What does a bike rider do when injuries stop them from riding a bike?
Judging by the speed with which modern pros are able to return to racing, they’re obviously doing something pretty special.
Mathieu van der Poel won the Tour of Flanders just 14 days after he came back from six weeks on the sofa. Remco Evenepoel recently won Liège-Bastogne-Liège to close a chapter on the horror crash at Il Lombardia in 2020 that crushed his pelvis.
And almost unbelievably, Egan Bernal could be back in competition before May is done, just four months after suffering 20 broken bones in a crash some feared might end his career.
“From the 120th day after the accident, I think Egan can return to his maximum power, get on the pedals and resume competition, in shape,” Bernal’s surgeon Gustavo Uriza said in an online press conference this week.
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So what actually happens when riders like Bernal, Van der Poel, or Chris Froome shut down Strava and go off-grid in their days of rehab and recovery?
It’s a lot more than bingeing box sets and feeling blue.
“Professionals can come back a lot quicker than recreational riders. They have better physical condition and ability to recover. Maybe more importantly, they have the time, facilities, and commitment to do absolutely everything necessary to get better,” said David Bombeke, physiotherapist to a stack of pro cycling’s top stars.
A timeline of a top pro rider’s recovery often chronicles oxygenation chambers, aqua jogging, gym work, and more.
So what’s the process behind pro rider recovery in 2022?
It’s time to take a peek inside the rehab rooms…
Ironing out the kinks: Therapies, chambers, and cups
Step one in fixing any injury is the easiest, but for a pro athlete, also the hardest, part of the whole process: rest.
Broken bones need to rebuild and torn tissues need to heal. The body needs the time, space, and energy for that to begin.
After that comes the therapy. Mobilization and strengthening work is a mainstay. Most of the initial treatments are well-known and practiced on weekend warriors around the world, but pros go far further in the hunt for even the most marginal of recovery gains.
Sport science is developing fast, and so are the types of treatment available.
Chris Froome believes the increased oxygenation provided by hyperbaric chambers was crucial to his comeback. The multiple Tour de France champ was also a big advocate of alternative “cupping” therapies and he regularly received the treatment from leading Monaco physician Alexandre Baccili.
Matteo Jorgenson employed every technique he could get when he was looking to speed his return from a torn hamstring this winter. Indiba therapy and hyperbaric chambers became regular features of his daily schedule after he was ruled out of racing in Paris-Nice.
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“You don’t know how much these things like a hyperbaric chamber move the needle, but it just helps if you think you’re doing something that might help it get better in any way instead of just sitting around,” Jorgenson told VeloNews.
“My hamstring would have healed just by rest, no matter what. But the initial estimate they gave me was four weeks, so I basically took it from that to two weeks just by doing these therapies. So either my body just healed really fast or these things actually worked, and it was pretty successful.”
Leading physio Bombeke has a prolific portfolio that includes working with Cadel Evans ahead of his Tour de France triumph, and helping Greg Van Avermaet come back from a broken ankle shortly before he won Paris-Roubaix. More recently, he guided Van der Poel on the road to Flanders.
The Belgian specialist believes in keeping it simple. He prefers to stay away from the modern machines and new-fangled practices permeating physio rooms.
“The three most important things in a recovery program are mobilizing and correcting the body with manual therapy, releasing tight or overused muscles with stretching and dry needling, and then strengthening the weak parts in a structured way,” he told VeloNews. “For the final part, you need a good screening of the body so you know where the weaknesses are, and then you build strength based on that.”
Rebuilding the chassis: Gym, gym, gym
As Bombeke says, time in the gym is a non-negotiable in any recovery process.
Bernal had to regain strength in wasted muscles after weeks of inactivity. Froome had to correct a 20 percent strength imbalance in his legs after his crash. Van der Poel had to correct and rebuild tightnesses and weaknesses in his core, hips, and glutes.
A pro racer could spend hours a day redeveloping muscle mass and ironing out imbalances when they can’t train like normal.
“I learned that I have to focus a lot on stability and fitness exercises, it was maybe a bit in the background in the last years because I had to switch disciplines and I didn’t have the time,” Van der Poel said this spring. “I even ride one hour less on the bike just to do my exercises now.”
And time in the gym isn’t just for those coming back from injury.
Strength and conditioning coaches are now as much a part of any top team as the masseuses, chefs, and medics. Weights sessions and pilates practices are as much a regular makeup of a pro’s program as the base rides or high-intensity intervals.
Maintaining the engine: Swimming pools and static bikes
A rider with a broken collarbone can chart a very different path back to fitness than one with a lower-limb injury. The former can be back on the trainer within a week, and the world barely knows they were gone.
Mathew Hayman famously came back from a broken arm by riding the trainer with his plaster-casted limb resting on a stepladder. Six weeks after smashing his arm at Omloop, he was using his newly healed limb to lift Paris-Roubaix’s cobblestone trophy.
When the injury is below the waistline, the ride back to fitness is a whole lot harder.
“If it’s a lower limb injury and they can’t bike, on a cardiovascular level, there’s not much you can do except maybe some training in the pool. We work a lot with aqua training or jogging because you have less loading on tendons and muscles in the pool,” Bombeke said.
“If it’s a fracture or similar, they cannot even go in the pool. In that case, you have to try things like handbike – it’s not ideal but it’s something.”
Keeping positive: Buying into the process
Whatever a rider’s recovery process looks like, time out of the peloton is no easy thing for a pro.
Even a young rider like Jorgenson will have spent the best part of a decade centering their life around training, resting, or thinking about training and resting.
“Being out injured really sucks. It’s the worst thing you can have as an athlete. I truly believe it’s a terrible time because you just lose control over everything,” Jorgenson said in a recent call.
“In my case, I just tried to maximize going to the therapist and doing absolutely the maximum there. But, at the end of the day, it’s just your body’s ability to send blood and nutrients and whatever to that area. And you really just have zero control over that. It’s very difficult mentally to accept.”
Stopping a rider from going stir-crazy when off the bike e is a crucial part to any comeback. Bombeke believes having 100 percent buy-in is key to keeping a rider positive, focused, and committed.
“I’m not a psychologist, but that area is a big part of our profession. I know that it’s mentally tough for guys if you have to say to them ‘you have to stay off the bike for four weeks,’” he said.
“In that case, the way you communicate is really important, whether you’re a doctor, physio or coach whatever. We have to have their full belief in the approach. And you need to take all three of the training, the medical, and the athlete into consideration in the diagnosis. It’s really important the athlete feels confidence in the treatment, all the way from the first week to the return to racing.”
Just like every other aspect of pro cycling, recovery and rehab is a rapidly progressing balance of art and science.
It’s a process no rider wants to have to go through. But if they do, at least it’s a journey that’s getting faster and more effective with every passing year.
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This is the latest of Jim Cotton’s “Behind the Ride” series.
“Behind the Ride” explores the world behind the peloton and looks at the training, psychology, and nutrition that keeps the pedals turning in the modern era of pro cycling.
Check the above link to check out features covering spring sicknesses, modern fueling methods, old-school training programs, and more.