Road Rash

Road rash is the slang term used to describe the abrasions and small cuts that often result from a crash or other accident involving the skin of an athlete and an unforgiving asphalt or road surface. Road rash is most common in cycling, with similar injuries also occurring to in-line skaters and skateboarders who lose their balance and fall on a hard surface. Virtually every cyclist or in-line skater will sustain at least one fall that produces road rash at some point in their career; given that impact between the cyclist and the road surface may occur at speeds in excess of 30 mph (50 km/h), the extent of skin damage can be considerable.

There are three general kinds of skin injuries sustained by athletes: abrasions, cuts, and lacerations. Road rash is usually an abrasion, an injury that will appear as a bright red series of blotches or marks caused by the body being dragged across rough pavement as the athlete falls. Road rash will impart a bumpy, cracked texture to the damaged skin that will be tender to the touch, due to the fact that many nerve endings over a relatively wide area of skin are exposed through the rash.

In more serious falls, the athlete may sustain a cut to the skin that involves damage to the blood vessels beneath the surface of the skin and an accompanying loss of blood. The most serious of skin injuries, a laceration, is a deep wound that damages both the skin and a significant portion of the underlying tissue.

Road rash most commonly occurs in the sport of cycling when a rider miscalculates the angle of approach entering into a corner of a roadway or race course, causing the bicycle to slide out from under the rider's body. In this angled position, the rider and the bicycle slide together on the road surface, often at significant speed. Road rash will result on the exposed position of the cyclist's body; the most frequent injury sites are the outside portion of the lower legs, the knee, the outside of the quadriceps and ilio band (thigh), the palm of the hands, the arm, and the shoulder. The hip is also subject to road rash, even where it is usually covered by the cyclist's clothing; the abrasion created on the hip is usually caused by the clothing being pulled across the skin surface during the slide along the road surface. When the force of striking the paved surface is severe, the road rash may overlay a more serious bruising or fracture.

While road rash is most common to cyclists who experience a fall on a paved road surface, mountain bikers who fall on gravel road ways and trails can also sustain this injury; given the greater cushioning of an unpaved surface, the consequences tend to be less severe that those on a paved road. In-line skaters tend to sustain their road rash in the same general regions of the body as the road cyclists.

The skin is the largest human organ. It has two major components: the epidermis, the outer layer, and the dermis, the underlying layer. The epidermis is the protective shell for the body, repelling harmful and infectious organisms from entering the muscles or internal organs. The epidermis has no blood vessels within its structure; it is nourished through its proximity to the denser dermis, which contains the nerves, hair follicles, blood vessels, and sebaceous and sweat glands of the skin. Most road rash is damage to the epidermis; where a cyclist sustains significant bleeding as a result of a fall, it is likely that the skin has been cut or lacerated into the dermis.

Road rash carries with it three major potential consequences. The first is that continued riding may be painful until the injury is treated; road rash often affects one or both of the legs, where the repetitive extension of the limb through pedaling is painful. A first aid kit with appropriate cleansing and antibiotic products should be immediately available to treat this injury. The other consequences are longer term, such as the potential for the skin to be come scarred as a result of the fall and the risk of infection developing in the affected area.

Road rash has a greater potential for long-term damage to the body than do other types of sports abrasions such a skinned knee that results from a fall on the basketball floor. The road surface has various kinds of loose dirt, small pieces of gravel, engine oils, and chemicals, all of which may enter the skin on impact. The careful cleaning of the injury is essential to the long-term health of the skin. The time-honored remedy for road rash was the cleaning of the affected area with mild soap or an antiseptic, with the area kept dry; more modern treatment options favor the physical cleaning of the rash, including a gentle scrubbing of the injury, followed by the application of a nontoxic cleaner (where the active ingredient is sodium chloride), with the area covered by a semipermeable bandage. A more serious road rash injury, especially where there is any degree of bleeding, should be attended to by a physician. Tetanus and other infection diseases can occur as a result of an improperly treated road rash injury.

Simply permitting the road rash to "scab over," without properly cleaning, abrading (removal of debris), and protecting the injury is an invitation to the promotion of infection.

SEE ALSO Abrasions, cuts, lacerations; Cycling; First aid kits for sports; Roller skates.