Although virtually any type of traumatic injury can result from a high speed motor vehicle injury, there is surprisingly limited literature documenting the minor and/or chronic orthopaedic injuries that plague participating drivers over the long run.
Some of the challenges cited when compiling research data arises from the difficulty in generating large sets of comparable facts and figures. The sport takes many diverse forms, so at any given time, there can be variations in the type and number of vehicles in a particular race, levels of driver skill, track layout, weather conditions, race duration and many other variables.
Additional factors to contend with, include the fact that professional race car drivers (as opposed to amateur/recreational drivers) generally drive more powerful vehicles, at higher speeds, over a longer duration and are do so more frequently than the average amateur racer.
Moreover, the chances of sustaining an injury increase in a larger competitor pool, and this can vary from race to race. These – among other variables – may increase the rate and risk of sustaining more significant syndromes and injuries.
Race Car Types and Injury Patterns
Single Seaters
Single seat race cars have a small drivers compartment with reduced legroom and a steering wheel placed closer to the driver. This results in an increased rate of lower limb injuries and a higher risk of head injuries.
Saloon Race Cars
The build of saloon racing cars replicates that of ordinary motorcars. They have a larger passenger compartment, have windows and a roof. For this reason, accidents in saloon race cars show a similar pattern of injuries to that seen in regular motor vehicle accidents.
Single Seaters vs Race Cars
Race car drivers use six-point harnesses and helmets. This reduces the rate of head and face injuries in comparison to that seen in public road accidents.
But, because race cars typically travel at high speeds, drivers have a higher rate of concussion in comparison to other high risk sports. The risk is higher in drivers of saloon cars than that in drivers of single seat racecars.
Many injuries in single seaters are, simply, bruises.
Saloon cars, on the other hand, have an increased risk of upper limb and neck injuries, due to the increased distance from the steering wheel.
Dehydration
The risk and incidence of dehydration is a concern – especially after races done during warmer seasons and in closed cockpits.
The use of full face helmets and fire retardant protective suits also encourage heat retention.
It is essential that drivers and their support teams ensure a regular fluid intake, and remain vigilant of ambient temperatures – both within and without the drivers cockpit to avoid complications.
Muscle Overuse
Simple muscle overuse may present as cramping and fatigue. In some instances this presents as paralysis, with drivers temporarily unable to elevate their arms after a race due to exhausted deltoid muscles. This paralysis is usually self limiting and resolves with rest.
However, a more severe condition known as compartment syndrome may occur when muscle use is sustained – particularly in drivers who participate in long distance races/rallies.
This sustained overuse increases pressure within the affected muscle compartments to such an extent that it obstructs blood flow, starving the tissues of oxygen and nutrition.
A driver suspected of suffering from compartment syndrome presents with severe pain, reduced reaction time, pins and needles among other symptoms.
In extreme situations, drivers suffering from severe compartment syndrome may need to undergo surgery (fasciotomy) to open and decompress the affected muscle compartments.
Ligament and Tendon Injuries
Repetitive and sustained grasping and turning of the steering wheel during racing eventually results in progressive stretching of the scapholunate (SL) ligaments at the wrist.
Drivers suffering from chronic SL injuries may present with pain at the back of the wrist. Dedicated wrist x-rays are a good basic investigation to assess evidence of chronic tendon dysfunction with instability of the wrist bones (carpals). These investigations may also be supplemented by advanced investigations (CT and MRI scans).
Other carpal ligaments (triquetrolunate and triangular fibrocartilage complex [TFCC]) may also be progressively damaged and stretched out.
These chronic ligamentous injuries eventually also lead to instability and osteoarthritis, that may require surgical intervention (that may include open/arthroscopic ligament reconstruction, joint debridement, osteotomies, fusion and/or bone excision) to address the pain and loss of function that arises.
Overuse of the thumb tendons when driving may lead to de Quervain’s tenosynovitis. This is due to increased friction surrounding two of the thumb tendons (the abductor pollicis longus [APL] and extensor pollicis brevis [EPB]) that run on the outside of the wrist.
This overuse results in thickening of the tissues surrounding these tendons, with resulting pain and a decreased range of movement of the thumb.
Hand conditions may be addressed by adapting the steering wheel through modifying its size, shape, steering wheel grips and shift paddles/buttons.
Rest and rehabilitation under the care of an Occupational Therapist may help, and would include condition-specific exercises and custom-made thumb splints. Failure of conservative treatment usually warrants consideration of a surgical release to address the loss of function.
Additionally, due to continuously gripping the steering wheel, drivers thumb muscles (lateral thenar muscles on the outside of the palm of the hand) become larger. This results in a decreased range of motion in the hand and forearm.
Vibration Syndromes
Due to race car design drivers also experience hand-arm vibration syndrome.
Through a stiffened suspension to improve the car’s performance and efficiency, vibrations from driving on the racetrack are transmitted to the drivers upper limbs through the steering wheel.
These sustained vibrations have been shown to cause nerve damage and impaired function, with drivers reporting pins and needles in the affected extremities, particularly made worse during effort.
Investigations (such as Nerve Conduction Tests) have also been shown to demonstrate decreased conduction velocity in the affected motor nerves.
These vibration syndromes are prevented by the use of sport-appropriate wrist pads, silicone splints and hand/wrist cushions to dampen and absorb vibrations.
Nerve Compression Syndromes
Due to overuse, wear and tear and repeated trauma with osteoarthritis, upper limb nerve compression syndromes may follow overuse at the level of the wrist and elbow joints.
Median and ulnar nerve compression syndromes are the commonest conditions diagnosed and usually present with incomplete nerve fallout.
Drivers typically present with vague or mild nerve disturbances involving their fingers and hands such as tingling, pain at the relevant joint, reduced grip strength and diminished range of movement.
Low Back Pain
Due to the stiffer vehicle suspension and prolonged periods spent seated and restrained in a fixed position, race car drivers typically suffer low back pain.
This can be addressed through the use of orthotic supports, installing adequately-cushioned racing seats and physiotherapy.
What's Needed Further in Motorsport?
Annually, racing draws both billions of fans and Rand in investment, globally.
What hasn’t drawn sufficient attention is the extent of the physical toll that such a demanding sport takes on its participants.
It is clear that more research needs to be taken into racing and it’s long term impact on drivers to bridge the current gap in knowledge.
Having more information will allow for better decision making, better vehicle design and will usher in preventative measures that aim to improve both drivers’ longevity and safety in racing.
Dr Anne Maina
Specialist Orthopaedic surgeon
MBBCh (Wits), FC Orth (SA), MMed Ortho (Wits) CIME
References:
- Masmejean EH, Chavane H, Chantegret A, Issermann JJ, Alnot JY. The wrist of the formula 1 driver. British journal of sports medicine. 1999 Aug 1;33(4):270-3.
- Minoyama O, Tsuchida H. Injuries in professional motor car racing drivers at a racing circuit between 1996 and 2000. British journal of sports medicine. 2004 Oct 1;38(5):613-6.
