What happens after you crash out of the Tour de France?

Jens Voigt remembers he was having a good day before the crash. He was out in the break, descending from the Col du Petit Saint Bernard, with a group that included Lance Armstrong, Bradley Wiggins, Vincenzo Nibali, Chris Froome, and his teammates Frank and Andy Schleck. He went to the back of the group to get some fresh water bottles for the boys. Then as he worked his way up to the front, he appeared to hit a divot in the road, causing him to lose his balance before landing on his face.

The next thing he remembers is being in a helicopter as it was lifting off.

The next thing he remembers is laying on a table, watching surgeons work on his hand and face.

Roughly six hours after his crash, at 10:30 p.m. in France, he was finally able to hold on to consciousness well enough to take stock of his condition. He had fractured his right cheekbone and sustained a concussion. His first thought was to call his wife and family in Germany, and tell them he was OK.

“On German television they announced, ‘The chances of Mr. Voigt to see the next morning are 50/50,’” Voigt says. “And my kids and my wife were watching.”

Voigt estimates he was involved in 75 crashes during his cycling career. He is regarded as one of the most durable riders in cycling history, having made a record 17 straight Tour de France starts, tied with George Hincapie and former teammate Stuart O’Grady.

But the 2009 crash on Stage 16 of the Tour de France nearly ended his career five years early. For six months he lost total voluntary control of his body.

“I’d go, ‘Honey, I’m completely knackered, I can’t keep my eyes open, my body shuts down, I need to lay down for half an hour.’ I never had that before,” Voigt says. “My body would just stop working, my brain would stop working, and my whole body would tell me that I need to sleep.”

Friends asked Voigt if he was going to stop riding, and he admits he felt like he had to slow down — if not for to care for himself, then to care for his family.

“Each child born slowed me down a little more. I started to break a little earlier,” Voigt says. “Because hey, I love the kids and I love the family. I want to be able to go back to them in one piece, and not in a wheelchair.”

He asked himself why he should keep going.

Photo by Lars Ronbog/FrontzoneSport via Getty Images

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Stress and doubt can creep into riders as soon as a crash happens, and become magnified if they’re forced to abandon a race. The decision to stop is a tricky one that usually takes place as riders are scrambling to get up off the road, get on their bikes, and back into a race. Team doctors look for telltale signs of a rider trying to muscle through an injury that he shouldn’t.

“There’s a certain posture riders have when it’s a critical injury, a fracture versus just going down and being in pain and a little angry,” says Kevin Sprouse, the team doctor for EF Education First. “So there’s a lot that you can pick up in that first cue on seeing them: how they stand up, if they stand up, how they’re holding themselves.”

Doctors also quickly check for signs of head injury, starting with the simple questions of “How are you?” and “What happened?”

“If they can tell me with some detail what happened, that’s always a really good sign,” Sprouse says. “Riders will say, ‘I don’t know, I was just going along and all of a sudden I’m on the ground.’ That’s always more worrisome than saying, ‘We’re riding along, and there was a median, and this guy crossed over, and this guy was a little slow and his wheel crossed mine.’ When there’s a lot of detail to it, it’s a lot more reassuring.”

Sprouse says he’ll also look at balance, and the way a rider’s eyes move. Then overt signs, like bleeding — anything that might disqualify a rider on sight. Still, the stakes of the Tour de France does change the decision process. Whereas a rider might pull himself out of a lesser race with a broken bone, he might ride through it on the Tour.

“There are [injuries] that you might be able to ride through, but they’re going to cause worse damage,” Sprouse says. But if an injury is stable, “then it’s, ‘Well you want to give it a shot? Then let’s go.’”

When riders are forced to abandon — whether the decision is made immediately after a crash, or after several kilometers of gutting pain — it can be difficult to accept. Unlike in ball sports, there are no injury timeouts, no referees who might blow their whistle and bring the race to a halt. When a rider crashes out of the Tour, his rivals and teammates will simply blow right past the scene of the accident if they can.

Then when the stage ends, there’s little time for consolation. The team has to move on to the next start town, often leaving a rider all alone in a hospital, or at an airport to make his way back home.

Christian Vande Velde started 11 times at the Tour de France and crashed out twice. The isolation after being forced to abandon can wreak havoc on riders psychologically.

Photo by Doug Pensinger/Getty Images

“There’s an immediate feeling of relief if you are injured and you stop, and then there’s also an immediate feeling of regret, of ‘Could I have kept on going?’” Vande Velde says. “You definitely have that feeling of isolation, and you feel like you’ve let your team down.”

That isolation is largely self-imposed. Sprouse says in the 10 years he has worked in cycling, he has never seen a rider ask to stay with the team after they’ve been forced out of a stage race. According to Vande Velde, injured riders worry about compounding their misery by bringing down their teammates.

“You don’t want to be a negative towards your team, whether it’s the way you look, or the way you feel, or your sorrows,” Vande Velde says. “Especially going back to the hotel, it’s not nice. You’re having to feel your feelings. And sometimes you have to go back to a race hotel where on average three or four teams will be there, and you just want to get out of there, you just want to get home as fast as you possibly can.”

Home is where the healing process truly begins. There, team doctors set up cyclists with specialists they can see on their own time, without having to worry about getting in the way of the team’s needs. After Tejay Van Garderen abandoned the 2019 Tour with a broken hand suffered during Stage 7, Sprouse kept in touch using Slack to make sure the rider was recuperating properly both mentally and physically.

Riders also work on declawing stress from their mind. Having a support system of friends and family aids the comedown from a hyper-competitive mindset, and helps riders come to grips with competing again.

Voigt’s decision to come back was particularly tough because of the severity of the crash. Talking it out was key.

“I felt it in too many athletes, when you stop too early there is a bitterness or disappointment,” Voigt says. “And I know myself, if that would happen to me I would become a miserable husband and a miserable father because I would be unhappy with myself.”

Voigt felt he had the right support.

“My wife, absolute legend as she is, she said, ‘Look, Jens, you can imagine what I want after this accident, but I know you, I can feel it still inside you, so I give you a carte blanche: whatever you decide, I’m behind you. It’s your decision, because you need to be happy with it.’”

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There’s no good way to prepare for a crash. The circumstances unfold too quickly to react. Teams do prepare for a few contingencies — who’s going to give up their bike if the team leader breaks his, for example. But the best, and perhaps only, way to stay safe is to stifle any fear.

“When you do crash, you have that question in the back of your head sometimes — whether it’s in the peloton or going down a descent — where you don’t have that straight up confidence that you’ve had,” Vande Velde says. “That’s what the biggest problem with me was just not trusting the people around you. Because a lot of times crashes don’t have anything to do with you, you just put yourself in the wrong position at the wrong time.”

Counterintuitively, that doubt is often strongest in veteran riders. Young riders may be more confident in their ability to recover physically, and less aware that their careers are finite and fragile. Older riders are more acutely aware of their mortality, and may be shakier in a tightly-packed peloton as a result. “When you get older,” Voigt says, “you lay on the tarmac and go, ‘What the hell, do I really need this anymore? Do I even want to do this anymore? Do I really want to go back on the bike?’”

When a jumpy rider touches another wheel, it can send dozens of riders tumbling to the ground. At that point, the best any rider can do is make peace with the situation.

“It’s Days of Thunder, you close your eyes and you just go straight and hopefully everyone’s going to move,” Vande Velde laughs. “But for the most part there’s not much you can do. You can try to avoid it and go left and go right, look for a soft spot. Let’s say you’re near the grass, try to go in the grass.”

But that’s if you’re lucky. Half the time, Vande Velde says, “You’re like Walter Payton going over the top into the end zone.”

Voigt remembers one of the few times he nearly succumbed to fear. He won the Critérium International stage race five times in his career, but there was one nervy day when he wasn’t sure he would survive a descent.

“Nobody braked. There was noise from the wind, the rain, the fog, and it was so freakin’ scary,” Voigt says. “Everything inside me was just screaming at me, ‘Brake, brake, stop and go slow.’ And there I was really so close to actually letting fear and panic take over.”

To put his mind in the right place, he gave it a logic exercise.

“I taught myself, just by the laws of physics, if 50 riders can pass the descent without crashing, then I can do it as well,” he says. “I tried to overcome my fear by logic, by telling myself, ‘It must work. One and one is two, and if 50 riders pass this, I can pass this, too. Just don’t brake.’”

After his 2009 crash, Voigt took 12 weeks off before competing again. He picked the Tour of Missouri as his first race because it seemed low stress. American roads are typically much wider than European roads, and the peloton of roughly 120 riders was significantly smaller than the nearly 200 that show up for the Tour every year. The climbs and descents were also less harrowing, which meant there wasn’t as much potential danger.

To Voigt, continuing was, again, a matter of logic. He felt that because he had such a long, relatively safe career before the accident, there’s no reason he should believe that it couldn’t continue. He also had his family to think about. He wanted to stay healthy for them, yes, but he also wanted to provide.

He references Frank Herbert’s novel Dune.

“There’s a little passage where a character goes, ‘I cannot be allowed to have fear because fear is a mind killer. Fear makes you get all nervous, fear makes you do mistakes,’” Voigt says. “You’re allowed to have respect for the descent and for the speed, but when fear and panic takes over control, you get stiff on the bike, you break too early, you break too late, you take the corner at a weird angle.

“Don’t have fear, have respect.”

Photo by AAron Ontiveroz/The Denver Post via Getty Images

Sprouse is busier at his job than he’d like to be. EF Education First has had a particularly bad run of injuries the last two years. In 2018, Lawson Craddock broke his scapula on the very first stage of the Tour de France, but bravely stayed in the peloton until Paris, and team leader Rigoberto Uran was forced to abandon with injuries he sustained on a brutal cobblestone stage. In 2019, the team lost Van Garderen, and Michael Woods rode with two broken ribs.

“I always say, ‘If I’m bored and you don’t see me on TV or in an interview, then usually things are going very well,’” Sprouse says. “So when friends back home, or family, send me a text message saying, ‘Oh, we saw you on TV,’ I’m like, ‘Ugh, that’s not good.’”

As you might expect, the Tour de France’s medical setup is robust, especially compared to smaller races. Every stage comes equipped with a cadre of emergency specialists, traumatologists, surgeons, and radiologists ready to assist team doctors in any way that they can. Near the finish there’s even a truck that can do X-rays and ultrasounds for riders as soon they cross the line.

Everything is coordinated by head doctor Florence Pommerie, a badass emergency doctor who takes time off from her day job in the Paris suburbs to oversee the Tour. Team doctors always make the final diagnosis on their athletes, but Tour doctors provide an important assist.

“If there’s some scenario where I’m not in the car, they’re fantastic on the road,” Sprouse says. “I’m of the opinion that the more eyes on a problem, the better. So oftentimes in those scenarios if the race doctor is around, I’ll say, ‘Hey, what do you think? Here’s what I’m thinking.’ Ultimately the decision from a medical standpoint would be mine, but I’m never opposed to some input.”

The medical safeguards need to be so robust in part because the Tour is arguably the most dangerous race in the world. Not only are the roads themselves dastardly, but riders take more risks. The Tour is the most important race on the calendar, and so riders are less willing to yield than they are any other time of the year.

“In the first week of the Tour, it doesn’t really look that hard, but the peloton is packed with people and everybody is fighting to be at the front the whole time,” Vande Velde says. “It’s nerve wracking. And when those crashes happen you can’t really see because you’re packed in there so tight like a school of fish.”

“Nobody gives up a square inch on the road,” Voigt adds. He describes a scenario in another race when a rider might give him clearance. “The same situation the first day in the Tour de France, the same rider sits next to you, he’s going to say, ‘Jens, there’s only two solutions: either we’re both going to crash, or you’re going to brake because I ain’t braking.’”

Voigt remembers when he finally came to grips with his injury after his crash. He was laid up in a Berlin trauma clinic, reading a book on his bed, when he heard a baby cry outside of his window.

“And I looked down into the little garden we had behind the building, and I see this woman, early 20s, she’s holding a newborn baby, and she’s spoon feeding her partner in a wheelchair,” Voigt says. “The guy in the wheelchair, he was probably on a motorbike, he didn’t look like he’s ever going to recover fully. His body did not move at all.

“Moments like that, they help you recover because you go, ‘Stop bitching, stop whinging, you are still lucky.”

Voigt felt if he could compete, then he should. The team atmosphere and challenge of the Tour de France was a good reminder that life is too full of potential dangers to get hung up on just one.

“Out there, if you fall and half of the skin on your leg is gone, you just laugh and go, ‘Fuck this, I’m going to go back on my bike,’” Voigt says. “This crazy mix of emotions — relief, happiness, being proud, being afraid, being anxious, can’t wait for tomorrow, being anxious for tomorrow — this wild mix, you can hardly find it anywhere else, and that’s why the Tour de France is such a special event.

“These moments, you cannot really duplicate in normal life. You have to go there, there is no shortcut.”

The Tour de France, in short, is worth the risk.