Cycling and Concussions
A cyclist shaking off a crash while lying on the side of the road has a split-second choice: either get up fast, because the peloton is speeding away, or quit. While event rules and protocols vary, the decision to start pedaling again is usually made by the athlete or the team manager, who is trailing behind in a support vehicle. I was in this very situation during the 2009 Tour of California as team doctor for Fly V Australia, I was looking after our GC rider, Ben Day after he crashed in the feed zone on the way to Big Bear summit. I was not there for the crash itself. The information was radioed to me and we sped through the caravan to get to Ben. He was already riding again, but well behind the peloton. When I saw him, he was clearly pedaling just fine, just bloodied all over his face. When I asked him some neurological questions, like time, person, place, and situation, he just mumbled and repeated words. It is a hard thing to do to have to take your main rider out of the race they have been prepping for all year long, but this time was obvious, and we stopped him and put him in the ambulance.
USA Cycling and other governing bodies of professional and amateur road cycling now have post-crash protocols for riders who may have sustained a head injury. Many of these protocols were created at medical meetings and are far from perfect, but they are certainly a step in the right direction. It is not a stretch to say that every rider in the Tour de France has been mildly concussed from a fall during their bike riding careers. The thing I see missing is preventative actions being taken after the fall. Usually a rider just rests, gets more sleep, hydrates and calls it good. They should be doing much more than that and being proactive in their recovery.
A great example was the crash at the 2015 stage 3 TDF involving Fabian Cancellara. This happened when a rider crossed wheels while descending at more than 35 mph. More than 20 riders went down and it is a good bet that many had minor head injuries. Just about everyone continued racing. Fabian Cancellara was reported to feel “groggy”. This is probably an understatement. Everyone knows that Fabian is an extremely tough individual. But being tough has nothing to do with recognizing a brain injury.
The main page for concussion information at the USA Cycling website, titled Concussions in Cyclists for Team Managers and Coaches, links to some important resources, including several concussion and cognitive-baseline-assessment tests.