Cycling accidents and the Morel-Lavallée Lesion- One Athletes Road to Recovery

Many cyclists will tough out injuries after a minor bike accident, if nothing seems broken at the time. If you’re moving well, your first worry is often your bike. After that’s assessed, you may squirt you’re water bottle over any blood draining down your leg or arms, climb back on the bike (assuming your helmet didn’t crack), and continue the training ride.

The Crash

The only good news during my accident was that my body protected my bike from the ground. I hit a small, almost invisible, slippery patch of water as I rounded a corner. I found out later, there was a film of algae there. The bike slid out from under me, slamming my helmet and right hip into the pavement.

Of course, at first I was shocked. The pain set in a bit later, as I tried to climb out from under my bike, watching numerous drivers pass by without offering aid. I hobbled to the sidewalk, dragging my bike with me, then washed my bloody leg with my bottle to look for deep cuts. Thankfully, I saw none. But one look at my mangled bar-end shifters told me my 60-mile training ride was over for the day. As I sat on the sidewalk, I wondered if I could at least ride home.

Going Nowhere Fast

Once the adrenaline from the crash wore off, my whole body started aching. My hip burned. My arm throbbed. When I looked at the pavement where I had crashed, I knew why. A long gouge on the street showed how far the bike had skidded (with me under it) before coming to rest in a heap. After the obligatory rescue call to my husband, I spent the day icing on the couch, lamenting the loss of a good training ride.

But no biggie, right? Two days later, I set up the wind trainer in the kitchen (because my bar-end shifters were broken) and rode for about an hour.

I was sore, but ‘tough it out’, right? Over the weekend, my hip I started swelling. The bruise widened. It drained down my leg with massage, leaving me purple from hip to knee. And I was limping pretty badly.

First Trip to the Doctor

So, yeah, I broke down and went to the doctor’s office- I was able to get an urgent appointment with the PA or I would have had to wait over a week to see my doctor. The hip was diagnosed as a bad bruise from the accident. I was assured there was no hematoma (blood filled pocket) or other concern. So, I spent another week icing. I even flew out of state on a trip.

But the swelling worsened to the point of extreme pain and a mushy mass grew under my skin. I was hobbling on crutches. After a few frantic calls to my doctor’s office, I finally convinced the PA to order an MRI.

Off to the Surgeon

Within 2 hours of the MRI, I was being contacted by the PA.

2 hours later, I was at a surgeon’s office.

The Morel-Lavallee Lesion

BloodSyringe

The surgeon needled 50 mLs of blood out of my swollen hip (yeah, it was a big needle). And that’s when I was told I had a Morel-Lavallée lesion. Basically, the force of hitting the ground (and probably that slide under my bike) sheared layers of skin and fat from the underlying fascia, leaving a gap that filled with blood. The fancy term for this is a closed “degloving” injury- which sounds as painful as it was. “Closed” because my skin on top wasn’t ripped open. All the tissue layers were still there,  just not connected inside the way it should be.

I was lucky. I had a hematoma (the big blood pocket) and a minor degloving injury. But often, these injuries are severe and warrant urgent surgery to undo the damage. If not rapidly treated, these injuries can lead to dying tissue and infection inside the leg, leading to much more serious surgery, with lots of tissue and muscle removed.

Morel-Lavelle debridement and injury photos (Warning-these pictures are very graphic):

Since then, I’ve often wondered what could’ve happened if I hadn’t pushed for the PA to get that MRI. If I hadn’t called complaining of severe pain. If I had just toughed it out and iced, like I’d been told to do.

Timeline of Recovery

My injury was in early July. My upcoming Ironman Arizona race was in November. And the goal, the surgeon explained, was to let the internal tissue rest while it tried to reform the connection between the tissue layers deep inside. I was also explained that, even though my injury was more mild than some, if I pushed training too fast the layers inside my thigh could separate again, leading to more aggressive surgery.

Cycling

Despite all the fluid that was removed from my thigh, my leg was very sore. I was 4 weeks on crutches, then 2 more slowly weaning off them. I slowly (and very gently) did low speed spinning on my windtrainer. My first session, I could tolerate about 5 minutes. And my thigh ached while spinning just from the movement of the tissue. I tried stabilizing it with an ace bandage wrap, but that hurt more.

Over many slow and painstaking weeks, I increased my mileage, getting closer to trying that 60-mile ride again. But Ironman was fast approaching, and I was far away from any reasonable training mielage yet.

Running

I could not run after the accident. It would be weeks after I got off the crutches before I would be able to add anything more than a moderate-paced walk into training. I needed light compression shorts and Rock Tape to strap the injury in place, even on moderate walks, or it would hurt. Because I had to ramp up so slowly, my longest run-walk before Ironman was 13 miles. If you know Ironman, you know I would be heading into my first 140.6 very undertrained.

Swimming

My initial swims were mostly arm workouts, with almost no kicking. Just the flow of water over my hip caused the injury to hurt enough to stop. And Rock Tape did not help. I eventually found that a very light-compression pair of jammers would protect my skin from the brush of the water, allowing for a bit more kicking. But there would be no pushing off at the end of a lap for a long time. No hard kicking.

My swim build up was slow, but at least faster than my running. I eventually made it to my 4000 yard workouts, but was never able to swim without the jammer protection.

Take Aways

As cyclists, we are all aware that impact crashes can lead to a wide range of injuries. And many of us try to tough it out, if the injury seems minor. But there are also those times we need to not just rest and ice. There are obvious times to seek medical care, such as head trauma. But, as I learned with this dangerous injury, there are times that the amount of damage isn’t obvious.

If you suspect a Morel-Lavallee lesion, seek help immediately. You may also need to advocate for yourself, since general practitioners are not likely to be aware of this specific kind of injury.

Don’t try to save face by being tough and end up loosing a lot more than you bargained for.

For a few tips on Ironman training, check these articles out:

Cycle safely!

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