Cycling-Related Concussions: 3 Tips To Keep Yourself Safe

As an Athletico physical therapist and competitive cyclist, I am eager to share my love for cycling with others. Right now, I’m super excited about the Tour de France. Over the past several years, it’s been gratifying to see cycling grow in the United States as a competitive sport, a fun way to exercise, and an environmentally-friendly way to commute. All outdoor cyclists, from the Tour de France riders to the city commuters in Chicago, are at risk of crash-related injuries. One of the most common is concussions. In this blog, I will discuss what you can do, as well as what physical therapists can do, to help you protect yourself.

Concussions Are a Common Cycling-Related Injury

Recently I worked with a group of physiatrists and physical therapists at Spaulding Rehabilitation to study injuries from cycling crashes. The lead investigator on that study, Dr. Dana Kotler, is a member of XXX racing, a Chicago-based cycling team and partner of Athletico. Dana and I were inspired to take a close look at concussions in our study due to our experiences as racers, where we witnessed crashes that led to head injuries and watched our fellow competitors struggle to return to the sport they loved.

Our data as well as data from other sources, indicate that concussions are common for cyclists, both in races like the Tour de France and for recreational riders. As of today, at least five of the 32 riders who have abandoned the 2021 Tour de France sustained concussions.² Our study surveyed 403 avid cyclists who reported a crash in 2015. 77 of them reported a head injury resulting from their crash.³ Similarly, the National Electronic Injury Surveillance System All Injury Program database showed that from 2001-2012 in women, cycling was the most common sports or recreational activity associated with a concussion diagnosis in the emergency room. For men, cycling was second only to football.⁴ This data suggests the prevalence of concussions in cyclists. As a cyclist, what can you do to protect yourself?

How Can Cyclists Minimize Risk of Concussions?

1. Wear a good fitting helmet. This is the single most important measure of protection against cycling-related concussions. The available data shows that helmet use greatly reduces your risk of head injury or death due to cycling.⁵ To be effective, you need to wear it each time you ride, and it also needs to fit! The front edge of your helmet should be about 1” (2 finger widths) above your eyebrow. If it is cinched in back with the strap unclipped, the helmet should not be easily removable from your head.⁶ Your local bike shop can help you to get a good-fitting helmet.

2. Be aware of the signs and symptoms of concussion, and don’t deny or downplay a possible head injury. Concussions are under-reported by athletes in many sports, including cycling. In our study, multiple cyclists reported three strong signs of concussion: loss of consciousness, post-traumatic amnesia, and helmet damage. Yet these same cyclists replied no when asked whether they had a head injury.³ As a society, we admire athletes who play through pain, but returning to sport too early after a concussion is dangerous. Your brain is in a chemically fragile state during the initial stage of recovery from concussion. A second injury soon after the first can cause a potentially serious or fatal condition called Second Impact Syndrome.⁷ The bottom line is that it’s very important to play it safe with a possible concussion. If there’s any chance that you hit your head in a cycling crash, seek medical assistance before returning to sport.

3. Engage in concussion baseline testing. Baseline testing measures your performance on tests of reaction time, memory, non-verbal problem solving, attention span, and processing speed before a concussion event. Information obtained from baseline testing can help you and your medical provider determine when you are ready to safely re-engage in physical activity if a concussion is sustained.

How a Physical Therapist Can Help

At Athletico, we are committed to helping cyclists and triathletes. You can receive a concussion baseline test and concussion treatment services at an Athletico clinic near you. Our physical therapists and athletic trainers are trained to administer ImPACT, an FDA-approved and scientifically validated concussion management tool, and also have advanced training in treating the symptoms of concussions.⁸ Learn more about ImPACT testing at Athletico.

If you notice abnormal aches and pains when biking contact an Athletico near you. Our team will assess your pain or injury and provide best recommendations for a treatment plan so we can get you back to what you love and as we bike racers say, keep the rubber side down!

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Where we ride: analysis of bicycling in American cities, Annual American Community Survey data report for 2017. League of American Bicyclists Website. https://bikeleague.org/sites/default/files/Where_We_Ride_2017_KM_0.pdf. Accessed July 10, 2021.
2. Who has abandoned the Tour de France 2021? Cyclist magazine UK Website. https://www.cyclist.co.uk/news/9808/who-has-abandoned-the-tour-de-france. Accessed July 10, 2021
3. Sarah Rice, Mary Alexis Iaccarino, Saurabha Bhatnagar, Greg Robidoux, Ross Zafonte, Dana H. Kotler; Reporting of Concussion-Like Symptoms After Cycling Crashes: A Survey of Competitive and Recreational Cyclists. J Athl Train 1 January 2020; 55 (1): 11–16. doi: https://doi.org/10.4085/1062-6050-91-19
4. Coronado, Victor G. MD, MPH; Haileyesus, Tadesse MS; Cheng, Tabitha A. MD; Bell, Jeneita M. MD, MPH; Haarbauer-Krupa, Juliet PhD; Lionbarger, Michael R. MPH; Flores-Herrera, Javier MD, MPH; McGuire, Lisa C. PhD; Gilchrist, Julie MD Trends in Sports- and Recreation-Related Traumatic Brain Injuries Treated in US Emergency Departments, Journal of Head Trauma Rehabilitation: May/June 2015 – Volume 30 – Issue 3 – p 185-197 doi: 10.1097/HTR.0000000000000156
5. Jake Olivier, Prudence Creighton, Bicycle injuries and helmet use: a systematic review and meta-analysis, International Journal of Epidemiology, Volume 46, Issue 1, February 2017, Pages 278–292, https://doi.org/10.1093/ije/dyw153
6. Fitting your bike helmet. National Highway Traffic Safety Administration Website. https://www.nhtsa.gov/staticfiles/nti/bicycles/pdf/8019_Fitting-A-Helmet.pdf. Accessed 7/10/2021.
7. May T, Foris LA, Donnally III CJ. Second Impact Syndrome. 2020 Jul 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28846316
8. Philip Schatz, Jamie E. Pardini, Mark R. Lovell, Michael W. Collins, Kenneth Podell. Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. Archives of Clinical Neuropsychology Volume 21, Issue 1 2006 Pages 91-99. ISSN 0887-6177, https://doi.org/10.1016/j.acn.2005.08.001.