The authors of an April 2019 paper that systematically reviewed all literature on concussion and concussion management in road cycling call for a cycling-specific concussion protocol. They call upon the Union Cycliste Internationale (UCI) to hold a consensus meeting with road cycling medical teams to develop this cycling-specific concussion protocol.

The Need for a Cycling-Specific Concussion Protocol

Cycling reportedly accounts for almost 20% of concussion cases in the U.S — the highest percentage of any sport

Cycling reportedly accounts for almost 20% of concussion cases in the U.S — the highest percentage of any sport (1). In an analysis of Tour de France races between 2010-2017, concussions accounted for just over 2% of the injuries suffered by professional cyclists (2). More generally, concussions account for 1.3-9.1% of all injuries in cycling events and this rate is increasing (3-6). Concussions in cycling not only place the injured athlete at risk of short and long term harms, but an undetected injured athlete may also cause an accident (for example, due to a lack of balance which is a common side-effect of concussion), thereby potentially harming other cyclists (7).

Current Cycling Guidelines

Unfortunately, there is no internationally agreed-upon protocol for concussion in cycling.

Given the prevalence and consequences of concussion in cycling, it would thus be expected that there are cycling-specific concussion diagnosis and management protocols, yet this is not the case. Unfortunately, there is no internationally agreed-upon protocol for concussion in cycling (8). The UCI and the American Cycling Association (ACA) recommend using the SCAT5 and SCAT2 respectively to diagnose concussion in road cycling. These recommendations are problematic (9). The SCAT2 is out-of-date (having been created in 2008) and the ACA guidelines are largely meant for education and providing a means in which a team can put in place SRC diagnosis and management processes that are “a bottom line of best practice on which team medical staff can build on.” While the SCAT5 is the latest concussion tool published by the Concussion in Sport Group in 2016, this UCI recommendation remains problematic because the SCAT5 requires modifications in order to be relevant and effective in cycling.

Further Cause for a Cycling-Specific Protocol

There are specific challenges that come with assessing concussion in cycling more generally, such as: the fast pace of the sport and the “remote nature of medical monitoring for cyclists” given that sometimes cyclists are in one country and the medical team is in another (10,11). Ultimately, simply using generic concussion tools is not adequate because they do not address the unique qualities of road cycling.

How to Move Forward

Very few studies have examined this issue and the two studies that were reviewed for this paper’s systematic review make broad statements that are not helpful in further developing a cycling-specific protocol (9,12,13).  Some specific recommended developments/changes that the authors of this paper have suggested are to:

  • Use real-time and replayed television images to create a concussion spotting system;
  • “Motor-pace” a cyclist back into position after they are assessed for concussion to reduce the negative impact a concussion assessment may have on the individual/team’s performance and position;
  • Change the Maddocks questions to include cycling-specific questions such as: what is the name of the race, how many kilometers are left in the race, who is the road captain, what was your last race, and what is your coach’s name; and
  • Create a central injury database to understand patterns of injuries which will, therefore, help develop methods to reduce concussion incidences in cycling.

Other changes that could be made are:

  • Adopt the saying ‘if in doubt, sit them out’ as per many other sports worldwide;
  • Provide the cycling concussion guidelines in multiple languages to reflect the internationality of the cycling community; and
  • Potentially consider an independent evaluation to ensure adherence to the concussion protocol (14).

Considerations also need to be made for both medical and non-medical roles — such as neutral mechanics who may be the first responder at the scene of a concussion-inducing incident.

Any adaptations also need to be evidence-based which means more research must be done specifically on concussion in cycling and what changes will make: 1) the sport safer and 2) concussion diagnosis and management effective in the cycling environment.

The paper can be found here: https://bmjopensem.bmj.com/content/5/1/e000525.

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.

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