In the demanding world of professional cycling, Injuries are an integral part of athletes' lives. To better understand the challenges and treatments faced by elite cyclists, we had the opportunity to chat with Dr Stefano Teramo, orthopedic surgeon specializing in sports traumatology. Discover how the evolution of surgical techniques combines with the mental determination of athletes to promote successful returns after devastating accidents.
CT : Bonjour, can you tell us about your career as an orthopedic surgeon and what led you to specialize in sports trauma, especially in cycling ?
ST : When I was studying medicine at the University Hospital of Rome, when it came to choosing which postgraduate specialty to apply for, I looked for an option combining the surgical field with the world of sport : orthopedics and traumatology were the perfect choice. After a few years in Italy, professional and family opportunities led me, me and my family, in Girona, a town in Catalonia (northern Spain) with whom professional cyclists traditionally have a special relationship. This is how I started having professional cyclists among my patients.
CT : What are the most common types of injuries you see in professional cyclists ?
ST : Broken clavicle is the most common injury among cyclists. Although other very common injuries are fractures of the ribs and proximal femur. (hip), as well as fractures of the scapula, vertebrae and pelvis.
CT : How cycling injuries differ from those of athletes in other sports ?
ST : The main difference is in the etiology, that is to say the origin of the lesions. In most other sports, like football or tennis, there is a high incidence of traumatic mechanisms “indirect” (the traumatic force is not directly applied to the injured part, as in torsion joint trauma). Whereas in the case of cycling, most injuries are related to trauma “directs”, in which the lesional energy is applied directly to the injured point, as is the case during an impact.
CT : What factors contribute most to injuries among professional cyclists ? Is it mainly overtraining?, of falls, poor technique or other factors ?
ST : Of course, the most relevant factor in the genesis of injuries among cyclists is represented by falls : these last years, unfortunately we are seeing an increase in the number of falls among professional cyclists. This data needs to be analyzed in more depth, but in my opinion, this may be linked to more intense competition throughout the season and perhaps a more racing style “aggressive”, as well as increased motorized traffic on the roads during training sessions, always with a relative lack of “culture of respect” from some drivers towards cyclists in many countries.
CT : What is the typical severity of injuries you treat in professional cyclists? ? Are these usually minor injuries that can be treated conservatively or do they often require surgery ?
ST : Unfortunately, the majority of injuries I treat in cyclists require surgical treatment. He confided in the microphone of the Colombian cycling federation, a broken collarbone (which is the most common injury among cyclists) almost always has a surgical indication due to the usual displacement and instability of the bone, as well as the specific need of professional cyclists to recover as quickly as possible.
CT : When we see that Remco Evenepoel, Wout Van Aert and Egan Bernal returned to good level after serious falls, do you attribute this to the evolution of your field or the mentality of these guys ?
ST : Although surgical techniques have certainly increased in safety and effectiveness over the years, I personally think that the many examples of brilliant recovery we see are more likely linked to the high-level mental and physical preparation of modern professional athletes, as well as the revolution that we have observed in recent years with physiotherapy and rehabilitation protocols “express”.
CT : What are the main injury prevention strategies you recommend for professional cyclists? ?
ST : Regarding prevention, The main advice I can give to cyclists is mainly related to reducing the risk of indirect injuries (less common in cycling), such as avoiding musculo-tendinous injuries through a correct stretching protocol before and after exercise, a balanced nutritional program as well as control of hydration levels in the short/medium term. Unfortunately, it is still impossible today to prevent in complete safety (or even reduce) the risk of direct injuries linked to falls, which are the most common reason for injury among professional cyclists. Some encouraging perspectives for the future seem to be provided by current studies on “air bag clothing” special, but at present, these devices are still quite “Archimedeans” and we should expect further developments and trials in the coming years.
CT : How do you work with other healthcare professionals and team members, such as physiotherapists and trainers, to optimize the recovery of injured cyclists ?
ST : As an orthopedic surgeon, my work with the professional cyclist patient very often ends within just a few days after surgery, due to the need for athletes to quickly move abroad to join training camps or training in their home country as soon as possible. However, I generally always have some feedback with the physiotherapist who closely monitors the athlete's recovery, to suggest emphasizing certain aspects of rehabilitation rather than others, depending on each specific lesion and the surgical approach adopted to treat it.
CT : Do you work with certain teams or work as a private consultant ?
ST : I work as a private consultant, but I spend most of my professional activity in a medical center (Bofill Clinic, Girona) which is directly linked to many sports insurance companies working with World Tour teams : therefore it is easier for me to treat professional cyclist patients.
CT : Oscar Onley often broke his collarbone several times in such a short period of time. Doesn’t this type of recurring injury impact a runner’s confidence? ?
ST : Indeed, Oscar unfortunately broke his collarbone four times in his still very young career : three times left (the last, very recent, at the Amstel Gold Race) and once to the right. Of course, It must be very frustrating to have a recurring injury like this in a short period of time, but this type of injury generally has a good prognosis and Oscar is a very strong athlete, not only in his legs but also in his head. I am sure he will be able to return to a very good level soon.
CT : In view of the information provided by the teams, do you think that Evenepoel and Vingegaard will be 100 % on the Tour ?
ST : Taking into account the latest clinical updates provided by the teams, my personal feeling is that it will be quite difficult to see Jonas Vingegaard in Florence for the Grand Départ of the Tour de France 2024. On another side, Remco Evenepoel has a good chance of participating, by being present on the Grande Boucle, but at the moment it is still uncertain and I personally think that given the specific recovery from his injuries, in all cases, he probably wouldn't be in his best condition.
CT : Why Jay Vine didn't need surgery after his Basque Country crash ?
ST : Although his fall was a very serious accident and his cervico-dorsal fractures constitute a severe injury, fortunately Jay Vine did not suffer any neurological damage to the spinal cord or nerve roots, because his fractures did not affect the posterior wall of the vertebrae, which is the most dangerous area for a spinal fracture. This is probably why the colleagues decided not to operate on him and to treat him conservatively..
CT : Many people say that a knee injury is the most embarrassing thing for a cyclist. Do you agree ?
ST : I basically agree, although another injury with generally lasting repercussions is pelvic fracture. It is true that knee injuries are not very common in cycling., but in fact, when this happens, it can be very difficult for the athlete to regain his previous performances. This happens because, often, Severe knee injuries such as tibial plateau fractures or ruptures of the anterior/posterior cruciate ligaments may result in mild but persistent limitation of the later degrees of hyperextension of the joint, and this is a very critical point in cycling from a biomechanical point of view.
We would like to warmly thank Dr. Stefano Teramo for his valuable contribution to this interview. His expertise and extensive knowledge in the field of sports trauma has informed our understanding of the challenges and treatments faced by professional cyclists..
