A handheld tool for medics on the move

There’s no doubt that professional cycling is an endurance sport like no other. Races, such as the infamous Tour de France, cover unimaginable distances and torturous terrains that stretch these elite athletes to their mental and physical limits. For the 28 riders of Belgium’s celebrated Deceuninck – Quick-Step World Tour Cycling Team, this is a way of life. Since the team’s inception in 2003 they have racked up an incredible 700 UCI victories, including 19 Monuments, 4 World Road Championships, 6 World ITT Championships, 4 World TTT Championships, 2 World Cups and an Olympic Title.

The Wolfpack, as they are affectionately known, is supported by a team that attends to their performance, health and wellbeing all year round, as well as in the peloton. However, it is inevitable in such a physically gruelling sport that injuries happen. Some are fairly straightforward (such as abrasions, saddle sores and muscle strain), but there are also more serious injuries, like fractures and concussions, that might put a rider out of action long-term if not treated swiftly. Dr Toon Cruyt, the head of Deceuninck – Quick-Step’s medical team, has been attending to the injuries of cycling teams for over twenty years, rising to the challenges of being a ‘medic on the move’. When following the cyclists and administering on-the-spot treatment, doctors regularly encounter the sort of unconventional and unusual locations that can make hospital visits difficult.

Like many sports, technology now plays an enormous role in addressing the unique scenarios that team cycling can present. “Cycling on a professional level is always seeking the limits and every day the riders take big risks,” says Dr Cruyt. “When a cyclist is seriously injured during a race, it has a big impact on the whole team. In such moments we are confronted with the fact that cycling is a dangerous sport.” However, pro cyclists are an extremely hardy bunch and in the event of an accident will often have a quick check-up with the race doctor (who follows the peloton) and then get back on their bike to finish the stage, rather than lose their place in the race. At the finish, Dr Cruyt and his team make a more detailed examination, using tools like Canon Medical’s mobile ultrasound scanner, which is around the size of a tablet computer and can be used to give an immediate diagnosis on muscle injuries, detecting tears and the presence of fluid. “For example, in case of localised muscle pain, with ultrasound you can make a differential diagnosis of hematoma or muscle strain or muscle tear,” says Dr Cruyt. “In case of hematoma you can let the rider start the next day, in case of a muscle tear we stop him.”

It sounds simplistic, but the reality is that having the tools on hand to make early diagnoses is critical to safety and performance. Deceuninck – Quick-Step are always on the road, often in remote locations with no or limited access to hospitals. They are also against the clock – by the time the cyclists have completed a stage and have returned to their hotel, it’s late. The following morning starts early, so it’s an incredibly narrow window of opportunity in which to find and access the nearest ultrasound facilities. Dr Cruyt gives the example of a rider who crashes and finds himself with a swollen elbow, which is x-rayed in hospital, but shows nothing untoward. Yet, the next day the rider cannot bend his elbow. “With the ultrasound we can check if there is a traumatic bursitis or if there is an intra-articular bleeding which can be an indication for further imaging of the elbow,” he explains. “Most of the injuries in cycling are multiple injuries and it’s often only one or two days later that some painful sites are becoming manifest. At this point the ultrasound is the number one way to reassure the cyclist that it won’t do any harm to race a few days with pain, and that it will only get better.”

Knowledge is most definitely power in performance sport and having a tool which can provide the team medics with immediate insight allows them to effectively and accurately manage the capabilities of the riders as they work through the season. For example, Dr Cruyt treated a rider who had arrived at the 2020 Paris-Nice race earlier this year having crashed at a race the previous weekend. He had a large and painful hematoma on his left hip but was still insistent on riding. The portable ultrasound meant that they could examine him immediately and, to his relief, they discovered no muscle injury, “He could start Paris-Nice with the guarantee that his efforts were not going to aggravate his injury and that time would heal his discomfort.”

Recovery times are, understandably variable, with Dr Cruyt describing professional cyclists as “very tough”. Common abrasions and contusions mean that riders will usually continue as normal unless they have other symptoms, such as a fever. A broken collarbone may require osteosynthesis (having the bones fixed with plates, screws or wires) and see the rider back on the rollers after three days, cycling after a week and racing in around three weeks. More serious fractures (femur, or vertebrae and the like) can have a recovery period of up to six months. In all cases, access to an immediate ultrasound can set a rider on a path to a potentially career-saving early intervention, which can only be a great thing for them – and their team.

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