Treatment depends on the type of fracture. With a greenstick or hairline, one can forgo a figure-8 brace as long as the rider is careful not to stress the shoulder. However, any simple or compound fracture needs to be immobilized. Motion in an unset fracture can cause excess calcification with a noticeable bump or an abnormal set angle. These are actually quite common as the brace is uncomfortable and it's even more uncomfortable to sleep on one side only. This can be remedied with a little tape and a couple of thumbtacks. It only takes a couple of nights to get used to it.
Broken collarbones rarely hurt unless reinjured. That's why it's important to understand the seriousness of a second trauma. A wide figure eight brace with padded straps 2 to 3 inches wide and tightened firmly will help prevent reinjuries and bad sets. All it takes is a slight turn or reaching for something at the wrong angle.
A word of warning. If the break is not allowed to sufficiently heal the ends of the bone will calcify preventing a strong bond and probable refracture from normal cycling loads. Also, a crash with an inadequately healed collar bone could sever the innominate or common carotid artery.
One can resume training on a turbo trainer after three or four days. This is best carried out with a road bike with dropped handlebars. Turn the bars upside down. Then take another set of road bars and tape them to the upturned set. This makes a big S giving you a rail to hang onto at a convenient height. This allows you to resume training on a turbo in a more upright position. If you feel any pain or discomfort stop.
LOW BACK PAIN
Low back pain is a common problem for cyclists.
If this is a new and severe problem, the first question to be asked is whether
it could be a herniated disc. If there is any question, see a doctor as a
slipped disk would be made worse by increased exercise. If the problem is muscle
imbalance, read on.
First, a little background. The back, or more properly the abdomen, is definitely the weak link for many riders. Cyclists have huge leg muscles but don’t have the torso strength to support and resist the tremendous forces which those big legs can generate. Any force directed into the pedals also goes up into the torso. If the torso is weak, that force DOESN'T go into the pedals but is dissipated in flexing of the torso. Look at tired riders - every stroke generates an "S" curve in the back, and it is the constant effect of the power of their legs that causes fatigue, and eventually, overwork and spasm of low back muscles. And as a corollary, a rider will never get stronger by pushing pedals alone as long as their torso continues to absorb the force generated by the legs.
Our evolution has given us musculature designed for quadripedal animals, and the muscles which could support a hanging, horizontal spine can't easily stabilize a vertical one subjected to all the impacts and forces our upright posture dictates. However, we have potentially quite strong abdominal musculature to provide stiffness to the entire torso to support and reflect the force of the legs, whether pushing away against the ground in quadripedal running, or pushing against the pedals in riding a bicycle. Riding with undeveloped abs is something like riding a bike with a cracked frame - all the energy gets dissipated in flexion, and doesn't get you down the road.
Here are a few tips from David LaPorte, U. of Minn. (david-l@microbe.med.umn.edu). It's been estimated that about 80% of low back pain arises because of poor posture. Posture problems occur when we stand but are even more significant when we sit or ride a bike. We tend to round up our low backs, stressing the ligaments and tendons which lie along the spine. It is the irritation and inflammation of these ligaments and tendons which leads to most low back problems.
It is important to remember that back pain results from the sum total of ALL the stresses your back experiences. Even if you only experience pain when you're riding, poor riding posture may not be your only problem. For example, you may be sitting poorly at a desk all day or lifting boxes poorly.
Low Back Pain and Posture
Since posture is the problem, it is also the solution. Those of us who suffer from low back pain need to be constantly vigilant. We need to maintain some arch in our backs as much as possible.
Sitting is a particular problem. Most chairs, coaches, car seats, etc. provide little low back support. You can buy low-back support pads at some drug stores. Try them before you buy them because they are not all comfortable. Alternatively, you can fold a towel and put it behind your low back. The key is to maintain some arch without being uncomfortable.
Position on the bike is also important. Get your bike fit checked at a shop that you trust. You should also work on maintaining a flat back when riding. One way to achieve this is to push your belly button toward the top tube. Try to do this by rotating your hips rather than by contracting your low back muscles.
Stretching
Stretching is an important way to achieve flexibility and improve your posture. A very useful stretch is to place you hands on you butt and push your hips forward while standing. You should feel this in the front of your hips. Tight hip flexors prevent an upright posture.
After a few seconds, arch your back and slide your hands down the back of your thighs. This movement puts the arch in you low back. You can do this stretch many times a day. It is particularly useful to do it periodically when you have to sit or ride for an extended period of time.
A more potent stretch that can be done a couple of times a day starts with you lying on your front. Using your arms, push your shoulders off the floor. Don't lift with your back. Keep your low back as relaxed as possible. Let your hips hang down, staying as close to the floor as possible. This is a powerful stretch and should be started gradually. Otherwise, it can do more harm than good. However, done properly, it can be enormously helpful. Over a period of weeks, you should gradually increase the height you achieve and the time you hold the position. It is also less stressful to do this stretch for short periods with a little rest than for a long period (for example, 3 X 10 sec with 5 sec rest rather than for 30 sec straight).
Once your back starts to heal, you will probably need to stretch it deliberately. This is apparently because of the scar tissue that built up during healing. Keep it gentle, especially at first. You could easily reinjure your back. Here's a good one: lie on your back with your legs straight. Pull your knees up, grasp your thighs by your hamstrings and gently pull your knees to your chest.
Stretching the ham strings can also help relieve low back pain. Tight ham strings tend to pull the pelvis out of line. This can stress your low back. The problem with most ham string stretches is that they also tend to stretch the low back by forcing it to round up. The most appropriate stretch I know requires the use of a doorway. Lie in the doorway with your butt near the wall. Gently slide your foot up the wall until you feel the stretch. Two ways to make the stretch more gentle are (1) bend the lower leg, keeping only your foot on the floor or (2) move your butt further away from the wall. To make the stretch more intense, loop a cord or towel over your raised foot and gently pull it away from the wall. As with all stretches, this shouldn't hurt.
Exercises
Another key to preventing low back pain is to keep your abdominal muscles strong. These muscles help support the back. Do abdominal crunchers, not sit ups. Sit ups emphasize the hip flexors, not the abs, and can be hard on the back. Crunchers are done by lying on your back with your knees bent. Press your low back into the floor and curl your head and shoulders off the floor. Hold for a couple of seconds, then lower back to the floor. Repeat until you can't get your shoulder blades off the floor. Abs can be worked every day.
Strengthening the low back muscles can also be helpful. To start, lie on your front with your arms and legs extended in a straight line with your body. Raise your right arm and left leg. Put them down and raise your left arm and right leg. Put them down and continue. As your back strength improves, try raising both arms and legs at the same time, arching your back in a "reverse stomach crunch". There are, of course, more powerful back exercises, but they are also more stressful and shouldn't be considered until your back is 110%.
Medication
Anti-inflamitory medication can be helpful. Ibuprofen, naproxin and aspirin are all available without a prescription. Acetaminophen (e.g. Tylenol) is NOT an anti-inflamatory. These drugs are most effective if they are taken early since inflammation is hard to get rid of once it's become established.
A danger in anti-inflamatory drugs is that they are also pain killers. Pain is your body's way of telling you that your doing damage. If you block the pain signals, you can easily aggravate your injury without knowing it.
Muscle relaxants are sometime prescribed for back problems. These should only be obtained from a physician.
Ice, Heat, and Massage
Ice is a great way to reduce pain and inflammation. A good way to apply ice is to freeze water in a paper cup. Peel the cup back to expose the ice and then use the cup as a handle while gently rubbing the ice over the effected area. Another alternative is crushed ice in a ziplock baggie. Ice is particularly good for the first couple of days. Some people find that it's useful to continue ice treatments beyond that. Others find that the ice treatments make their backs tight if they continue beyond a couple of days.
Heat, especially moist heat, can be useful. However, it should not be used for a couple of days after injuring your back or after aggravating a current injury. Regardless of the timing, if you feel worse during or shortly after heat treatment, stop doing it.
In the later stages of a back problem, I find that my low back muscles get tight. Gentle massage seems to help them relax, promoting the healing process. I suspect that massage could make things worse in some cases, such as when the injury is fresh.
Book
An excellent book on this subject is "Treat Your Own Back" by Robin McKenzie, Spinal Publications Ltd., P.O. Box 93, Waikanae, New Zealand ISBN 0-9597746-6-1. They use this book at the Low Back Center of the University of Minnesota Hospital.
SPRAINS
As a general rule, If you can do ordinary activities
without pain then continue to do them. However, if you experience increased pain
as you return to your workout routine, you are better to leave that activity
out.
In addition to rest, ice (for up to 20mins) and mild compression (if there is some swelling) are helpful. Remember to protect your skin with barrier cream or baby oil if you are using ice massage directly to the skin. An alternative is crushed ice in a ziplock baggie or you can make an ice block by freezing water inside a paper cup in the deep freeze. It helps to use a hand towel or paper towel to protect your hand (and skin) when using both the crushed and block ice.