# How do you break a collarbone?



## Ichijin

The recent lance armstrong incident sparked my interest. I've been thinking about it for a long time and can't figure out how you can break it. Also why do people say that if you put your hand out to break the fall that you have a higher chance of breaking it?


----------



## crispy010

The best way to make sure you break it is to stick out your hand in a fall. What happens is your elbow locks out, so all the force is transmitted to your shoulder. Since your shoulder doesn't really "give" in that general direction, a large percentage of the force goes into your collarbone. In this situation, your collarbone is in compression (i.e. the forces acting on it are trying to "squash" it).

Your collarbone is what is known in engineering terms as a "long slender member". In engineering, long slender members are (almost) never designed to be loaded in compression, because they have a tendency to buckle or shear (aka break). This is precisely what happens to your collarbone.

Collarbones are actually not really load-bearing bones at all for most of your shoulder's range of motion: they serve as more of a stabilizer; you can live just fine without your collarbones. In fact, horse jockeys used to have their collarbones surgically removed BEFORE they broke, so they wouldn't break it at an inopportune time.

There are, of course, other ways to break your collarbone besides sticking your arm out in a fall. Hitting it transversely hard enough will break it, but it's pretty rare in cycling accidents to have something hit you hard enough in your shoulder/upper chest area to break your collarbone. Additionally, if you are unlucky enough to land on your shoulder at just the right angle, you could break you collarbone. 

Full Disclosure: I broke my right collarbone in a mountain biking accident about a year ago. I got launched off my bike at about 20 mph and flew for about 25 - 30 feet and landed on my chest. To my memory I didn't stick out and lock an arm, but I think the impact was hard enough that merely having the arm slightly extended (due to my windmilling while airborne) was enough to break my collarbone. The initial pain was surprisingly little, but I still do not recommend attempting to replicate the experience.


----------



## Ichijin

I'm a mechanical engineer so your explanation is pretty clear, but what I don't get is since that shoulder can move up, down, left, and right, won't it act as a damper to absorb some of the forces or better yet put the collarbone in a position which the force acts in tension to the collarbone?

Edit: Also, why would you lock your elbow? You would have a better range of motion to break the fall if your elbow was bent. Plus you can use your muscles instead of your bones to break the fall as well.

Like I get why basketball players land on their heels instead of their toes to decrease the probability of spraining an ankle, but I don't see the advantage of locking up your elbow.


----------



## crispy010

When you fall, your arm is typically close in in-line with the tops of your shoulders, (or above) and rotated slightly towards the front of your body. This essentially means your collarbone ends up directly in line with the force vectors.

The best way to prevent breaking your collarbone (or anything else) is to KEEP YOUR HANDS ON THE BARS as you go down. This is totally counter-intuitive, but will save your bones and skin from serious injury.

P.S. ME student here. Glad to know I can throw the lingo at you and have it make sense 

As for acting as a damper, much of the shoulders ROM (range of motion) is rotational, which doesn't absorb impact. When you hit, your shoulder wants to move towards the center of your torso; your collarbone is directly opposing this motion, so *SNAP*!


----------



## onlineflyer

*wrestling training*

Pull your hand to your waist, keep elbow tight on your rib cage, tuck your shoulder and roll your body on impact


----------



## Ichijin

I agree with your statement that the shoulders are almost purely rotational, but what I meant was the muscles to rotate your shoulder could act as dampers


----------



## Ichijin

Also in the case where you grab on to the handlebars and fall to the ground the force vector parallel to you collarbone (although a little less than the normal force from the ground) could still break your collarbone no? It could be even bigger as well since you didn't absorb any of the energy from trying to break the fall.


----------



## Ichijin

onlineflyer said:


> Pull your hand to your waist, keep elbow tight on your rib cage, tuck your shoulder and roll your body on impact


A lot of martial arts incorporate techniques to help reduce the damage in falling, some of which do stick their arms out.

But haha, I don't think you answered my question, but thank you for bringing that into the discussion


----------



## Kerry Irons

*Dampers*



Ichijin said:


> I agree with your statement that the shoulders are almost purely rotational, but what I meant was the muscles to rotate your shoulder could act as dampers


Of course they do. But that doesn't mean that they dissipate enough force to prevent the fracture.


----------



## John Nelson

When I broke my collarbone, my hands were still on the handlebars and my feet still on the pedals. It happened so fast, there wasn't time to blink. I suffered no damage to skin or clothing or bike. In fact, the only thing damged was my collarbone.


----------



## Ichijin

Kerry Irons said:


> Of course they do. But that doesn't mean that they dissipate enough force to prevent the fracture.


I agree, it doesn't. 

But how does putting your hands on the handlebar during a fall prevent you from breaking the bone? Seems that there would be more force when you land on your shoulder. Minus the energy taken away from the handlebar hitting the ground.


----------



## zoikz

Falls on outstretched hands (FOOSH) will generally result in wrist and hand injuries but can also cause isolated shoulder injuries. Most commonly would be a AC (acromium clavicular) seperation. This is the joint that attaches the clavicle to the shoulder. Could also dislocate the shoulder or result in a rotator cuff injury. In order to fracture the clavicle your arm during a FOOSH it would generally have to be parallel to the clavicle, ie. sticking out at around 120 degrees from your body. To transduce enough force to break the clavicle you'd virtually be guarenteed to break your wrist. While it's possible to fracture the clavicle with the described mechanism by far and away the most common is a direct force on the shoulder. As you fall over to the side the first thing to hit and absorb all the impact is often your shoudler. Clav fx's are very common injuries but less common than an AC seperations which can also happen with a direct impact. While easier in theory than practice you should roll when you fall rather than try and stop your momentum with your arms or body. The injuries outlined in this thread all described a direct force on the shoulder.
They hurt like an SOB. Lord knows how Hamilton did the ToF on a broken one.


----------



## Ichijin

zoikz said:


> Falls on outstretched hands (FOOSH) will generally result in wrist and hand injuries but can also cause isolated shoulder injuries. Most commonly would be a AC (acromium clavicular) seperation. This is the joint that attaches the clavicle to the shoulder. Could also dislocate the shoulder or result in a rotator cuff injury. In order to fracture the clavicle your arm during a FOOSH it would generally have to be parallel to the clavicle, ie. sticking out at around 120 degrees from your body. To transduce enough force to break the clavicle you'd virtually be guarenteed to break your wrist. While it's possible to fracture the clavicle with the described mechanism by far and away the most common is a direct force on the shoulder. As you fall over to the side the first thing to hit and absorb all the impact is often your shoudler. Clav fx's are very common injuries but less common than an AC seperations which can also happen with a direct impact. While easier in theory than practice you should roll when you fall rather than try and stop your momentum with your arms or body. The injuries outlined in this thread all described a direct force on the shoulder.
> They hurt like an SOB. Lord knows how Hamilton did the ToF on a broken one.



I'd like to hear your thoughts on keeping your hands on the handlebars while falling. Whether it is a good idea/bad idea. 

Could you also elaborate on what kind of motion is needed in order to break your wrist?


----------



## cdhbrad

I was in a crash about 4 years ago where I just dislocated my left collarbone.... trust me, when you crash like that, you don't have time to think about where you place your hands to minimize injury, it just happens so fast you deal with it when you wake up. The dislocation hurts to this day. Maybe, I would have been better off with it broken.


----------



## rkj__

cdhbrad said:


> I was in a crash about 4 years ago where I just dislocated my left collarbone.... trust me, when you crash like that, you don't have time to think about where you place your hands to minimize injury, it just happens so fast you deal with it when you wake up. The dislocation hurts to this day. Maybe, I would have been better off with it broken.


Yeah, I think when crashing, instinct takes over in many instances. I suppose you could practice crashing. :idea:


----------



## sdjeff

*tuck and roll*

I actually had time to think about it the one time (so far) I crashed in a group ride... I was just tooling along, the mind drifted off a little bit, next thing I knew I was too fast, too close (okay, overlapped), and getting squeezed into the curb. 

Rather than falling on my outstretched arm/hand I just kept my hand on the bar, tucked my left shoulder in as best I could, and fell/rolled over onto my back... with the next couple of guys on top of me. Worked out okay that time, I try to pay better attention now (and I ride with a faster group so its not as likely to happen in the first place).


----------



## jmlapoint

The clavicle is very superficial and provides the only bony articulation of the upper limb to the thorax.
Clavicle fractures are very common.
Clavicle fractures are caused by 'indirect force' through a fall on the lateral shoulder or on an outstretched hand. A direct blow to the subcutaneous clavicle is also a common mechanism for a clavicle fracture. The clavicle usually fractures in the middle third and the incidence is highest in the second decade due to MVA, and sports injuries.
Most clavicle fractures, especially in the young are treated without surgery.


----------



## pacificaslim

crispy010 said:


> Additionally, if you are unlucky enough to land on your shoulder at just the right angle, you could break you collarbone.


BTDT and have the rebuilt shoulder and scar to show for it. It was 18 years ago and hey, they did a hell of a job fixing it up because to this day it doesn't bother me at all.



Ichijin said:


> A lot of martial arts incorporate techniques to help reduce the damage in falling, some of which do stick their arms out.


Yes, but usually you don't put your hand down so that your palm hits the ground. Instinct makes you want to do that, but to properly "roll" to dissipate the energy of the impact over a large area, you land on the back of your hand, or kind of the outside of your hand, and make an arc with your arm that extends from that hand up and through your shoulder. Tuck your head towards the opposite shoulder to keep it out of the way as you roll.

I think everyone who participates in sports where falling is possible should take a few Aikido or Judo classes to practice how to fall! It's saved me so many times (30years of skateboarding...no head impacts, and the only time i broke something was when i put my palm down - the wrist guards i was wearing keep the hand bent like that and the impact transfered all the way up and broke my arm at the elbow. ouch. should have just rolled...)


----------



## uzziefly

Ichijin said:


> Could you also elaborate on what kind of motion is needed in order to break your wrist?


I had a soccer ball ram straight into my wrist as my palms were facing outwards with the fingers pointed downwards.

Absolutely no time to react to parry the ball at all. Pretty close range. Broke both my radius and ulna.


----------



## Ichijin

Ok, so why do people keep saying to hold on to the handlebar when you fall? Still doesn't make sense to me.


----------



## crispy010

Ichijin said:


> Ok, so why do people keep saying to hold on to the handlebar when you fall? Still doesn't make sense to me.


Think about it. If you're falling sideways and you stick an arm out to catch yourself, all that force (and it's a lot) goes straight into your arm in a linear way. 

If instead, you keep your arms on the bars, four good things happen:

1. Your body now has a tendency to roll when you hit the ground. Rolling can absorb a lot of energy that would otherwise be going into you. Even if you stay attached to your bike, you can roll well over 90 degrees before your bike hits the ground again.

2. The impact force is now spread over a wider part of you: nearly the entire side of your torso rather than your hand. Distributing the force greatly reduces the chance you'll break a bone. Plus, the bones in your torso are more substantial than the ones in your hand, wrist, and arm. Even better, your ribcage is naturally springy, making it ideal to absorbing impact without breaking ALL your ribs.

3. Your side gets scraped up instead of your hand. Hands take forever to heal, and they're pretty useless while they do. 

4. You present a smaller target to the riders around and behind you. Smaller means you're easier to avoid. Once on the ground, curl up tightly and stay there.

Crashing is always a messy business, no matter how it happens. By keeping your hands on the bars you tilt things in your favor. Yeah, it's still gonna hurt like hell.


----------



## fast ferd

sdjeff said:


> I actually had time to think about it the one time (so far) I crashed in a group ride... I was just tooling along, the mind drifted off a little bit, next thing I knew I was too fast, too close (okay, overlapped), and getting squeezed into the curb.
> 
> Rather than falling on my outstretched arm/hand I just kept my hand on the bar, tucked my left shoulder in as best I could, and fell/rolled over onto my back... with the next couple of guys on top of me. Worked out okay that time, I try to pay better attention now (and I ride with a faster group so its not as likely to happen in the first place).


This and what an earlier poster said is totally true: roll with the bike. I took judo as a kid and they embed this trait into you, so you instinctively roll when falling. And, unfortunately, this instinct came into play many times over my many years. Made for nice road rash, but never any broken bones. And many of my spectacular spills were taken at high speed in crits and fast rides.

When Levi fell in the ToC, he put his arm out to break the fall. Lance, Tyler, and other pros ought to take judo or wrestling. :wink5:


----------



## JCavilia

Ichijin said:


> Ok, so why do people keep saying to hold on to the handlebar when you fall? Still doesn't make sense to me.


If you put your arm out straight, all the force can be transmitted through the outstretched arm to the shoulder, causing a big load to the clavicle. If you hang on, before the shoulder contacts the ground you will typically have some impact of the pedal, leg, hip, and the handlebar. All of that absorbs some energy and slows the deceleration borne by the shoulder and clavicle. You can still break your collarbone, of course, but it's less likely

But there's another factor: wrist and arm fractures, which can be as bad as or worse than the collarbone, slower to heal, with worse long-term consequences. Putting your arm out greatly increases the risk of those breaks.


----------



## Ichijin

Then it seems the easiest solution would be to not have your arm completely straight, and have it slightly bent


----------



## jupiterrn

Ichijin said:


> Then it seems the easiest solution would be to not have your arm completely straight, and have it slightly bent


How do you brake a collar bone. EASY, rapid deceleration trauma, and I have the Xrays to prove it.


----------



## jmlapoint

Ichijin said:


> Ok, so why do people keep saying to hold on to the handlebar when you fall? Still doesn't make sense to me.


I think if you are grasping the bar, you may have a more stable setup when you land and this 'might' distribute the stresses/loads. However, even if you are holding the bars, if you land hard on your shoulder, chances are the clavicle may fracture.


----------



## Ichijin

crispy010 said:


> 2. The impact force is now spread over a wider part of you: nearly the entire side of your torso rather than your hand. Distributing the force greatly reduces the chance you'll break a bone. Plus, the bones in your torso are more substantial than the ones in your hand, wrist, and arm. Even better, your ribcage is naturally springy, making it ideal to absorbing impact without breaking ALL your ribs.


Well that is assuming that the side of your body is completely flat, but if you hold on to the bars, the main points of contact are your hips and your shoulder.



crispy010 said:


> 4. You present a smaller target to the riders around and behind you. Smaller means you're easier to avoid. Once on the ground, curl up tightly and stay there.


I agree, keeping the hands on the bars create less injuries if there is a pile up.


----------



## bahueh

*i had two teammates..*



John Nelson said:


> When I broke my collarbone, my hands were still on the handlebars and my feet still on the pedals. It happened so fast, there wasn't time to blink. I suffered no damage to skin or clothing or bike. In fact, the only thing damged was my collarbone.


do the exact same thing during two separate cross races last fall....both had hands on the bars, feet clipped in, and simply went down hard on their shoulder in transition areas...

lots of ways to break a collarbone....bike accidents....big rocks....a piece of re-bar could probably work....a baseball bat...


----------



## Kerry Irons

*Just stop*



Ichijin said:


> Ok, so why do people keep saying to hold on to the handlebar when you fall? Still doesn't make sense to me.


You are WAY overthinking this. You can easily break a collarbone by falling on your shoulder, and you can easily break a collarbone by trying to brace the fall with an outstretched hand/arm. In practice, you may likely have zero choice in what happens during a crash. Being able to roll is good, but lots of experienced riders who practice taking falls and rolling still break their collarbones. Just give it a rest.


----------



## crispy010

Ichijin said:


> Then it seems the easiest solution would be to not have your arm completely straight, and have it slightly bent


Right, because when you're heading towards the ground the first thing that you're worried about is not locking out your elbow. 

Practice falling while keeping your hands on the bars until it's instinctive. Practice on grass on a junker bike with a friend or teammate; the experience is highly instructive.

I think I'm done with this topic. To the OP: if you're still not convinced, feel free to experiment on yourself to see what *really* breaks your collarbone!  (this is said in jest)


----------



## bikeboy389

You should just keep trying--you'll manage to break one eventually.

//did mine racing motorcycles. Happened so fast I never took a hand off the bars or a foot off the pegs. Just upright, then WHAM.


----------



## ken71nj

Unfortunately, I'm pretty familiar with falling and shoulder injuries. There are definitely ways to move your body to lessen the impact, but to a certain degree, the angle you hit the ground is luck. The concept of rolling into the fall works great on a skateboard, but you're usually tangled with the bike until you hit the ground. As far as keeping your arms in, I always have, but it's not necessarily better. I went over the bars on my dirt bike and ended up taking the impact on my shoulder. The result was a 3rd degree AC separation which means that all he ligaments holding my collarbone to my shoulder are snapped. This is permanent and the bone noticeably sticks out. As mentioned in other posts, the joint does not need the collarbone to function, but it does create limitations. I would have preferred a broken bone. unless there are complications, you're 100% in a couple months.


----------



## jcjordan

I have recently found another really effective way of breaking your collar bone, getting jumped on by skippy.

On Friday the 13th I got landed on by a big red while riding with a mate. Have ended up with a nice plate and 6 screws.

Also broke the forks on my TCR Advanced.


----------



## tyciol

crispy010 said:


> Think about it. If you're falling sideways and you stick an arm out to catch yourself, all that force (and it's a lot) goes straight into your arm in a linear way.
> 
> If instead, you keep your arms on the bars, four good things happen:
> 
> 1. Your body now has a tendency to roll when you hit the ground. Rolling can absorb a lot of energy that would otherwise be going into you. Even if you stay attached to your bike, you can roll well over 90 degrees before your bike hits the ground again.
> 
> 2. The impact force is now spread over a wider part of you: nearly the entire side of your torso rather than your hand. Distributing the force greatly reduces the chance you'll break a bone. Plus, the bones in your torso are more substantial than the ones in your hand, wrist, and arm. Even better, your ribcage is naturally springy, making it ideal to absorbing impact without breaking ALL your ribs.
> 
> 3. Your side gets scraped up instead of your hand. Hands take forever to heal, and they're pretty useless while they do.
> 
> 4. You present a smaller target to the riders around and behind you. Smaller means you're easier to avoid. Once on the ground, curl up tightly and stay there.
> 
> Crashing is always a messy business, no matter how it happens. By keeping your hands on the bars you tilt things in your favor. Yeah, it's still gonna hurt like hell.


Would this not be a false dichotomy since a third option exists of taking the foot off the pedal and sticking out the foot and leg to absorb the force...


----------



## red elvis

...or you can go snowboarding. thats how i broke my right clavicle several years ago.


----------



## PlatyPius

I got "lucky" in that when I was doing my "Hey y'all, watch this!" and went flying off of my bike, I did a total shoulder separation rather than breaking my collarbone. I get all of the benefits - my right collarbone sticks up more than my left - plus the additional grooviness of a shoulder blade that sticks out farther than the other and the ability to tell when it's going to rain.

Thanks to that, I've maintained my record of never having a broken bone.


----------



## JCavilia

*In real life, no*



tyciol said:


> Would this not be a false dichotomy since a third option exists of taking the foot off the pedal and sticking out the foot and leg to absorb the force...


The kinds of falls that result in impacts sufficient to fracture the clavicle are generally much too fast for anyone to get a leg out far enough to do any good. Even if you have extremely fast reflexes in getting the foot off the pedal, by the time you realize you are going over the foot and pedal will already be too close to the ground.


----------



## PJ352

JCavilia said:


> The kinds of falls that result in impacts sufficient to fracture the clavicle are generally much too fast for anyone to get a leg out far enough to do any good. Even if you have extremely fast reflexes in getting the foot off the pedal, by the time you realize you are going over the foot and pedal will already be too close to the ground.


+1. From posts I've read on this topic, only the riders experiencing crashes understand just how little reaction time there sometimes is... essentially, none.

I was already on the ground before I knew what hit me (a dog) and it took three days before I realized my head hit the pavement - cracked helmet. But I knew my collarbone was broken right away.  

We don't like to think in such terms, but fact is, sometimes we're victims of circumstance having little or no power (or time) to manipulate the outcome.


----------



## dysfunction

PJ352 said:


> +1. From posts I've read on this topic, only the riders experiencing crashes understand just how little reaction time there sometimes is... essentially, none.
> 
> I was already on the ground before I knew what hit me (a dog) and it took three days before I realized my head hit the pavement - cracked helmet. But I knew my collarbone was broken right away.
> 
> We don't like to think in such terms, but fact is, sometimes we're victims of circumstance having little or no power (or time) to manipulate the outcome.


I agree. I still don't know what exactly happened on my last crash, there was no time for reaction. This was confirmed by the people that I was riding with. Unclipping? Sheesh, the speedplay cleats snapped as I was separated from the bike on impact.


----------



## TomH

Check out the MTBR injury section.. one of the most common stories is "I was riding along, next thing I knew I was on the ground/in the hospital!".

I think road crashes give you a little more time to react, for the most part. The nature of mountain biking has you going pretty fast through varying terrain, theres just tons of constant opportunities to smash yourself into the ground at high speed.

CE student  good to see people keeping up with math and science.


----------



## dysfunction

TomH said:


> Check out the MTBR injury section.. one of the most common stories is "I was riding along, next thing I knew I was on the ground/in the hospital!".
> 
> I think road crashes give you a little more time to react, for the most part. The nature of mountain biking has you going pretty fast through varying terrain, theres just tons of constant opportunities to smash yourself into the ground at high speed.
> 
> CE student  good to see people keeping up with math and science.


I'm not so sure, my road crashes have been faster and far more painful than anything I've managed on a mtb, barring a full on gravity **** type downhill crash.


----------



## dgeesaman

Ichijin said:


> Then it seems the easiest solution would be to not have your arm completely straight, and have it slightly bent


You can keep trying to analyze it, but the bottom line is this:
Of all the joints in our body, the shoulder is regarded by experts as the joint with the least effective structural form for it's current use. In the event of a wreck, where impact force is transmitted through the shoulder, the collarbone is the weakest of the bones involved. The ligaments of the shoulder are the weakest of the soft tissue.

So no matter how you fall, whether you roll, slap, slam, or slide, you will see an overwhelming number of shoulder separations and broken collarbones. In the event of a crash you won't have much choice of how you go down anyway.


----------



## PJ352

TomH said:


> *I think road crashes give you a little more time to react*, for the most part. The nature of mountain biking has you going pretty fast through varying terrain, theres just tons of constant opportunities to smash yourself into the ground at high speed.


Yeah, I had time to react, but chose not to, because I _wanted_ my fork to emulate Pinarello's. And I like my brake pads positioned _*right on *_the sidewall. Assures_* very *_quick stops - from ~20 MPH.  
View attachment 225531


----------

