Concussion in cycling has been a hot topic in general over the past two years, ever since Tom Skujins crashed in the Tour of California and stumbled about trying to get back on his bike, only to be helped on by a race official. If you haven’t seen the video the link is below but be warned, it’s disturbing to watch given the amount of danger the rider was placed in and the danger he caused to other racers.
Cyclists are tough but there comes a point at which injury and safety for all concerned cannot be ignored. Clearly these factors were ignored in that Tour which quite rightly sparked some serious debate about how to better manage these accidents in the future.
Cycling Australia and the Australian Institute of Sport have recently released their guidelines about concussion recognition and management (they’re the same in case you’re wondering). They are sensible, easy to understand and practical, but more about this later.
So what exactly is concussion? Concussion is a brain injury that usually occurs when you hit your head or jerk your head violently like a whiplash (even if the head doesn’t receive an impact). The brain is vulnerable to injury because it is very soft (not much firmer than jelly). Injury occurs because the soft brain is within a hard bony case (the cranium) whose interior has rough edges. The impact or whiplash-like motion of the head results in the soft brain being shaken against hard bone. This causes damage to the neurons within the brain which can vary from minor to more significant levels of brain damage. This damage is usually temporary, sometimes permanent, or sometimes cumulative if multiple head traumas occur (which is exactly what the NFL is dealing with).
The other thing that seems to almost universally happen in this type of trauma is neck damage, since whatever accident shook your brain and head around violently enough to injure it also tends to injure the neck much like a whiplash injury. Depending on the accident, there might be even more damage to the rest of the body… I’m sure Toms was feeling sore all over after his accident.
To give you an idea how common neck pain is after concussion, a recent research paper found 90% of adolescents sustaining a concussion had musculoskeletal neck problems and pain that likely contributed to their ongoing symptoms including headaches, dizziness and pain. The conclusion was that examination for the neck, ribs and upper back (thoracic spine) was recommended after all concussion injuries.
After a crash or other trauma to the neck/head, what should you do? In terms of managing concussion, a Sports Physician is one of the best types of doctors to seek advice and treatment from. Typically the brain needs a rest afterwards to heal and recover, and the amount of time this takes varies depending of course on how badly you damaged it. A Sports Physician can help advise you about this. The current concussion management guidelines from Cycling Australia recommend 24-48hrs of cognitive and physical rest for all age groups immediately after a concussion. Yes that’s right - rest from thinking to rest your brain! This may require a few days off school / work. Without covering all of the steps here, it is important to note that for children under the age of 18 no contact sport is recommended until at least 2 weeks following resolution of all concussion symptoms. In adults the recommendation is slightly different, and for everyone a full medical examination is recommended before return to sport. So if you suffer a concussion check in with your Sports Physician. This also means no interval training or high intensity efforts. There’s no shortcuts here – if you push too hard too soon all you do is prolong your recovery!
For your neck, ribs, thorax and the rest of your body, a skilled Physiotherapist can evaluate what structural damage or dysfunction might have occurred and set about treating this immediately. This is best done early after an accident as it usually means a lot less treatment is required than if your wait several months, by which time many other parts of the body have started to lock up in compensation. If you need a bit of time off the bike whilst things heal up it’s sensible to book in to manage all of the components of your injury so that they don’t impair your performance upon resuming cycling. I’ve seen quite a lot of cyclists who have ignored this simple truth this year alone, and as a result have required a lot more treatment some months down the track, with their self-neglect causing a whole lot more time off the bike than if they had acted straight away.
Reference: Tiwari D et al (2019): Characterisation of cervical spine impairments in children and adolescents post-concussion. International Journal of Sports Physical Therapy 14(2):282-295.
How to recognise concussion: Concussion Recognition Tool 5 (CRT5)
This is the assessment tool currently recommended by cycling Australia and many other sports to help coaches, parents and players recognise concussion and provides some guidelines about what to do. If in doubt - ALWAYS seek professional medical care.
