Many sports are bringing in procedures to deal with concussion. For years a knock to the head has been part of the rough and tumble of sports but medicine has shown that one hit can cause brain trauma and crucially a second or repeat injuries can compound this and cause permanent brain damage.
Pro cycling’s started this process too and it’s very much a learning issue for team medics, race doctors and officials. There are guidelines and procedures which have been borrowed from other sports but they run up against cycling’s very nature of travelling across the landscape. James Knox’s disqualification from the Tour Down Under was instructive as it raised issues but I wanted to wait and take stock of the situation rather than replay one case.
For most sports there are two paths to reduce concussion and brain trauma. First is to reduce head injuries, for example in youth soccer some have adopted the practice of not heading the ball, or are trying to cap the amount of headers a player can make. In cycling helmet use helps mitigate this. The other path is to examine participants who have taken a knock to the head. In field sports like soccer or rugby this is easy with players benched while medics perform health checks to test their cognitive function. Cycling has borrowed from this with shared guidelines from ice hockey, equestrianism, soccer and rugby but it’s here where the problem comes for cycling because you can’t rest a rider for a few minutes to perform checks because the race is riding away.
In a sport where just closing a ten second gap to the peloton can be tough, let alone getting going again after a crash, a bike change, waiting to get a medic on the scene and then doing the checks which can take minutes. Sometimes a rider can be so far behind they have to be disqualified because the broom wagon’s gone by and they’ve had to reopen the road to general traffic.
That’s the pocket-sized card for concussion checks, literally a cut-out and keep guide to have in a race vehicle. It’s important to stress this is just a guide and something done in the moment following an incident, there’s a longer checklist to go through after the race and the race doctor is usually tasked with the follow-up, they should ask after the rider involved or get team staff to monitor them.
Stopping to do a concussion assessment is the right thing to do so losing time shouldn’t be a consequent penalty. Easier said than done to correct this. First some races can run to a tight timetable, especially early on the course and a rider could find themselves out of the race by stopping for too long as police or marshals reopen the roads to traffic so even trying to pace a rider back after a check can be out of the question if there are traffic lights or roundabout priorities to respect. The concussion check has to be done at the side of the road rather than when a rider holds onto the doctor’s car and the medic’s car isn’t a specialist taxi or motor-pacing service, and while we’ve all seen how easy it looks in the Tour de France, not every race has convertible cars, nor medics and drivers who are so experienced. Remember we’re dealing with riders who might have sustained a head injury. Pacing back with the help of the medics car is not ideal. Maybe a waiting team car could be better? Yes, but still risky. Maybe a vehicle where the rider can get inside and is transported? But in the time you’ve taken to read that one you’ve probably worked out that the car couldn’t just drop the rider back in the field, they’d have to find a place to stop, get the bike off the roof and it’d be complicated, who regulates this?
Which means even if some sort of compensatory pacing or travel is allowed, the next question is how much? A footballer can sit on a bench and return to the field of play after 10 minutes. Is the rider towed back to the peloton? Not always, imagine a multi-rider crash where other riders are trying to make their way back, anyone who’s stopped for a concussion check should probably be allowed to rejoin these chasers, but not get an advantage beyond this. So it’s almost as if an extra commissaire is needed to work out who could be given some assistance back and they in turn have to know the location of riders and time gaps, much easier said than done.
One issue that doesn’t seemed to have happened yet is a rider being stopped from racing – disqualified for their own good – if they display “red flag” symptoms following a crash, only for subsequent tests to reveal there’s no trauma; take a random example where someone shows outward symptoms like slurred speech because it’s because they their tongue in the fall; or what someone looking at a rider mistakes for a convulsion is just cramp. Now a medic should be able to tell the difference but given there are few medics around, others are given the authority to exclude a rider from the race like commissaires, team staff and race officials. This extended authority to exclude a rider ought to be a good idea given the precautionary aspect but you can imagine the online outrage if a rider is ejected by someone who earnestly believes they’re doing the right thing but turns out to be wrong. Hopefully it doesn’t happen but it’s just something to be aware of, there’s a grey area when non-medics are tasked with diagnosis.
Another issue is whether riders stay in the race. The sport was founded on the myth of resilience and endurance rather than speed or skill. Riders were celebrated for overcoming adversity of the time with ideas like Nietzsche’s Übermensch and it’s a theme that persists today, the Tour de France is special because it is so gruelling. We’ve probably all seen the meme where cyclists mock footballers who dive at the slightest touch while the hardy rider hauls themselves out of a ravine. But the football dive is all about incentives, the chance of getting a free kick from the referee or removing a rival from the field of play. Now road cycling has its own incentives too as a cyclist who suffers a fall may feel compelled to get back on their bike before the gap grows, and downplaying or hiding symptoms becomes part of this. They may feel loyalty to team mates or pressure from management. One aspect here might be to normalise withdrawals so it just becomes one of those things, that riders and team managers alike know it happens to a lot of riders and it happens often.
There could be wider policies such as rider substitutions during a stage race. This is changing the nature of the sport and perhaps a step too far? After all a rider who falls and loses skin or breaks a bone doesn’t get replaced and which teams have riders spare who can travel with a race just in case.
Concussion checks are the right thing to do and there’s an awareness campaign to make everyone in the race convoy aware of the likely symptoms. They’re handy to know for a group ride too.
The big issue is the addressing the time cost of stopping riders beside the road. Just pacing a rider back isn’t as easy as it sounds, hanging behind a car at 60km/h or more is risky at the best of times, more so if a rider might still have brain injuries. Finding reliable ways to mitigate the penalty is hard, a solution that works in the Tour de France has to work in the Tour du Poitou-Charentes as well. There are practical challenges like working out how to get a rider back to the race and also cultural ones like overcoming the almost instinctive instinct to jump back on the bike.
The thing to cheer though is that at least riders are being checked, the real problem was when nobody cared or noticed. It’s not an intractable problem but solutions, if the sport can find them, are going to be clumsy and imprecise.
some of the images are of riders who’ve crashed but without concussion