Who is in charge when concussion happens in racing?

Posted on July 23, 2013 by jtaylor

Concussions don't bleed, swell, ooze, or rupture, which makes it challenging to identify riders who may have sustained a concussion. Tony Martin (Omega Pharma-QuickStep), who crashed in Stage 1 of this year's Tour de France and lost consciousness on his way to the hospital, was later diagnosed with a concussion. This would have instantly qualified him for removal from competition in other sports yet, within 24 hours of crashing, Martin was back on his bike and working toward his team's objective to win a Tour title.

Tony Martin's injuries took Tour de France hard-man act too far

10 days later Martin, the current time trial world champion, seized victory in the 33 km. individual time trial in Stage 11. Data on the latent effects of concussion in cyclists are rare, however a few of the known long-term effects of concussion include abnormal brain wave activity, a wasting away of motor pathways, as well as symptoms similar to Parkinson's
disease. By crashing, losing consciousness, concussing and subsequently winning, Tony Martin, his physicians, and supporters succeed in undoing efforts to raise awareness about the seriousness of traumatic brain injury in cycling.

Brain Scan

In a race like the Tour de France, where racers often ride elbow-to-elbow, any lapse in concentration can lead to wheels touching at high speeds. Crashes are typically unavoidable and the resulting rider pileups yield a litany of carnage unrivalled by most other sports. These are the injuries, according to Tim Renowden in his article linked above, that "are routinely brushed aside by the rider involved, in the interests of team goals and romantic notions that this is a sport for the hardest of the hard."

Taking a concussed racer out of competition costs him the race and all the advantages in its wake (stage wins, prize money, future endorsements, racing contracts etc.), keeping him in the race gambles with his health and the welfare of his fellow racers. Put a racer back on his or her bike following a concussion and disequilibrium and slowed reaction times increase the risk for further injury to the concussed cyclist and those around him/her if precautions are not taken before returning to training and competition.

Tony Martin confessed via the Tour's official website that when he heard he could continue the race, he knew he "wouldn't be 100 percent" for the Stage 4 team time trial but by Stage 11, he claimed to be "more-or-less recovered."

Cyclists may dismiss the gravity of concussion simply because there isn't a lot of talk about concussion in cycling. Except that, as one surgeon put it, "Brain trauma is brain trauma, no matter the sport." Football players suffering the lasting effects of repeated blows to the head have sparked studies about concussion. In a landmark case that may shake the foundation of the National Football League, 4,000 former players argue that the NFL deliberately withheld information about the risks of playing football, namely the long-term effects of traumatic brain injury.

Can Just One Concussion Change the Brain?

Concussions in races like the Tour de France challenge team physicians and team directors to make a conclusive diagnosis based upon ambiguous symptoms, some of which can evolve for up to 14 days and persist for many weeks afterward. A lack of education about how to recognize and assess concussions, plus a "tough guy" mentality, seem to persist in professional cycling, where a concussion can cost a racer more than just minutes in the General Classification.

Undiagnosed Concussions In Cycling Cost More Than Just Minutes In The General Classification

Which is why it was so perplexing following a crash in Stage 6 that, rather than risk permanent damage to his left knee after crashing hard, Janez Brajkovic (Astana) was ordered out of the race by no fewer than three physicians while Martin rode on.

Until there is historical data against which to measure long-term effects of concussion in cyclists, cavalier physicians and uninformed team directors will continue to toy with the health and welfare of professional cyclists.

Concussion in Cycling docs now in French, English, Hebrew, Portuguese (soon Italian + Spanish)

Posted on July 12, 2013 by mabramson

The "Concussions in Cycling Consensus Statement 2012" has been translated from the original English into French and Hebrew thanks to the generous contributions of the community. And the Concussions in Cycling Assessment Card has been translated into French, Portuguese, Hebrew and soon will be available in Spanish and Italian.

Thanks so much to Paul T, Tomer G, Fabiano A, Wendy B and Marco B for their contributions!

You can find the documents and all translations on the Guidelines page.

Bicycling Magazine Article Features MOC’s Concussion Assessment Chart

Posted on June 21, 2013 by mabramson

Bicycling Magazine recently published Bruce Barcott's very well researched article about helmet standards, helmet design and concussion in cycling.  The article features an adaptation (used with permission) of the Medicine of Cycling Concussion Assessment Chart.  An excerpt from the article:

"Bicycle helmets do an outstanding job of keeping our skulls intact in a major crash. But they do almost nothing to prevent concussions and other significant brain injuries—and the very government agency created to protect us is part of the problem. The time has come to demand something safer."


You can read the full article on the Bicycle Magazine website at www.bicycling.com/senseless

Medicine of Cycling Concussion Evaluation & Assessment Cards Now Available in French

Posted on June 14, 2013 by mabramson

Thanks to the efforts of Paul Trégouët, we are now offering the Medicine of Cycling Concussion Evaluation / Assessment Cards in French on our Guidelines page.  This is in addition to our English and Hebrew versions. Full-color printed and laminated versions will be available prior the Tour de France.


If you would like to see the cards translated into another language or would like to coordinate an alternate language translation, please contact us.

Laminated Cycling Concussion Symptom and Assessment Cards Now Available For Purchase

Posted on January 29, 2013 by mabramson

Due to popular demand, we now have waterproof laminated concussion cards available for purchase.  These cards are a handy 5.5" x 8.5" size and they fit in any gear bag, car seat back or in the team bus.  Purchase as many as you like; bulk pricing is available by contacting heidi (at) medicine of cycling.com.


View the details and purchase from the purchase page

New York Times: To Encourage Biking, Cities Lose the Helmets

Posted on October 2, 2012 by mabramson

Is the importance of city bike usage more important than wearing a helmet?  The New York Times takes a look a bike sharing programs, helmet usage and the adoption of these programs.  The real question is: do the benefits of getting more people on bikes outweigh the risks of not wearing a helmet while doing so?

"In the United States the notion that bike helmets promote health and safety by preventing head injuries is taken as pretty near God’s truth. Un-helmeted cyclists are regarded as irresponsible, like people who smoke. Cities are aggressive in helmet promotion.

"But many European health experts have taken a very different view: Yes, there are studies that show that if you fall off a bicycle at a certain speed and hit your head, a helmet can reduce your risk of serious head injury. But such falls off bikes are rare — exceedingly so in mature urban cycling systems."

Read the full article here.



Huffington Post article “Is Cycling as Dangerous as Football?” features MOC Co-founder Anna Abramson MD

Posted on September 12, 2012 by hwoodhull

Josh Dines, MD, orthopedic surgeon and HuffPost blogger takes on concussions in cycling in a new article posted to the Huffington Post:

"If you had to guess, what percentage of adults had a concussion? Last year, Dr. Anna Abramson, co-founder of Medicine of Cycling Conference and co-author of the "Concussions in Cycling Consensus Statement," asked an audience of almost 100 high-level cyclists if they had ever had a concussion and 95 hands went up."

See the full article at http://www.huffingtonpost.com/dr-rock-positano-and-dr-joshua-s-dines/cycling-concussions_b_1814645.html

Concussion in cycling, skin care, legal issues, bike fit and research at Medicine of Cycling Conference 2012

Posted on August 25, 2012 by mabramson

COLORADO SPRINGS, Colo. (August 25, 2012) Post-crash management during a bike race can make the difference between retiring from the race and continuing under potentially life-threatening circumstances. A cyclist with a concussion may keep on racing for the sake of his team, sponsors, and sometimes, his paycheck. The lively topic of concussions in cycling started off Day 2 of the third annual Medicine of Cycling Conference, where attendees learned how to determine if an athlete has suffered a concussion and what are the current tools and different methods to diagnose a potentially concussed athlete. Neurologist Jeffrey Kutcher, MD and researcher Steven Broglio PhD of the University of Michigan Neurosport presented the latest findings from the fast-moving field of research of brain injury.

The attendees were also reminded about life-threatening issues that may be elevated in cyclists through improper skin care. Timothy Berger, MD, a professor of clinical dermatology at UCSF, presented some of the most important skin-related issues facing cycling: sun exposure and protection, road rash, saddle sores, skin cancer and poison oak/poison ivy.

"The sessions so far have been great, and I was particularly impressed with the dermatology lecture," said Rozanne Puleo, a family nurse practitioner and registered clinical exercise physiologist from Boston. "The skin is our largest organ, and one frequently impacted by the sport of cycling, but because it is seemingly non life-threatening, it gets under-emphasized in sports medicine circles. But today's talk reminded us of the great risk our cyclists face in terms of skin cancer, and also provided practical tips for prevention that can apply to every cyclist in every discipline."

Stephen Hess Esq. addressed the legal ramifications of practicing telemedicine, which he defined as any audio/video/data communication that occurs in the physician's presence with the patient. From a legal standpoint, Hess explained that the "practice of medicine" varies from state to state and advised attendees to check the law before traveling.

The afternoon set the stage for the controversial topic of bike fit, in which Curtis Cramblett, PT delivered an overview of bicycle fitting tools, technologies, theory, and practice. The fact that bike fitting is not yet a licensed profession has created a legion of self-described bike fit experts and unvalidated theories on "proper bike fit." To address this, the newly-formed Medicine of Cycling Bike Fit Task Force commenced panel discussions in order to build some consensus on this topic of great importance. The task force and panelists include some of the foremost experts on bicycle fitting from the diverse stakeholder groups of the bicycle industry, physical therapy, bicycle retailers and physicians.

The conference continues tomorrow at 8 a.m. (MST) with presentations on lower extremity conditions in cycling, nutrition for high performing cyclists, cardiovascular screening, the female cyclist, triathlon medicine, and cycling and doping. For more information, visit http://www.medicineofcycling.com/syllabus-for-2012-medicine-of-cycling-cme-conference/

Laminated concussion in cycling evaluation quick reference cards now available

Posted on August 21, 2012 by mabramson

The Medicine of Cycling Concussion & Traumatic Brain Injury Task Force has put together a quick reference card and TBI evaluation flowchart.  We had 500 printed up and laminated.  These are going to attendees of the 2012 Medicine of Cycling Conference and we will be distributing several hundred via the USA Cycling Coaching Summit to be held this fall.  They will also be available via our website shortly.

Concussion in Cycling Evaluation Flowchart Laminated Card (side 1)

Concussion in Cycling Evaluation Flowchart Laminated Card (side 1)

Dr. Anna Abramson and 2012 Concussion Guidelines Featured in VeloNews Article

Posted on April 26, 2012 by mabramson

VeloNews' Mark Johnson just published a detailed article about head injuries and the work that Medicine of Cycling and USA Cycling have done towards improving concussion management in cycling. It also features MoC Concussion Task Force member Dr. Kristin Wingfield:

Kristin Wingfield, the physician for the Exergy-Twenty12 professional women’s team, explained that cycling is particularly unique when it comes to concussion management in that, unlike other sports, “there is no time out; there are no player substitutions.” Yet putting a rider who has suffered a concussion back into a race can be both harmful to the rider, who may be suffering loss of balance and cognitive function, and the riders around who are depending on her to hold a line, stay upright and exercise sound judgment when diving into corners and sprinting for the finish.

You can read the full article on Velonews' site: