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UCI tackles danger of head injuries with new concussion protocol for racing

Joseph Delves
10 Dec 2020

Lack of roadside assessment addressed with increased training for non-medical staff

Concussion in sport has become an increasingly prominent issue. While much of the debate around the dangers of Sports-Related Concussion (SRC) has focused on repetitive exposure to traumatic head injuries, like those sustained in boxing, rugby or football, the risks to elite cyclists are somewhat different.

Although there’s the possibility of receiving a concussive injury while competing in road racing, no one expects to be sustaining this type of injury regularly.

Instead, in elite racing, the problem is often the lack of any attempt at diagnosis following an impact.

If a rugby player appears injured, they might step away from the game for assessment. If a track sprinter or BMX rider falls, their race is over, allowing a natural pause for them to be assessed by the doctors at the venue. However, on crashing most road racers will try to get back on their bike.

With the race continuing without them, and medical assistance potentially minutes away, most won’t receive any assessment before remounting and continuing to race.

The result of this is a lack of treatment for the individual, plus the potential risk of further crashes involving them or other riders as a result of their impaired condition.

Greater roadside assessment

With the impossibility of race doctors being everywhere at once, the UCI’s recently announced solution is to train more people involved in the racing to spot signs of concussion in athletes.

'The main difficulties that cycling faces are the time it can take to reach injured riders and the ability of first responders to remove them from the road or track, confirm the diagnosis, and make a quick decision on whether they should be returned or withdrawn from the competition,' explained the UCI in a statement announcing the protocol.

Balancing the need to act in both the interests of the rider involved, but also the safety of other participants, the UCI highlighted how this was particularly difficult in road competitions.

'In responding to this problem, the protocol recommends that non-health professionals, in particular coaches, Sport Directors, mechanics and riders be trained to recognise the signs of suspected SRC since they are very often the first people on the scene after a rider falls.'

With huge emotional and financial pressure for riders to get back on their bike, the idea is to train a wider range of people who might be first on the scene to help assess them.

'If these signs are detected, the diagnosis will need to be confirmed by the race doctor. In the absence of any initial signs pointing to SRC, the rider should be monitored by the medical service.'

Should a rider be found to be concussed, the protocol also sets a time limit for their return to competition. Mandating a period of complete rest of between 24 and 48 hours along with a break from competition for at least a week after their symptoms have cleared up.

Given the danger of riders continuing to compete having suffered head injuries, the move is surely a welcome one.

The development is partly thanks to the work of UCI Medical Director Professor Xavier Bigard.

'The issue of sports-related concussion was one of my priorities, along with the misuse of tramadol, when I arrived at the UCI in 2018,' he explains.

'Cycling now has guidelines that set out the various phases involved in dealing with SRC. This protocol applies to all disciplines while considering their specific characteristics.

'It will make it easier to trace individual SRC cases and better understand their place in cycling traumatology.'

Put me back on my bike

The move brings cycling closer in line with other sports that have developed more robust strategies to deal with concussion.

However, currently, without any corresponding enforcement framework, it’s hard to know how widely greater diagnostic skills concerning concussion will be employed.

For instance, it’s difficult to imagine a race leader letting their position slip away while a directeur sportif assesses them at the roadside should they seem otherwise physically able to continue.

While it’s natural to applaud a rider for getting back on after a crash, we should be careful to also keep in mind their welfare as they compete in an often dangerous and highly pressurised sport.

Perhaps, initially, the UCI's new protocol will be of more benefit to riders further back in the pack. If the training of staff was made mandatory, and a mechanism compensating riders for time lost while being assessed was devised, cycling’s longstanding but unhealthy tendency to always push on might finally begin to change.

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