Brain Injuries in Mountain Biking - Are We Doing Enough?

Aug 3, 2016
by Descent World  
Lorraine Truong was much like any other 26 year old, pursuing a career in sport - talented, dedicated and devoting her energy into being the best she can be. Except now, unlike many of her professional contemporaries on the EWS circuit, Lorraine has spent the last year unable to ride and is sometimes unable to sit in daylight.

The cause?

The chronic effects of concussion.



InForTheCount



IT COMES WITH THE TERRITORY

Anybody who pursues a career in mountain biking is inherently aware of the risks. It's unusual to find a top racer who hasn't broken a bone - it comes with the territory - and when you pitch competitive people on bikes against mountains, accidents will happen. Largely, we accept these risks and for the most part, serious injuries are rare, though finding data and quantifying serious and non-serious injury is a moot subject. Nevertheless, we know what we're getting into when we swing a leg over our bikes.

In the same way that strains, sprains and fractures constitute a scale of injuries that affect bones and joints, brain injuries similarly occur across a range of severity, from concussions, through contusions, to lacerations.

John Waddell was in his prime. Riding for the Intense Tyre/Santa Cruz team, John was a rising star of World Cup DH. Like many of his Aussie peers, John was focused on racing World Cup DH, and succeeding at his chosen sport. At the 2003 Mont Sainte Anne World Cup, John's life would veer in a direction that no one saw coming.

Coming into the infamous 65-foot double jump with too much speed, John got bucked mid-flight. Going over the bars, his head took the brunt of the impact.

bigquotesI suffered severe contusions to the right frontal lobe. An injury which put me in a coma for 26 days. - John Waddell

Since Waddell's crash in 2003 the sport of downhill mountain biking has progressed massively. The market for mountain biking is bigger, the tracks are faster for TV marketability and the equipment and training knowledge we have has transformed the performance level that athletes are able to consistently achieve. Helmets are better, body armour has been revolutionised, and overall the sport is in a great place. Yet there are areas of this discipline, and mountain biking as a whole, that haven't kept up.

We aren't the first sport to witness first-hand transitionary periods where elements of the sport progress faster in some areas than others. In the 1960's, Formula 1 was at its most exciting and arguably most dangerous. Jackie Stewart, three-time World Champion, knew the dangers of Formula 1 first hand, having seem many fellow drivers die in tragic accidents. Stewart, along with the late, great Formula 1 Medical Officer Sid Watkins, lobbied hard for improvements to be made and in time, Formula 1 evolved from a sport where young men went to die, into a sport where death has mercifully become the exception rather than the accepted.

What is interesting though, is that prior to these changes becoming enforced, Stewart hired his own private doctor to travel with him to all races. Chastised at the time for being 'unpure', Stewart was far from the 'weak' character many claimed him to be; conversely, he was incredibly tough for proving you could both win and be safety conscious. Through his actions, Stewart directly shaped the future of Formula 1 and we'll never know how many lives he indirectly saved.

Of course, the two sports are very different and crashing at 165mph is a whole different world compared to crashing at 40mph. Yet, head injuries don't need an excuse or a certain speed to occur.

bigquotesI lay unconscious with tubes coming out of me on a Quebec hospital bed, accompanied by a family member, friends and team manager, Derrin Stockton. As the weeks passed, through movement and stimuli, doctors knew I was improving. My doctors put me in an induced coma to fly me back to Australia. Because I was so restless as my brain improved, I didn't really give it a chance to mend. So being put in an induced coma was the best decision for the recovery process. - John Waddell

InForTheCount
John Waddell spent 26 days in a coma, and has gone on to make a tremendous recovery, even racing the 2007 24hr World Championships. Photo credit: Russell Barker

bigquotesI only survived because Derrin Stockton made it compulsory for us to wear helmets which were to a Moto-approved standard. My helmet, getting painted by Red Bull, had only arrived days before Mont St. Anne WC. - John Waddell

Eventually John returned to MTB, racing marathon events, including the epic 2007 24hr World Championships. His story is one of the most positive outcomes we'll see in sport and furthermore, John's life now has a sense of normality and his future looks bright.

However John's crash, some 13 years ago, should have served as a warning sign. While his injury was indeed at the more severe end of the Traumatic Brain Injury spectrum, as a community we have largely ignored the seemingly lesser injuries of concussion, which, we are now discovering can lead to devastating consequences, as bad if not worse than the more obvious TBI's, if not managed properly.



THE EVIDENCE AND THE IMPACT - A SNAPSHOT

Sadly, injuries of the brain are often the forgotten injuries of the extreme sports world. The reasons for this are many and technical, but the most simple and obvious reason is that we simply don't appreciate what we can't see - and as yet we don't have any data to know how prevalent they are.

Recovering from a brain injury is not as simple as mending a broken bone, and as mountain bikers racing at Elite level in DH, Enduro and Freeride (and further) are starting to discover, concussion is very much the elephant in the room.

Concussion, from the Latin concutere ("to shake violently") or concussus ("action of striking together"), is the most common type of Traumatic Brain Injury.

One of the biggest problems of putting this article together was the alarming lack of data available on concussions among Elite World Cup DH riders, or any other discipline for that matter.

The issue is further muddled by the fact we are dealing with racers who will choose to race even with the odds firmly stacked against them and the fact that diagnosing a concussion is the job of a qualified healthcare professional.


InForTheCount

We spoke to many riders and nearly all said they've raced a World Cup race with a concussion or symptoms aligned with concussion. Furthermore, we aren't just talking about single concussions either. Successive blows to the head can cause equally as much damage even if they are less severe, with the effects being cumulative.

This way of thinking is alarming, but not unexpected. It's time we were aware of the damage that this can do to our long term health.

A simple way of thinking regarding 'cumulative' - rather than simply repeated - blows to the head is that 2+2=22, not 4. Two mid-grade concussions, not too far apart in time, may result in an extremely severe concussion, with potentially life-changing outcomes.

A good analogy is the Richter Scale used for earthquakes, which is a base-10 log scale, with each successive step being not 2x but 10x the severity of the former.

In short, we know riders are racing and competing with concussions and after bangs to the head, we have no idea what is going on inside their brains when they do this rarely and even less so when they do this repeatedly. We don't know how many times they have suffered a concussion, we have no return-to-race program, no formal medical director on site and at the moment, no power to stop them breaking the beam when they are not fit to race.

We aren't the first people to notice this state of affairs and in 10-15 years time, we could have a serious problem on our hands with today's riders having to deal with the most devastating consequences.

After watching countless World Cup DH racers on the Red Bull TV live feed, emergency doctor Colum O'Hare contacted Wyn Masters (a vocal advocate of rider safety on social media), to discover more regarding the safety protocols in place.

bigquotesI was driven by Ratboy's injury at the World Champs. There was a lot of mixed information - some good, some bad - that people decided to post. I would be of the opinion that people should be aware of injuries, what treatments are available immediately at track-side, longer-term medical treatments, what rehabilitation would be required etc. In addition, I am pretty sure no one considers concussion in the sport.

People are essentially told to 'walk it off'. The nature of the mechanism of injury dictates that this should not be the case. - Dr. Colum O'Hare

There is unfortunately a legacy of 'toughness' that surrounds sport, and as they say; courage is the finest of all traits, as all others are derived from it. Yet we are talking about people's lives here and riding with a concussion is not a case of riding through the pain barrier, being made of steely stuff or however you want to describe it.



UNDERSTANDING CTE

Racing with, or repeatedly suffering from concussions is like playing a game of Russian roulette. Tragically, we have witnessed the mistakes of others to learn from. Ominously, we also have others to 'thank' for revealing what we could be looking at if we don't educate ourselves.

Dr. Bennet Omalu, a forensic neuropathologist who performed the autopsy of Hall of Fame Steelers center Mike Webster in 2002, may have become the star of the Hollywood movie 'Concussion', but he was a safety pioneer first. Webster died at the age of 50 after experiencing dementia and depression, and during the autopsy, Omalu found the tangles of tau protein in his brain, consistent with CTE, which had previously been recognised in 'punch-drunk' boxers.


So far, 87 deceased NFL players have been discovered with CTE on examination. So just what is CTE and why should we be aware of it?

CTE, or Chronic Traumatic Encephalopathy, is a result of repeated concussions or blows to the head. It is formally described as a form of tauopathy, a progressive degenerative disease found in people who have had a severe blow or repeated blows to the head.

For those that dismiss the notion of severe blows occurring when wearing a full face helmet, Dave Mirra was diagnosed with CTE upon his autopsy following his tragic suicide. CTE can technically only be diagnosed via autopsy, although the tell tale signs can be spotted through the use of fMRI (functional MRI), PET (positron emission tomography), and various specialist MRI scans, as well as some more specialised scanning techniques.

However, awareness is key and in the past, many have mistaken the symptoms of CTE, leaving the sufferer ostracized, alone and confused about why they feel like they do.

bigquotesAfter a certain number of blows to your head, nobody knows exactly what number, your brain resets itself and begins to initiate abnormal biochemical cascades that result in the buildup of abnormal proteins like tau. So by the time tau is accumulating, the injury is already done. - Dr. Bennet Omalu



LORRAINE'S STORY

We all know that blows to the head are not uncommon in DH, enduro, and even general non-race riding (let alone events like Rampage). And serious head injuries aren't just the preserve of professional big, butch male riders taking savage blows.

Lorraine Truong is slight of build, determined by nature and was riding for the BMC global team when, after a series of prior blows to the head, she had a hard impact at the Samoëns round of the EWS in July 2015. Lorraine's story is one of personal struggle at an age where she should be in her mental and physical prime.

bigquotesIt was in the first stage of the second day, and I think I went over the bars when my front wheel hit a hole or something. I don't remember it really but think I remember going forwards and thinking "It's gonna be ok". - Lorraine Truong, BMC

Lorraine completed the race and even grabbed an 8th place finish.

bigquotesI have a memory of being in the last stage, stopped, with tape all around and thinking: "Where I am? What I am doing?". Weeks later I saw that I gave an interview after my crash, but I have no recollection of it. So in short, I finished the race having no idea how I did it. - Lorraine Truong, BMC

Lorraine Turong broke into the top ten for the first time this season with a great ride to take her to 8th this evening and close enough to challenge for a place even further up the results sheet.

InForTheCount

Since that moment, which was a small crash in a line of prior crashes, Lorraine's life has been transformed into something no-one could have predicted.

bigquotesSoon I had to face it wasn't fine at all. The headache was crazy, I needed to vomit all the time, light and noises were driving me mad, I was struggling to speak, my body wouldn't respond, each tiny task was a huge effort, my mind was so cloudy...something was wrong. - Lorraine Truong, BMC

Tracy Moseley, one of the most decorated rider ever to race a mountain bike, adds some insight into the psyche of athletes, which applies to riders across the board, not just professionals.

bigquotesHaving studied biology at university, I have always had an interest in the human body and especially the anatomy and physiology and what makes us work. I always had an understanding that hitting your head a second time in close proximity to a first hit was not good...but that was as far as my understanding really went when it came to concussion! I think like most athletes, you often don't think that any of the problems you hear about or potential dangers of our sport will affect you, when things are going well you feel invincible and the drive to succeed and be the best can often overshadow and push away any concerns you have with your health or injuries. - Tracy Moseley, Trek Factory Racing Enduro Team

A year on from Lorraine's initial crash, life has not improved. With a history of bangs to the head during the three years leading up to that Samoëns crash - bearing in mind the cumulative effect ( crashes often occured outside of races as well) - Lorraine is acutely aware of what she faces and is focused on staying positive, yet that doesn't make it any easier for her.

bigquotesSince the crash, I haven't had a day without headache. Going from being a junior engineer - who used to be able to do her mathematical analysis homework while following a class of quantum mechanics - to a person who struggles to write this text, having to look at it with a massive font size to be able to read it and have to take breaks every 10 minutes or so, is a massive change in my life and also in my self-esteem. I was a young rider appreciated for her riding style, with a bright career ahead. Now I'm a woman who walks with a stick. It's hard to hold on.

Most of the time I feel very ashamed of myself. Despite all I've learnt and am still learning about brain injury, I still have that inside voice that tells me it's nothing. That if I was stronger I could do more rehab and get better faster. I've only hit my head a bit! But how to fight what your own central computer can't achieve?

I often feel crazy and so desperate that the only way I see to make all those symptoms stop is not a way where I am alive. Luckily, my sport doc has always backed me up, is kind and compassionate and allows me to take my time and to rest as much as I can. I also sometimes read or meet someone who's been through the same kind of journey or a doctor who actually understands, reminding me that I am not alone and that all this is not my fault, but that I am wounded. - Lorraine Truong, BMC



THE POWERS THAT BE

At the top of global cycling and hence mountain biking, sits the UCI. They are indeed aware of the issues that concussion can present. I spoke to Ton Zasada, the UCI medical officer. Ton is not on site at World Cup races but has prepared some documentation for the Local Organising Committees (LOC), which reads like a plan that makes sense. Ton is a decorated GP and has been around the scene for a long time.

bigquotesFor appropriate clinical evaluation for suspected concussion, for concussion management and return to training and competition, doctors should refer to the Sport Concussion Assessment Tool 3 (SCAT 3). However, the SCAT 3 should not be used solely to make or exclude the diagnosis of concussion in the absence of clinical judgement. A rider may have a concussion even if their SCAT 3 is 'normal'. I want to emphasise that when there is any doubt, then the rider should stop training or competition immediately.

Every experienced race doctor will have had at least once a discussion with teams and will remember the pressure they tried to put on us to let the rider compete. There should never be an emotional or commercial argument that affects the medical decision. - Ton Zasada, UCI Medical Officer

It is clear there are many strands to the web here, not least the commercial interests of teams and sponsors, as Ton continues.

bigquotesI think it would be a great step forwards, if the people who are living next to the rider would be paying more attention to the signals of a concussion and undertake action when there is a suspicion. The drive to achieve sport results should not make people blind to this. So an appeal to all the people who are living close to the rider and all the stakeholders may be helpful. - Ton Zasada, UCI Medical Officer

So why aren't these procedures being implemented by the LOC or medical staff at World Cup DH races and why on the UCI Sport Mentoring program are there no DH riders listed? And are team managers and riders themselves doing enough ? The medical regulations of the UCI medical regulations state:

bigquotesAt cycling events, it is the responsibility of the team or race doctor, if any, to determine whether an injured rider may continue in or return to the competition. This decision may not be delegated to other professionals or personnel. At all times, the priority must be to safeguard the health and safety of rider. The potential outcome of the competition must never influence such decisions. If the team doctor and the race doctor have a different opinion on whether the rider may continue or return to the competition the rider shall not continue or return to the competition. - UCI Medical Regulations



IT'S NOT JUST ABOUT THE PROS

Of course, we have focused heavily on racing in this article, but sole responsibility does not just lie with the UCI, EMBA or other organisers. There should be a collective drive towards rider protection and that includes riders themselves being educated about the consequences. A head injury can occur at any point, and as shown in Lorraine's case, her EWS crash was the tipping point on top of other concussions sustained both in and out of racing.

InForTheCount

bigquotesI'm all for a good show and crashes are a part of the sport for sure, but there needs to be some way to make sure the riders' safety is taken care of properly. The rider is the last person who should be deciding if he or she can ride following a concussion, especially as there's also financial and outside pressure on them already to be competing. And when you hit your head, your brain doesn't work as it should normally, so how can you make a good decision? I hope that some system can be brought in to manage rider safety more effectively and in the near future. - Wyn Masters, GT Factory Racing

InForTheCount

Wyn Masters has been a vocal advocate of more stringent safety procedures, and his chats with Colum O'Hare really prompted him to use his standing to bring this issue to light.

bigquotesIt was only this year that I realised how much of a serious injury concussions actually are, and with how much respect they should be treated. I had a crash in Lourdes and it caused on-going issues for a month or more, during which time I've done plenty of research and almost feel bad for not knowing how serious these injuries really are; even just one can be enough to cause serious damage and potentially life changing effects, especially if it isn't treated right. The general attitude from what I've seen from my years racing is that following a concussion, you just get on with it and it will be alright. I've seen so many crashes and people with serious concussions within the World Cup racing over the years and even this season. Generally the riders are racing the same or following day. That is just wrong, and for sure the riders need to be more informed of how much risk that poses to their future health and well-being. No race is worth long-term health issues, full stop. - Wyn Masters, GT Factory Racing



WHAT CAN BE DONE TO IMPROVE THINGS?

Armed with a better grasp of the problems we face, how can we, as a sporting community, develop a pathway to tackle a problem that might not arise for another 5-10 years, if at all?

While for many riders concussion is a subject they don't want to spend much time thinking about, for obvious reasons, some are looking at the future and life beyond the bike. Chris Kilmurray - coach to a raft of top EWS and World Cup DH riders - understands the mechanisms of head impacts better than most, and takes steps to protect his riders wherever he can. On-site at a lot of races, and a driven, good rider himself, Chris has a clear idea when it comes to this topic.

InForTheCount

The SCAT (Sport Concussion Assessment Tool) procedures have helped considerably but as renowned neurologist, Professor Paul McCrory states, these are constantly being redeveloped to match with new research and knowledge.

bigquotesWe should treat any bang to the head as the worst possible scenario - and there is absolutely no Return-to-Play that day - amateur, elite, child. The reason we treat any symptoms at all as a concussion, is that we have become less certain about our sideline assessment. - Prof. Paul McCrory, member of the AFL Concussion Working Group

The Return-to-Play pathway is something we can use as a model to build upon. Chris Ball, EWS director is well aware of the risks and has a track record of implementing positive change in mountain biking

bigquotesI began work back in January on a database that I intend to grow into an injury monitoring database for our riders. We've invested heavily in this and we plan to educate managers and riders to keep this up to date outside of EWS races as well. The issue is hugely complex and isn't as simple as saying "lets have a doctor on site". I want to build the data first so we know what we are dealing with, and how we can best protect the riders health. In my experience over the years, the biggest problem has been team managers, I have stopped one woman racing a World Cup once (ED: Chris was UCI Technical Delegate), way above my pay grade, but she had been taken out of the medical room by her manager after a massive head injury. - Chris Ball, Enduro World Series

Recently, AMA Supercross became the first motorised sport in the world to implement a concrete pathway and protocol when concussions are concerned. To compete in the AMA series, every racer must undergo a baseline test before the start of the season. In a recent RacerX article, Asterix health care professional, Eddie Cassilis, gave some insight into what they are doing and why.

bigquotesWe have a baseline test that every rider has to take. In the event that we find the rider did have a concussion at the race, then we require them to take the ImPACT test and pass that before they can return to the races. If we're trying to determine if the rider had a concussion at the event in the first place, we use what is called the SCAT 2 test. They are taken into our rig - by themselves, parents are not allowed to come with them - and we test memory, short and long term, balance, coordination. We have a minimum score they have to reach in order for us to have confidence that they can race or not. - Eddie Cassilis, Asterix

AMA Supercross is currently the leading light in managing these situations, and with the introduction of SCAT 3, there are people constantly seeking to improve procedures. However, AMA Supercross is financially light years ahead of mountain biking and we need to be pragmatic.

There is no gospel on managing theses situations, but we must do what we can with the knowledge we have to hand.

bigquotesI have to mention that a ton of head injuries, including a lot of Lorraine's, happened out of competition. So to focus as much on EWS and WC racing is to miss a vast amount of rider injuries. That's why I feel focus needs to be on education, a centralised database of info that the manager and rider have to understand that they need to keep up-to-date. Otherwise, for example, you could have a rider turning up at an event, concussed, with no record or knowledge anywhere of that injury.

I have also witnessed one of the sports most known team managers allow his rider, who was concussed during training, having not seen medical, race in the afternoon. I was shocked, but again that would have flown under the radar of any doctor. - Chris Ball, Enduro World Series

There are of course influences that need to be considered as the sports of EWS and DH get commercially bigger. We need to make sure that procedures are followed as best we can, and ad-hoc decisions aren't made.

Riders and teams have sponsor obligations that need to be respected and we can't just witness a crash and rule someone out of competing because it looked 'a bit rough'.

An on-site medical director has many potential benefits, not just medically, and also helps to portray our sport as outwardly more serious, with a correspondng big marketing potential. Bear in mind that in Formula 1, Professor Sid Watkins became a marketable asset in his own right for companies brave enough to embrace a personality that, by default, they couldn't have control over, although in mountain biking there are currently financial obstructions to making this happen, which will require an industry-wide push to overcome.

Racing is a career for the top riders and at every opportunity we should be giving them the chance to go out to do their job, but at the same time, we need to be acutely aware of the devastating effects that concussion and CTE can have on individuals, families and friends. Furthermore, we can affect change from the top down as Chris Kilmurray points out:

bigquotesIf changing culture is core to a longer-term improvement in concussion 'issues' in the sport, then the top down approach may very well educate the grassroots faster than we think...just like you choose your tyres based on what your favourite rider runs, if the top dogs don't ride when 'zoned', your weekend warriors will be less likely to as well. - Chris Kilmurray, Point1 Athletic Development

The testing procedure at races needs to be entirely independent and carry ultimate authority. It should be free from sponsor, parent, relative or other influences.


Of course, how we find a team of health care professionals or doctors for the year is an issue that needs to be broached. A rounded, collaborative financial funding model would surely be attractive, and this is a discussion for the main players: manufacturers, major sponsors and other key stakeholders.



THE TIME FOR ACTION IS NOW

The medical science in proven, the desire for improvement in management is clear and as Professor John Pickard states:

bigquotesAs you know, there is now worldwide concern about sport related concussion - it does not seem sensible for every sport to develop its own guidelines, but it is essential to document the extent of the problem in each sport and the evidence for what components cause the concussion. - Prof. John Pickard, professor emeritus of neurosurgery, Department of Clinical Neurosciences, University of Cambridge

As far as a route forward is concerned, I believe a five-point-programme should include:


1. Build awareness in the wider mountain bike community of the potentially devastating effect of multiple head injuries, and establish a working group made up of all parties to develop a framework for education.

2. Implementation of baseline testing (fMRI or similar hospital-based test, together with a cognitive SCAT3 ) for UCI World Cup DH riders and EWS riders. This will be voluntary to begin with but all UCI Elite teams and EMBA teams should be actively encouraged to participate. This is repeated every 12 months with spot tests throughout the year in case of crashes outwith races. People are already exploring creative ways of making this financially feasible.

3. Provide on-site medical officers with the ability to make an absolute, final decision on whether a rider is allowed to race or not, based on a SCAT 3 or similar assessment. We must frame this for what it is - a long term health benefit to the rider.

4. Open a dialogue with all key stakeholders to create a feasible solution that also covers new developments in technology or procedures.

5. Build a support structure for riders who may need to take long-term rest from competition due to head injury.


With concussion, it's not a case of what we can afford, it's a case of what we can't afford to ignore. The time for action is now.



Descent-World would like thank everyone who contributed to this article, including Farah and Oli from geebeebee media, and Dr. Anthony da Costa (Consultant Neurophysiologist, retd.), but especially Lorraine Truong for her words.

For references or to learn more about concussion, you can use Trip Database and you can also get involved at Love Your Brain.

Join the debate about head injury awareness on social media by using the hashtag #InForTheCount and follow the Facebook page: facebook.com/InForTheCount



MENTIONS: @descentworld / @geebeebee / @mattwragg / @GTBicycles / @trek / @ridebmc /




182 Comments

  • + 231
 If Wyn Masters is taking something seriously (which he never seems to do), everybody else probably should too.



Head injuries are no joke. #RipMirra
  • + 43
 I think this is the first article on pinkbike that ever shoked me. But im glad to see an article like this on pinkbike because this is the first time i recognised the danger of CTE in our sport.

Brook macdonald got knocked out in dh wc training or qualy, sleeped for 2 seconds and rode on. I hope you're fine brook. we all love you and want to see you in the future racing and smiling. Take it easy.

I for myself will invest in a better helmet next time, for moto and dh. i hope more manufacturers will bring "reusable" helmets like poc, this way it is easier to spend those huge amounts of money for a good helmet.

And good luck to all MMA fighters and boxers
  • + 67
 I hope this helps....

I currently sit in bed in Japan one week after a huge over the bars, with a rather large number of stitches, a broken scapula and cheekbones with zero recollection of anything other than waking up in the ambulance and thinking "this is an ambulance".

I had three separate specialists (neurosurgeon, facial trauma and orthopedic trauma) dealing with me for over six hours in ER until sufficient diagnosis and prognosis could be decided (so they tell me).

I left ER under no illusion by the team that there was to be absolutely no way I should be placing myself in any situation whereby I might receive another blow, however small, to the head. My head swims when I sit up or lay down and I have no feeling in the left side of my face right now, although they say that will come back slowly.

I consider myself lucky that this happened just down the road, near my house, in an RTA (road traffic accident), meaning that I instantly saw it for what it was and is; a very serious brain injury that I should treat with respect.

I will not be back riding trail for at least six months to a year given the prognosis. I am mighty grateful to the excellent staff at Yokkaichi City Hospital for their frank and honest appraisal of what has happened.

Surely, regardless of where such things happen, RTA or UCI WC race, the procedure should follow the same process and knowledge base?

Ride safe and be smart all and enjoy the day! I am; bed is great!
  • + 31
 @orientdave: That sounds pretty scary. Take care and heal up man.
  • + 23
 Holy crap! Healing vibes to you Dave.
  • + 10
 @orientdave: Dude. Best wishes for a full and fast recovery!
  • + 6
 @orientdave: Sorry to hear man! Hope you make a quick and complete recovery!
  • + 18
 Concussions are horrible. My injury list is massive with damn near 10 broken bones and even messing up internal organs. I also have 3 concussions. I would rather lacerate my spleen again and deal with puking and shitting blood than get another concussion. My last one I don't remember an entire day. It took me 2 months before I could work out for more than 10 minutes. Otherwise anytime I tried I would get a headache and would get dizzy. Any difficult thinking, whether it be at work or school, gave me a headache. I felt horrible for over a month and my mood sucked. Took me over a year before my memory was back to what it was. I refused to place myself on a bike at the time. 5 months after the accident I got back on a bike and it took me over 8 hours of riding before I could ride properly again. I managed to almost forget how to bunny hop and do basic things on my bike. For the love of biking and all that is good, if anybody reading this gets a concussion or other brain injury, treat it more tentatively then you would a broken bone. You need to heal. Patience is worth your life
  • + 18
 @kamelfront: and remember when Semenuk took a hard head slam at crankworks a couple years ago and his team let him go back out even though he was telling them he couldn't see straight. www.pinkbike.com/news/steps-to-the-top-brandon-semenuk-2015.html
Lucky he realized he shouldn't be doing it part way down and stopped but it could have been a lot worse if he had wrecked again
  • + 11
 @chize: Yeah and IIRC he got boo'ed on site when he backed out of the competition because he couldn't see straight and people called him all kinds of names until he came forward with his side of the story. We have a culture problem for sure.

Oh and speaking of cultural problems, I remember seeing a study claiming that a very big percentage of respondents were willing to sacrifice 10 years of their life if it meant they achieved the top spot in their field. I don't think we can trust people to call it off when they should if there's a lot on the line.
  • + 8
 This is serious, really. More than you`ve ever thought.

I have 5 brain concussions, two of them -deadly. I just had the luck to be saved. Woke up 4 hours later in the hospital, could remember only my name- no dates, no days, nothing... you just feel empty.
Strong headaches,feeling weak, every bit of sound or light is disturbing. I was laying on my bed for more than a week, could not tilt my head left or right- also, i was constantly puking every single 5 minutes.

Doctor`s response:
1st thing to do- MRI !!!
Even if you have a concussion without any current leftovers, all of the symptoms might appear years later. Imagine you are walking on the street, go down... and that`s it. END of story... Yes, this could happen to as well.
Other symptoms - dementia,paralyzing.....

And yes, this is my current experience. All i can say is- be smart, think twice. Even if you have a minor little suspection or awareness- please go visit a doctor.

Hopefully, you would take my words more serious as they could prevent you buddies for any further bad occasions.
  • + 6
 @chize: didn't help either that a trek manager of sorts said to semenuk its all in your head and only you know about it and when semenuk tried to explain about it he didn't listern.
  • + 2
 @orientdave: Wishing u a speedy recovery, man!
  • + 2
 @zixs:
Almost 4 months ago I suffered a very severe concussion.
Laid in the dark silent room for 2 weeks straight, couldn't have lights on or hear any noises, had troubles walking, couldn't balance, felt like I was going to puke 24/7.
I couldn't remember my families and friends names or what had happened.
Now almost 4 months later I still can't work or do much of anything. My memory just starting to get better and my motor skills are slowly coming back.
The doctor has told me that I shouldn't ever ride mountain bikes again, I rode every single day possible and would build on days I couldn't ride.
Needless to say bikes were my life and now I'm lost.
I've spiral fractured my femur, broken my ankle, tore my Achilles' tendon, have torn meniscus in each knee, crushed my hip, broken my collar bone. I've done all this stuff biking, dirt biking, snowboarding, skiing and playing hockey. I would take all those injuries all at once over my recent concussion.
  • + 3
 @dirtbag-tyrel16: you are only 24 with such load. Isn't God trying to tell you, that you may be trying too hard?
  • + 86
 stop posting and promoting videos where people are not wearing helmets would be nice to see too.
  • + 20
 100% agree!
I know J. Bryceland and S. Peat can do wheelies safely without lids, but it is not educational to put it in the Syndicate video watched by my 6yo son...
  • + 16
 Sorry, such videos are very rare and in such climate if your kid is riding without a helmet then it's not Steve Peat's fault. It's kids fault. Kids are stupid. My kid can be incredibly stupid. I can be freaking stupid as well. NOt you guys off course, you are fantastic and your offspring is the smartest
  • + 5
 I'm not specifically saying pinkbike but other places post them. It doesn't matter if your steve peat or not, you should be wearing a helmet when cycling.
  • + 4
 @WAKIdesigns: It is not about my kid (he wears helmet, otherwise bike is gone), it's about missed opportunity to be educational, saying with no words: "I'm a very good biker, x-times better than you and I always wear helmet"
  • + 1
 @Guarana2th: they are just humans, film makers included. None of us is fully rational or ethical, and nobody can be a role model 100% of the time. It would be more damaging for your kid if you told him that pros always wear helmets. We all fk up sometimes.
  • + 3
 @Guarana2th: Make your kid wear a helmet. Expose him to riders who do wear a helment.
  • + 4
 @Brainthecrazyfreerider: Always ride in helmet, when you ride with your kids. I think 99% of pro riders ride in helmets 99% of the time. If my kid would base his attitude towards helmets on that 1% then he's into much bigger trouble spreading across many other aspects of life. That needs to be resolved and the only person to blame for not explaining this issue, that no human being is perfect, and we should always look at the whole picture would be me. So no blame on Steve on some idiot on a pumptrack or in skatepark or on dirt jump site. Your kid must be able to take decisions based on the whole picture, not nitpicking anomalies supporting his current desire/ point of view. It's called teaching ability for critical thinking based on variety of evidence.
  • + 3
 Then your kid must be able to question an authority as well. Be it Steve Peat or that idiot neurosurgeon fck from UK who said on TEDx that helmets are worthless against concussions, they make it more likely for a driver to hit you with his car, and that's why he commutes without one. Don't let your kid watch TEDx
  • + 2
 @WAKIdesigns: Yep, education starts at home
  • + 1
 It would be great. I see parents riding all the time with no helmet while their children are wearing one. Not a way to model behavior. As I tell my son, it is an accident because you didn't plan on it. I have known several people that have been seriously injured just cruising to the store. My policy is, if you are on the bike, you wear a helmet. Everyone is free to make their own choice, but I always suggest thinking about what it will mean to others if you suffer a serious brain injury due to no helmet. Whether it be your parents, significant other, children, or friends, a serious head trama affects more than the the injured person.
  • + 1
 @carym: totaly. I find it extremely frustrating to advocate helmet use for the older generation, it's like knocking a wall of 10ft thick concrete with your head. I had many bad arguments with my wives father who rides road 3-5 times a week (depending on weather) and never takes a helmet. The last time we spoke about it escalated to up with a serious word fight, I told him that if he does end up on hospital bed due to head injury I will forbid my wife and my kids to come and see him and that I will not pay a penny and not change i single diaper if he turns into a half veggie. I will leave him on his own. I also told him that if my daughter or son asks why is grand dad riding without a helmet I will tell them that it's because grandpa is stupid. I will use word stupid or idiot. No remorse, they just don't get it, they just don't. Meanwhile kids get it for the most part and quite frankly I believe that helmet stickers do a big deal of it.

I just found pics of 21 yr old myself riding in the woods without helmet. Because I couldn't afford a cool helmet so I was ashamed of it.
  • + 1
 @carym: Half world away same story, kid helmet - dad haircut... consequently our kid is the only one in the village who wears helmet voluntary.
  • + 2
 @WAKIdesigns: Helmets can obviously help reduce brain injuries, but they absolutely do not prevent them. If you think you're brain is safe because you have a helmet on, you are mistaken. Most safety/education programs are not honest about what helmets actually do.

I wear a helmet when riding, but I ride like I'm not wearing one.
  • + 1
 @uberlounge: I have no delusions about helmet protection when a car smacks a cyclist at +30MPH. All it takes it loosing balance while riding through the town center and falling on your head. I witnessed a concussion where dude got knocked out and shat himself on site. He had a mid-priced 661 fullface helmet on, stopped to zero speed after his DH run and lost balance, falling on a ski net. That net made it impossible for him to stretch the arm out so he hit the ground as he stood. Roads are hard. Advocate buying a fitting, comfy and eye pleasing helmet, so that you don't feel like you are wearing it.
  • + 1
 @WAKIdesigns: Having been hit by a car, i will vouch for a Helmet. Even though the impact was light it was enough to graze the helmet i'd rather keep my scalp on please.
  • + 1
 @Andy-ap: bejesus, first uberlounge talks to me as if I said that helmet will make me survive a plane crash, now you pull from the opposite direction as if I said that helmets are useless because cars kill people anyways. I wear helmet always when riding mountain bike and pretty much always when commuting, despite having a luxurious cycle path system around here. The only time I ride without one is when it's pissing bricks and I need to cover my head with jackets hood.
  • + 1
 @WAKIdesigns: Sorry WAKI, my comment was not directed at you personally. My comment was intended for the general conversation but I inadvertently replied to you. I only meant to say that helmets aren't what many 'legislate helmets for everything' zealots claim them to be. Again, I did not mean to suggest this was you. My apologies.
  • + 1
 @uberlounge: i am sorry too.
  • + 1
 @WAKIdesigns: Yeah internet doesn't convey tone well. I was merely agreeing with your point of wearing a helmet. : )
  • + 50
 How about better helmets. The testing standards for helmets used, whether in full DH, Enduro, or even by the majority that use simpler (but legally compliant) lids, is woefully inadequate, hence the use of a moto-approved helmet in 2003...the standards have not changed since then. MIPS is a step in the right direction, but compared to other industries, helmet technology and the standards are out of date. The criteria for testing is more than 20 years old.
SNELL: 1998 Standard www.smf.org/stds (need to scroll down for a while)

The aptly named Bicycle Helmet Standards page www.bhsi.org/standard.htm

An enlightening, if somewhat self-serving interview that highlights some of those issues: www.bikerumor.com/2016/07/01/pc16-interview-koroyds-case-better-helmet-standards-john-lloyd-bas-jongsma

While PB's article thankfully highlights the issues in managing head-trauma at every level as an important element in recovery, how about looking at what can be done to reduce the likelihood of injury at the moment of impact? What is the aversion within the industry to adopting some of the technologies from motorsports and other areas to get beyond the polystyrene shell that fractures on impact to absorb/dissipate that impact energy?
  • + 11
 How about new technology like this?

brainshield.technology

Apparently more effective than MIPS, which is a good start, this is essentially a patch that can be applied to most helmets and reduces the rotational and linear acceleration of the brain upon impact.

Looks like they've done some testing with good results so far:
www.cbc.ca/news/canada/british-columbia/b-c-high-school-football-team-reports-zero-concussions-after-trying-new-technology-1.3386488
www.vancouversun.com/news/simon-fraser-university/patch+could+prevent+brain+injuries/11406803/story.html
phys.org/news/2015-10-brainshield-football-helmet-effectiveness.html

Hopefully we'll hear more of this type of technology, and soon.
  • + 10
 @MnMDan MTB helmets have come along way in the last few years but i agree a bit more could be done but going to the motor sport world isn't necessarily the best idea. I believe pinkbike has covered this but DOT approved helmets can be worse in slower speed crashes like we see in MTB most of the time. Remember motor bike go a lot faster than MTB so the speed they have to be able to withstand are much higher. Really tho without a helmet being 2 feet thick its never going to 100% safe no matter what its made out of.
  • + 2
 @nismo325: I think the stuff we're seeing from helmet companies in moto lately has been good, they've really been focused on the lower speed hits. Bell and TLD have both recently made helmets that are supposed to cover a wide range of impacts, and of course there's 6D too. 6D already made some mtb helmets with their stuff, and I'm sure the Moto 9 Flex from Bell and the SE4 from TLD will have scaled down versions for mtb soon that will be much safer than most of the stuff currently out.
  • + 3
 Switching to a dot mx troy lee se was a no brainer, pun intended. The weight is neglitiable for me at least and I found one online cheaper than a d3. Ithink recent events would make it extremely obvious that concusion protocol needs to be revide. Two legends, two diff sports, one ultimate outcome I belive at very least complicated by repeated concusions. R.I.P Junior Seau and David Mirra. Too many similarities here to overlook.
  • + 1
 Australia I believe has some of the most stringent helmet testing and acceptance of any country in the world. They have a set standard that has to be met before any sort of helmet can be sold and the testing to get approval is extremely rigerous, when you buy a helmet it has a silver sticker inside, this is the proof that it has been approved. If you are at a race and your helmet doesn't have this sticker..guess what champ, either find another helmet or your not racing.
cyclingtips.com/2013/04/australian-helmet-standards-what-you-need-to-know
  • + 1
 Maybe something that uses the technology of a football helmet. As a highschool defensive linemen, i can say those things do a pretty good job. In all my years of football only had 1 minor concussion
  • + 2
 @fecalmaster: Watch youtube. Young shredders wearing Troy Lee and having it fly off because they are too cool to do up the strap.
I wont ride with anybody who doesn't wear gear properly.
  • + 41
 Great article by Pinkbike.

No technology exists that can completely prevent concussions, we can only reduce the chance of trauma. Are we as helmet manufacturers doing enough? Articles like this help push the discussion, change the conversation about injury prevention and hopefully change the current culture around head injuries.

Manufacturers need to apply every bit of available knowledge and technology to produce products that are the best at reducing the chances of linear and rotational trauma to the brain. No helmet company has a brain trauma expert on staff, therefore manufacturers need to be much more reliant on objective data.

We need to work more closely with academia to collect data about brain trauma and impact energy management. There is a ton of research going on, but there is a huge disconnect between people that produce safety technology and those that research it.

The more we learn and the more we understand, the better protective gear we can provide to the athletes of our sport. That is the goal - to deliver the absolute best available protection to riders.
  • + 1
 @derekfloyd: did you read the part of the article that gave the stunningly high percentage of autopsies nfl players with CTE?
  • + 5
 Good point...its a glaring omission from this article. How can you list 5 points without mentioning the helmets as a critical part of the potential problem i.e. are they doing a good enough job? We need better helmets...if we don't have this opinion we are assuming helmet technology is already as good as it can be which is hard to believe. Its interesting the trend in Enduro helmets with lower protection around the back of the skull.One should ask by default in any concussion 'Could the helmet have done a better job?'. I'm not saying that the helmets can prevent all issues but we need to be critical of their performance and testing standards.
  • + 1
 @Flathout: I think helmet companies will always try to improve their products but I do think we need to realize that helmets are likely never going to do a great job of preventing concussion. Concussions happen when the brain slams against the inside of the skull and are caused by the rapid deceleration of the head. The only way to prevent this is to find a way to decelerate the head slower, which would mean doing so over a longer distance. Simple physics would say that it's going to be very hard to design a helmet to achieve this and still fit the size constraints of what I wearable by an athlete. the only way to increase that 'distance' I'd to make the helmet larger.
  • + 5
 Kali shiva is DOT....and will be my next helmet........very very soon!!!!! anyone have one and a quick review would be cool......
  • - 1
 @sino428: Exactly. Either you have a Space Balls Vader helmet, or there will always be a very real risk your brain is injured when your skull goes from 17 mph to 7 mph the other way. Or maybe move WC DH, Loosefest and Rampage to the Moon? Although I'd be moderately concerned that Lacondeguy would follow Voyager into interstellar space.
  • + 37
 Mental health is another area people need to pay close attention to following a TBI. Rates of depression and anxiety related disturbance increase substantially following a TBI. Most startling perhaps though is the elevation in suicide risk. Suicide risk for those who have experienced a recent TBI or have a history of multiple TBI's is nearly five times that of a comparative sample of those who have not experienced recent TBI. If you have experienced a TBI and notice shifts in mood, sleep, appetite and thoughts of death or dying, contact a local mental health service provider.

I say this particular to the males out there as service usage rates for males in mental health is particularly low (Roughly one in five males who need service actually seek it). There is nothing weak about asking for help or admitting that you are struggling. It could save your life. "Man up" is one of the worst phrases in the English language because it assumes that taking risk is akin to being masculine. I disagree. Look after yourself.
  • + 4
 Amen.
  • + 3
 Yes. Support for all types of mental health.
  • + 2
 thankyou mirra for your legacy so we know this.
#RIPMIRRA
  • + 29
 Glad to see an article on this! It’s no joke. Here’s a link to an article about a friend of mine with a head injury from riding and the very real toll it’s taken.
www.singletracks.com/blog/uncategorized/the-long-road-back-from-a-traumatic-brain-injury-part-1
  • + 1
 Very well put together and further reinforces the message. Good on Mark and you guys for being supportive too. One thing we can always be sure of as a community is that support is all around us. We are one really, who makes these articles more touching. All the best to Mark and well done to you guys keeping your eyes on him. Truly heartwarming.
  • + 25
 Amazing journalism on display here. Thank you pinkbike! Perhaps pinkbike can be the leader on this topic. I can think of no other biking organization that is as well positioned to bring about change. Concussion protocols won't make racing any less enjoyable. Sure, occasionally a rider will miss a race or a season. But overall I think we're ready for it.
  • + 24
 As an Intensive Care Physician this is sooo the best article i have ever seen on PB. It is well balanced and well reasoned. Share the f*ck out of it. We have all lost days after big crashes.... we don't need to lose any more.
  • + 11
 I'm a severe TBI survivor while helmeted on 7/2/15. Coma for 2 weeks. Now a wheelchair graduate. Once again a skier and cyclist. Neuroplasticity is an incredible thing about the body. Be safe, have fun. It's possible to do both.
  • + 11
 The physics and the biology of this inevitably mean that no piece of equipment can be designed that would prevent a person from experiencing a concussion when the body goes from moving at X mph to zero instantly. The brain is continuing to move at that speed inside the skull and no helmet can be designed in such a way as to slow the heads decelleration to such an extent as to prevent a concussion from occurring. Helmets prevent trauma. They may minimize really low speed low impact concussions but they do nothing for high speed incidents beyond the trauma. As to the idea that the data should be collected and then a solution put in place. Thats - clinically - a little like suggesting that we should collect diagnoses of cancer and the stage at which they present and once we have sufficient data look at what the best intervention is. Its not ethically permissible to conduct a clinical trial preventing someone from taking advantage of a known treatment that works. For what it is worth, having spent the last 5 years working on developing and subsequently implementing a disease specific national health strategy, and knowing what all the evidence says about concussions, and their known long term effects e.g. that not all people who experienced cumulative concussions subsequently appear to develop CTE, but some with a specific gene anomaly which makes them susceptible to Alzheimers appear to develop it at a rate far higher than those with out The result of this research and direction of travel clinically in the NFL might be that if you test people for the gene defect and state that if you continue to play football your likely hood of being diagnosed with CTE is 3-4 fold that of those without that gene anomaly they can make an informed choice. For the EWS and other UCI Mtb events two actions would be worth undertaking. The first is a voluntary code of conduct - no bike manufacturer is going to want to be associated with compelling a cyclist to get back on their bike if a possible outcome is a brain injury The code should have a pre-season cognitive assessment and then a basic Concussion pathway which is provided to clinicians on site at each stop of the tour - for basic assessment you do not need to have the same clinicians at every event - thats why we have clinical pathways, so stroke assessment in Wisconsin is exactly the same as that in south london. The bigger question of this is that in a sport which is dependent on scoring in every round, if it can be made so that one person is not being disadvantaged by looking after their health by withdrawing from a stage and could still be in the running for the overall then compliance is more likely to be obtained. Where you have to enter every stage and you have to complete every round to win overall, the incentive is to jeopardize your health so as to not lose points. If the overall title was the cumulative time over the season, and the concussion scorecard was implemented in a fair way by a third party and you assume that the rates of concussion per individual are similar in competition e.g. 1-2 over the season and that each person might effectively miss one total round of the series and one half round e.g. they get a concussion half way through one round of the series. If every competitor at the end of the season has X stages to their name - cumulative time over the season would be one way of awarding the title. So long as the pressure is on to get on the bike and score points in each round the pressure will be there. The final factor is that the competitor can not have a say in the decision. Its well evidenced that decision making is impaired and that having had one concussion the likelihood of a second increases each time. Anyway - this is one of the most interesting areas of sports medicine at the moment. The technology for these sports - mtb, skiing, boarding, skating and then physical ability of the athletes has far surpassed the ability of the body to handle the consequences of them going wrong. I would recommend The Crash Reel for everyone to see, and to read League of Denial - both of which make it crystal clear what the consequences of repetitive blows to the head do. Good article - slightly disappointed that Dave Mirra was not mentioned!
  • + 1
 You are my new favorite pink bike user. Thanks for the well thought out response.
  • + 2
 Hey Andrew. We mentioned Dave Mirra, although only briefly in the article. What you say largely aligns with our 5 point plan - we aren't medics so thanks for your feedback. Super appreciated.
  • + 10
 This story really hits home. After nearly 20 years of mountain biking I sustained my first concussion last spring in an enduro race. I got bucked face first into a tree at speed. I really should have had a full face on. As soon as it happened I wasn't sure where I was for about 10 seconds then my first thought was to get out of those woods. I felt nauseous the rest of that day, had an emotional breakdown in the ER and foggy and flu like for a week or two. I can't imagine getting back on the bike immediately after that. Its scary and its serious and recovery requires a lot of rest. I'm still not the same on the bike 3 month later. I really hope helmets and safety protocols continue to improve.
  • + 3
 Get well soon chap, any injury sucks - I've broken loads and had organs removed. But NOTHING even comes close to this stuff. Best wishes!!!!!
  • + 2
 @Freewheelbuzz: if you are still feeling 'off', or 'just not the same', you should not be biking. I know that sucks, but that's the point of the article. Brains CAN take a remarkably long time to heal. Give it that time. Peace.
  • + 2
 @Togeone: Giving it time and patience are essential, but that is easier said than done. After the initial acute phase which @Freewheelbuzz mentioned, it is important to ease back into activity and begin to progress back to a 'normal life'. Riding at a reduced intensity, on easier trails and without pressure to push your limits might be the best thing for you. Another huge complication with concussion is depression. When we prescribe withdrawing from all exercise and activity, often that coincides with a withdraw from socialisation, each of which are essential in avoiding depression. All concussions are inherently different and all demand attention and patience for recovery, but at the same time, we must continue to focus on recovery by engaging in activity when possible.
  • + 2
 @CBJC: I hear you and completely agree with what you are saying. I wonder if trail running might be better suited for @Freewheelbuzz FOR NOW, as it is less risky than mountain biking.
  • + 12
 Also if you out riding and one of your mates has a head knock - make sure they finish up for the day and have a medical check.
  • + 9
 Reading this at a table for one in a hotel for work and almost in tears - this sucks so bad. An article like this is great however if for nothing else but to raise awareness, so that individuals can start to regulate themselves better. I feel so bad for those struggling with it & solemnly wish them the best for their recovery.
  • + 9
 Having spent around 8 years as a caretaker of people with TBIs, I have seen first-hand how devastating these injuries are. It is nice to see the education improving around this subject because, whether the injury occurs from Moto, Car, or Bike, the consequences can be the same.

I've had patients that were bedridden for years, lost the ability to speak, and required lifetime assistance with tasks as menial as bathing. Others were totally incapacitated mentally. In many ways, a severe TBI is worse than a spinal cord injury. If you lose your brain's higher level of function, what good is it to have that connection to the extremities?

Wishing the best to anyone who has to go through even a minor brain injury...
  • + 7
 Hard not to get choked up reading Lorraine's story. I've tried to follow her updates and was glad to see her image pop up in a PB story on an EWS event. A year out from the injury and sporting glasses and a cain, you know it's still a daily struggle for her. You're not alone, Lorraine! Keep fighting and don't ever stop. You're in my thoughts frequently when I ride. Same with Paul B. Man I love this sport, but it's equally terrifying.
  • + 7
 Best article I've seen on Pinkbike in a while!
Timely for myself, having had a few concussions recently and also witnessing friends recoveries.
It would be great to see a revision of standards and also see helmet manufacturers lead the charge by making the higher end technologies like MIPS the standard.
Hopefully this will lead to better entry level helmets as sometimes (most times?) those new to the sport and those learning to progress are experiencing these impacts on sub standard or 'hand me down' helmets.
  • + 6
 People who ride regularly really need to stop bickering about helmet prices and stop buying cheap price point helmets. I see way too many people ripping down the mtn in either a thrashed out 15 year old moto helmet or a cheap crossover skate helmet. Its just not worth it.
  • + 8
 Agreed. Problem is that there is no testing or way to tell if a expensive helmet is actually better than a cheap helmet (beyond the obvious new helmet is better than a 20 year old one). We need a better helmet testing/rating systems
  • + 2
 i agree about the price bickering, however, i crash a lot and i certainly cant afford to replace a $200 helmet every time. this put me in the shitty situation where i either:
a) dont ride until i can afford a new one
b) keep buying cheap helmets (661 comp)

its no 15yo or skate lid, but its not the best. however, i can afford to always have one on my head.
  • + 1
 Disagree, if helmets protect your head and are this important in preventing brain/head injury the cost should be lower because if you hit your head you should stop and replace your helmet. You have to remember not all of us that ride bikes and have kids that ride bikes are made of money. It costs alot to outfight a family in ie "mips" helmets. We could afford to buy helmets, but no bikes to ride. Maybe if the multimillion dollar helmet companies would struggle making less on (I know business is business) helmets someone should work on subsidy for them. Just doesn't make sense to me, and no have not hit my head lately.
  • + 2
 No evilness intended towards helmet companies and the advancements being made to produce better helmets.
  • + 1
 Aside from Mips and a few new innovations (these are great but unproven), I'm not sure that price has a big impact on safety.

Buy a name brand with all of the correct certifications for your country and replace it every second season or when it cops a good knock.
I'd trust a new budget 661 more than a three year old D3 that's been regularly ridden, transported, dropped, ect.

PS. Everything I've written is based on a very vague knowledge of this stuff so please correct me if I'm wrong!
  • + 1
 @Brainthecrazyfreerider: Good link. I wish companies like bell would publish the results from all the helmet tests they do.
  • + 6
 Are we doing enough? No.

Wearing helmets is one thing, knowing about the effect of multiple smaller hits is the problem. I've had numerous small concussions from various things, not just bike accidents, and the cumulative effects are currently minor. The odd behavioural issue (I go into my shell and want to be alone for a day or two every now and then) and the odd change in random stuff. Can't drink for example as it gives me massive headaches.

The docs did warn me that any more larger traumas may have worse consequences so I take care of myself but I know others that don't. Decent helmets, keeping hydrated and getting regularly checked out after any crashes.

At the end of the day we cannot know exactly what damage multiple brain traumas do, even the medical experts are learning all the time. Sometimes a bit of caution - resting after a crash for example - while being annoying at the time could do you a lot of good in the long run.
  • + 9
 Are we doing enough? Nope. Shit is scary as f*ck!!
  • + 5
 Eeg scan is being established as an objective diagnostic tool which will help. The scat is better than nothing, but not good enough. It takes a solid year for the amount of brain activity to get back up to pre concussion levels. Helmet testing needs to change and get with the times. I like what Kali is doing, but objective third party sensitive tests are needed.
  • + 5
 And click below for the Fails of the Month, almost all of which include entertaining potential for serious head injuries. Perhaps part of what we need is a culture change internal to the sport, where we as riders take the issue more seriously and stop laughing about it.
  • + 2
 I'm glad you brought up Fails of the Month - there's too many riders going too big too soon. This past month's videos showed more than one guy who couldn't manual or pedal slowly off a drop the size of a curb let alone the drops they did.
  • + 2
 Two of the issues I see with FoTM is peer pressure and camera pressure. People need to learn to scale their riding according to their abilities. Too many people attempting stuff they're obviously nowhere near being able to do. Sometimes shit happens and you f*ck up but it seems like a lot of the f*cking up could easily be avoided if people looked at the situation with a cool head. Sometimes it is just kids being kids (I f*cked up a fair share when I was younger) but when it happens to grown ups, I can't help to feel they should have known better.
  • + 3
 I like FotM, as it serves as a healthy reminder not to get ahead of myself as I am not a good as I sometimes think. I don't like them being too bad, more silly stuff, but they seem to cut out anything too gruesome. Given that the riders post up I don't see a problem with it - we all show off our scars and tell stories of bad crashes and this is no different. I think the main point of this article is having responsibility towards yourself and other riders in that if you have a big accident you don't just brush it off, particularly if you hit your head in that accident.
  • + 0
 Oh I have nothing against the FoTM concept, it is very entertaining. I was just commenting about what could drive some people to hit trails/features way above their league in the first place, long before the video actually makes it to pinkbike. I highly doubt people break their bones and ruin their bike season to possibly win a backpack.
  • + 5
 I got a concussion playing rugby last year, I was knocked for just a couple of seconds. Luckily it happened during a time when concussion and brain injury was big news in rugby. I was feeling fine within an hour after the impact but regardless I was kept in hospital for 4 hours and giving a ct scan. Even after, I was out of school for 3 days and I was allowed return to rugby training for 14 days and even after that, I wasn't allowed be involved in contact. Everyone that was on my team was taught how to identify a person with concussion and perform a SCAT test. A similar approach would be good for mountain biking and a good return-to-bike process will probably eventually be introduced. And wear a helmet, and replace if you're involved in a crash, not buying a new helmet after you've obviously broken it is not saving money
  • + 4
 I thought I'd share this cause it is an article about head injuries after all, so... about 6 months ago I was skiing with my team, and I came up on this cliff I had hit a thousand times without issue (I complete in big mountain skiing). I really don't remember much, but by what my teammates said I went a little fast into the takeoff, went about 40 feet down and overcooked the landing. Apparently I hit a patch of really bad snow and it bucked me forward. All I remember is seeing the ground very far below me and thinking "oh, shit" and waking up the next day.

That was the biggest crash in my entire skiing and mtb career, certainly the most consequential. I went to the doctors later that week, and they said I was fine. I didn't know jack sh*t about concussions and I thought I could wait a week and be back on the mountain at 100%... well 3 months and several days spent at the hospital later I was finally able to swing my leg over a bike. Turns out the first doctor was wrong and everything was not "fine". It took me a while to get all my confidence back and be at 100%. I remember I got cleared to ride about 3 days before Sea Otter. I had already registered for the DH so I figured why not... I crashed twice in my run. I was shaking and out of control and every second on the bike the thought of if I crash and get another concussion I could be f@cked for life was always in my head. Yeah, that was definitely a stupid idea. I've broken many bones, but by far the scariest injury I've had is that concussion. And thank god I was wearing a helmet or I would probably be toast.

And those were possibly the worst 3 months of my life. I felt drained, depressed, and my head felt like it was gonna explode. My family and friends all noted how I seemed different, not like myself. It was torture just sitting at home in a constant state of pain staring my bike right in the face.

Point is: There should be more education about head injuries, especially for young riders and WEAR A HELMET. Helmets are cool. Thanks for this article guys.
  • + 2
 That's gnarly. I've had a few close calls snowboarding where if I didn't have a helmet, I wouldn't have made it off the mountain myself. Now I religiously wear a helmet no matter what activity.
  • + 2
 I got one of my worst concussions snowboarding with a helmet. I don't want to imagine what would have happened if I didn't have the helmet but I feel it is very important to remember that they don't make you invulnerable either and it is important to ride accordingly.
  • + 4
 Even trail riders need to take this very seriously. I was knocked out briefly (along with a few broken bones) after crashing down a bank. A&E treated the fractures but never warned me about the possibility of brain injury. Six months on after short term memory loss, mood swings, inability to concentrate and chronic tiredness I finally sought treatment. Three years on its better but it is as though my brain has gone from having 4Gb of RAM to 250Mb. Stuff is still in my brain but I have to think and think to bring it up and I still get cognitive tiredness very quickly.
IMHO after any decent blow to the head even if you are not knocked out you should NOT ride again for a couple of days. And you should be aware of the symptoms of TBI (google them) and watch for them closely. I can only wonder how much better my recovery would have been if I had taken it seriously right at the start.
  • + 4
 I think the scariest parts of this whole thing is: 1) how little attention brain injuries and concussions get and 2) how little we know or understand about the effects of those injuries. I can only hope that no one else has to die to keep this issue in the limelight.
  • + 4
 Great information here. But it's pretty embarrassing how Chris Ball's first priority seems to be distancing his race organization from responsibility. If you say that more data needs to be collected before implementing any regulations, then you are behind even the NFL, and that is truly embarrassing. I'm sure there are many who will disagree, but if riders feel incentivized to keep riding after something like that, they need to remove all incentive, even up to the point of allowing the rider to completely restart that run if they pass the concussion tests.
  • + 1
 I'm not sure I completely agree with you on Chris Ball - as the article states you can be injured at any time, including out of competition. I therefore believed the responsibility should sit firmly with teams. They know the riders the best and are in the best position to notice if something isn't right. They are also going to be better aware of any accidents that riders have had outside of competition. As soon as you say it is the responsibility of EWS/UCI/etc, riders and teams will ignore their own responsibility as someone else has to make the decision. This is a massive cultural shift and, with the pressures on teams and riders, very difficult to implement, so the less excuses that can be made the better. I'm sure all the event organisers have medical professionals at their respective events, but overall responsibility should be on the individual and team IMHO...
  • + 2
 @slimboyjim: ethically from a clinical perspective it would not be permitted to collect data as opposed to implement known good practice - if you know the consequence of a concussion is X then failing to implement a known best practice solution simply to collect more data on incidence would be willfully negligent

Overall responsibility can not be left with the team - their is a flat out conflict of interest between paying someone to ride a bike and at the same time holding them accountable for the welfare of said rider
  • + 1
 @slimboyjim: Nobody has ever said that riders and teams don't have responsibility for accidents that happen in practice, and even in races. The fact is that a rider had a major concussion in a EWS race, and ended up finishing her run. The first thing Chris Ball says about that is "I have to mention that a ton of head injuries, including a lot of Lorraine's, happened out of competition." f*ck that guy. I have to mention that he had no protocol in place to get her immediately tested, or to keep her from finishing the race. That's his stewardship, that's where he has to start.

@andrewmc is 100% right. Teams have incentive to let that slide. They are responsible for their riders lives, and they're definitely responsible for the expectations that they place on riders who think they have to compete after an injury. They have to be held responsible, and it's the job of the governing body to make sure that the rules preventing these issues are in place. Nobody will have to make those decisions, because there would be no decision to be made.
  • + 1
 New rules in the NFL will have teams fined hundreds of thousands of dollars for violating the concussion protocol. I'm guessing that will go pretty far in preventing things like this from happening in the future:

www.youtube.com/watch?v=204GsqfRlKc

I would also like to point out that these billion dollar lawsuits are against the NFL, not teams, coaches, and trainers. That gives an indication as to who the law finds responsible.
  • + 4
 Hi Everyone, I think it's worth me jumping in here to clear a few things up. When speaking to Tommy, who wrote this article, what has been written wasn't the first thing I said, in fact I explained how important I thought this situation was but how complex it is. I gave some examples, which have popped up in the final article. I have never said it's not our responsibility, in fact, although it's not that detailed, I have mentioned that we have begun to look at this and work out a system to help the riders and teams track their injuries, which will one day in turn, I hope lead us to be able to make decisions on who can compete and who can't. Head injuries in MTB and within MTB competition are unique in that our sport is not like F1, or NFL. We go and ride our bikes with friends, at other events and more often than not we are not supervised when we hurt ourselves. In rugby, football, motorsport etc typically you are supervised and therefore injuries can be recorded by a third party much easier. This means that for me, and as I explained to the journalist putting this great article together, that we need a more holistic approach in this sport. One that educates riders and teams, and somehow tracks head injury for riders when they are not in one of our competitions. Otherwise I feel the biggest issue, which is repeated injury or lack of recovery following an injury, will be missed. After all, there are 8 EWS weekends in a year but racers are out riding and racing almost every week of the year elsewhere, out of our control or our watchful eye. As is eluded to in the article, we have starting at the beginning of the year, creating the building blocks that I hope, with the right funding will grow into a proper tool for our riders career long. That is a lot more than anyone else is currently doing in the sport and in other disciplines. There aren't any answers yet but it's very much on our mind as we all begin to understand the importance of the subject. Thanks, Chris
  • + 1
 @thedeathstar: hi Deathstar. I feel we need to defend Chris here. If you read his comments, he has actually stopped people from racing when he knows a concussion or big slam that warrants a "non start" has occurred.

We should also point out that on a stage 3 miles long, seeing every crash is nigh on impossible so on the whole we felt Chris is on the money. He is acting on this issue and his comment regarding the cumulative effect of concussion ( out of race crashes going unoticed or unreported ) is important - as you could get a rider racing with concussion symptoms that would be unbeknown to the EWS race director - in turn leading to another crash. This is not a blame game - just a debate to open new routes forward.

The database needs to happen - creating a rider health profile is the most accurate way of trying to protect them in the long term, along with the SCAT 3 and baseline testing structures at events.
  • + 1
 I think the most difficult part is to create a rule that cannot be abused. As mentioned there is so many ways that the rules can be circumvented - crashes may not be seen even within a competition. Whilst there is money, sponsorship and expectation considerations, teams and riders will always do everything they can to race.

There is no easy answer, other than rely on the teams and riders who are conflicted. Even the system Chris is proposing relies on rider/team honesty so is flawed, but I cannot see a better way.

The biggest hurdle to overcome will be the attitude of the general community. Look at how everyone has praised Rude for competing in the last EWS with an injury, or how dismayed everyone was when Semenuk didn't complete a second Joyride run. Now I don't have inside information on Rudes' accident, and it may have been entirely appropriate as a decision to race, but Semenuk dropped into his run because of that pressure before, thankfully, thinking better off it. As a community I feel that there has to be more of an acceptance of the negative side of injury, and perhaps an injury passport as proposed will be the first step towards that?

I wish Chris the best of luck, along with anyone else working on a solution.
  • + 3
 Concussions are gnarly.

A very good friend of mine who used to compete in the X-Games had a career ending concussion a few years back. He said it took years to feel "somewhat normal" again & that for the first year and a half, it felt like he was living in the movie Inception, he didn't know what was real & what was just in his mind.
  • + 3
 Its a bit of happy and scared feeling reading this, just 3 weeks ago I hit my had really badly for the first time, I knocked my self out, I still only know that I ate breakfast and then I woke up in the woods... The doc told me to rest. And let my brain recover, no screens no reading no music. I pretty much ended up lying in bed for 3 days straight, after that I had to do something, ride my bike... I still have a few symptoms, I cant remember quite well tasks or things I recently said, now its a bit better but its still difficult to focus when there is a lot of noise... Its good to read this and be aware of what can happen... Thank you PB for an awesome article
  • + 3
 Ironic that I see this article on PB. Last Wednesday I got into an accident while riding my road bike home from work.

Some foolish ignorant driver was coming out of a parking lot into the road I was on. My hands were in the drop position of the drop bar so my fingers were not near the brakes.

My gut was to turn right. Unfortunately the sidewalk curb jack knifed my bike and I went over the bars and head first into a "No Parking" signs pole.

Luckily I had my helmet on. The helmet didn't survive but my head did. The next day I went to the doctors and said to look for any symptoms that could be from the head impact.

A week later and I'm doing good. Thankfully.

It's so damn important to wear a helmet. That is only if you value your brain.
  • + 3
 I can't believe that in this whole article there has not been a single mention of neurofeedback. It fixes errant brain activity caused by head injuries, emotional problems, and anything else. I suffered several concussions earlier in my life from various crashes and by my mid 30s had severe mental health problems. Neurofeedback got me back on track in a matter of months and now I am leading a new, vibrant life. Back dirt jumping and socialising, don't even need the shades so much any more.
  • + 3
 I'd love to see a discussion about how it would go in a competition.
I would imagine eventually a paramedic will make the call that a top pro can't finish a run and people will lose their shit.
Are the spectators and athletes really ready for that to happen?
  • + 2
 I think this is the crux of the issue. Spectators, teams, organisers and the riders themselves need to accept that any impact to the head needs to be checked out properly before the rider continues, a may end the racing for that rider for the day/weekend/season.
  • + 2
 If appropriate recovery time is given after a concussion (I was not unconscious, but did suffer short-term memory loss of the event; no symptoms since)...should I be extra careful not to hit my head again?

Serious question...obviously the goal is to avoid serious crashes all together, but do I need to be even more cautious than I had been in the past prior to my first concussion?

I try to ride within my limits, but between bike park trips and weekend shuttles I am guilty of pushing myself more than I should. I really freaked myself out in the few weeks I took-off from the bike post-concussion as I began to closely read about the possible life changing aftermath that comes along with brain trauma.
  • + 1
 Yes! Concussions are cumulative. Did you see a doctor following your concussion? They are the only qualified people that can answer your question...
  • + 2
 Hi everyone! Brain injuories happening not only in mtbiki g,that's was said in the article as well. For those who suffer from concussions and feels negative impact of em in their lives-there is a hope. Brain injuories could "turn off" blood flow and electric activity in injuried brain regions, and that could have big impact on how we think,perform or even feels emotions frontal lobes>. First of all learn about brain functionality and then, if U suffer from crashes, perform SPECT imaging. You will find out "turned off"regions.then you can give a try to all those nootropic medicals who increase blood flow in the brain and stimulate Nerve Growth Factor. It is possible to fix those problems:look more for group of racetams (phenylopiracetam amongst other),noopepd,nsi 189,and celebrolizyne/cortexin to say at least. Those medicals works, I can tell.
  • + 2
 I think this is a great article, but all too often i see in the comments people writing the slogans of NO FEAR! adverts from the 90s. Go big or go home, you only live once, etc. Everyone pretending (and maybe being) so hardcore. Look at the kinds of risks some of the young riders are taking - it's insane. Without scaling those back, the types of injuries will be insane. A better helmet won't save you from paralysis.
  • + 2
 Glad to see PB get this out there also & kudos to all those supporting this effort in the article.
I like training and Information for individual riders/racers & mandatory qualified EMT personnel at events "with authority to actually preclude further riding" And on the subject of helmets, I like MnMDan's subject of updating requirements for mtn bike helmets. Although the best MIPS helmet won't keep someone from getting back up and causing further brain injury, it's a good start to improve the chances of proper recovery after impact. Lastly, it would be nice to see Bike Parks not rent the cheapest recycled (rider after rider) helmets, especially to those with little experience, or worse, to small children (experienced or not)!
  • + 2
 I wish i could have gotten here earlier. It's important to remember that helmets work when they decelerate the head as softly and unabruptly as possible. The brain can only withstand ao much g-force before you are concussed the best way to so this is to SLOW down the impact of the skull into the ground.

There are 3 levels of protection involved here.

1- The shell of the helmet. A composite (carbon, fiberglass, or a mix of the two) will absorb the impact and transfer its energy outward along the shell. Plastic will not do this. Plastic transfers the impact straight across into the foam.

2- The foam. The foam is designed to compress on impact, therby slowing the deceleration of the head. theres more than one kind of foam out there and the best is a multi density foam. Ideally, the foam under the outer shell is more dense, and the foam around the skull is softer. This creates a progressive decel for the brain.

3- The padding. This essentially furthers the decel of the skull making for a softer, more cushioned landing. It's also important that the padding allows the helmet to grip the head and not rotate in the event of a crash.

Composite shell, progressive foam, and comfy padding: all items to look for.
  • + 2
 I wish i couks have gotten here earlier. Ita important to remember that helmets work when the decelerate the head as softly and unabruptly as possible. The brain can only withstand ao much g force before you are concussed the best way to so this is to SLOW down the impact of the skull into the ground.

There are 3 levels of protection involved here.

1- the shell of the helmet. A composite (carbon, fiberglass, or a mix of the two) will absorb the impact and transfer its energy outward along the shell. Plastic will not do this. Plastic transfers the impact straight across into the foam.

2-the foam. The foam is designed to compress on impact, therby slowing the deceleration of the head. theres more than one kind of foam out there and the best is a multi density foam. Ideally, the foam under the outer shell is more dense, and the foam around the skull is softer. This creates a progressive decel for the brain.

3-the padding. This essentially furthers the decel of the skull making for a softer, more cushioned landingn. Its also important that the padsing allows the helmet to grip the head and not rotate in the evenet of a crash.

Composite shell, progressive foam, and comfy padding: all items to look for.
  • + 2
 Please delete i couldnt edit out the typos
  • + 2
 cyclingtips.com/2013/04/australian-helmet-standards-what-you-need-to-know

Here in Aus the gov takes its bike helmets seriously and ALL helmets sold have to meet the same standard, no sticker no sellee. Concussion here in aus is becoming a major issue with anthor of our major sports rugby league now having concussion testing done during a game if a player is hit on the head, Dr makes the call after a set of tests to determine if the player is fine to go back, or is sitting out the rest of the game.
maybe similar should be introduced to Bike racing. Have medics and a doc and if a rider goes down then the dr can make the call onsite and medical attention can be arranged straight away. (Neutral 3 party doc not team doc)
  • + 3
 I'm doing my part by being a huge wimp! I wonder how my high school tough guy friends are doing, the ones that would slam over and over trying to nail a skate trick...with no helmet.
  • + 1
 tell your tough guy friends they wont be tough guys when theyre in a coma. they need to wear a damn helmet.
  • + 2
 Another thing I noticed after my last hospitalizing motocross crash, was feeling very sluggish and taking a nap every afternoon. This was two years after the crash. It was told to me that my symptoms indicated a low level of testosterone and that concussions can have an impact on the body's ability to produce certain chemicals. Blood tests confirmed the doctor's suspicions. So if you have a concussion and are subject to taking a 2 hour nap just about every afternoon, then see your doctor for testing your hormone levels.
  • + 2
 If I read this article last year I'd definitely go to see the doctor after taking a small digger that resulted in feeling very tired for a month, having memory loss, finding myself wondering what the hell am I doing at the place I was ATM. I worked like an idiot, instead of going to see the doc. I didn't because I didn't lose consciousness and didn't had much of a head ache while once when I knocked myself out doctors said, no signs of concussion.
  • + 2
 I have read that sadly helmets will not necessarily prevent concussion/brain injury.. They will of course prevent trauma (fractured skull etc) but you can suffer concussion from whip lash, falling hard on your ass off a skateboard/ roller skates.. This type of brain injury comes from your brain being shaken hard.. So, this complicates things even further with regard to helping us all know when damage has potentially been done.. Depressing and scary..
  • + 1
 My worst concussion happend through a whiplash I got from "falling hard on your ass off a skateboard" when I slid off a 4' minivert transition straight to my ass. I had an helmet but my head never touched anything. Those are probably much more rare in MTB though.
  • + 2
 Awesome article @DescentWorld, thanks for sharing. Pretty scary to think that team managers are putting pressure on riders to compete under injury!

Sounds like a lack of reporting injuries is holding back on making progress on this. Hey @mikelevy @paulaston how about we get a front page pinkbike poll to raise more awareness and generate some more knowledge on the area?!
  • + 2
 Teams have a conflict of interest about pulling athletes from competition EWS should have on site clinical assessment for Concussions on every stage. EWS should be responsible for permitting riders to compete Both riders and Teams have a obvious conflict of interest in determining if they can carry on EVEN where teams state they have their riders best interests at heart - Teams do not pay riders to sit out events
  • + 2
 Thank you so much for writing this article. My life dramatically changed three years ago from a garage accident. I spent a year with moderate to severe PCS symptoms. Although many of my symptoms have subsided to the point that I can enjoy biking and other activities, any crash or any mild hit to my head is enough to reaggrivate my head injury. I've leaned a lot, but most of all the physical and mental challenges of dealing with the short and long term effects of a TBI are life changing. I cannot stress enough to anyone that gets a TBI to REST and seek therapeutic (physical cognitive etc) treatment asap if you don't fully recover within 10 days.
  • + 2
 @MnMDan @KaliProtectives :

The longer your head takes to slow down in an impact the less llikely an injury will occur.
With this in mind why not have an airbag system which can inflate around a traditional helmet?

What I'm proposing is if you take the Hovding airbag helmet and made it inflate around a traditional bike helmet so that the rider is protected from both blunt and sharp objects on impact. This would dramatically reduce the amount of deceleration experienced by the head and would help prevent concussions.

Hovding airbag helmet gizmodo.com/is-an-airbag-for-your-head-really-safer-than-a-bike-hel-1557666518

I would love to see helmet companies like Kali come up with new and improved ways of protecting our noggins.
  • + 2
 First of all, I have not read all the comments above.
There’s an increasing number of young riders, mostly within the new generation of Mountain biking riders, who deal with all types of crashing injuries, as trophies of bravery!

This sub-culture of stupidity, leads to even more (and worst) injuries. This is quite apparent here at Greece, were “speeding the DH trail” is mainly possible due to the high-end DH rig and not due to the rider’s talent/experience.

Of course, it is more than obvious that riding a bike includes some risks. But looking for trouble in order to be accepted as “an accomplished rider” or a “big balls rider” (or a no fear whatever), always counting by the sear number of… crashes, makes no sense (but it will. After some years all those accumulated injuries will remember you, at least every time the weather changes…!).

Destroying your life, just to be cool, it is not… cool. I guess that there has to be some real effort by the DH/Dirt Jump and the rest of communities to educate the youngsters into safe riding. I believe this responsibility fells also upon the shoulders of the relative media by turning their attention upon a safer way to enjoy our sport.

Ridding your bike it an exhilarating experience, whichever clan you are fond of. After the ride, one has to be happy and healthy. So safety first.
  • + 1
 Helmets need to change. A friend crashed last year in a Troy Lee full face helmet at relatively low speed, and got a severe concussion. He sent the helmet to Troy Lee for replacement and they sent it back saying NO DAMAGE. The helmet did NOTHING to soften the energy of impact. All it did was provide abrasion resistance. The liner material needs to crush on impact and dissapate energy instead of transferring it to your skull. TLD did NOT do that. And yes they meet the current spec, so they are not at fault. The spec is total crap. Hard outer shells spread the load so wide that none of the inner layers compress, ensuring all the energy hits you. MIPs and D6 are a start, and Kali dual density holds promise, but this needs to change. I am replacing all my helmets.
  • + 1
 Two years ago I had a serious MTB accident on a moderately challenging single track. I pushed my limits beyond reason that day and had to pay the consequences with a concussion and scars on my face that I'll have for the rest of my life.

I consider myself lucky that I didn't lose teeth or fracture my skull or face. However, after that crash I ALWAYS wear my Bell Super 2R full face helmet. Even on mellow rides on single track that I've been riding for years. It gives me the peace of mind knowing that if I ever mess up and crash like that again, I'll have a better chance of avoiding a concussion or needing facial reconstruction.

I'm convinced that if you are a rider that is pushing yourself riding "enduro" you should be wearing a full face helmet. The speeds that we are obtaining with modern enduro bikes and the structure of our riding is basically the same as downhill riding 10 years ago.
  • + 1
 this is a really well done article. unfortunately you'll never see a real concussion protocol implemented in UCI DH or EWS. There's just no money for it. BEST we can hope for is better helmets and rider education (articles like this). The riders just MIGHT begin to take charge and make better decisions themselves. But in reality, we're talking about 20-something extreme sports athletes. this is just old-people talking about old people stuff. They're back on the bike as soon as the headache dies down. its just the way it is.
  • + 1
 "5. Build a support structure for riders who may need to take long-term rest from competition due to head injury."
We need to focus on this. People fall behind when they take time off. They means rent money that they can't score from podiums, purses, etc. This is why they race injured. There shouldn't be the punishment there.
  • + 1
 As someone who who has gotten 8 concussions now (6 of which are from mountain biking) this article is really important to me as a rider. I hope soon we can move towards even more protection with the current size of helmets currently out
  • + 1
 Without doubt the best and most informative article on PB right now, massive thanks to @DescentWorld for raising awareness on this often taboo subject.
I type this (in pain) as I'm recovering from a Mtb accident I had last December. This resulted in a Traumatic Brachial Plexus Injury that has paralysed my dominant arm, this is a subject that needs more awareness in its own right - not for now.

I also suffered a severe concussion that put me in hospital for 8 days so I have experience of what Lorraine and many others are going through.
Keep strong people, lifes short - live it and love it Smile
  • + 1
 Having suffered concussion of average severity and brain hemorrhage, I strongly support any measure, that leads to people at least fully realising the risks connected to brain injuries. Debate on the matter is good for starters, so good job, PB. Also, the AMA Supercross procedure sounds simple enough to implement on every sanctioned race at least, so that could be a start. And of course this one thing - ALWAYS, absolutely ALWAYS wear a helmet. A helmet is the only reason I am still able to write comments on PB.
  • + 1
 This is an issue that should of been highlighted before. I sustained numerous concussions when I was younger, the worst injury was playing rugby when I got a fractured skull, (orbital blowout fracture) sever concussion and minor brain damage. Being a tall guy I have suffered the most concussions from something that isn't even sport related.....walking through low doorways with a cap on! (I don't wear a cap any more) We should all know that we are involved in a risky sport and thats part of the reason we love it but we should also be aware of all the consequences of head injuries, not just the obvious ones. I didn't really know about CTE before I watched the Will Smith film Concussion. It was a very interesting watch and would recommend it to anyone who wants to know more about this condition.
  • + 1
 I can't say enough about concussions, having experienced an undiagnosed one myself (wake boarding of all things). My actions in the couple days that followed were not proper because I just didn't know. Educate yourselves! K ow what the symptoms are and know that it's as simple as a rough fall when wakeboarding! Cheers to pinkbike for publishing this article!
  • + 1
 Brain Buckets have come leap years in technology over the years for all sports. Aside from Pro riders that push the limits at the highest speeds where no matter how awesome your brain bucket is...concussions and brain injuries occur. Now talk to the weekend warrior that is looking for the cheapest brain bucket to save a few bucks. As I always say...when you have THAT wreck, you're going to wish you had the best brain bucket out there. Save money on bike parts, your MOST expensive piece of equipment on your bike is your bloody HELMET! You only get one brain...treat it well!
  • + 1
 Sometimes you can't avoid hitting your head. I went for years without doing so and have had one concussion - about 4 years back. Since then I've dented helmets a few times but never suffered concussion symptoms. What I would like to see is tips and advice on how to avoid concussion - are some helmets better than others for instance, or is it a case that helmets only protect against a fractured skull and laceration? The second thing is how to treat a concussion - ie what should Lorraine Truong have done after her previous incidents to minimize the risk at the EWS where she injured herself. Finally we also need to bear in mind no person is the same, some are just more susceptible to injury than others...
  • + 1
 After going down hard on stage three, EWS Aspen, and smacking my head at the temple, I called it quits. Back in "the day" it was part of the game to shake it off and just jump back on the bike. These days, with the education avail, it is just STUPID to get back on the bike and ride at race pace the same day, or the day after when a head injury is present. Even an asymptomatic shot to the head should not be taken lightly when considering getting back on the bike within 24hrs. I was lucky and didn't suffer anything too significant, short of a mild headache for a few hours. Still, race ender for me.

I'm not sure how this can be regulated given that most race crashes are rarely seen by medical staff, and most riders, after crashing, if they can feel all of heir fingers and toes, and move everything, if a rider comes by and asks "are you ok" the downed rider will generally say "yes". I did. Adrenalin is a great thing, but it can cloud good judgement. I'm not sure anything practical but the continuing advancement of gear, can be done out on the race course.
  • + 1
 Fantastic article, with one suggestion: Include a bold-letter recommendation for all the people that might be reading this and have/will find themselves sustaining a TBI at some point: GO SEE A DOCTOR, even if you think you're alright! And if you don't (bad idea) but are experiencing symptoms, wait not just a few days, but a few WEEKS to return to your activities.
  • + 2
 I think there should be more focus on education. Improvements in helmet technology are great, but I've had two concussions—one snowboarding, one DH—where my head or helmet never even touched a thing.
  • + 1
 While I certainly agree with what is being said here, I don't think anything other than technological changes at the helmet level will do too much to curb head injuries at the elite level. I know that in the NFL and CFL, concussion baseline tests have become the norm. However, players simply do poorly intentionally on the baseline examination so that minor symptoms result in a "baseline score" and they are allowed to return to play. Not every athlete will risk TBI to continue playing, but I see no reason why we won't see the same "gamesmanship" among elite MTB athletes as long as a paycheck and sponsorship are still on the line.
  • + 1
 It's a bit like drugs in sport. The truth is that the athletes are often their own worst enemies. It's difficult to stop people gaming the system but fixed procedures can make it more difficult. And hopefully, a change in culture will make it easier for athletes to admit that there is an issue.
  • + 1
 Unfortunately the only way to be immune to the risks of a concussion is to not ride your bike. Also all of the helmets commercially available have not been proven to protect from concussion in any measurable way. The only thing a helmet will do is protect you from cracking your skull or experiencing some type of severe head trauma. Thus we ride at our own risk.... As mountain bikers we should never be ignorant of these risks. Buy the best helmet you can afford. Ride within your limits. if you experience a wreck and any part of your head hits something ( ground, tree, rock, etc) call it a day. Sorry but getting a DNF or not getting your KOM is much less a consequence than suffering irreversible brain damage. If you are experiencing any TBI symptoms (loss of consciousness, headache, forgetfulness, light sensitivity) stay off your damn bike. If you have had concussions in the past, educate yourself and honestly evaluate if the risk is worth the reward. We need more of this on PB and every other mountain bike sites.
  • + 1
 You can only do so much with a helmet. Its like a seat belt, they are designed to increase survivability. Its a roll of the dice but I preach the value of wearing a $30 piece of styrafoam designed for the soul purpose to protect the head which could potentially be the difference between walking out of the hospital, being permanently brain damaged for a life time or worse... So is it worth wearing and being worn properly, i firmly believe so!
  • + 1
 I agree that is one of the best articles and way overdo. Thank you. So a lot of comments have been around the need for better helmets, which is a product that can always be improved, but it takes time.

So I am wondering what is the best helmet on the market today? Either brand or specific model.
  • + 1
 Great article!! Most people think concussions are like a scar, that it will heal over time and won't causs for future problems, even if you had many. Raising awareness for this is very important. Without these articles on Pinkbike I wouldn't have known either, so I'm thankful to you for the information. Definitely makes me think twice before trying something stupid and also makes me realize always to wear my helmet (a decent one I invested in), even on easy flat rides.
  • + 1
 Cant figure out how to reply on mobile or get line spaces in

Anyway @chrisball and @descent

There are two issues. In competition and out of competition injury BUT you must follow clinical best practice irrespective of whether you know whats preceeded it

Doctors in an ED do a full work up at presentation they dont miss something because it may have been done before they saw the patient and they dont usually take the patients word for it

Here we know if someone gets their bell rung they should be pulled. It does not matter if its the first time in 6 months or 3rd in a week they should be out and no database will change the fact that removing them is the clear guidance they should be in place at present

Granted it makes the series more complicated but solutions can be developed to mitigate that
  • + 1
 Maybe one way to help prevent team managers from shuffling athletes off to race again, or to better teach them to warning signs for serious head trauma would be to put in place a mandate that requires training and education classes and training. I know it may not necessarily be as effective for the privateers, but the UCI could make it a mandate that requires this training to hold status as a recognized team on the World Cup series. While it may not totally fix everything, it could help in early detection for future problems. Which from what I take away from this article is the most important step to take to prevent CTE.
  • + 5
 I've hit my head too many times to read through all of this.
  • + 1
 More needs to be done to promote use of safer helmets and push for improvements in helmet technology. After a TBI I didn't want to stop having adventures and wanted to do things i loved so i looked if there were ways of reducing the risk. Its not just a case of having a tough helmet to protect your skull - I discovered MIPS technology which is a helmet technology which claims to reduce concussions so now my bike and snowboard helmets have this. Lots of brands offer a helmet with MIPs but i have found them hard to track down in stores and had to purchase online. I really think action sports media could do a lot to review, discuss and promote advancements like this and other options which i might not know about. www.mipsprotection.com
  • + 1
 Everyone who rides knows that there are inherent dangers. A big part of that is what fuels us, pushing to our limits and getting the adrenaline going. But everybody has to know their bodies and listen to what they are saying. A small bump on the head may not seem like much at the time but if it is followed quickly by another the consequences can go through the roof. I grew up with a guy who took a solid hit on the football field and decided to go back in a few plays later. He delivered the hit on the next play and made it back to the sideline to collapse into a massive brain hemorrhage. Watching a buddy almost die puts things in perspective. A year later a doctor told me I needed to stop playing due to my own head injuries and his words carried a lot more weight then. I'm not saying we need to ride around in a bubble suit but listen to what your body is telling you. Sometimes calling it a day can seem like the hard choice but being healthy to ride again should be an easy one.
  • + 1
 Nicholi Rogatkin ragdolled down 30ft and yet was not stopped at all by event organizers from hopping onto his bike and jumping the Canyon Gap less than a minute later.

youtu.be/NUtCP7MW_lE
  • + 0
 Great to read an article that raises awareness of such a potentially life changing injury I have suffered several concussions over the past few years which resulted last year in an MRI scan and more memory loss, I have lost some memory of the time around the crashes and currently suffer difficulty explaining things when I have to think deeply, frustration and severe mood swings that affect my home life and people around me. If you suffer concussion......seek medial advise
  • + 1
 Seriously might be the most motivating article I've read on pb. I've had a couple concussions myself, and as a hopeful future neurologist, this is definitely something I have in the back of my mind a lot.
  • + 1
 Here a good article about Dave Mirra's suicide and CTE: www.theguardian.com/sport/2016/may/24/bmx-dave-mirra-brain-trauma-disease-cte
  • + 1
 Great article. The first line of Lorraine's last quote really worries me. I truly hope she has a strong support network that is looking out for her emotionally.
  • + 1
 Great article - it's certainly something that the industry and we as riders should be more aware of! And good on Wyn for being a vocal advocate of this problem recently.
  • + 1
 at least mountain bikers tend to be hard-core helmet wearers.... If I had a dollar for everytime I saw a BMX'r or Skater helmetless I'd be one wealthy dude.
  • + 1
 Fantastic article ! I work as a paramedic and can't express enough the importance of protecting your head from injury both as a rider and a healthcare proffesional
  • + 3
 I feel bad for laughing at the SCAT acronym now.
  • + 1
 I've been debating a mouth guard for some time now. Definitely going to grab one and start wearing it when going big.
  • + 3
 Good job PB!
  • + 1
 This is interesting to read right after coming home from the park with a concussion and a cracked D3.
  • + 2
 I never should've played high school football. It's why I'm so dumb.
  • + 2
 Based on the typical comments in Pinkbike? Not nearly enough!
  • + 0
 making a joke about TBI's on an article talking about how serious they are...?
  • - 1
 @lyophilization: I think there funny!! I have had 2 TBI and my sense of humor is now dark. Don't get a head ache over internet comments
.
  • + 2
 Not nearly enough. Helmets are way too expensive still.
  • + 2
 if anyone needs more proof watch matt hoffman..........
  • - 1
 Well regardless of whoever says what about concussions we're still gonna fuckin send it! its an extreme sport, you wanna get good, your gonna get hurt! Ride on fellas!!
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