Traumatic Brain Injury/Concussions in Cyclists

Below is an article that I wrote earlier in the month for the Capital Bicycle Club Newsletter here in Olympia.  It was inspired by all of the injuries, especially concussions, that were part of this year’s Tour de France.  As you will see in this introduction, I think we all stand to learn a lot about what happens when we fall and hit our heads as cyclists:

The injury count in the Tour de France thus far has been high, as a result of the many crashes that have occurred.  One type of injury that has been in sharp focus this year is traumatic brain injuries, also known as concussions.  In fact, three major talents, Tom Boonen, Janez Brajkovic, and Chris Horner, all have had to abandon the race after hitting their heads hard enough to cause concussions.  Video footage of Chris Horner as he crossed the line after Stage 7 clearly shows him as being confused and without memory of a crash that he was involved in 30-40 kilometers from the end of the stage.  He was quickly taken away to the hospital where the extent of his injuries were to be properly evaluated.  Concussions are not limited to pro riders, though, they affect mere mortals, as well.  The Centers for Disease Control (CDC) names bicycle accidents as a leading cause of concussions in the United States.  The rest of this article will give you an overview of some of the basics you need to know about concussions.

What is a concussion? The Centers for Disease Control & Prevention (CDC) and The American Academy of Neurology (AAN) describe concussion as a traumatic brain injury caused by a bump, blow, or jolt to the head that changes mental function.  Loss of consciousness may or may not accompany the concussion.  In cycling, these injuries occur when the head hits the pavement or other object hard enough to injure the brain.  Helmets can help, but do not prevent these injuries, and should be worn whenever cycling.

How do I know if someone has a concussion? Commonly observed early symptoms of a concussion are vacant stares, amnesia, confusion, delayed verbal and/or motor response, disorientation, loss of consciousness, dizziness, nausea or vomiting.  Sometimes symptoms come on in the days and weeks following a blow to the head, however.  These late symptoms are persistent headaches, light-headedness, poor attention, irritability, and sleep disturbance, among others.  Concussions are commonly graded 1-3 according to increasing severity of symptoms.  The AAN’s grading scale is broken down as such:

Grade 1: Transient confusion, no loss of consciousness, symptoms resolve in less than 15 minutes.

Grade 2: Transient confusion, no loss of consciousness, symptoms last longer than 15 minutes.

Grade 3: Any loss of consciousness, either brief (seconds) or prolonged (minutes.)

What treatment should be sought for concussion? The best course of treatment is immediate evaluation by a qualified healthcare provider.  Often, the severity of a concussion can’t be made until symptoms begin to resolve and a clear picture of the extent of the damage is made.  Your medical provider will be able to observe progress or decline in your condition and determine an ongoing treatment plan.  In mild cases, rest, observation, and pain medication to control symptoms may be all that is needed.  In other cases, specialist care, and advanced imaging (CT scans or MRIs) may be used to evaluate for bleeding, swelling, or other more complex injuries.  Either way, concussions are not to be ignored, as many of the symptoms may not occur until days or weeks after the incident.

Even though I don’t provide emergency services in my office, I have frequently been the first to recognize that someone has had a concussion when they come in to my practice after an accident.  (Bicycle, motorcycle, automobile.)  In my experience, I would assert that many concussions go unrecognized and untreated, because they don’t recognize the extent of their injuries.  My hope is that by reading this article, you become more familiar with this injury and what to do in case you ever need the information. The Mayo Clinic offers a lot to readers who are interested in more reading about concussion.  Until we meet on the road… take care!


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