Starting the Discussion About Pre-Season Concussion Screening in Cyclists

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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 noiseConfusionSlowed thinkingSlow reaction time   Impaired judgment Impaired attention Distractibility Impaired memory Disorganization Poor problem-solvingFrustrationIrritabilityRestlessness   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 medicineofcycling.com/guidelines

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