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.
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.
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.
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.
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.