• Head Games: Recognize Signs, Symptoms of Concussions in Cycling

    by  • August 1, 2014 • trainin and tactics

    By Heather Johnson
    Heather Johnson lives and writes in Oakland and rides for (who else?) Team Oakland. She loves to ride up big hills and competes primarily in duathlon.

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    We’ve all heard gruesome reports from races or training rides—sprains, strains, broken bones, lost skin, sometimes missing teeth—recounting either a collision with another rider or with a vehicle. With a number perfectly pinned to their jersey, bike racers will pick themselves up and carry on if body and bike will allow. But when the collision involves a hard knock on the head, with or without a cracked helmet, it’s time to put on the brakes. Remember Chris Horner, who finished Stage 7 in the 2011 Tour de France concussed? Don’t do what he did.

    That well-crafted dome of expanded polystyrene (EPS) and plastic will greatly decrease the odds of a traumatic brain or skull injury, but it won’t protect you completely from brain trauma. Much like the seat belt in an automobile, the helmet can save your life, but it won’t keep you head injury-free.

    The United HealthCare Pro Cycling Team’s physicians conduct baseline assessments of every rider to log their reaction time, memory and balance. When a rider crashes, the MDs can compare pre- and post-crash assessments to determine if and to what extent the rider is concussed. As amateur athletes, we don’t have team coaches, managers or physicians at our disposal for every race.  But every rider can recognize the symptoms of concussion and the importance of immediate assessment. As a group, it is wise to set some ground rules.

    “A team should have an agreement ahead of time: if they are at a race or on a ride and someone goes down, and there’s an actual head injury, especially if there is a loss of consciousness, that person needs to be pulled out,” says Michael Roshon, MD PhD, team physician for United HealthCare Pro Cycling Team. “Don’t ignore the symptoms. They can sometimes seem mild, but you are better off taking a couple days off.”

     “High risk” symptoms include loss or change in consciousness, nausea and/or vomiting, severe headache, disorientation, inability to speak or swallow, amnesia, significant trauma to the head, fluid leakage from the nose or ears, seizure and an inability to walk or ride in a straight line. Dizziness, headache, poor balance, head and neck pain and “brain fog” are less serious symptoms but should not be ignored.

    If a rider shows any of these symptoms, not only should they stop racing, but they should also get themselves evaluated by a physician. Jukka Valkonen, a heath care industry expert for Kaiser Permanente Medical Group as well as a former professional triathlete and formidable masters competitor, recommends that riders bring their helmet to that MD appointment. “Current evidence shows that while an athlete may not show signs of a concussion, they may still have white matter damage,” he says. “There is a growing concern over these microconcussions.”

    According to a Consensus Statement derived from the 4th International Conference on Concussion in Sport held in Zurich in November 2012, “It should also be recognised that the appearance of symptoms or cognitive deficit might be delayed several hours following a concussive episode and that concussion should be seen as an evolving injury in the acute stage.” When a maroon Nissan Altima U-turned into me at the start of a ride, I had a splitting headache, but no other concussion symptoms. When I sat up in bed the next morning, the room started spinning worse than if I had just leapt off of an old merry-go-round at the playground. The vertigo continued for weeks.

    While some symptoms may surface immediately, others may not manifest until up to two weeks post-crash. Teammates, coaches and family members, in addition to the rider himself (who may insist he or she is fine just to keep riding) should pay attention to mood changes (for the worse), ongoing headaches, fatigue, insomnia and a decrease in reaction time. If any of these symptoms surface; again, medical attention may be required.

    Contrary to our compulsion to get back on the bike immediately, the medical report recommends a gradual “return to play.” Depending on the severity of symptoms, take one or two days off followed by a period of low-intensity training. “It’s important to get the right rest before you start hammering again,” says Roshon. If the symptoms return after a ride, take a step back. Doing otherwise will put you at risk of a “second hit,” which can cause damage much more serious than the first, such as permanent brain injury or death.

    To better understand the symptoms of head injury and action steps, Medicine of Cycling put together this handy flow chart. The chart also has a link to the Cycling Consensus Statement for even more information.

    Outside of a podium spot or “catting up,” every rider’s goal is to complete the racing season injury and crash-free. But if the unfortunate happens, and it involves a knock in the head, don’t tough it out. Your brain is more important than one ride or another race. Be in it for the long haul.

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