Cycling healthcare providers offer tips as they urge increased attention to head injuries

Professional (and scholastic) football has been in the news a lot in the last year or so for an increased attention to the dangers of repetitive head injury. Cycling medical providers, too, are starting to take head injuries more seriously, and riders should take note.

Symptoms of concussion can include any one or more of the following:

• Headache
• Irritability
• Confusion
• Amnesia
• Dizziness
• Ringing in the ears
• Nausea or vomiting
• Slurred speech
• Fatigue
• Feeling of fogginess
• Unexpected changes in behavior such as impulsivity, more hostility than usual, disinhibition, emotional lability.

Head injuries were a major topic at the 2010 Medicine of Cycling Conference, held in Colorado Springs, Colorado, last month. Various medical providers associated with cycling, including doctors who work with teams and races, boned up in the latest research and best practices. Since many riders are not on teams that employee physicians — and many injuries result from crashes in training or recreational riding — all riders should learn more about the signs, symptoms and possible long term implications of head injury.

For example, most people do not realize they can sustain a concussion without losing consciousness. Most people also do not know that you are more vulnerable to concussion if you’ve had one previously. This is problematic because many well-meaning medical personnel overlook possible head injury and focus their treatment instead on the scary-looking visible wounds. If pain medicines are prescribed, and/or sleeping aids, or if an athlete goes out on bingers because they are frustrated about their injuries, all of these things can cause further danger if the athlete is simultaneously concussed or has a slow bleed.

Tools called the SCAT2 and the Pocket SCAT are used worldwide for assessing concussion in sport, and yet the application of these tools to cycling, a sport with no time outs or sidelines, proves challenging at best. Extra seconds on the roadside assessing a head injury can make the difference between a rider catching back on, winning the lantern rouge, or getting appropriate medical attention if needed.

Nothing in this article is meant to replace a doctor’s timely evaluation and recommendations. It is very important to consult a medical professional for guidelines on returning to activity or you could cause more undue stress on your brain, and delay and impede your return to full functioning.

Any cyclist, coach, or parent of a cyclist should know that loss of consciousness is not required for the diagnosis of concussion.

Here are a few more facts from the conference:
• Some studies show that wearing a bike helmet can reduce the g-force of a crash by 50 percent
• A study of retired NFL players with three or more career concussion showed that the incidence of early onset dementia disease was much greater than in the general population
• Kids, teens and young 20-somethings are more vulnerable to concussion, and their brains take longer to heal
• Getting tested for baseline data at the beginning of your season is one of your greatest assets for treating you in the event of a crash.
• It is critical to inform your team or primary physician of your head injury history
• If you suspect you may have a concussion, do not drink alcohol.
• If you suspect you may have a concussion, ask your physician before drinking alcohol or taking any other pain medicines to address the more painful, visible wounds

It’s good news for our sport that cycling medical providers are meeting to share information and become educated on sport-specific issues. And as much as possible, the information should be spread throughout the cycling community. Plans for the next Medicine of Cycling conference are already in the works, and it looks promising that this special interest group will continue to grow.

Keep the rubber side down!

Julie Emmerman is a doctor of clinical psychology whose private practice caters to elite and professional athletes of all disciplines. In addition to numerous professional road, mountain and cyclocross athletes, she has worked with members of the Garmin-Cervelo team since 2008.