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"

Funding Opportunities for Medical Research Through the Department of Defense

Posted on March 6, 2012 by hwoodhull

Like any medical organization, Medicine of Cycling is always looking for research dollars. As a reminder, the National Institute of Health (NIH) has a budget of $30 million per year.  The military has a considerably larger annual budget.  The following is a NEW funding opportunity that some of our physicians may be interested in pursuing.  The 2012 Defense Appropriations Act provides $50 million to the Department of Defense Peer Reviewed Medical Research Program (PRMRP).  Like medicine of cycling, the vision of the PRMRP is to improve health and well-being.  The PRMRP targets all military service members, veterans, and beneficiaries.  The 2012 PRMRP will solicit research applications for topics including: Arthritis, Composite Tissue Transplantation, Dystonia, Drug Abuse, Epilepsy, Food Allergies, Fragile X Syndrome, Hereditary Angioedema, Inflammatory Bowel Disease, Interstitial Cystitis, Listeria Vaccine for Infectious Disease, Lupus, Malaria, Nanomedicine for Drug Delivery Science, Neuroblastoma, Osteoporosis and Related Bone Disease, Paget's Disease, Polycystic Kidney Disease, Post-Traumatic Osteoarthritis, Scleroderma, Tinnitus, and Tuberculosis. Although these topics do not directly pertain to cycling, if you are doing research in one of these areas, perhaps you can tap into this resource.  Please take a look at the Congressionally Directed Medical Research Programs website - http://cdmrp.army.mil/pubs/press/2012/12prmrppreann.shtml.  Good Luck!

Starting the Discussion About Pre-Season Concussion Screening in Cyclists

Posted on January 9, 2012 by hwoodhull

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.


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.


  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.


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”?



Sleep disturbances

Vision changes

Ringing in the ears


Balance problems

Sensitivity to light and noise

ConfusionSlowed thinkingSlow reaction time

Impaired judgment

Impaired attention


Impaired memory


Poor problem-solving


Mood lability



Personality changes


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.


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.


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.

Call For Abstracts for Medicine of Cycling Conference 2012

Posted on October 6, 2011 by mabramson

Medicine of Cycling is pleased to announce the Call for Abstracts for the 2012 Summer Conference to be held next year in Colorado Springs.  The tentative dates for this conference are August 24-26, 2012.  Medicine of Cycling and UCSF invite you to submit your original research papers now through December 31, 2011.

We encourage abstract proposals in dermatology, nutrition, wound care, physical therapy/rehabilitation and recovery, general health and cycling and cycling with disabilities.  However, our program is not limited to these topics. We welcome all topics that address medical issues seen in cycling.

Abstract proposals are sought for both oral and poster presentations.  Abstracts should generally be no longer than 300 words and must cite quantitative data from representative studies.

Oral abstract presentations will involve a 10-minute presentation followed by a 5-minute Q&A.

Poster abstracts will be displayed at the conference.  The poster should be clear and organized for viewing measuring no larger than 4’ x 4’.  The presenting author of the poster will be assigned a time slot during which he/she is expected to be physically present at the poster to answer any questions.

Abstracts must address the following:

  • Objective
  • Methods
  • Results
  • Significance to Cycling Medicine

Submitters will be notified by e-mail of their submission status in March 2012.

Abstracts may be submitted via email to Anna Abramson, MD at anna (at) medicine of cycling dot com or via regular mail to:

Medicine of Cycling, Inc.
480 Gate 5 Road, Suite 124
Sausalito, CA 94965

We look forward to your submissions!




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.”