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WALK IT OFF:
CHANGING WHAT WE THINK WE KNOW ABOUT CONCUSSIONS



Four years ago I spent five minutes not remembering who I was – and then I spent six months worrying that I would never be the same again. When I came to after my crash my helmet was broken and my brain was bleeding internally. Breaking your brain, in an instant or cumulatively over many small bumps, can forever change who you are and how you deal with your reality, and progressively we are learning about the dangers involved with concussions. To date, this has mostly been through research funded by other professional sports, but when parallels were drawn between Dave Mirra and the NFL players who have suffered with Chronic Traumatic Encephalopathy (CTE), it brought the reality of brain injuries squarely to our two wheels with an urgency that would be foolish to ignore.

The problem with the human brain is that it is extremely complicated. If you compound fracture your leg you can look down and using your healthy uninjured brain think ‘well, shit, that’s bad.’ When you bump your head however you may look completely fine – but be completely f*cked. It is also important to note that the brain doesn’t have the pain receptors our limbs have, injuries to it may not be immediately felt as they would with a broken bone. Everything from how many concussions you’ve had previously, to the shape of your skull, damage from drug or alcohol abuse, and the force of the impact itself can all play a role in the level of resulting damage. Even how well you have weathered life’s traumas in the past can dictate how much your brain can withstand.

Getting back up
bigquotesI think it's equally important for us as athletes to be educated on the seriousness of concussions and we need to be smart enough to make the decisions on our own. Granted, that can be hard to do at the times, but you have to just listen to your body, and if your head doesn't feel right then it's time to throw in the towel and take some time off.
- Tyler McCaul

Our frontal lobe is the biggest lobe and also the area most impacted from falls. Here is where we find our conscious thought, voluntary movement, and individual personality characteristics. Damage to this area can impair judgment, attention span, organizational ability, and can cause you to lose motivation. It can also leave you blissfully unaware that there is anything even wrong. The result can be impulsive and rash behavior that is uninhibited and inappropriate, and in the long term patients can experience such things as depression, anxiety, memory loss, and sleep disturbances. Unfortunately, in extreme cases when it is impossible to work or maintain relationships, the sufferer will often turn towards substance dependence in order to cope.

Studies have shown that the biggest improvements relating to recovery happen within the first few weeks post injury, although less rapid improvements have been observed up to three years following. Once a brain is injured however there is no ultimate cure. Any treatments will focus on enhancing remaining skills and honing adaptation strategies to compensate for those that are lacking. And unfortunately, it is the most often affected frontal lobe that is the most difficult and slowest to recover.

Tyler McCaul launching of his massive drop during Red Bull Rampage 2015
  Tyler's crash on this line last year at Rampage put him in the hospital with a pulmonary contusion and bad concussion. Photo: Paris Gore

Tyler McCaul has experienced his fair share of head injuries over the years. This past season he had an exceptionally bad crash at Rampage and was hospitalized with a pulmonary contusion and bad concussion: “I can definitely attest to how concussions can change you, and although the changes are usually temporary, it’s still a scary thing in the moment.” After the crash, Tyler experienced quick and unexplainable changes in mood that would take him to dark places mentally. He experienced anxiety, confusion and depression, all for no reason apparent to him. Luckily these symptoms have now passed and Tyler feels back to normal but at the time he was embarrassed to talk to anyone about it. He now realizes that it is something people need to be aware of as chances are they or someone they know may one day be dealing with a concussion.

A so-called ‘closed’ head injury often exhibits no outward signs and yet with astounding speed and force, your brain may have just collided with the inside of your skull. And what’s more, impacts taken to the feet or other parts of the body can transmit shockwaves to your brain that cause a concussion without you even having sustained a direct hit to your head. The same goes for impacts to the back of the head resulting in frontal lobe damage because the brain is forced forward and collides with the front of the skull. When Geoff Gulevich fell 45 feet off the Oakley Sender a few years ago he was adamant that he hadn’t hit his head. The medic on site administered a SCAT (Sports Concussion Assessment Tool) based exam anyway, given the shock that had been absorbed through his body on impact. In his case, after two hours of observation, he was cleared to ride. Through that experience though he became aware that head injuries come in all different types of crashes and ‘saves’, and he now believes that “people really don't take concussions seriously enough, and with the research coming out of the NFL, I think we all need to be more aware”.

Gully stacking hard two for two.
Gully rides away slightly busted but not as bad as his teammate Thomas. Both guys took some violent crashes today with Vanderham out hopefully Gully can put together everything he has been working for come tomorrow.
  Surprisingly when Gully crashed off the Oakley Sender at Rampage in 2013, he didn't land on his head, instead, he 'belly flopped' the landing - still creating potential for a head injury.

Just walk it off. This has been every coach’s answer to a non-incapacitating injury for the last century. Really, it wasn’t until a decade ago when Dr. Bennet Omalu discovered CTE – a progressive degenerative disease found in people who have suffered a severe blow to the head - that our thinking began to change. In 2011 both the National Football League (NFL) and the National Hockey League (NHL) changed their Concussion Protocols and developed their own initial testing for all head and neck trauma incidents. The NFL now conducts an evaluation based on the SCAT; a standardized test and focused screening neurological examination that is aimed at excluding cervical spine and intracranial bleeding. There is also an assessment of orientation, immediate and delayed recall, concentration, and a balance evaluation. Much like in other professional sports, doctors in the NFL find themselves in a conflict of interest, not wanting to let down the team or team owner with a diagnosis that would affect play. Due to this an independent neurologist assesses players. In the NHL any player who has sustained head or neck trauma is immediately removed from the ice and placed in a quiet room for a minimum of 15 minutes while they complete testing similar to that followed by the NFL protocol. If they show any signs of concussion they are not allowed to return to play, nor will they be until the can pass future psychological and cerebral tests.

bigquotesI feel education is so important because I wouldn't want someone thinking that head injuries are trivial. There has been a lot of advancement in understanding of head injury risk in the past decade or so and this information takes time to get to the end user - cyclist, soccer player, or their coach, trainer, etc. Or even worse they are basing their understanding on what their old-school coach told them; just tell the player to "walk-off" concussions, don't complain, get back out there and play, and so on.
- Brooks Hogya, Event Safety Specialist
Brooks Hogya

While the steps taken by both the NHL and NFL are impressive and demonstrate the seriousness of such a trauma, perhaps the most progressive of all major sports leagues in this regard is that of Major League Baseball. In 2007, they implemented official sideline tests based on SCAT2 for players and umpires, but they also require that everyone conduct baseline testing following player signing and during spring training. Further, to these baseline measures, there is a 7-day and 15-day disabled list for players with concussions, and the league’s medical director must clear all players who have suffered a concussion before they return to play.

Dr. Rui Avelar, who spent thirteen years as the Team Doctor for the Vancouver Canucks says that it is typical of a sport that is early in its concussion appreciation evolution to not have standardized protocols in place across competitions. A major and important function of a well-designed concussion protocol is that it takes the return to play decision out of the hands of the injured athlete, because as he says “nothing else works.” Not only do professional athletes in our sport already have pressures stemming from career goals, sponsor expectations, cash prizes, and simple pride, to expect the potentially brain injured to make a responsible decision about whether or not to continue in competition is absurd. All aspects of organized mountain biking - events, societies, associations, and clubs - should have a protocol for head injuries in their rulebooks or guidelines. In this way riders would not be wimping out, they would be following the rules.

bigquotesIt's easy to worry about a lot of things other than your health when you're a professional athlete in a dangerous sport, especially the fear of losing sponsors due to being injured. Ultimately what it comes down to though is that if you're worried about a sponsor dropping you because you've decided to pull out of an event due to a concussion, then it's time to find a new sponsor anyways. The companies that value their athletes well being on top of anything else are the ones worth partnering with.
- Tyler McCaul

Gregory Clark, MD, CCFP-EM is the Associate Chief for the Department of Emergency Medicine MUHC at Royal Victoria Hospital in Montreal. Once a year he spends a week of his summer traveling with the BC Bike Race as Medical Director. He, along with Safety Director, Brooks Hogya, have developed a concussion protocol for the seven-day stage race using the SCAT3. The entire medical team (approximately nine people on the course and ten at basecamp) is given information on how to use the tool prior to the event. If a rider has a suspected concussion corroborated by a SCAT3 showing a high likelihood, Dr. Clark will administer the exam a second time before pulling them from the race. This extra step is two-fold. One, while everyone on the medical team is competent to administer the exam not everyone has the same amount of training with it, and two, he understands that disqualifying a rider from the remainder of the race is not something to be taken lightly. As he says, “It is a big deal to tell someone who has trained long and hard that their week of racing is over.”

BC Bike Race Crew Photo
  The BC Bike Race medical team wears green - shirts are basecamp and jerseys on the course so that they are easily identified by racers from around the world. Photo: Dave Silver

If a rider breaks their helmet but the SCAT3 isn’t indicative of a concussion, the rider must still liaise with Dr. Clark – and replace their helmet before racing the following day. In order to enforce this rule the attending medics will remove the rider’s race plate. The plate, and attached timing chip, is returned when they have been medically cleared. During this step in the protocol the racer will be put through a progressive series of activities to see if they elicit any concussion symptoms. If they do, they will be pulled from the race. If they do not they will be allowed to return to play.

SCAT3



One of the major challenges that we face in implementing concussion protocols is that mountain biking is not a spectator sport. We do not have a contained field of play, and often these injuries happen on unobserved areas of a racecourse. This is a challenge that Tara Mowat, the High-Performance Team Manager for Cycling BC is up against. This year she will be implementing a newly designed concussion protocol for the Cycling BC Team. Riders will be required to complete a baseline SCAT3 exam at the beginning of their season. The completed exam will then be uploaded to a medical database accessible through a phone app to parents, coaches, and other pertinent personnel throughout the year. As we all vary in our abilities with memory at the best of times, Tara feels strongly that having a baseline to compare further SCAT exams too is key to her program. But her biggest challenge remains how to examine racers who don’t admit or don’t think they have concussion symptoms.

At the root of it all, we need to deprogram generations of thinking. We need to stop applauding racers who finish injured and we need to stop cheering “get back on the bike and finish!” to those racers who crash in front of us. When he was younger Tyler McCaul says he took the gamble and competed at an event even after he hit his head in practice. “I used to think that as long as I didn’t have a broken bone I was fine, so I would be stupid not to compete.” Today riding with a concussion is something he doesn’t take lightly. It slows your responses and causes you to be more likely to make another mistake that could lead to further injury. Post Concussion Syndrome causes your brain to lose its ability to auto-regulate and therefore a second injury could result in a more pronounced brain injury or death. It’s more important to look at the bigger pictures, Tyler says, rather that worrying about getting a result that weekend.

Photo Margus Riga
bigquotesI feel like a lot of riders do push [themselves] when they really should step back, but it is so hard when we all just want to succeed so badly! I know the majority of 2014 I still had post-concussion symptoms that I ignored. I would wear sunglasses driving home from the park at night and had a headache like 90% of the time - I wasn't being very smart. I feel like having it monitored takes the pressure off; a lot of us are very hard on ourselves.
- Brayden Barret-Hay

In 2013, Brayden Barrett-Hay was competing in his first ever Crankworx at Whistler when he crashed off a drop at the beginning of his run. “The next thing I remembered was four days later in the hospital.” Brayden had a Traumatic Brain Injury (TBI) with six different bleeds in his brain. Luckily for him, the bleeding stopped before doctors had to operate and induce a coma. Terrified he would never be the same, Brayden struggled with a lack of knowledge in the medical system about what he was experiencing and the diagnosis from three different doctors that he should never ride his bike again. A year later Brayden was back on his bike and feeling like his normal self. During a contest that year, however, he hit his head again and withdrew. “At this stage in my riding, if I hit my head and feel weird at all, like uncoordinated on my bike, that’s when I know. I didn’t hit my head that hard, I just had a headache, but I was scared to push my luck.”

Photo Margus Riga
  Brayden is back on the bike, and making more informed decisions about competing with concussions, since suffering a Traumatic Brain Injury during Crankworx Joyride in 2013. Photos: Margus Riga

Knowledge is the most important tool we have. We don’t have a cookie-cutter sport; there’s no contained playing field and in most cases, no spectators watching our every move. The protocol we adopt will have to be developed to fit our unique challenges. But the more we educate our riders and community as a whole, the more we broaden the reach of our protocol and shrink our playing field. At this point, concussions are an issue that falls in all of our hands. Event organizers have a responsibility to the riders, but so do parents, coaches, sponsors, teammates, and most importantly, so do the riders themselves. In order to have a cohesive protocol in place, it needs to grow from the bottom up, through the riders themselves, and not just from the top down. And perhaps the most necessary message needs to be that the decision to return to play should never be left to the injured rider.

bigquotesWhat we do is dangerous, but it's fun, so that's ultimately why we do it. You can be as careful as you want when you ride, but shit still happens. It's important though to weigh the risk versus reward factor, and that will usually help you to avoid most injuries before they happen.
- Tyler McCaul

Off to work... Tyler McCaul mentally wrestling the size of the monster he s created with his desire to throw down the line he knows he s capable of delivering.


MENTIONS: @Gulevich87 / @dbaker / @TMcCaul / @BCBR / @braydenbarr




107 Comments

  • + 151
 Brilliant article, well written and informative. Good to see that you had the pros chip in too as these guys will likely have a more positive influence on the youngsters than the article itself. Well done and let's hope no more Mirra type incidents occur. Here's to health not wealth people! Cheers!
  • + 9
 ^ well said
  • + 20
 Let's hope some of those kids actually have enough attention span/patience to read the entire article...
  • + 3
 So concussions are caused by the law of relativity. the rapid stop of motion causes the brain to squish against the skull. Im thinking the softer the helmet shell the more the helmet absorbs the forward momentum. So if a helmet breaks into little pieces its doing a better job at preventing a concussion than if your helmet stays intact.
  • + 6
 @Sshredder, you're on the right track. A helmet is tuned to a certain range of impact forces. Think of the helmet like the shock on your bike. If your helmet is too stiff for the impact, it won't compress, and won't absorb much of the impact, and it will be as if you weren't wearing one at all. Or, if the helmet is too soft, you'll blow right through the padding, and hit your head on the shell, and again the helmet will not have saved you. So different helmet standards give different impact force ranges, such as XC, DH, or moto, and you really want to choose the helmet that best matches what you are riding.
As far as breaking apart, having the helmet break would be a good way to dissipate some energy, but if you were still tumbling, it might not be so awesome
  • - 1
 Great article, but who wrote it?
  • + 24
 I read it all. I'm 17.
  • + 2
 Danielle Baker
  • + 6
 To add to what Sshredder said, it doesn't take a hit to the head. It's the sudden stop. I hit a tree last year with my shoulder taking most of the impact and stopping me very abruptly. Didn't hit my head at all. 2 weeks of headaches and dizziness before figuring out I had a concussion. Symtoms lasted for months after.
  • + 3
 @h82crash

its a common experience, and one that many dirt jumpers and bmx riders have experienced

a typical one is "casing" the landing of a dirt jump - hanging up your back wheel and coming to a very sudden stop; sometimes causing you to fall or go over the bars (if lucky landing running), sometimes just coming to a very abrupt stop

impact travels up the spine and shakes the brain. a nasty head ache can be the result for several hours, or days

I've experienced this myself dirt jumping, and also landing too hard in the skatepark on my bmx - missing a landing and going to 'flat' not crashing but coming down very hard and suffering a big shock through the bike

the nastiest head slam to date was a jogger running into the road without locking whilst I was riding home at night.

I hit him square on, over the bars head first into road, hit my helmet (TSG piss pot) on the road, squashed the liner flat, shell had weird abrasion like a claw mark, cut my eyebrow open.

After picking myself up, got about 2 miles down the road, stopped at train station, getting tunnel vision and my focus zooming back and forth. got to hospital, got checked out, given some drugs to take, felt better 2 days later.
  • + 4
 @Sshredder not relativity, my friend, but on the right track in terms of Newtonian physics.
  • + 1
 Great article. Just back on the bike from my first concussion and couldn't be happier to see this awareness being spread.
  • + 2
 Unfortunately that is only a small piece of the puzzle. You're not taking into account a few things; the inside of a human skull isn't smooth so physical damage is easier than it would outwardly appear, once you've had a concussion it's easier to get the next one and the next, rotating forces can be worse than a blunt impact, just to name a few.
  • + 2
 @yzedf I mentioned above I hit a tree but didn't hit my head. Because I caught it hard with my one shoulder the rest of me still had momentum and it spun me sideways causing my head to snap to one side. My doctor said, and as you mention, rotating like that can be even worse and likely a factor of my concussion without head contact.
  • + 2
 @h82crash

yeah as you mentioned that is the problem. your body is moving at velocity, which includes your brain inside your skull

when you suddenly stop moving, parts of your body experience de-acceleration - often causing a fracture or internal organ damage. because your brain is not fixed inside your skull it also moves.

if you look at what happens in automobile accidents, its the rapid de-acceleration that causes the huge damage even at relatively low speeds, the amount of kinetic energy transferred through the body is immense, even on a bicycle.

when I was younger I experienced being hit by a car when out riding my bicycle on the road, this is when I realised how much energy is involved in a moving motor vehicle

I can only describe it as being "picked up by the hand of god" and literally lifted and thrown about 20 feet forward into thankfully a soft hedgerow. I escaped with a smashed helmet, head ache and abrasions to my palms.

classic hit and run, the driver did not stop. my bicycle had the rear wheel squashed flat against the seat tube with the stays also squashed
  • + 4
 @hampsteadbandit Sounds like you got lucky.That's why I'm not a roadie! I'll take my chances on the dirt.
  • + 3
 @h82crash

fortunately I was riding an old steel Peugot mountain bike - which was a burly bike and probably helped in the impact

unfortunatgely it was my dad's bike, so I owed him a new bike, and he never let me forget that!
  • + 55
 bleed you brakes not your brain
  • + 35
 Make stickers, and they will be bought!
  • + 1
 Brakes not Brains. I'd buy 'em
  • + 31
 One of my mates friends got a concussion once, went to the hospital and sat in the waiting room. After sitting there for a few hours he though f*ck this, took a couple of painkillers, and went home to sleep.

He never woke up...

Proves that the general public think that concussions aren't a big deal.
  • + 4
 I have been guilty of this on way too many of an occasion. You don't even need to take a significant head injury to get a concussion. Just rattle yourself around in a big spill is enough sometimes
  • + 4
 Thats really horrible man. I've suffered 3 (maybe a 4th) and its scary to read that they say 1 is too many. You start going through the list of possibilities, start analyzing yourself. Serious business but you've got to pay to play I guess.
  • + 14
 Similar story, out riding a local trail with the mates, a trail that we have been riding for something like 10 years. One takes a massive spill but since he was riding last it took a moment for us to realize he was missing... we hike back up as fast as possible and find him in the process of getting himself up off the ground, he has no idea what happened but seems pretty much unscathed and thinks he's good to go. OK, so we decide to hike the bikes back to the top, after about 4-5 minutes the "crasher" stops in his tracks, gets this really weird, confused look in his face and says, "sorry guys, but where the f*ck are we?" We laughed our *sses off....

End of story... he's fine, but after reading this I feel ashamed for not having taken that incident more seriously.
  • + 2
 ^same happened to a buddy of mine at our local hills. Funny thing is a couple months before it happened to him I crashed on the same mtn and blacked out for a min and the same friend helped me back to my car. The 2 incidents were very scary.
  • + 2
 @raschaa Same kinda thing happened to my brother one time this winter, except we were going to school. He was in a rush and slipped on the ice going down the driveway and smacked his head or some other part of him. He got up and got to the bus stop but during the bus ride he asked me "what day is it again" and "where's my jacket" (he was wearing a new one since his had gotten stolen a few weeks ago, which is an event he didn't remember either) in the exact same confused voice I don't even know how many times.
I texted my dad about it and he said he would come get him. I ended up skipping class and pulling him out of his myself because he thought he was fine for the day.

Long story short, he got taken to the Doctor and puked a bunch while he was there, so it just confirmed he had one.
He's had a fair few minor ones from random accidents, all of them leading to him heaving later, but this makes me wonder about him some more. I've never been diagnosed with one, but I have hit myself a couple of times with the whole "walk it off" mentality seeming to work for me. But this article definitely makes me reevaluate my choices
  • + 3
 And that big crash can happen on the smallest thing. youtu.be/ek4yFrMvjMo
  • + 1
 when I ran the bike park (Esher Shore) in the UK we used to see a good number of accidents every month typically fractures or concussions. The concussions were scary at times because the evidence was not visible, the rider might appear okay to start with - we'd have their helmet and could see an impact and their riding buddies would account for what had happened if they'd see the slam.

The paramedics would always attend these accidents, and would go through a series of questions similar to those mentioned in this article - not as complex as this was a few years back.

The typical rider response would be general confusion and asking the same question over and over again "Where am I"? "Where's my bike?", etc. This would be repeated every 30 seconds.
  • + 2
 Ive taken many a hit on the bike but is was skiing when I broke my leg 10 years ago that has really had the lasting effects. I was last behind a crew of patrollers at whistler I went down and 20 mins later they hiked up and found me just waking up. Problem was my leg was on backwards and they all focused on that. The ski doc dosed me with morphine and treated me wonderfully, gave me great first aid, but had what is well known in medical training as tunnel vision where the attendant sees the obvious injury and not what else is underlying. I spent 6 months on mind altering pain killers which masked my head injury so that no one realized it till 5 years later when I was diagnosed with chronic pain and ptsd. So if you come across a friend with a major broken bone (like my femur and knee) think to yourself... was there enough force to do damage elsewhere.
It's 10 years later and all I can recall of the crash was the loud "ding" as my helmet smashed on the snow. Lights out.
I had to eventually change jobs from being a paramedic and today work as a massage therapist. I see people almost daily that tell me they have post concussion syndrome by telling me their symptoms and none of them are aware they have suffered a head injury. Plain and simply we are not as tough as we think we are and the long term effects are so much more than a field test.
The brain is the Center of most everything in our bodies and when you damage it in any way all kinds of things start to happen. One of those is hormone production, or more important stopping the production of hormones. Specifically testosterone and growth hormone. These stop being produced in a way that literally puts the brakes on your performance. You won't recover from injuries as easily or quickly and you will lose your drive to get out there.. Call it the "fear" call it surgery season whatever but you don't get back on the horse and rebuilding your strength gets harder and harder. Your doctor will tell you, your aging and to get over it or that your thyroid is broken and throw some meds at you but if they test for those hormones dollars to donuts they are low and can be supplemented.

That's all I've got time for right now but check out
Www.tbimedlegal.com
Search dr mark Gordon
There is so much information coming out and no one is putting the story together because the people effected have the concentration of a newt and the docs that treat them were trained 30 years ago. Keep it shiny side up guys!
  • + 1
 @bigtim you did an excellent job responding to that crash.

@erikwyattatmedotcom I had a similar experience. Because of a significant injury I sustained not much attention was given to the possibility of a concussion. It wasn't until I got home and realized I was having memory issues, etc that I started to figure it out.
  • + 31
 Guys, concussions are not a joke at all. Unfortunately i`ve experienced 4 of them, and one of them was the most risky and my life was in danger. Felt on a Urban Downhill Race and lost breathability for more than a minute..had the luck that the doctor came in time. Have been out of consciousness for more than three hours and woke up in the hospital. Couldn`t remember anything rather than my first name. One of the best articles in terms of injuries. Please take my words serious and think twice.
  • + 5
 I second this. I've had a few my own, and once that put me in a dark room for 2 months straight, and left me with pretty severe anxiety and depression that I'll always have to deal with know. This stuff is serious. Take all the measures to protect your head, and if you hit your head and feel even the slightest symptom, STOP RIDING. Cheers for writing an article that really needed to be written.
  • + 27
 Well, with this level of writing I may just have to reconsider my usual "I am just here for the pics" view of pinkbike. Thanks for writing such a well researched article on one of the dark side of bat in trauma - we all need to hear this loud and clear. Simply brilliant...so good to have the bakery back in action ....I sure missed your witty writing style when it left bike mag...
  • + 27
 Simply the best-reported piece I've seen on Pinkbike, and one of the best-written. Terrific job!
  • + 5
 +1
  • + 13
 Of note, if you hit your head....avoid taking any type of NSAID(motrin, naproxen, mobic) or pain relievers like asprin or tylenol. As some who has been diagnosed with TBI and also a medical provider who treats folks with suspected TBI, that is the first thing I advise my fellow riders on.
  • + 3
 If you or a fellow rider take a digger and can't remember what happened, where you are, what day of the week/time of day it is and one other "key" common knowledge event. Get them off their bike and to a medical provider. Something medical folks refer to as AO(alert/oriented) x3 or 4.
  • - 1
 Take ibuprofen (like Advil) instead.
  • + 2
 Yeah, no. Ibuprofen is a NSAID too. I'm assuming paracetamol is about the only thing you should be taking.
  • + 2
 Uh oh, can you explain what this does? I crashed badly, smashed head on ground, eye socket and face actually, got a concussion that was apparent for 5-6 weeks at least, back right side of right eye always felt funny, right temple too, but at time of crash I had smashed ribs and shoulder, so I took 5 200mg ibuprofen I had in my pocket, helped the pain while getting down to car and driving to ER. I remember at ER the doctor and nurses kept bugging me to admit that I had been drinking or was high, I was sober, I kept telling them that, except for banging head and ibuprofen.
hmm, scary stuff, you never know what the long term affects can be, and they are hard to measure. Thanks for article.
  • + 1
 I'm not a medical professional but I believe NSAIDs are mild blood thinners, amd taking a blood thinner after a concussion might lead to an increased chance of a brain bleed
  • + 2
 Any NSAID isn't a "blood thinner" per say. They just inhibit proper clot aggregation and prostaglandin mediation. So, if you have a suspected bone break or a brain bleed, you are inhibiting your body's ability to form clots and stop bleeding while slowing your body's ability to reconstruct bone tissues.
  • + 11
 Dear PB,

Firstly, thank you for one of the best pieces of well-researched journalism I have seen here; we should not be surprised since Danielle has been writing content of similar quality for years (thanks Danielle).

More strikingly for me though is the clarity with which it is possible to see how the quality of the journalistic input here has elevated the comments section from its usual vitriolic self into something far more....well, just better.

There are some excellent, pertinent and insightful comments that have added greatly to the article itself; and we should forever be grateful to Danielle for achieving that through her writing.

So, I have a suggestion for you, Why not send Danielle Baker and Vernon Felton to cover the same story once in a while? It would make compelling reading.
  • + 10
 I'm reminded of Semenuk's crash last year at Rotorua, where he had concussion symptoms and still tried to ride the second run. When he pulled off early, people thought he was being a poor sport after not getting the double-truck on the first hit, but he really couldn't see properly. The pressure is real on these guys.
  • + 2
 "went to double truck the stepdown again and I couldn't even see my left hand"
I just watched that again earlier...

I'd shit my pants if I was jumping down like 20 feet and missing half my vision. He's lucky muscle memory helped him catch it properly
  • + 8
 Great article! Last summer my girlfriend fell off her bike and hit her head. She instantly had some memory loss for about 5 mins, in not knowing where she was or how she got to where she was. We didn't think much of it, but we decided to go to the hospital anyway. When the doctor saw her he handed her a piece of paper and asked if she was experiencing any of the symptoms on the form. Although, she didn't have any of the symptoms of the form such as vomiting, sleepiness, or any signs of bruising, the fact is that the doctor didn't take the necessary measures to assess her correctly. We asked several times over if she could get a proper assessment done, but the doctor refused and said that she was fine. Till this day, we're fearful of the health system
  • + 9
 MTB has been the only extreme sport where I consistently see the athletes wearing helmets. BMX, Skate, and Inline I guess think that they are above serious head injuries.
  • + 9
 Great article, thanks PB for bringing this very important issue to the wider publics attention.
  • + 6
 Sorry to post a question here, but what should we do if we fall off a bike at hit our head? I've knocked myself out a few times and been concussed a few other times too, and I've not once taken a trip to the hospital. Sometimes it's only really dawned on me that I was concussed a day later and sometimes I've not taken any notice at all. This is a great article, but if the takeout for us plebs is that we should see a doctor every time we hit our head then I think a lot of us are going to miss that message. I realise this is not the point of the article, but I'd like to be told in plain language what I should do if I hit my head (or if I see someone else on the trail hit their head) and when to see a doctor...
  • + 3
 Go see your GP would be my advice. Explain to them when you think or know you've had a whack to your head and they'll take it from there. Don't leave out any hits or times you've felt odd, it'll help them build up a picture. Might be worth asking your family and friends whether they've spotted any odd behaviour from you around these times too.
  • + 2
 also, it might sounds logical, but never take aspirin after you hit your head
  • + 2
 Good question uberwax. See a doctor and rest. A huge issue is if you hit your head again before the brain has 'healed'. The concussion protocol in our area is that you need to be 'COMPLETELY symptom free' for 2 weeks before you should return to light training (aerobic), then you can build up to anaerobic, then light practice, then return to 'risky' activities. Most doctors don't know much about it, but that's improving. However, if your symptoms persist, you will have at least a record of your doctors visit which will help with getting further medical help down the line.
  • + 1
 I'd say A&E is the best bet. If its serious they can get you scanned (MRI or CAT) a lot quicker than if you went to your GP. (who would only refer you to a hospital anyway) I want to know if there is any extra danger for people who easily get light headed and are prone to fainting. I've had countless concussions over the years, although mostly not from riding. The worst being a knee to the face during a game of rugby, that fractured my scull (orbital blowout fracture) knocked my eye out of place and resulted in minor brain damage and sever concussion. Luckily I got medical attention pretty quickly or I wouldn't be here now.
  • + 9
 über wax - your question is probably the most important thing in this article, there are some on trail things you can do first thing.

Take a few minutes
Adrenaline can run high and hide any injuries, so chill out get your heart rate down & assess what is going on.

if you feel weird at all!

Let someone know
If you are riding in a group this is easy, have them follow you down to the car. If you are alone, calling someone you trust who will take you seriously is imperative. You can also use the gps to find out where you are.

Be wary of your pain
Munching on some painkillers can be a really bad idea if you have internal bleeding, a lot of the off the shelf (ibuprophen for example) painkillers thin your blood. This makes it much harder for your body to clot a leak.

Get home safe.
Just chill from here on out, keep the heart rate down, (don't pull wheelies and do bunny hops to check you are allright,) have a mate drive you to the Drs. Shock can kick in quite a bit later after an accident too so, be careful if your on your own, make that phone call.


I hope this helps a bit, I have made all these mistakes in the past, however in my last crash I suffered internal bleeding. I had no pain or symptoms, but I felt wierd. Fell into shock 2 hours later at the hospital. I survived because of the smart people around me, making good objective decisions, I was lucky.
  • + 9
 Great article, good to hear this being brought up more in the mountain bike community.
  • + 5
 The major sports who are dealing with all of these concussion issues all have the same problem; every time a guy gets knocked out or his bell rung theres a silent pressure to keep going, to "walk it off" and "man up".
As soon as the stigma attached to calling it quits after a bad knock is removed we'll see a drop in the repeat concussion issues.
I think the MTB community is ahead of the other sports in this regard, but i think at some point the pros have to lead by example, show that theres nothing wrong with sitting a major event out because you suspect a concussion, red bull's profits arent worth the shit repeated head trauma can cause.
  • + 5
 2 years ago I managed to knock myself out whilst riding, I was unconscious for about 5 minutes. Thankfully I was riding with a friend who managed to get me back to where we were parked. This took an hour and I have no memory whatsoever of either the accident or the trip back to the car. He took me to hospital where they kept me under observation for 8 hours before sending me home. It took at least a month before I fully felt like I was the same person as before the crash. For me this was the scariest part, when you just don't feel like the person you know yourself to be. This isn't just about competition, concussion can happen even on the most relaxing of rides.
  • + 4
 Great article. I'm super appreciative of any awareness on concussions. I've now had more than 20 concussions, dont remember the last time i didnt have a headache and have real messy mood episodes that doctors believe are linked to the concussions. On my worst days even running can aggravate the head. Such an unknown area of medicine, a journey ive been on for years and the more we learn about this the better.
  • + 1
 maybe you should have chilled after the 5th, or 6th or 10th or 15th. just a thought.
  • + 1
 PLMedia, maybe you look like a douchebag trying to impress us all with your amazing powers of hindsight. Just a thought.
  • + 1
 Mate, you make it sound like I'm an idiot who just keeps doing the same stupid stuff. My first 8 or so concussions happened before the age of 13. My worst, and the one the i got the headaches from was falling off a playground at the age of 8. At 9 i got hit in the face by a hockey stick in a school game not wearing a mouthguard (primary school hockey in the 90s). Combine that with concussions in soccer, hockey, getting king hit at a gig at the age of 18.

Only 3 of my 20+ concussions have come from mountain biking. and when i do mountain bike i usually wear a mouthguard along with a helmet. I now have to wear a padded helmet and mouthguard just to play soccer.

The thing you've got to realise is that so much damage was done by the first one, and then collectively by ongoing concussions that each it is easier each time to get a concussion. I will take all precautions, but i'm not going to become someone who only goes to the gym because everything else is too dangerous for him, I'm 28 years old, i'm not going to not do the few things that keep me sane.
  • + 1
 Fair enough man, i've had a few from hockey as well and looking back I wish that I would have stopped playing before I did. I'm not saying live a sedentary life, but like the article states this is a real problem and I'm glad that you are still doing what you love. 8 or so before 13 though. I would be putting my kid in chess club after that many hits to the dome.
  • + 4
 Great read. It's something that I have first-hand experience of, knocked myself out 3 times in the last 15 years or so by various means plus two other brain traumas (one oxygen starvation from choking and one CO poisoning). The last two were in quick succession (CO poisoning and a 45 minute concussion 3 months apart) so damage was done then, had massive headaches and would zone out for a while. Since had to change a few things - no alcohol as even small amounts give me migraines, keeping on top of my hydration and making sure I get plenty of decent sleep - plus it's held back my biking slightly, don't do any more of the big jumps or drops. Don't want another hit just in case it's one too many!

If you have a crash or even just a bad, heavy landing just be aware of any odd behaviours or feelings. Get then checked out.
  • + 1
 what no Skull Attack? terrible..
  • + 4
 MIPS, MIPS, MIPS. If I walk into a bike shop this summer (for a helmet or bike) and the salesperson doesn't at least suggest a MIPS helmet to me I'll be thoroughly disappointed in them. It's not a perfect system, but there is literally zero excuse not to have MIPS in your helmet now. XC/Road/Recreational lids can be had for sub $100, and All-Mountain for under $150. Your head is the most important thing by kilometres, and I'd rather ride an 8 spd X-4 group and have a safe brain rather than run flashy kit and take that chance.
  • + 3
 Side note: Between 15 years of hockey as defence, and moving straight into DH (without a clue what I was doing) I've managed to rack up 9 concussions over 21 years. 5 of those were at the extreme side of things (4 from Hockey). I fell 17 feet to the top of my head in the WBP in 2013 and knocked myself out. I literally had no idea I had also broken my wrist until I had ridden back to the village and was stopped in the lift line. Take care of your head, you're going to live in it for the rest of your life.
  • + 1
 6D also seems to be doing some advanced stuff with regards to impact dispersion tech in their helmets, comparable to if not better than MIPS. Look at the data on their homepage www.6dhelmets.com
  • + 3
 Nice to see this article out there, and such a great response to it. The mountain bike community seems to be pretty good about wearing helmets, I just wish this mentality would be more widespread in freestyle skiing/snowboarding and skateboarding. Helmets look pretty rad these days, so I don't understand doing a sport with such a high risk of head injury and not wearing any protection...
  • + 3
 I bump my head to many times on and off bike. Had a sever one after a very bad motorcycle accident. I now have hypofyse insufficienty, so my hormone balans is disrupted. I took 11 years of suffering and numero's doctor visits To find out. This occure often after accidents especially when you also have whiplash. You only live once, but you have only one body and That s Unique so not many after market party are available. So take care and have a save ride. Dont be afraid of skipping parts of THE trail and come back later with more confidence And skills. Progression is made by tiny steps at THE time... Have a save ride Great article by THE way
  • + 3
 Excellent article, not scaremongering or trying to install paranoia but strong enough to remind us is all it takes is one cock up.
Interesting to find out that our brain's have no pain receptors. So headaches are our brain creating the sensation without actually being told to by the none existent receptors?
  • + 3
 I worked in professional rugby as a Physiotherapist and managed concussion a lot in conjunction with our team Doc. The governing body for rugby (RFU) utilize the SCAT3 and have mandatory lay-off's post injury (this is extended for younger athlete's - which I think is also important). Initial management is essential for recovery and following an appropriate rehab protocol is also (the SCAT3 outlines this protocol and its a free-download). I think the majority of what needs to be done is common sense; use the evidence available, seek expert opinion and if there is any doubt, sit them out!
  • + 3
 Thanks so much for writing this. I suffered a debilitating case of post concussion syndrome after a garage accident in 2013. I spent nearly 12 months off the bike and completely out of racing. Now, three years later I feel good most of the time but some of the symptoms are ever present and likely permanent. Any fall riding (head hit or not) results in a weeklong setback in brain function. To this day I still wonder if I could have avoided some of the worst of it by resting better in the weeks post injury. Remember to rest until you are fully better!
  • + 1
 Very similar to my experience. When it happened to me, I thought a concussion meant you take a week off and then you're good as new.
  • + 4
 Although not really evidence based enough for the mainstream medical establishment. I've found cranial osteopathic treatment worked really well in treating mtb/kayak related head trauma.
  • + 3
 Good article - SCAT3 a useful tool but really need an electronic version (ios/android) - SCAT2 had this ans it was very useful.

The 'return to learn' aspect is also very important as folk with concussions at the weekend return to college/school and have huge difficulties with workload/concentrated for a period of time after - the sports side of concussion is well recognised and managed, the educational side of recovery after concussion much less so...
  • + 3
 SCAT3 is very useful to see the list of 22 symptoms people experience after a concussion

'Return to Learn' is an important part of concussion recovery - crash at the weekend then have issues at school/college with concentration/headaches etc - the sports side of concussion recovery is well recognised and better managed now, but the impact of concussion on schoolwork is less well recognised/appreciated. Folk may need less homework/shorter days for a while after a significant concussion - ask if your school/college has a plan for this - if not they should have!
  • + 2
 Education is key here while I feel no test can replace how the individual feels, It can help them realize in the moment that they need to let the adrenalin subside and re-evaluate the situation. Thankfully this sport does a much better job at the pro level of not pushing riders who dont feel ready. The fans seem to be ahead of the curve as well and dont demonize riders for making the tough but right choices. But theres always room for more knowledge..

Sadly some other sports like Supercross / motocross aren't as tuned into this. Anyone who follows SX knows the controversy on concussions this year. Even the fans have been extremely critical and have misdirected their ignorant lack understanding to harsh judgement and criticism of certain riders. Some of the crap that was spewed on social media was down right disgusting. Theres big money in those teams and the ensuing evil of money shows when they allow and even push their riders to attempt racing when there are clearly some lingering symptoms. When participating in one race can mean 10s or even 100s of thousands of dollars for investors. A riders well being can be pushed aside.

Bottom line Mountain biking has a fantastic community, on both the private side and business side, that shines brighter than many when it comes to rider safety and education. I hope the education keeps pushing and riders keep listening. Because it doesn't have to mean less fun, but more fun for much longer. Take time and heal when you need to.
  • + 2
 This is another great article for anybody looking for more information regarding bike related concussion injuries. www.bicycling.com/sites/default/files/uploads/BI-June-13-Helmet.pdf. " Bicycle helmets do an outstanding job of keeping our skulls intact in a major crash, but they do almost nothing to prevent concussions and other significant brain injuries—and the very government agency created to protect us is part of the problem. the time has come to
demand something safer.

Be safe out there. Best rule of thumb... if you ever crash and your head is the first thing to hit, or takes the brunt of the fall, call it a day, spend the rest of the next week catching up on Netflix, let your body rest.

Even if you show no neurological signs or symptoms of a concussion, falling on your head (even with a helmet) from any height isn't doing your brain any favors, and remember, just like the article said- BRAIN DAMAGE IS IRREVERSIBLE- we have a lot of neurons to do go around, but once they are gone, its over.
  • + 3
 superb article. you'll never be quite the same after you've rattled your bonce so hard your brain smashes against your skull. when it happens to you, you're now a lot more informed about how to deal with it
  • + 2
 When I was 9 I fell down a ladder and sufferd a fractured scull. Passed out for hours and after 3 days of observation in hospital i had to stay in bed for about a month. Recovery is very important. The only long-term effect I have to live with is that I can't smell anymore.
This can happen even with a "normal" concussion, as it may disrupt the olfactory nerves...
  • + 1
 Glad you said that. My sense of smell and taste were affected too.
  • + 6
 Great article, the hardest part is for a person to put their ego aside.
  • + 1
 I'm recovering from a concussion I got skiing a month and a half ago. 30 foot cliff, missed my landing like a goon (yes I was wearing a helmet). That made me go out and buy new ski helmet with mips, and a good full face helmet for biking. Also went out and bought a neck brace since I really messed up my neck. Point is, don't be cheap when it comes to your head. Thanks for the article!
  • + 1
 Great article Danielle, really pleased to see this being bought into the forefront. I know I've mentioned it previously but the movie called The Crash Reel is a really good one to watch if you want to learn more about TBI and its effects.
  • + 1
 Great to see a growing awareness on this topic within the mountain bike community and the Medical Community in General. This is a field of study that is slowly awakening and much more will be found out in the coming years.

I have sustained five concussions where I lost consciousness (3 bike related, 2 not) between the ages of 12 and 23. I am now 25. I do not know how many other low grade concussions I suffered over this period of time, but I do know that my personality went through a dramatic shift during my late-teens. This wasn't the normal change that most go through during this time, but a more pronounced, in-your face sort of thing.

Medical professionals focusing on this area of study are finding out with increasing regularity that TBI's (Traumatic Brain Injuries) sustained months or years ago can still have pronounced effects on cognition, hormones and mood. I still find myself susceptible to depression, mood swings and attention deficits and have not sustained a concussion for years.

I urge those of you who have dealt with concussions in the past to do more research on this topic. They are finding that TBI's can have a dramatic impact on hormonal regulation by down regulating the hypothalamus' neural and vascular connections. This can effect testosterone, growth hormone, estrogen and many other key hormones.

I have not got a hormonal test yet, but plan to in the near future. Many medical doctors are not up to date with this information so it is hard to get a sound opinion. One doctor making strides with the military and TBI/PTSD is Dr. Mark Gordon out of California. He has a great deal of information available on his websites: www.millenniumhealthcenters.com/index.html and www.tbimedlegal.com. He has also been featured on the JRE #438, #547 and #700. He talks more about the topic on those episodes. Additional resources can be found here: www.lifeextension.com/magazine/2012/1/Using-Hormones-Heal-Traumatic-Brain-Injuries/Page-01.

I am not advocating that hormonal replacement is the way, as I am not a medical practitioner nor have I gone that route myself. What I do suggest is finding out more information and digging deeper if you have sustained a concussion (losing consciousness or not) and now experience symptoms ranging from depression to loss of libido even if years have gone past.
  • + 2
 Good article to raise awareness , nothing worse then a big crash and not any memory of why or how. One week of hellish recovery then a few months just not feeling sharp on my bike.
  • + 1
 As an ER Nurse, EMT and fellow rider, this article could not come at a better time for our sport. Just today I saw a rider on the trail "taking it easy" riding along because he forgot his helmet, while he just came down a trail with at least a 500ft descent. That may not be much of a descent but if you ride your bike anywhere on the trail-please wear a helmet or don't ride. Better to take a day off and live to ride when you can do it with a helmet. Safety education for the public is of the highest importance, well done Pinkbike.
  • + 1
 Thank you for posting this. I had terrible crash 12 years ago and till today I don't know details how I got into hospital. Today I am dealing with all above includes problem to focus, no motivation , huge depressions time to time. I thought this all is caused by age but slowly starting to understand that it most likely is related to my previous injuries. Now it looks like even know how to properly crash may not help. Understand that we can't live in room with soft walls, eat healthiest food and live till 150 year old - what kind of live it would be? I say get out there , enjoy and think twice before you make that bad decision. Hat down to all top athletes out there. Thanks again for this article and raising awareness!
  • + 1
 Sorry to hear that you still have symptoms to this day. I recommend looking at recent research on TBI and getting in touch with a doctor who is up to date on this subject. Keep living life brother, but see if there are ways to reduce the symptoms you face to this day.
  • + 3
 Brilliant article and should be linked to the recent "when should change your helmet" article on Pink Bike a couple of weeks ago.
  • + 3
 Great article, helmet technology needs to improve as does concussion research and treatment. Check out 6D helmets, definitely an improvement over older helmet designs!
  • + 1
 As a person who works daily in charge of 3 young athletes; this is golden information you are giving!. First aid and first wilderness responders courses dont ever tell you nothing about how to asses such condition or even how to react in case of "non evident" head trauma; read blood puring from your forehead or ears! . Heck, those courses are not even needed to work with the atheltes, so thank you for shinning a light into such an important subject and making me want to learn more about it!!!
  • + 1
 This is a very good and relevant article. I can't help but speculate that perhaps Mirra's suicide was a result of depression due to head trauma...speculation I know, but it has been observed in the NFL for some time and it's time our sport and others like it took this issue more seriously
  • + 1
 really awesome article, very well written and researched! super stoked on how thorough the article was. I've had a couple concussions and they are really scary, i want to prevent them at all costs. thanks a ton pinkbike!
  • + 4
 This article is a head of its time. Well done.
  • + 1
 I need my brain to perform at an extremely high level (coding, logic and maths all day). After a concussion that took months to heal I just can't take risks anymore. I've had to replace DH and DJ with less risky XC.
  • + 3
 Awesome article Danielle!
  • + 1
 Thanks for a well-researched and well-written article, Danielle. It brought out some interesting and thoughtful dialogue. Keep up the good work!
  • + 2
 Greate artcle Thanks a lot for the informations
  • + 1
 Other than 6D helmets what are your recommendations? Is it important to have a bike shop fit you for the new helmet?
  • + 3
 Excellent job.
  • + 3
 Great article Danielle!
  • + 2
 Really informative! Thanks PB!
  • + 3
 Nice work Danielle.
  • + 1
 Great article thanks. An important topic.
  • + 1
 @matinkhani
did you get a concussion test or anything after you stacked?

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