He’s been busy this week, Camiel Aldershof. As a doctor of Team DSM you know of course that it can always happen that riders fall, especially in the Tour de France, when it is hectic and the peloton is full of nerves. But he had hoped that ‘his riders’, as he calls them, would get through the first week unscathed.
The opposite happened. It started with Casper Pedersen driving over a slippery rock in the first leg just as he was taking a gel. Hop, lose the handlebars, on the ground, three men along, bicycle frame in half. “It happened so fast that I don’t really know exactly what happened,” says Pedersen. The result: sore knee, sore shoulder, bruised ribs, black eye, and a hand and elbow that needed stitches. But he could go on.
That was not the case for teammate Jasha Sütterlin, one of the dozens of riders who crashed in the massive crash caused by a spectator. Full on the wrist, luckily not broken, but at the end of the Tour.
“We have had a lot of bad luck,” says Aldershof after six days of racing. “I think only two of our riders were not involved in a crash in that first stage.” In stage 3 it was hit again: Tiesj Benoot slid down with a speed of 50 kilometers per hour, “he sanded half the way”, according to Aldershof. Fortunately, the Belgian only had a sore left side, plus some abrasions on the elbow.
The peloton is behaving like its predecessors in many past Tour editions this year. It is crowded, with high speeds on small roads, and as a result many falls. So far, seven riders have dropped out, and 27 riders have had themselves examined by the race doctor after a fall during a stage or had X-rays taken after the finish or other examinations carried out by the medical service. Many more riders have fallen, but have been able to continue the race without medical help.
First the bike, then the body
The fact that the riders get back on their bikes the next day despite all those tumbles is due to two things: themselves and their medical team. The riders are not afraid of pain, says Theo Eltink, now a physiotherapist and between 2004 and 2009 a rider at Rabobank and Skil Shimano. In that period he finished the Giro three times and the Vuelta three times, and was also “unfortunately” regularly involved in a crash. “That happened on average ten times a year. It just fits. As a rider you learn from an early age that you have to deal with pain. You have to suffer, and pain is seen as emotion; you can turn that off.”
A rider, says Eltink, first looks for his bicycle after a fall, then he checks whether the bicycle still works, and only then does he check whether he can still move. “Although you know immediately if you can’t go on.” After that, you want to cycle again as soon as possible, he says.
The first thing Pedersen did when he fell was yell into the radio that it was him. “So that they knew in the team leader’s car.” Then he asked for a new bicycle. “I just tried cycling again, then you’ll see how it goes.”
During the race, Pedersen was able to have himself examined by the race doctor for a concussion – he did not have one – but the real damage could only be measured after the finish.
Only then does the day begin for the DSM medical team, says Aldershof. “Then it’s full throttle.” He visits all the riders every day, whether they have fallen or not. There are often pains in the buttocks or feet. In the case of the fallen, it is important that the wounds are properly cleaned and bandaged – inflammation must be prevented.
Eltink remembers well from his time as a rider how painful it is to take a shower after a crash. He can still remember a crash in a bunch sprint in the Vuelta – “Erik Zabel was there too” – where he was “catapulted” over his handlebars. “We fell 3.3 kilometers from the finish, and the neutralization started at 3 kilometers, so I was more worried about the time than about my body.” Once over the finish line, his thigh, arm and hand, “in short, my entire left side”, turned out to be open. “I still have the scars on my arm.”
It used to be normal for the wounds to be left open, says Eltink. Then they could air dry properly. Nowadays, bandages are applied to keep the wounds moist. Eltink: “In this way, a second skin can be created from within. It is also more hygienic and prevents scarring.”
Then it is time for physiotherapy, or the riders have to visit the manual therapist or osteopath. Team DSM has three on this Tour, and choices still have to be made, says Aldershof. “It is a huge logistical operation to give all riders the right attention. We weigh up what needs to be done now, what can be done tomorrow morning, what can wait until rest day, and so we make a plan.”
It is just as important to treat the bruised body as the wounds, Eltink also says. “Your body has been shaken up. As a result, it may be that you are out of balance, that you can exert more force with one leg than the other, or that you sit crooked on your bike. You don’t get better at cycling that way.” DSM uses techniques such as dry needling and a pressure point treatment to relieve built-up tension in the body.
During the night, time and nature have to do their job. Rest and sleep, that is good for the recovery of the riders. At DSM they get painkillers, paracetemol and ibuprofen, if necessary, “a standard dose of four times 1,000 milligrams per day,” says Aldershof. That is more to relax than against the pain, says Eltink, because a good night’s sleep is essential. “Wound repair takes energy, so proper rest is very important. You have to cycle long distances every day, so that recovery has to take place mainly in bed.”
When the next day has arrived, the wounds are again examined and cared for. If the riders are very stiff, they are put on the exercise bike, says Aldershof. But often the neutral part of the start of the stage is also long enough to kick off.
Mental support is important just before the start, says Eltink. “Because when you put on your suit, you realize it’s going to be a tough day.” Aldershof does this by telling the riders what kind of day is coming.
Are you ready for a stage of almost 250 kilometers with five categorized climbs? “I tried to sleep as long as possible,” says Pedersen. “Fortunately, things are getting better, but it is survival.”