Physiotherapy for Bicycle and Motorcycle Accidents

In tropical countries, “urban cycling” is gaining popularity. Riding a bicycle or a motorcycle is the preferred mode of transportation because of its cost-effectiveness, convenience, and sustainability. Because of the increasing number of motorcyclists and bicyclists, accidents have also been on the rise in major cities of Southeast Asia in recent years. Notably, Thailand has been hailed as the most accident-prone country for motorcyclists in the world according to a 2015 report study by World Health Organisation (WHO). It is useful to know how to manage injuries from bicycle or motorcycle-related accidents to minimise damage and promote recovery.

Here are some physiotherapy or physical therapies recommended for the different injuries resulting from these accidents, categorised according to the 3 major stages of injury.

Inflammation Phase

In the initial stage of any injury of the muscles or bones, inflammation should be expected within the first 72 hours. For major or life-threatening injuries, call for an ambulance immediately. For managing minor acute injuries, the P.R.I.C.E. protocol may be helpful to follow. This protocol  stands for:

P: Protection of the Injured Area

• Protect the injured area to avoid further damage. For example, avoid putting weight onto the injured leg or use a splint to temporarily immobilise the affected arm. 

R: Relative rest (not total rest or immobility)

• Immobilisation for a short duration is useful to avoid further stress to the injured area. Physiotherapist-recommended exercise should be initiated when appropriate. This can help improve strength of muscles surrounding the site of injury to confer better support.

I: Ice

• Applying ice limits pain and swelling by reducing blood flow. Use an ice pack containing crushed ice or ice wrapped in a damp towel. This is applied directly for 20 minutes or two 10-minute sessions with a 10-minute break. This can be done 2 to 3 hourly.

C: Compression

• Compression is the use of an elastic bandage over the affected area to provide support and minimise swelling. Begin wrapping a few inches below the injury. Then spiral upwards to a few inches above the injured area. Some tension should be applied, but the bandage should not be excessively constrictive. Loosen it if it causes numbness or increased pain. It is best to remove the elastic bandage before sleep. 

E: Elevation

• Elevate the injured area to above heart level. This helps to reduce blood flow to the injured area. This can also limit swelling and loss of range of motion.

Reparative Phase

After the initial or inflammatory phase, the reparative phase occurs typically 3 days to 3 weeks post-injury. New goals of physiotherapy are the following:

1. Continued protection of the injury site

2. Increase range of motion of affected joints and tissues to its full range

Examples of treatment regimen:

• Muscles and joint manipulation
  • Specialised massage to relieve pain and stiffness
• Static or dynamic stretching activities
  • Dynamic stretching involves moving joints and muscles with sports-specific motions for around 10-to-12 repetitions
  • Static stretching involves moving a joint as far as it can go and holding it for a length of time e.g. 30s

Examples of adjunctive therapies:

• Heat therapy and cold therapy

3. Regain “proprioception” or sense of position

Examples:

• Weight-bearing exercises
• Mini trampolines
• Balance boards
• Increasing speed of the task or performing task without looking at the affected limb
• Use of elastic bandage

4. Progressing to muscular strength, coordination, power, and endurance especially in participating in functional tasks

Maturation Phase

Maturation begins three weeks to two years post-injury. Sufficient motion and force should now be incorporated into the exercise regimen. Goals of physiotherapy are:

1. Muscle strength
2. Muscle endurance
3. Cardiovascular endurance
4. Improvement of muscle power
5. Muscle speed
6. Muscle agility

Exercise Programme for bicycle and motorcycle accidents

The following is an overview of the different exercises for the major components of an exercise program:

1. Aerobic exercise or endurance training – jogging, walking, swimming
2. Strength exercises or resistance training – body weight resistance like push-ups, free weights, use of resistance bands. Multi-joint exercises such as squats, deadlifts, and chest press
3. Mobility exercises – maintaining range of motion at the shoulders, hips, and thoracic spine
4. Warm up and cool down – doing the regimen at a lower intensity and speed (warm up) and incorporating recovery techniques (cool down) are equally important in the treatment

Note that not one regimen fits all. A suitable regimen should be tailored depending on many factors. These factors include: the extent of injury, level of physical fitness, pain tolerance, existing medical conditions, medications, and lifestyle.

Discharge from physiotherapy

In general, the following criteria should be met to be discharged from physiotherapy:

• Acute signs such as pain, swelling, and restricted movements have been resolved
• Full and dynamic range of motion in all joints affected
• Adequate strength and proprioception in fulfilling daily tasks independently and successfully
• Achieving overall performance at pre-injury level

Avoiding these bicycle and motorcycle accidents

Prevention is better than cure. Hence, here are some ways to reduce bicycle or motorcycle-related accidents and severity of injuries:

• Provision of bicycle and motorcycle lanes
• Wearing of helmets (all passengers including children)
• Adequate sleep before riding
• Absolutely no driving or riding under the influence of alcohol
• Avoid speeding
• Observe road signs and rules
• Stretching or taking breaks in the middle of long rides

Article is written in conjunction with World Bicycle Day 2021, held on 3 Jun.