KEEPING CONCUSSION A PRIORITY
SERVAAS BINGÉ The deadly invisible injury that can go unnoticed in the melee of a race
We need to talk about concussion. Or rather, we need to keep talking about it. The medical teams connected to professional cycling have done a lot in the past few years to ensure that concussion treatment is in line with other elite contact sports, but it is my opinion, that it’s still an underestimated problem. Concussion needs to be kept in plain sight; talked about. Concussion: the word sounds soft and minor. But it is a brain injury and must be taken seriously.
If a rider breaks a collarbone we can see the damage. The rider is highly disabled but we are dealing with something we know is obviously broken. And when it is healed, we know it is better. But concussion is unseen, the extent of the damage unknown. The time it takes to heal is an undefined window unique to every case. One concussion well managed is not a problem but one on top of another is a recipe for serious and long-term problems.
Research now points to serious implications for those who have repeated concussions over a long period of time, including a greater probability of developing Alzheimer’s and Parkinson’s disease.
As a doctor, I treat every high-speed crash as a potential concussion. And I’d say the doctors across all teams are switched on to the danger. After we’ve done our ABC – airway, breathing, circulation – what quickly follows is the D, for disability and this includes looking for signs of impaired brain activity.
In the immediate aftermath of a crash, doctors may be able to spot subtle signs like disorientation, memory loss and so on. Symptoms in the days after become more elusive. The rider may be sensitive to light – photophobia – or suffer headaches, nausea and vomiting but they are all unseen and need to be reported to the doctor. If there are any suspicions the situation is not improving as we expect we send the rider for an EEG and neurological consulting.
Each winter we do a questionnaire with our riders to give a baseline of their cognitive function and how they react to stimulus. In a crash we only have maybe 30 seconds to a minute to assess them. It is sometimes obvious that you need to pull a rider but sometimes it is not. The dynamic environment of a bike race is an imperfect place to make a diagnosis for something as subtle as concussion. So after the race, when we go around the riders who crashed, we have more time to make a deeper evaluation using the winter questionnaire. It’s proved invaluable and I have withdrawn riders from races at both the scene of the crash and later at the hotel.
I’ve found riders rarely question the withdrawal; the harder conversation comes at the return-toplay point. Immediately after a concussion, there can be no training whatsoever. Even indoor training is off limits because their blood pressure must be kept low. Later, light training is possible. For a very motivated rider with upcoming goals it’s tempting to push it but we have a duty to closely monitor the evolution of the symptoms and, if need be, to stand in the way of riders for the sake of their health.
Our team, Lotto-Soudal, has been hit by two particularly nasty accidents which have resulted in head injuries. Kris Boeckmans suffered a bad brain injury in a fall at the Vuelta in 2015. Thankfully he’s back racing, though the effects lingered for over a year. Stig Broeckx, who collided with a motorbike at the Tour of Belgium in May 2016, is less fortunate. However, we’re observing small signs of recovery. It will take time to see how far we can get. We wish to support him in the hard process of rehabilitation.
These incidents went far beyond concussion but they are at the far end of the same continuum and made me even more attuned to the danger. When crashes happen we must treat concussion with the seriousness this invisible injury demands.