Clavicle Fractures in Mountain Bikers: Recovery, Rehabilitation, and Return to Sport

Mechanism of Injury

The clavicle, or collarbone, is a relatively vulnerable bone that connects the arm to the torso, acting as a conduit for many upper body movements. It’s positioned at the point where the shoulder blade and sternum meet, making it a key support structure for the shoulder. Mountain bikers often break their clavicle during crashes, especially when they fall onto an outstretched arm or directly onto their shoulder, as the bone takes on much of the impact force.

In a DH setting, the mechanism of injury typically involves a high-speed crash, where the rider may fall on their shoulder or side, generating enough force to cause a fracture. The position of the body, the angle of the fall, and the force of impact determine the type and severity of the fracture.

Types of Clavicle Fractures

Clavicle fractures can vary in severity and classification, generally divided into three categories:

Type I (Middle third fractures): The most common type, occurring in the middle part of the clavicle. These fractures are typically less complicated and can often be managed conservatively with rest and physical therapy.
Type II (Lateral third fractures): These fractures occur at the acromial end of the clavicle. They often involve damage to the ligaments and may require surgical intervention to ensure proper alignment and healing.
Type III (Medial third fractures): These are the least common and occur near the sternum. These fractures are rare and often require surgical treatment due to the proximity to critical structures.

The need for surgery depends on the fracture's location, the degree of displacement, and whether the bone is at risk of puncturing surrounding structures. In many cases, fractures that don’t involve displacement or damage to nearby structures can heal with non-surgical methods like immobilization and physical therapy. However, more severe cases may require plates or screws for stabilization.

Timeline of Recovery and Rehabilitation

The recovery timeline for a clavicle fracture can vary based on the severity of the injury, the treatment method, and the individual’s age and overall health. Best consult with a team of professional to decide the best timeline to ensure a setback free recovery.

A general outline of recovery includes:

Protection Phase (2-4 weeks post injury): During the initial stage of recovery, the focus is on protecting the fracture site and reducing pain and swelling. This typically involves wearing a sling or brace to immobilize the shoulder and allowing the bone to begin healing.
Movement Phase (Weeks 2–6 post injury): Once the fracture has stabilized, gradual passive movement of the shoulder begins. This phase is crucial for preventing stiffness and maintaining joint health while allowing the bone to heal. Gentle range-of-motion exercises are introduced.

Strengthening Phase (4–8 weeks): As healing progresses, strengthening exercises for the shoulder girdle are introduced. This includes exercises to target the rotator cuff, mid and low traps, serratus anterior, and other stabilizing muscles around the shoulder blade. These muscles play a critical role in shoulder stability and are necessary for mountain biking movements.
Return to Sport (2–4 months): Full rehabilitation involves progressing to more dynamic movements like pressing and rowing exercises to build strength in the larger muscles of the chest, back, and deltoids. This phase integrates the shoulder into global movements like squat rows, landmine presses, and med ball throws to enhance coordination, explosive power, and overall body readiness for riding and racing. As well as working on specific energy systems training and progressively coordinating complex riding skills on technical terrain.

Shoulder Rehabilitation and Strengthening Exercises

To strengthen the shoulder girdle, here are common exercises incorporated into rehab protocols for clavicle fractures:

Range of Motion Exercises
- Passive or Active Assisted Dowel/Pulley exercises: Improve Pain free range of motion.
- Stretching Pecs / Lats / Rotator Cuff: Relax tight muscles which are stiff from protecting the healing bone.
- Isometric Exercises: Introduce muscle contraction in a safe pain free way.
Shoulder Blade Control:
- Scapular Push-ups: Strengthen the serratus anterior and help stabilize the scapula.
- Facedown Angels: Improve scapular control, mobility and muscular endurance.
Rotator Cuff Strengthening:
- External Rotations: Focus on the infraspinatus and supraspinatus to enhance stability.
- Internal Rotations: Work on subscapularis strength to maintain proper shoulder balance.
Global Strength Movements:
- Pressing: Build pressing power in the chest, shoulders, and triceps with exercises like Push Ups, Bench Press, and Overhead Press
- Rowing: Strengthen the lats, mid-back, and rhomboids, which play a key role in shoulder stability with exercises like Bent Over Rows, Pull Ups or Pull Downs
Explosive Power Movements:
- Landmine Presses: Integrate upper body pressing with full-body movement.
- Renegade Rows: Combine lower body strength with upper body pulling movements for shoulder integration.
- Med Ball Throws: Enhance coordination, timing, and explosive power that translates to bike handling.

The goal is to ensure that the shoulder can handle the demands of mountain biking, where sudden movements, high impacts, and technical challenges require a well-conditioned and resilient upper body.

Riding Progression

During recovery, it's essential to avoid high-risk activities, including technical descents, jumps, and aggressive riding. Once cleared by a healthcare professional, riders can return to low-risk activities such as:

Pedalling and cadence work on a stationary trainer: Focusing on fitness and pedalling technique without placing undue stress on the healing clavicle. Many injured riders can pedal with their njured arm in a sling supporting their upper body with their non injured arm.
Flat non-technical terrain: Riding on smooth terrain at a gentle pace, avoiding heavy impacts and aggressive movements.

As strength and mobility improve, riders can progress to higher-risk activities, such as:

Moderate trail riding: Reintroducing minimally technical terrain and riding at a more challenging pace.
Short climbs and descents: Gradually increasing the intensity of the riding to simulate race conditions.

Returning to full competitive racing should only occur once strength, shoulder stability, and confidence are restored. It’s essential that riders allow their body to fully adapt to the physical demands of the sport, avoiding premature return to high-impact actions. It's common for the bone to be 'healed' and strong as well as the muscles, but the body and mind are not up to race pace requiring more time working on skills, pacing and coordinating technical maneuvers at speed before taking on the risk of racining and larger trail features.

Every year, I work with multiple riders, guiding them through the entire spectrum of injury recovery—from just days after their clavicle injury all the way through to returning to full action. My experience as an Athletic Therapist, Athlete Performance Coach and Mountain Biking Coach allows me to eliminate the gap in traditional healthcare models, where athletes often transition between physio, trainer, and coach—each focusing on only one aspect of the injury recovery process. I provide a seamless, integrated approach that covers all stages of rehabilitation, helping riders recover fully and return to their best performance on the bike.