Should cycling do more to treat concussion?

Head trauma has become a hot topic in other sports, so should pro cycling follow suit, or will safety concerns end up ruining the racing?

hy has concussion become a concern in pro cycling?

It’s a growing concern in many sports, and cycling has its share of serious head injuries.

Last year Cannondale-drapac were forced to pull Latvian rider Toms Skujins from the Tour of California after a horrifying crash left him struggling to remount. The footage is shocking not only for the way in which he staggers around in the path of other riders, but also for the way in which race officials try to help him back on to his bike.

Mark Cavendish has also been in the wars this year, crashing in three successive races. The last of these, at Milan-san Remo, involved a high-speed collision with a big yellow bollard that has led observers to suggest the previous blows to his head may have affected his judgement.

What is concussion?

‘Concussion is a mild brain injury that results from a blow to the head, or whiplash,’ says Dr Andrew Soppitt, a physician and cyclist who has represented Britain at age-group triathlons. ‘Symptoms can include headaches, nausea, poor coordination and balance, memory loss and impaired judgement. Symptoms can last from a few days to three months, or even longer if it’s a serious blow to the head.’

How do other sports deal with it?

Other sports take a strong line on concussion, notably rugby. The RFU changed rules on how players tackle or engage in a ruck, and brought in the Head Injury Assessment (HIA) protocol – a checklist for any player who suffers a blow to the head. If they fail they’re withdrawn and have to complete the Graduated Return To Play (GRTP) protocol before being allowed back.

So can’t the UCI just adopt the HIA and save everyone a headache?

It’s not quite that simple, largely because cycling isn’t like other sports.

‘Concussion is more likely to be spotted in football or rugby,’ says Dr Howard Hurst, senior lecturer in sport, exercise & nutritional science at the University of Central Lancashire, who is currently taking part in an international research project on concussion in cycling. ‘TV cameras focus on the lead group or the GC group. Accidents further back often go unseen by the cameras, race director or team cars.’

There are other issues. For example, who takes the decision to pull a rider from a race? ‘It was painfully clear Skujins was in a bad way, but did the rider of the service motorbike have the right to stop him trying to get back on his bike?’ asks Hurst. Imagine, for example, that it’s Froome or Nibali who crashes, that they’re fighting for the GC and that the severity of the impact isn’t so clear-cut. ‘Do we pull them from the race or spend time conducting a roadside assessment?’ says Hurst. ‘Results should never be prioritised over rider health, but this does pose tricky questions, especially as our sport doesn’t have the luxury of substitute riders.’

Perhaps cycling could use substitutes?

The HIA permits temporary substitutions to be made when a rugby player needs a pitch-side assessment. One problem with this in cycling is that it could throw a rider who’s been sat in a team car for hours into the heat of battle without any warm-up. ‘I’d argue it could actually lead to more accidents,’ says Hurst. ‘I do think that if a rider is removed with concussion, teams should be allowed to bring in a sub for the next stage, although this raises issues because if it happened towards the end of a three-week Grand Tour any team suddenly fielding a sub would be at an advantage. The idea does have potential, but the ruling may be open to abuse.’

So what’s the answer?

Teams are beginning to wake up to the dangers. In his diary for the Irish Independent, pro rider Nicolas Roche wrote, ‘Over the winter my BMC teammates and I had some concussion tests done and got some training to help us diagnose concussion. No matter when you crash, your first instinct is to hop back up on your bike and chase after the bunch. It’s only when you stop that you realise there’s something wrong, so it’s good that it’s being taken seriously.’

It’s a start, but Soppitt is clear on who should take the lead on this. ‘Getting straight back on the bike is just stupid. It’s a bit like a drunk person saying they’re OK to drive. The UCI should make cyclists pass some sort of HIA if there’s any risk of concussion.’

Hurst agrees. ‘The UCI regulations on concussion amount to half a page, and essentially say that a rider with suspected concussion should be pulled from the race – advice that isn’t being adhered to.

‘There needs to be more visibility of GRTP being implemented, but I’d like to see a form of cognitive passport, whereby riders are tested every year on a range of cognitive functions to see how they’re affected by crashes over the years. If a rider falls outside an agreed margin from the baseline, their licence is revoked. More needs to be done to protect them.’

‘Your first instinct is to hop back up on your bike and chase after the bunch. It’s only when you stop that you realise there’s something wrong’