Anna Abramson, MD speaks about Concussion Concerns in the Marin Independent Journal

Posted on April 10, 2012 by hwoodhull

"A concussion is like an iceberg," said Dr. Anna Abramson of Mill Valley. "You only see the tip and you don't see the most serious part. Most people don't know they have it and don't seek medical attention if they do. I don't think people have a good idea of the ramifications of having a serious crash."

Dr. Abramson, an attending physician and assistant clinical professor at the University of California, San Francisco, is also an avid cyclist. She says bike riding can be even more dangerous than car racing. "Cycling is basically the same as NASCAR, but instead of having a protective cage around us, we just wear Lycra and a helmet."

 

To read more visit - http://www.marinij.com/sports/ci_20344197/cycling-marin-concussions-concern-pros-and-amateurs

303 Cycling continues the discussion about concussion in cyclists and references the Medicine of Cycling Concussion Task Force and Guidelines

Posted on April 4, 2012 by hwoodhull

From 303 Cycling's recent article:

"Performance has no bounds. Persevere through the pain. Reaching the goal is the only option. Do you remember when professional cyclist Chris Horner of Team RadioShack crashed and was knocked unconscious in Stage 7 of the 2011 Tour De France? According to New York Sports, Horner insisted on finishing the next 35 km, none of which he remembers: the crash, whether or not he finished, or even that he was riding in the Tour de France...

To read more visit - 303 Cycling's "Concussions Can Be Deadly"

3 Tips for Aspiring Team Docs from Professional Cycling Team Physicians

Posted on March 14, 2012 by hwoodhull

For physicians who are trained and dedicated to practicing high levels of patient advocacy, becoming a pro cycling team doctor offers many the possibility to apply their professional skills to something they are equally passionate about. A pro cycling team doctor largely steers clear of any perverse sponsorship arrangements or scoreboard objectives that might compromise patient care.  Generally speaking, caring for athletes shouldn't be reactionary, as is common, but rather proactive, which means the team doctor may take command of racers' health before they even swing their legs over a bike for the first training ride of the season.  Here are some tips and comments from three team physicians.

The racing season for ProTour team, Movistar, began this year on January 15 in Australia with the Down Under Classic, which would prove a test to how well the team had prepared during pre-season training. For team physician Dr. Jesús Hoyos, it was a chance to see if his careful planning for the health and well-being of the team would pay dividends.

"I have many responsibilities as the team doctor: caring for the health of all team members, not only racers but staff as well; helping to plan out the race season with respect to specific races; supervising racers' training plans; organizing periodic health examinations to insure racers' maximum performance potential; and providing psychological support as necessary," Hoyos said.

Optimize your cyclists' health

Optimizing cyclists' health prior to the racing season starts with obtaining an assessment of athletes' baseline neurologic function so that — in case of a concussion — the information would allow for accurate diagnosis in the event of future injury. Athletes with a history of prior concussion are at an increased risk of repeat injury, so it is particularly imperative for these athletes to have a baseline cognitive assessment. This data will also be invaluable to racers who have sustained a concussion, since the team doctor can compare pre and post-concussion data to assess whether a racer is fit to return to competition.

"This year I have brought on board a neuropsychologist who will perform baseline neuro psych concussion testing on the team at team camp," said Dr. Kristin Wingfield, a primary care sports medicine specialist who works with the Exergy Twenty12 pro women's team. "Then we will use this as a baseline for each athlete and they can re-do the test post head injury on the road. We will then receive their scores and can make decisions about return to play (training and racing in this instance) without being there."

Evaluate each racer's health individually

The team doctor should take the initiative to evaluate each racer individually since athletic performance is keenly linked to a racer's health.

"A lot of times the athletes don't have their health optimized. For example, an athlete with asthma may be overly reliant on a rescue inhaler," explained Dr. Dawn Richardson, team physician for Champion System Pro Cycling Team. "Maybe they just don't know any differently or, for financial reasons, they didn't have access to preventive medicine. I explain that if they're using a rescue inhaler, their airways are inflamed and they don't want that. Just getting on maintenance medication for an asthmatic can make a huge difference in preventing airway inflammation and this in turn improves performance."

Dr. Richardson raced professionally until she retired in 2002; she had already completed her training and board certification as an emergency medicine physician. Her experience as a racer affords her a familiar perspective of the stresses of racing so, in addition to being available to the athletes without being disruptive to their routine, she assists in many ways above and beyond the call of duty.

"It's obvious fairly quickly that the mechanics and soigneurs are working very long days, so if I can do simple errands for them like supermarket runs, gassing up the team vehicles or run the athletes' laundry bags through the laundromat, I do it," Richardson said. "Something as simple as going to the pharmacy for an over-the-counter medication is way too much hassle for the athletes during a stage race, so I end up going on pharmacy runs at least every couple days."

Plan, monitor, and maintain racers' health regularly

Stage racing, especially a Grand Tour like the Tour de France, places heightened demands on a team doctor, like being "on-call" for 21 days straight. In addition to overseeing the team's health, Movistar's Dr. Hoyos maintains a daily routine that starts with waking the racers and recording their heartbeat, blood pressure, weight, sleep quality etc. He then follows up with racers who have suffered wounds that require specific treatment and continues to work with racers on mentally preparing for the day's stage. Following the stage, he records the same data as in the morning and notes each racer's state of health. He also supervises the racers' nutrition and monitors dietary supplements, such as vitamins, protein, and adequate hydration. Lastly, he administers treatments specific to incidents outside the norm (such as lesions, road rash etc.).

Unchecked injuries that can lead to serious health problems run counter to cutthroat competition, which has led to serious medical problems long after the athlete has retired from the sport. Sports like football and basketball are learning this the hard way through federal lawsuits filed by players who say that brain injuries have left them struggling with medical problems years after their playing days ended.

By comparison, doctors — like Dr. Richardson — who are cyclists as well are bringing their professional influence to bear on the sport, which sets a precedent for unparalleled athlete care. Of course a racing career isn't obligatory to becoming a pro cycling team doctor; a successful team physician doesn't need to produce results, just healthy racers.

Steven Broglio, PhD to speak at 2012 Medicine of Cycling CME Conference

Posted on February 24, 2012 by hwoodhull

 

Steven Broglio, PhD

Steven Broglio, PhD, ATC is an Assistant Professor in the School of Kinesiology and NeuroSport Researcher at the University of Michigan.  As Director of the Neurotrauma Research Laboratory, he has evaluated numerous clinical tests used in concussion assessment, injury biomechanics, and the acute and persistent effects of injury.  Dr Broglio is currently chairing the upcoming Position Statement on concussion management from the National Athletic Trainers' Association.

Jeffrey Kutcher, MD to speak at 2012 Medicine of Cycling CME Conference

Posted on February 24, 2012 by hwoodhull

Jeffrey Kutcher, MD

Jeffrey Kutcher M.D. is an Associate Professor in the Department of Neurology at The University of Michigan.  He is the Director of Michigan NeuroSport, one of the few sports neurology programs in the country.  Dr. Kutcher was recently named the Director of the new concussion management policy in the NBA, is the team neurologist for University of Michigan athletics, a consultant to the NHLPA, and leads the Sports Neurology section of the AAN.

Anna Abramson, MD presents at fourth annual USA Cycling Race Director Summit

Posted on February 21, 2012 by hwoodhull
Dr. Anna Abramson speaks at Race Director Summit

The fourth annual USA Cycling Race Director Summit offered a new twist for the more than 70 attendees who converged to discuss the 2012 season and growth of the sport domestically; the increased participation of more than a dozen of the nation’s top team directors.

Held for the first time in Salt Lake City due largely to the support of the Larry H. Miller Tour of Utah, the annual summit saw not only race directors but 13 Pro Continental, Continental and Domestic Elite Team directors in attendance as well as several mountain bike stakeholders.

“The race directors really wanted to bring the team owners and directors into the conversation and it was one of the things that we heard as feedback from last year’s summit,” said Tara McCarthy, USA Cycling’s race director certification manager. “The discussion was very positive and everyone came away super happy they attended.”

The group discussed a variety of topics throughout the three-day event hosted by the Salt Lake City Sheraton, including: sponsorship, head injuries, risk management, televising cycling and governance & rule changes. Small constituent groups also broke out to discuss scheduling, applications, team branding and on-site activation. The group also capitalized on networking opportunities over meals sponsored by Visit Salt Lake, Backcountry.com, DNA Cycling and PSA Sports.

“I feel like we all put on these events in a vacuum, so the most important thing to me is the opportunity to meet ‘colleagues,” said Mike Weiss, director of the Tour de Grove, the sixth stop on the 2012 National Criterium Calendar (NCC). “I’m a fairly new race director at this level and so I find the opportunity to tap into all the experience in that room quite worthy. I also thought the panel discussions were so valuable. Hearing from people who are really immersed in different facets of the business is beneficial as we as race directors can’t be experts on every side. I also thought the break-out sessions really got people talking and thinking outside the box. I left with a lot of great takeaways.”

Following USA Cycling CEO Steve Johnson’s State of the Sport address, a detailed discussion of USA Cycling’s new results & rankings program was led by Tom Mahoney, results & rankings manager. An insurance and risk management presentation was aimed at race directors while a UCI team break-out session ran simultaneously. Friday’s afternoon session was dominated by sponsorship panel led by Matt Wikstrom, V.P. of Wasserman Media Group and Steve Miller, Senior V.P of the Larry H. Miller Group. Dr. Anna Abramson, founder of the Medicine of Cycling group, also offered a moving presentation on prevention, warning signs and consequences of head injuries in cyclists.

“I think having input from so many men's and women's cycling teams this year was vital as a shared forum with event organizers to strengthen the business of cycling,” said Jackie Tyson, who works as the director of public relations for the Tour of Utah. “The team directors provided valuable feedback for these events to continue to improve as viable entertainment properties, as well as earning opportunities and development platforms for the athletes.”

Saturday morning’s focus turned toward media as USA Cycling Communication Director Andrea Smith moderated a panel of experts on the topic of new media. Jackie Tyson, president of Peloton Sports, Allan Padgett, CEO of Tour Tracker and Jesse Hammond, USA Cycling’s new media manager offered tips on how to capitalize on social media, the emergence of mobile applications, reaching out to the ‘new’ media and more. Medalist Sports’ Jim Birrell then joined forces with Dave Chauner of the TD Bank International to lead discussion on cycling and television. After lunch and a brief break-out session, participants heard from USA Cycling staff on branding and bidding for national events. A panel on moving from a national to a UCI-level event including Karen Weiss, executive director of the Tour of Utah; Don Edberg, director of the Wisconsin Off-Road Series (WORS) and Sean Petty, COO of USA Cycling wrapped up the event on Saturday afternoon.

For USA Cycling the summit marked the completion of its annual ‘summit season’which included face-to-face dialogue with Local Associations, Sport Committees, junior and high school racing stakeholders and race directors.

This Article Published November 16, 2011 For more information contact: kkahn@usacycling.org

Starting the Discussion About Pre-Season Concussion Screening in Cyclists

Posted on January 9, 2012 by hwoodhull

STARTING THE DISCUSSION ABOUT CONCUSSION IN THE PRE-SEASON
Anna Abramson M.D.

As your teams and athletes head into the new season, consider the events from the previous year. Multiple high profile athletes had a race or season ending fall resulting in concussion. Cycling like many other sports is now taking a closer look at the previously unrecognized risk associated with brain injury. The most crucial step in concussion is awareness. The Medicine of Cycling Concussion Task Force is making strides in setting guidelines but the first step is ensuring that athletes, teams, team managers, and coaches know the facts about concussion. The Medicine of Cycling website has the complete guidelines at http://www.medicineofcycling.org/publications.aspx.

WHAT IS A CONCUSSION?

Concussion is a form of brain injury resulting from a direct blow or rapid acceleration and deceleration of the brain inside the skull altering the cellular processes in the brain. Concussion or other types of brain injury can occur without direct impact or loss of consciousness. It produces characteristic signs that are evident immediately, and can result in symptoms that may evolve over the course of minutes, hours, days, or even months. Some symptoms are only evident with specific testing or questioning. Concussion evaluation is important because after an initial injury, the brain is susceptible to repeat injury. Resultant disequilibrium and slowed reaction times that may be caused by an initial injury increase the athlete’s risk for further head injuries.

WHAT TO DO IN PRE-SEASON

  1. Discuss the definition, symptoms, and risks of concussion with the athletes.
  2. Encourage athletes to disclose history of concussion and events that occur in training or competition.
  3. In event of a fall that may have resulted in concussion, encourage cooperation with exam. This will allow for a quick return to competition.
  4. Let a concussion ruin a race or even a season, don’t let it ruin a career or a life.

HOW TO EVALUATE FOR CONCUSSION?

The most important evaluation starts with suspicion of concussion. If any of the following signs of concussion are positive, the rider should be off the bike and ideally seen by a medical personnel.

  1. Did the rider lose consciousness? Was the rider unresponsive after crashing their bike?
  2. Does the rider have amnesia? Can the rider remember and describe the crash, the period before and after the crash?
  3. Does the rider seem confused, disoriented, slow, or foggy? Ask 4 questions about current events that the athlete should know the answers to, that you know as well. For example: What city are you racing in? What lap are you on (criterium)? How far are you from the finish of the race? Was there a break in the race? What teams or riders are in the break? What's in the pocket of your jersey?
  4. Does the rider seem “slow” or “off their game”?

WHAT ARE THE SIGNS AND SYMPTOMS OF CONCUSSION?

HeadachesNauseaFatigue

Sleep disturbances

Vision changes

Ringing in the ears

Dizziness

Balance problems

Sensitivity to light and noise

ConfusionSlowed thinkingSlow reaction time

Impaired judgment

Impaired attention

Distractibility

Impaired memory

Disorganization

Poor problem-solving

FrustrationIrritabilityRestlessness

Mood lability

Depression

Anxiety

Personality changes

WHAT IS THE RISK OF CONTINUING TO TRAIN AND RACE WITH SYMPTOMS OF CONCUSSION?

A rider with concussion is at risk of:

  1.  Repeat crash due to poor balance, concentration problems, or slow reaction time.
  2. More severe injury next crash because the brain is already in a vulnerable state.
  3. Prolonged or incomplete recovery
  4. Hurting another rider.

WHAT IS THE TREATMENT OF CONCUSSION?

The only treatment for concussion is brain rest and time. The brain is taxed by even daily activities such as reading, using a computer, riding a bike, driving. Instruct the athlete to abstain from alcohol and non-steroidal medications such as aspirin and ibuprofen. Use a step-wise approach to returning to training and racing which minimizes the likelihood of long-term side effects and high-risk trauma of in-race high-speed falls.

CONTACT CYCLING PHYSICIANS TRAINED IN CONCUSSION:

Matthew Bitner M.D. matthew.bitner (at) duke.edu
Jason Brayley M.D. jaybray1 (at) yahoo.com
Julie Emmerman Psy.D. Juliliz1 (at) aol.com
Mark Greve M.D. markgreve (at) hotmail.com
Ramin Modabber M.D. rmodabber (at) smog-ortho.net
Kristin Wingfield M.D. kristinwingfield (at) yahoo.ca

See the complete guidelines at http://www.medicineofcycling.org/publications.aspx.

Anna Abramson, MD presents Concussion and Event Medical Management at USA Cycling Race Director Summit

Posted on November 16, 2011 by hwoodhull

Colorado Springs, Colo. (Nov. 16, 2011) – The fourth annual USA Cycling Race Director Summit offered a new twist for the more than 70 attendees who converged to discuss the 2012 season and growth of the sport domestically; the increased participation of more than a dozen of the nation’s top team directors.

Held for the first time in Salt Lake City due largely to the support of the Larry H. Miller Tour of Utah, the annual summit saw not only race directors but 13 Pro Continental, Continental and Domestic Elite Team directors in attendance as well as several mountain bike stakeholders.

“The race directors really wanted to bring the team owners and directors into the conversation and it was one of the things that we heard as feedback from last year’s summit,” said Tara McCarthy, USA Cycling’s race director certification manager. “The discussion was very positive and everyone came away super happy they attended.”

The group discussed a variety of topics throughout the three-day event hosted by the Salt Lake City Sheraton, including: sponsorship, head injuries, risk management, televising cycling and governance & rule changes. Small constituent groups also broke out to discuss scheduling, applications, team branding and on-site activation. The group also capitalized on networking opportunities over meals sponsored by Visit Salt Lake, Backcountry.com, DNA Cycling and PSA Sports.

“I feel like we all put on these events in a vacuum, so the most important thing to me is the opportunity to meet ‘colleagues,” said Mike Weiss, director of the Tour de Grove, the sixth stop on the 2012 National Criterium Calendar (NCC). “I’m a fairly new race director at this level and so I find the opportunity to tap into all the experience in that room quite worthy. I also thought the panel discussions were so valuable. Hearing from people who are really immersed in different facets of the business is beneficial as we as race directors can’t be experts on every side. I also thought the break-out sessions really got people talking and thinking outside the box. I left with a lot of great takeaways.”

Following USA Cycling CEO Steve Johnson’s State of the Sport address, a detailed discussion of USA Cycling’s new results & rankings program was led by Tom Mahoney, results & rankings manager. An insurance and risk management presentation was aimed at race directors while a UCI team break-out session ran simultaneously. Friday’s afternoon session was dominated by sponsorship panel led by Matt Wikstrom, V.P. of Wasserman Media Group and Steve Miller, Senior V.P of the Larry H. Miller Group. Dr. Anna Abramson, founder of the Medicine of Cycling group, also offered a moving presentation on prevention, warning signs and consequences of head injuries in cyclists.

“I think having input from so many men's and women's cycling teams this year was vital as a shared forum with event organizers to strengthen the business of cycling,” said Jackie Tyson, who works as the director of public relations for the Tour of Utah. “The team directors provided valuable feedback for these events to continue to improve as viable entertainment properties, as well as earning opportunities and development platforms for the athletes.”

Saturday morning’s focus turned toward media as USA Cycling Communication Director Andrea Smith moderated a panel of experts on the topic of new media. Jackie Tyson, president of Peloton Sports, Allan Padgett, CEO of Tour Tracker and Jesse Hammond, USA Cycling’s new media manager offered tips on how to capitalize on social media, the emergence of mobile applications, reaching out to the ‘new’ media and more. Medalist Sports’ Jim Birrell then joined forces with Dave Chauner of the TD Bank International to lead discussion on cycling and television. After lunch and a brief break-out session, participants heard from USA Cycling staff on branding and bidding for national events. A panel on moving from a national to a UCI-level event including Karen Weiss, executive director of the Tour of Utah; Don Edberg, director of the Wisconsin Off-Road Series (WORS) and Sean Petty, COO of USA Cycling wrapped up the event on Saturday afternoon.

For USA Cycling the summit marked the completion of its annual ‘summit season’ http://www.usacycling.org/news/user/story.php?id=7143  which included face-to-face dialogue with Local Associations, Sport Committees, junior and high school racing stakeholders and race directors.

CDC Article: Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities

Posted on October 20, 2011 by mabramson

The CDC has just released a new report entitled "Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged ≤19 Years --- United States, 2001--2009."  It provides a wealth of information on the topic and a number of references to other articles and resources.  One of the key points is:

"From 2001 to 2009, the estimated number of sports and recreation--related TBI visits to emergency departments (EDs) increased from 153,375 to 248,418, and the estimated rate of TBI visits increased from 190 per 100,000 population to 298. The two most common sports and recreation activities associated with ED treatment for TBI were bicycling and playing football."

Check out the complete article on CDC's Website.

USA Cycling and Medicine of Cycling release Concussion Guidelines for cyclists

Posted on September 30, 2011 by mabramson

USA Cycling and the Medicine of Cycling group have released recommendations for treatment of riders who have sustained head trauma in cycling. Foremost amongst the guidelines is that any rider with a witnessed loss of consciousness during training or competition should be immediately removed from competition for evaluation by a medical professional trained in diagnosing traumatic brain injury or concussion.

Concussion Release on USA Cycling's Website

Concussion Release on USA Cycling's Website

“Concussion can occur without direct impact or loss of consciousness, and can result in physical, cognitive or emotional symptoms that may be evident immediately or evolve over days or weeks,” explained Dr. Anna Abramson of the University of California, San Francisco and co-founder of Medicine of Cycling. “The Centers for Disease Control and Prevention estimates that there are 1.7 million people that sustain a traumatic brain injury annually.Concussions can occur during falls, motor vehicle accidents, struck by/against events, and assaults. However,  concussed cyclists are more likely to have impaired function that could lead to a repeat crash, potentially hurting themselves and others. Those with previous concussions are at increased risk of repeat concussions and brain injury, and are most susceptible during the post-concussion period.  This is dangerous in the short term and has long term implications of post-concussion syndrome.”

Medicine of Cycling, an independent group of physicians and psychologists working to improve processes that can have a meaningful impact on the way care is delivered to cycling athletes, recently formed the Medicine of Cycling Concussion Task Force which aims to increase awareness of concussion and improve safety for cycling athletes. The guidelines pertain to adult athletes only, as younger riders are even more vulnerable to brain injury. These guidelines are intended to educate cycling team managers, coaches and athletes on the symptoms and management of concussion in athletes. The guidelines are not a surrogate for evaluations by appropriately trained medical professionals.

The concussion statement issued by the Medicine of Cycling Concussion Task Force outlines actions team managers and athletes can take in the pre-season, tips for recognizing and evaluating concussion immediately post-injury and considerations for return to competition. The concussion statement recommends educating athletes on the seriousness of concussions and assessing basic neurologic functions in the pre-season. Following head trauma, the statement emphasizes the importance of cooperating with medical personnel and identifying key symptoms. For return to competition a slow, step-wise approach is advised once an athlete is asymptomatic.

Overall the guidelines recommend that any rider with a witnessed loss of consciousness during training or competition should be immediately removed from competition for medical evaluation. These guidelines do not imply that a rider who sustains a head injury without witnessed loss of consciousness is fit to ride.

The Medicine of Cycling Concussion Task Force also outlines a list of additional resources and contact information. View the full guidelines for concussions in cyclists on the Anti-doping & Health page of usacycling.org.

“Our intent in issuing this statement, is to both emphasize the seriousness of the potential risk of concussion to the cycling community; and also proved some insight into the current proven techniques for preventing and minimizing the effects of head trauma.”

http://www.usacycling.org/news/user/story.php?id=7098