Tour de France 2020

Commentary: Should EF Education First-Drapac send Craddock home?

While fans have been awed by Lawson Craddock's heroics after crashing hard on stage 1, the ethics of his continued participation are complicated.

Editor’s Note: Following the initial publication of this opinion piece, Team EF Education First-Drapac management and medical officials contacted The Outer Line to offer a pointed critique and differing perspective on the article. Team doctor Kevin Sprouse provided us with the following corrections: (1) Lawson Craddock’s range of motion is in fact not impeded, and his injury does not involve a joint; (2) Craddock apparently took the brunt of his fall on his shoulder; despite the laceration above his eye, team doctors do not believe he took a serious blow to the head, and Craddock doesn’t think he hit his head; (3) the specific dosage of anti-inflammatory medication which Craddock is taking does not increase his risk of internal bleeding. We have modified our article to make those specific factual corrections. Team EF officials also disputed our question about whether the team is being vague about the extent of Craddock’s injuries; Dr. Sprouse indicated that the medical team is evaluating his condition on a day-by-day basis and determining, in consultation with Craddock, whether he should be continuing in the race.

On the first road stage of the 2003 Tour de France, a chaotic wave of riders came crashing down into a colorful but turbulent sea of team jerseys, tanned arms and legs, and open wounds. Among the contenders who were laid out, Tyler Hamilton dusted himself off, visited the ER to confirm a fractured collarbone, and after taking a fateful decision with his team advisers, soldiered on through an epic edition of the world’s biggest race. His performances in that Tour (and in his previous crash-marred second place at the 2002 Giro d’Italia) delighted fans and brought him accolades as one of cycling’s new “hardmen” — fighting through the pain and injury to earn respect, and very nearly the glory of a second grand tour podium.

Professional cyclists are often willing to fight through serious injury to stay in the race. In contrast to the absurdly theatrical overselling of ‘injuries’ that makes a mockery of the concurrent FIFA World Cup, cyclists typically set a determined example of dedication and grit. Lawson Craddock is cycling’s current man of the moment, and his resolve and determination are impressive. But by soldiering on after a Hamilton-esque crash on day one of the Tour, his condition, and his desire to stay in the race may not be quite as “feel-good” as the story is being spun. Performances like Hamilton’s 2003 exploits set a hollow reference point for pro cycling — and more critically, they ignore an important point.

First, Hamilton set an impossibly high bar for all other riders to persevere through injury, because he was doped to the gills: painkillers, EPO, transfusions, testosterone and human growth hormone. His fourth-place overall and stage win at that Tour demonstrated — as he wrote in “The Secret Race” — that he had played the game well. But that mixture of performance enhancement and injury didn’t just put Hamilton’s top-10 aspirations in jeopardy — it placed him, and every rider around him, at risk for potentially more serious harm because he was riding in an injury-impaired state.

A body-wide recovery system kicks in when a rider is shocked by a high-speed cycling crash. A tremendous amount of physiological resources are needed to repair the damage after you break a bone, shred off skin, and bruise or shear muscle as the result of a 50kph wreck. As we have seen throughout the week here on VeloNews, there are experts who have thoroughly explained how this actually works. But in layman’s terms, you can maybe stitch a cut or bandage some road rash, kinesio-tape a bruised or torn muscle and tightly wrap an incomplete fracture, but underneath there is a microcosm of cellular regeneration hard at work. And that regeneration requires energy to be effective, as well as rest, so that physical exertion can’t undo the repairs as fast as your body is making them.

Now, Team EF-Education First team doctor Kevin Sprouse disputes the idea that Craddock’s continuation is slowing the regeneration of his body. In an email to VeloNews Sprouse said that cellular regeneration is not an “either-or” outcome during intense physical exertion. “Physical exertion doesn’t undo these repairs,” Sprouse said.

Earlier this week, Chris Case reported on how difficult it can be for doctors, team staff, and the injured rider to determine whether he should carry on. There are only a few injuries when its 100 percent clear a rider should abandon.

Despite all of WADA’s and the UCI’s recent problems, the Athlete Biological Passport (ABP) has had an impact on the kind of doping abuses that were rife in the early 2000s. Indeed, Hamilton was one of the reasons why the ABP was developed in the first place, but he survived and thrived in that 2003 race both by force of will and creative abuse of medication. He had the luxury of HGH and testosterone to supercharge his recovery, not to mention the benefit of an oxygen-enriched EPO and transfusion-boosted blood transport system to saturate his injured bone and muscles with everything they needed to heal rapidly — maybe not like “Deadpool” in a firefight — but at a superhuman pace nevertheless.

According to the team, Craddock is only using painkilling anti-inflammatory medications like ibuprofen and physiotherapy. Unlike Hamilton, Craddock only has force of will at his disposal in 2018 and per the rules, his body is trying to heal on “pan y agua” alone. Craddock is a tough challenger, no doubt about it, and it’s stories like his that catch the imagination of the public, especially at a time when there are very few compelling stories in American cycling.

But will the pain reach a point for Craddock where it impedes his reaction time, and he is unable to avoid a pothole, a touch of wheels, or an errant musette bag? Though team doctors have okayed him stay in the race, given his injured state what further and possibly more serious injuries could befall him? Even though he is spending most of his time at the very back of the peloton the last few days, could riders in his immediate vicinity suffer injuries at his expense? And is Craddock at higher risk of worse outcomes should he crash again?

Lawson Craddock
Craddock has ridden many kilometers alone, off the back, coping with his injuries. Photo: Chris Graythen | Getty Images

Pro cycling is an inherently dangerous sport, which is made all the riskier by hazardous behaviors. Whether it is from doping, cheating, or riding in an impaired state, in a sport in which winning and losing can be separated by only hundredths of a second, and where the difference between crashing and carving a clean line can be the same kind of razor-thin reaction time, these risks are real.

Fans of cycling are in awe of Craddock’s performances and optimistic outlook over these first days of the Tour. We know just how hard the Tour is, and when you compound that with his injury tick-list, Craddock’s determination is all the more impressive. But many fans on the outside of cycling who are looking in might see something else; in an era where science and sporting regulation are better understanding and dealing with head and body trauma, are we doing Craddock and/or his paceline peers a disservice by cheering him on? Should Craddock tumble again, do we applaud him when he rises up and gets back into the race, or do we condemn the sport for allowing an injured athlete back on the pitch to suffer an even worse, and possibly avoidable injury as a result?

For all the talk of a broken anti-doping system and its risk to the sport’s future, the sport itself needs to come to terms with a more tangible risk that could do just as much personal and public damage. Craddock is making the case that pro cycling should weigh all of its athlete health and safety risks better. When a rider falls, he or she becomes a sort of wrecking ball that tumbles through a tight pack of other riders. One injury can sometimes become many, and as contenders fall out the character and outcome of a race shifts. In the case of the rider already weakened and at risk for another crash, that liability is something the race itself can, and should control.

Much has been written about mainstream sports creating new rules to govern athletes who are injured. The NFL and the NCAA are reaching critical points in the courts, and in the morgue, regarding the effect of repetitive, cumulative traumatic encephalopathy (CTE) high impact brain injuries on football athletes. The body of knowledge being accumulated has led to deeper examination of concussive head and body injuries in other sports like soccer and rugby. It is becoming widely accepted that injured athletes should be pulled from the playing field and rested, to allow them to recover from injuries but also to protect the health of other athletes around them who might subsequently become injured due to impaired play. And that should not be the decision of the athlete; as in many other team sports, it must be the informed decision of competition referees and officials.

Accroding to Team EF, Craddock did not suffer a head injury. According to reports, Team EF Education First has enlisted a team of experts to help Craddock manage the stress of day-to-day racing with his injury, aide in his recovery, and monitor his well-being. Sprouse says that

Risk management is a delicate balance; it is analogous to knowing what cards you have in your hand, and guessing what cards the dealer might draw. For the moment, Craddock is riding a wave of luck and a hot hand — hopefully he is able to finish the race or he and his doctors will determine the appropriate point to withdraw. But asking the prizefighter, the linebacker, or the winger whether or not they can continue in a match is no longer a reasonable standard in sport. And the competitive and health consequences when an athlete can’t or won’t completely disclose how badly they’re really hurt are becoming clear. In the worst case, another Craddock fall, at speed, on live TV, will do serious damage not just to Craddock, but also to the sport’s public image.

Sprouse says that Craddock, himself, is not solely in charge of whether he continues to ride, or whether he gives up. Yes, the team asks him if he feels OK to ride, but staffers also examine his injuries each day, Sprouse said.

“He’s had a complete and ongoing medical examination,” Sprouse said. “Since I travel with an ultrasound, we even have serial imaging of the fracture.”

Improving athlete health and safety means more than just protecting the individual athlete — we must also safeguard the collective body of athletes who comprise any competition. Lawson Craddock is being accurately portrayed (and celebrated in some corners by the media) as a captivating and human feel-good story. And we need these kinds of stories, particularly given a Tour that started out on a sour note, with doping innuendos, incompetent crisis management, and ongoing public snipes between its top governance antagonists. But for all the challenges and risks that the sport can’t seem to get its arms around, this is an obvious one that it needs to take very seriously.

According to Sprouse, Craddock has “largely recovered from the shoulder injury,” meaning his progression in the race will likely continue.

The cobblestones are coming up tomorrow – an extremely tough stage even for superbly conditioned athletes in peak physical health. While Craddock has endeared himself to fans everywhere, and as unpopular as it may sound right now, is it time for the EF Education First-Drapac team to send him home to recover – not just for his own health, but also for the good of professional cycling.