start the inventory: collarbone, wrists, hands, hips, ribs. Silberman's review of bicycling injuries notes that the collarbone, the wrist and the shoulder are the classic fracture sites, because riders go over the bars and land on an outstretched arm or the point of the shoulder.

Concussion: the timeline is not negotiable

The current international consensus on concussion in sport, from the Amsterdam conference published in 2023, replaced the old advice of strict rest with a graduated return. The first 24 to 48 hours are relative rest: normal daily activity, but nothing that provokes symptoms, and less screen time. After that, light aerobic exercise is encouraged as long as symptoms stay mild, followed by a stepwise increase in intensity, then sport-specific training, and full contact or racing only when symptoms have cleared and a clinician has agreed. Each step takes at least a day, and any return of symptoms means stepping back.

The UCI's protocol for licensed riders follows the same shape with firmer numbers: complete rest for 24 to 48 hours, and no return to competition until at least a week after symptoms have fully cleared, two weeks for juniors. The NHS page is more conservative for the general public and advises no contact sport for at least three weeks. Those are different populations with different levels of medical supervision; a club rider without a team doctor should lean towards the more cautious end.

• See a doctor. Not a physio, not a coach, not us. A clinician assesses a head injury, to a standard, and signs off the return. That is their job, and no amount of feeling fine replaces it.
• The turbo is not a loophole. "Light aerobic exercise" in the consensus means light: an easy spin with no intervals, stopped at the first sign of headache, fog or nausea. It does not mean a sweet-spot session because you are bored.
• Replace the helmet. Whatever it looks like. A helmet that has done its job once is not guaranteed to do it twice; we explain why in helmet safety standards.
• Symptoms that linger need follow-up. Headache, poor sleep, irritability or trouble concentrating that persist beyond a couple of weeks are a reason to go back, not to push through.

Fractures: the collarbone and the rest

A broken collarbone is the cyclist's fracture. Robertson and Wood's systematic review of return to sport after clavicle fractures found that around 92% of athletes got back to their sport, at an average of about 96 days across all sports and treatments, with surgery producing faster and more reliable returns for displaced mid-shaft breaks. Professional cyclists get back much faster: Konarski and colleagues reviewed 188 clavicle fractures in professional road riders and found a mean return to competition of about 57 days for isolated fractures, with no meaningful difference between those treated surgically and those treated without. Professionals have daily physiotherapy, a team doctor and no day job, so the club-rider timeline is longer, but the shape is the same: turbo first, then flat roads, then bunches, then racing.

What decides the timeline is not how you feel but what the bone is doing, and only the surgeon or fracture clinic knows that. The questions worth asking them, in order, are: when can I turn a pedal on a trainer with no load through the arm; when can I bear weight on the bars; when can I ride outside where a fall is possible; and when can I ride in a group. Those are four different dates. Riders who hear the first one and act on the last are the ones who end up back in the clinic.

Wrists, ribs and hips each have their own rules. A scaphoid fracture in the wrist is notorious for being missed on the first X-ray; if wrist pain in the thumb-side hollow persists after a crash, ask for it to be re-imaged. Broken ribs mostly need time and painkillers, but they make deep breathing hurt, which makes hard riding a bad idea for several weeks regardless of what the legs can do.

Road rash and the boring injuries

Abrasions are the most common crash injury by a wide margin and the least likely to keep you off the bike. The essentials are unglamorous: clean the wound thoroughly and early, which hurts, remove grit, and keep it covered and moist rather than letting it scab and crack. Signs of infection, meaning spreading redness, heat, pus or fever, mean a doctor. Riding with fresh road rash is unpleasant but not dangerous unless the wound sits under a strap or a saddle. Bruised muscle is similar: painful, slow, and mostly a matter of waiting and moving gently.

Before riding outside again

Decock and colleagues' study of acute injuries in competitive road cycling found that most race crashes happen in the bunch, in the final part of the race, and on descents and in corners, which is to say in exactly the situations a returning rider is most nervous about. Ardern and colleagues' consensus statement on return to sport makes the point that psychological readiness is part of a return, not a soft extra: athletes who go back frightened perform worse and, in some sports, get hurt again more. The sequence that works is gradual and honest.

1. Trainer first. No traffic, no descending, no risk of a second fall on a healing bone. This is where fitness is maintained while the injury does its thing. Moveee Indoor pairs a smart trainer or a power meter in a browser, so an easy endurance ride or a structured session needs nothing installed and no upper-body effort beyond holding the bars.
2. Quiet roads alone. Flat, familiar, daylight, dry. The aim is to find out whether the injured part tolerates road vibration and braking, and whether your head is comfortable at speed.
3. The specific fear. If you crashed in a corner, go and ride corners, slowly, on a quiet road, until they are boring again. Avoiding the thing does not make it go away; it makes it larger. Our post on descending faster and safer has drills that work for this.
4. A group, then a race. Riding in a wheel is the last skill to return because it requires trusting other people. A small, known group first; the club chain gang later; racing last.

The training plan after a crash

Fitness lost in three weeks off the bike comes back in roughly three weeks of sensible riding; fitness lost to a second crash from rushing the first one takes a lot longer. If you were on a plan, rebuild it rather than trying to rejoin it where you left. The plan wizard takes blocked dates, so you can tell it which days are out entirely, and a plan built after the injury will start at the volume you can actually do rather than the volume you did before. We cover the fitness side of coming back in getting back on the bike after a break.

Finally, once more, because it is the one thing in this post that can actually go badly wrong: a head injury is a medical matter. Get it looked at. The bike will wait.