Cycling’s Concussion Dilemma

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German Tony Martin crashed hard on stage 1 of the Tour de France but raced the next day.

German time-trial specialist Tony Martin separated his shoulder and suffered a concussion in a crash during the first stage of this year’s Tour de France. One day later, the Omega Pharma-Quick-Step team rider was back in the race, lending credence to cycling’s reputation as a “hard man” sport.

There are those in the cycling world, however, who would have preferred Martin quit the race in light of his head injury. Dr. Anna Abramson, co-founder of the group Medicine of Cycling, said cycling’s tradition for overcoming pain and injury has led the sport to overlook the dangers of concussions.

“Cycling has taken a very passé approach to dealing with head injury,” Abramson said. “I think cycling is actually worse than hockey culture, because hockey is actually ahead of us in studying concussions — that’s the sad truth.”

Concussions are becoming a hot-button topic in cycling, as scores of amateur and professional racers have seen their careers derailed by head injuries. Chris Horner dropped out of the 2011 Tour de France after crashing onto his head during the seventh stage stage. Tom Boonen also abandoned that year’s Tour after crashing on his head. American Evelyn Stevens cracked her teeth and suffered a minor concussion after crashing at the Classica Citta di Padova race this past March. And American cyclists Scott Nydam and Sinead Miller both saw their promising careers end after suffering numerous concussion.

These cases and others like them are in part why the topic has become a primary focus of Medicine of Cycling, a consortium of doctors, coaches and cycling advocacy professionals who meet once a year to publish medical reports on cycling. Organized by Anna Abramson and her husband Mark — a former president of USA Cycling — the group was founded in 2010 and meets once a year. The next meeting is September 20-22 in Colorado Springs.

The group has published documents about everything from skin care to bike fits. In 2011, Medicine of Cycling decided to tackle the concussion issue, and published a seven-page document on the diagnosis and treatment of head injuries.

“People understood how important this was,” Abramson said. “But they said ‘I need something shorter than a seven-page document.’”

In February 2012 Abramson boiled down the information into a two-sided paper, which she laminated and distributed as a “concussion card” that provides how-to directions for diagnosing and then treating serious concussions. USA Cycling now carries the concussion cards in team vehicles during races. Abramson said she also gave the cards to various team directors of U.S. domestic pro race teams.

The cards provide a roadmap for treating a cyclist after a crash. The first step is to ask a series of orienting questions (What race is this? Was there a breakaway? Where are you? What lap are you on?) to establish if there has been any loss of memory. Should a cyclist fail to answer five or more questions correctly, he or she should withdraw and seek medical help.

According to the cards, a cyclist should also quit the race and seek medical help if he or she exhibits “high risk” features after a crash. These symptoms include: significant head/neck trauma, seizure, skull fracture, nausea, severe headache, disorientation lasting 30 minutes or more, inability to speak or swallow, fluid leaking from nose or ears or inability to ride in a straight line.

A concussion results from a complex series of reactions that occur in the brain following serious trauma. But the broad strokes of concussion are fairly straightforward. The brain is in metabolic crisis. It feeds on sugar, and after trauma and swelling, the brain has difficulty feeding itself, so it works slowly. The sensation can last days, weeks or even months, and can be exacerbated by exercise.

“We realized concussion is more dangerous in cycling than other sports,” Abramson said. “When you get back on your bike, you’re increasing your metabolic needs without increasing blood supply and decreasing the swelling in your brain.”

Abramson said Medicine of Cycling is continuing to study concussions. She said that in a perfect world, athletes would establish a cognitive baseline, which could be then used to determine the severity of cognitive loss after a head injury. She said Medicine of Cycling continues to study the topic, and currently one of its affiliates is studying the affects of exercise on the traditional Sports Assessment Concussion tool.

Abramson also recommended cyclists either purchase or print off the concussion cards to keep in case of a head injury. You can download PDF versions here.

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  • W Kaufner says:

    No mention of the article about new helmets that limit concussions in recent Bicycling Magazine.

  • Mark Wynn says:

    Many sports now have mandatory observation and rest periods for a concussion.

  • MrBad Example says:

    I know I’m in a minority of riders (maybe 1% of cyclists), but people on recumbent bikes are far less likely to be pitched forward head-first. because of the reclining position of the seat, it’s next to impossible to be thrown over the handlebars in a head-on accident. And in a sideways accident (for example, if you can’t get out of clipless pedals), you aren’t falling as far because of the lowered seating. just sayin’.

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