Lance Armstrong Breaks Collarbone in Crash

Armstrong injured during race in Spain; "Hurts like hell..." he twitters.

March 23, 2009— -- Seven-time Tour de France champion Lance Armstrong was rushed away in an ambulance with a fractured collarbone after a fall during a bike race in Spain today.

The famous cyclist was seen holding his right arm after a pileup crash 12 miles from the finish of the first stage of the five-day Vuelta of Castilla race.

"I'm alive!" Armstrong posted on his Twitter feed late Monday evening. "Broken clavicle (right). Hurts like hell for now. Surgery in a couple of days. Thanks for the well wishes."

Armstrong said he would fly back to the United States to see whether he needed surgery, according to Phillippe Maertens, a spokesman for Armstrong's Team Astana.

The accident could endanger his hopes of racing in the 2009 Tour de France, which begins July 4.

"I have been lucky to avoid one of the most common cycling injuries," Armstrong said in a statement. "The crash has put my upcoming calendar in jeopardy but the most important thing for me right now is to get back home and rest up and begin my rehab."

Although Armstrong's personal Web site said he is "officially retired," the 37-year-old cancer survivor and Tour de France champion had returned to racing with the Astana team and was said to be preparing for a run at an eighth Tour de France title. But Maertens said Armstrong could be back on the road in a month, in time for a race in Italy in May and the Tour de France in July.

"The collarbone is broken, and I have a little bit of road-rash abrasions," Armstrong said as he left Valladolid University Hospital. "I've never had this happen before; it's pretty painful. I feel really miserable."

Astana team leader Johan Bruyneel was optimistic, writing on his Twitter feed that Armstrong appeared poised to make a speedy recovery.

"Clean collarbone fracture without complications," he wrote. "Should be fast recovery."

Armstrong had already covered 97 miles of the stage and was at the front of the pack when he fell, Maertens said, adding that Armstrong knew immediately what had happened, although he had never before broken his collarbone in his 17 years as a cycling professional.

When he fell, Armstrong's first reaction to the crash was reportedly to utter the single word "sh**."

From the time he returned to racing in 1998 after his battle with testicular cancer to his retirement after the 2005 Tour de France, Armstrong was not sidelined for any significant time periods from crash-related injuries in training or competition, although he did take an occasional spill.

"Crashes are a part of what we do in training and in racing," he told Sports Illustrated in 2000. "It seems like every year, I have two big crashes. I did last year, I did this year. Like I said, it is just part of our job."

While training for the 2006 New York City Marathon Armstrong experienced some of the most taxing injuries of his athletic career.

"I'm icing my shins right now," Armstrong told USA Today in November 2006. "I've been riding the bike lately because of these nagging little injuries."

That shin splint problem was diagnosed as a stress fracture 10 days after the marathon, according to Armstrong's Web site.

"Having survived so many things, having climbed so many mountains, it seems to me that this is just another mountain for Lance Armstrong to climb," said Christine Brennan, USA Today sports columnist and ABC News consultant.

The Injury Risk When Lance Armstrong Crashed

Zooming down roads at speeds averaging more than 25 miles per hour, professional cyclists risk serious injury even from a simple fall, according to Dr. Sherwin Ho, an associate professor of surgery and the director of the sports medicine fellowship at the University of Chicago.

"Any fall directly onto the shoulder basically collapses your shoulder in against your body," said Sherwin.

Under normal circumstances, two body parts work in tandem to keep the shoulder in place -- the clavicle bone that keeps the shoulder joint at the right distance from the body and a ligament called the AC (acromioclavicular) joint that connects the shoulder to the clavicle.

In a fall, "something has to give, and it's either one of these two," said Sherwin. "It seems like the higher the impact, the faster they break, the more often well see the collarbone break." Sherwin said he sees more AC tears from people falling at lower speeds.

Sherwin said it is sometimes possible to tell whether someone fractured a collarbone or tore an AC joint just by looking at the person. For instance, a clavicle bone jutting out under the skin by the shoulder often indicates an AC tear.

"If you see it, that's actually the end of the clavicle sticking out," said Sherwin. On the other hand, a fractured clavicle often looks like general bruising and swelling on the center of the bone.

In either case, Sherwin said a fractured clavicle or torn AC ligament are relatively easy to treat. "It's just a lot of pain, and it's hard to use your arm," said Sherwin. "In most cases you don't need to fix it, you just need to protect it and leave it alone."

Unless Armstrong completely snapped his clavicle in half and has a gap between the pieces, Sherwin predicted he may not need surgery. However, it is likely that Armstrong will need several weeks -- Sherwin often recommends six at minimum -- before he can go back on the road.

But Jacinto Vidarte, the press director for the Vuelta of Castilla, said he has seen athletes return from similar injuries much sooner -- around four weeks, or even earlier.

"If you start too early you run the risk of re-injuring it," said Sherwin. "You need that arm to control the bike or you'll end up crashing again. So it's key that he heal before he starts riding."

Most cyclists can continue training on a stationary bike while their shoulders heal.

How Fast Can Armstrong Heal?

Unlike many other contact sports, Sherwin said cyclists face only the occasional acute injury.

"The incidence of injury is not as high as a contact sport," he said. "However, when you do get a traumatic injury because they're moving at a high rate of speed, and because they're falling from a high position on the bike, and because they're falling on a concrete, then the injuries tend to be more severe."

ABC News' Miguel Marquez contributed to this report.