Assessing sports-related concussion in road cycling

Mild traumatic brain injury, or concussion, is common among athletes. Increased media coverage for sports-related concussion has drawn national attention to the issue, sparking initiatives to research the condition, implement new safety protocols, and develop policies to improve public education about head injuries. But most of these advances have focused specifically on contact sports (particularly football), despite the prevalence of concussion in other sports and recreational activities. Because concussions can have serious health consequences, there is urgent need to address sports-related concussion among athletes who are currently underrepresented in scientific research.

A research team in the United Kingdom reviewed existing literature related to concussion among road cyclists. They pointed out that recent high-profile cases have demonstrated that many road cyclists continue to participate in races despite suffering from concussion, highlighting the need for new safety protocols in the sport. To this end, the researchers identified two relevant, high-quality studies of sports-related concussion in road cycling.

The first was a case study of pediatric concussion following a cycling crash. The authors of this paper discussed using the Sport Concussion Assessment Tool (SCAT) to evaluate the child’s head injury, which aligns with the Union Cycliste Internationale’s recommendation to use the SCAT to assess head injury among cyclists. However, the reviewers suggested that this tool would require significant modification to be relevant for road cycling injuries.

The second study discussed a number of traumatic brain injuries that occurred during the 2011 road cycling season. These authors called for riders to be formally withdrawn from competitions following loss of consciousness or amnesia, suggesting that professional riders are discouraged from stopping to receive roadside medical care because they will fall behind in the race.

Although both of these studies emphasize the importance of using SCAT assessment and propose the development of a return-to-play protocol, there remains a significant shortage of literature related to assessing and managing sports-related concussion in road cycling. As a result, the reviewers call on interested clinicians to address this research gap by meeting with stakeholders (such as the Union Cyclist Internationale and road cycling medical teams) to develop a concussion protocol designed specifically for road cyclists.

Elliott J, Anderson R, Collins S, & Heron N. Sports-related concussion (SRC) assessment in road cycling: a systematic review and call to action. BMJ Open Sports & Exercise Medicine. (April 2019).

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