UCI Recommends a Minimum of 1 Week Without Racing After Concussion in New Protocols

Dec 10, 2020 at 7:42
by James Smurthwaite  
photo

The UCI has set out new concussion protocols that are designed to increase rider safety and reduce long-term effects on memory, speech and reaction speeds following a serious crash.

The new protocols are built on the 2017 Berlin concussion consensus statement but have been tailored to the sport of cycling. Sports Related Concussions (SRC) are estimated to account for between 1.3% and 9.1% of injuries in cycling, depending on the discipline.

Concussion Assessment

The UCI identified that reaching an injured rider in a good amount of time is the biggest obstacle in treating concussion at cycling events and mountain biking is a sport that is particularly at risk for this. To combat this, the protocol recommends that non-health professionals, including racers, mechanics and coaches be trained in recognising the signs of concussion and making the correct initial assessment. The UCI says the signs of a concussion include, "feeling stunned or dazed, trouble with balance, headaches, slurred speech, changes in vision" and that it will be publishing training resources in the form of symptoms cards to help these non-health professionals.

When a medical professional arrives at the scene, they will carry out a more thorough investigation of the symptoms including tests of orientation to time and place (Maddocks questions) and balance. After the initial assessment a SCAT5 tool assessment should be carried out and this should be taken again the next day. All concussions should be made known to the UCI Medical Director. This will allow the SRCs to be monitored and traced as scientific research has shown that repeated SRC events can have serious neurobiological consequences for athletes.

Return to Competition

The UCI advocates that athletes suffering a concussion should have a period of complete rest of between 24 and 48 hours and not return to competition for at least a week after their symptoms have cleared up (two weeks in the case of juniors).

This marks a change from the current guidelines that state "For appropriate clinical evaluation for suspected concussion, for concussion management and return to training and competition doctors should refer to the published guidelines (Consensus statement on concussion in Sport – 4th International Conference, Zurich 2012) and the Sport Concussion Assessment Tool 3 (SCAT 3) and any update thereof."

The new guidelines will be introduced in 2021 and the UCI Medical Rules will be updated in January to reflect this.

bigquotesThe issue of sports-related concussion was one of my priorities, along with the misuse of tramadol, when I arrived at the UCI in 2018. Cycling now has guidelines that set out the various phases involved in dealing with SRC (initial assessment, diagnosis, recovery, and return to competition). This protocol applies to all disciplines while taking their specific characteristics into consideration. It will make it easier to trace individual SRC cases and better understand their place in cycling traumatology.—Professor Xavier Brigard, UCI Medical Director

The full document can be read, here.

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82 Comments
  • 57 1
 Good. It is about time the UCI makes this change. Now if they can just keep teams from putting riders back on a bike after an obvious head trauma. Anyone remember Levi Horner crossing the finish line in stage 7 of the 2012 TDF? He had no recollection of the crash that left him with broken bones. It was just terrible.
  • 10 0
 Ummm chris horner. levi leipheimer
  • 19 1
 i guess the marshals (mostly dh & enduro ofc) should also be trained not to let riders continue w/ their runs after a crash w/ possible head injury - i know, hard to judge but better save than sorry imho.
  • 3 0
 @CarlMega: No it's obviously Levi Horner and Chris Leipheimer ;0
  • 8 0
 or Toms Skujins at the TOC in 2017 when couldn't he even sit up straight and the mechanic is trying to get him back on the bike. Its amazing how far Cycling has come in the last 3 years with its attitudes to concussion and athlete safety, hell even BArdet got pulled from the tour after his concussion this year, which is a big call from a fairly backwards french team.
Funny that you don't hear about it as much in MTB given that almost everyone at a WC crashes a couple of times in practice, I guess the declarations in the crashes are just less severe? or theyre happening at lower speeds so the rider is more likely to get more time to prepare and put and arm/shoulder down before their head!
  • 7 1
 Good way to encourage covering up a concussion.
  • 1 0
 It was Levi Leipheimer on Stage 12.
  • 1 2
 @scary1: Correct. Simply don't get the CT that is required for a true diagnosis...the rest of the symptoms could be hyponatremia or the converse...also common...
  • 1 0
 @JustAnotherRiderHere: concussion is not diagnosed via CT. CT is done after head injury to rule out more serious injury such as hematoma, fracture, or swelling. Concussion is diagnosed by symptoms alone in the absence of a more serious injury that would show up on head CT.
  • 2 0
 This is the part of the 'culture' that needs to change, for road racing. For the support staff or even spectators that assist they may not have all the information, it's just get them going as quick as possible, when it's quite clear from TV replays that there's been a significant blow to the head. For me, in a stage race situation, allowing a rider who's crashed the opportunity to not finish that day, but still rejoin the race the next day after passing medical assessments for any injury after a crash, might make the whole thing a lot safer for the riders. For example, not head related, Pinot in this years TDF, had he stopped after the crash, been treated immediately then allowed to rejoin the next day, that may have given him the edge to recouperate enough to continue. In mtb races, it's usually the rider who gets themselves up and goes again, but really the marshalls need to have the power to stop them, for any reason. The whole thing is about getting to the end and setting a time. If there was some protocol for giving a time to those stopped after crashes there would be no need to take the risks. A calculation based on previous results, timed training, times in the run before the crash happens etc and including a 'penalty' calculation for the crash so you cannot crash and win, seems like a sensible thing to me. Maybe you don't appear on the leaderboard and record a DNF, but still get appropriate UCI points. Anyone familier with cricket will be able to explain the Duckworth Lewis method for deciding rained off cricket matches!
  • 1 14
flag JustAnotherRiderHere (Dec 11, 2020 at 3:24) (Below Threshold)
 @sfrancey: "Concussion is diagnosed by symptoms alone in the absence of a more serious injury that would show up on head CT". - not where I work. Period.

Is this like ChinaFlu? I mean, get tested for something you are not symptomatic of and then panic? Concussion protocols are nothing more than subjective opinions (at best). They are getting to be ALMOST as big a crutch as ChinaFlu (more so in youth sports)
  • 1 3
 @Braindrain: Sure, the French (or whom ever) will "bump their noggin" on every mountain stage.
  • 2 0
 @JustAnotherRiderHere: let me phrase this in a way that you might understand: when someone has neurological symptoms after head trauma such as confusion, memory loss, loss of consciousness, changes in vision, etc..., yet no evidence of that trauma on imaging (such as hematoma, visible swelling, fracture, etc...) then the diagnosis for that traumatic head injury is concussion.

There is zero incentive for an athlete to avoid a head CT in the presence of neurological symptoms after head trauma. The CT is to rule out a more serious injury, not to diagnose concussion.
  • 1 7
flag JustAnotherRiderHere (Dec 11, 2020 at 5:17) (Below Threshold)
 @sfrancey: You confuse theory with a diagnosis. The standard protocols that you use are not much more than assumptions, that, as I said can replicate many other neurological issues. Drunkenness is a common one.
  • 45 1
 Years ago I competed in high level sports (not biking), and I would always get back up and continue after a head injury since I felt it was my "job" and I didn't want to let myself or anyone else down. Years later at the age of 38 I CAN'T work, drive, walk more than 100m or socialize. 90% of my day is spent on the couch in silence. So those of you that "are fine" after a head injury you won't be if you continue.
  • 42 0
 Mines on the bottom right !
  • 4 0
 Why is it so swollen?

jk, jk *brofist
  • 2 1
 I think that represents most of us.
  • 14 1
 They should look at using a device like the NeuroCatch to measure actual cognitive function against a baseline test. Similar to an ECG for your brain, and gives actual objective metrics of brain function instead of subjective questioning.

This technology is finally catching up in this world, and it's about time we had proper data for somebody's brain health instead of them saying "I feel fine, and my middle name is Rosco"
  • 13 1
 Should I be worried if I got a concussion and I got smarter?
  • 19 0
 Person, woman, man, camera, tv. See, perfectly fine.
  • 2 0
 For sure, everyone racing should have a baseline. We had this required on my college cycling club, it's ridiculous that the pros don't considering how much is at stake for them.
  • 1 0
 Ok and how would we quantify the baseline given that brain function can and does greatly vary depending on the individual and their mind state (i.e. meditation vs concentrated focus) Are the tests done during a mental task?
  • 13 0
 Boy, you don't say... 1 week minimum recommendation? Facepalm At least it's supposed to be after symptom abatement, but still... treat your brain gently...
Glad we're finally getting something into hard writing. tup
  • 15 0
 seriously, a week is barely anything but progress I guess.
  • 12 0
 When Rogatkin stood up at Rampage and they allowed him to get on his bike someone handed him and continue was a very bad moment in our history. So many more I could name where the rider is obviously out of it after rag dolling into a broken pile then after standing up and able to raise an appendage they continue. It takes a community to stop the insanity and I applaud this protocol 110%
  • 6 0
 I hope the best for him later in life but that boy has knocked him self out prolly 30 plus times on film alone. I wonder how his day to day is
  • 3 0
 There's a lot of respect and admiration sent to those that get back on the bike immediately after a crash. It's evident in the cheers, the admiration of the announcers, and even the sponsors here.

www.redbull.com/us-en/videos/this-gnarly-crash-couldn-t-stop-nicholi-rogatkin

It touches on a conversation that we as a community need to have: understanding the difference between true grit and when it's time to stop.

We can cheer for someone who gets up after sliding out in a corner, but we shouldn't be listening to a concussed rider who instinctively says "Yeah, I'm fine."
  • 14 0
 I had to wait 2 months for my concussion to heal
  • 5 0
 same. scariest injury recovery ive ever had.
  • 1 0
 @Gibbsatron: I've had more concussions than I care to think about, but one in particular took me around 3 months to fully get over. Not feeling like yourself for months and not knowing if you ever will is indeed very scary.
  • 4 0
 Almost 5 years after I still have have issues with headache, dizziness and fatigue/tiredness...
  • 4 0
 7 Years post concussions
Chronic headache, brain fog, memory issues...
Neurologist says welcome to the rest of your life.

Do not f* around. It sucks to ride the couch for a few weeks and miss a season, but far far better a few weeks as opposed to the rest of your life.
  • 5 0
 Still haven't recovered my sense of smell from a concussion 5 years ago, plus brain fog, some days my I tend to lose balance like someone is pushing me, fortunately no headaches, more than 3 months to feel close to ok (broke my occipital bone)
  • 11 0
 www.bbc.com/sport/rugby-union/55208227

on dementia because of brain trauma
  • 9 0
 Is it just me or does this feel like not long enough? Also it only covers racing. Teams and sponsors should be signing up to a voluntary code which includes training as well. Maybe PINKBIKE could lead on such an initiative?
  • 12 0
 The title is a bit misleading. They are requiring a minimum of 1 week after concussion symptoms have cleared up, not 1 week after the onset of a concussion. Depending on the severity of the concussion, this could be anywhere from a few weeks to a few months. This would just force people to give it a little extra time instead of jumping back into racing after they "feel fine".
  • 7 0
 When I was a kid and I got a concussion they just put me back in the game or back on the bike. Those were the days.....What was a writing about again?
  • 5 0
 I don't remember ever getting a concusion! Wait what was this article about again...
  • 2 0
 The scandalous part of this announcement isnt the misleading 1week in the title, its that some concussion symptoms can take days to rear their ugly head so the "period of complete rest of between 24 and 48 hours" that initiates the time off is complete garbage.
  • 2 0
 The protocol for a rugby concussion in ireland is 1 week complete rest and then another two weeks away from sport regardless of symptoms, if you get symptoms after those 3 weeks, you start the whole 3 week process again. After having two rugby concussions, i can attest that nowadays, they don't f*ck around with brain injury in underage rugby
  • 1 0
 Crazy shit, I’ve been knocked out twice from dirt jumping and probably had a concussion once when I was in my teens but who knows how it will affect my future. I don’t believe I’ll have CTE and what’s he talking about the misuse of Tramadol? I took that for a back injury once and it was basically a strong ibuprofen
  • 5 4
 And how money, time and other resources did the UCI spent to come up with the life-changing, NEVER before thought of or even conceived protocol. I mean, sure no other medical journal or even Web MD could have come anywhere near this level of research? I digress...
  • 1 0
 Only a week? Having suffered a few through rugby the protocols issued in that sport keep you resting for far longer.

Can be really nasty and weird side effects. Worse is that it can change you years later so you don’t realise at the time that you are doing damage
  • 2 0
 Nothing like taking a nice little "dirt nap" after a hard slam.... you don't have to tell me to take time off! But I've seen guys get right back up and go at it again...
  • 3 0
 I have had a lot of hard hits and gotten right back up and moving. Pretty stupid, but in the heat of the moment you aren't thinking about that.
  • 1 0
 Wow super late. Not in the industry but we have been using SCAT5 and concussion guidelines for years now. UCI is far behind EBM. But we all knew athletes were at risk and kept watching.
  • 3 0
 In amateur boxing it's a 30 day medical suspension. Did the UCI do any research on this? A week isn't much at all.
  • 5 1
 Should be a month minimum. The UCI once again fails.
  • 2 1
 1 week..... are you F*CKING kidding me? A MONTH a minimum, it's your brain.. you only get one. Last I checked there were no brain transplants yet but hey you never know.... I am just a guy on the internet
  • 1 0
 With all we know about the effects of concussions we should probably recommend athletes take 24-48 hours off with any head impact, even if they don't meet the criteria for a clinical concussion.
  • 7 4
 They really needed a study for this? Common sense maybe ?
  • 8 0
 What is this "Common Sense" you speak of???
  • 18 2
 Every Dr. recommends at least 2-3 weeks, longer depending on severity. One week isn't enough.
  • 10 0
 Common sense and competitive personalities don’t always mix. I think a lot of these riders feel pressure to get back to work ASAP after an injury. whether that pressure is real (from team/sponsors) or imagined, the pressure is there. Now there is some built in safety protocols that are being backed by scientific research, it may affect the short term bottom line but the overall benefit to the athletes is unmistakeable.
  • 6 0
 @SlodownU: if you read the wording it actually says 1 week AFTER symptoms have cleared up. Realistically that is going to be more like 2-3 weeks from the actual injury.
  • 3 0
 Most pro athletes fear losing more than they fear death. Ill health or worse in the future is an abstract, losing is something even the top guys know only too well. Add sponsors who have money riding on an athlete competing and common sense goes out the window. It's not just a cycling problem, look at Marc Marquez, five months after his big crash and he's still going through surgery and bone grafts. All because nobody wanted to be the one who told the reigning champion to go home and take it easy.
  • 1 0
 @Fix-the-Spade: MM93 is an interesting example. The kid (pulled the bone headed mistake) hit another rider so hard HE WENT BLIND! Surgery corrected it, and he returned to racing.
  • 2 0
 @Mattysville: Then someone needs to change the headline here, because its very misleading. I realize its been created for clickbait, but head injuries are too serious to f*ck around like this.
  • 3 0
 1 week is a joke, should be 30d minimum unless testing proves ok prior.
  • 1 0
 More than a week might mess up the PED cycle,,, ,,kidding, a week is a crazy bad joke
  • 2 0
 It says its one week AFTER symptoms have cleared, so I guess that will be a lot longer then 1 week total in most cases.
  • 2 0
 Thats been the goto protocol for mainstream sports for about 20 years now. I cant believe this is now just a thing.
  • 1 2
 On the other hand.....have you seen the drama in professional level soccer all along? One slight nudge and the player goes down, rolling all over the ground, writhing in agony.......oohhh the pain....hand out the red card.....give them a penalty kick......and these guys are getting paid millions a year.......ridiculous, just plain ridiculous....
  • 1 0
 Is there any actual treatment for concussion other than rest? And how does early resumption of activities negatively affect the outcome?
  • 2 0
 You can't put somebody on a bike after they have a concussion.
  • 2 0
 Let's call it a month instead, just to be safe.
  • 2 0
 Came here to say this.
  • 1 0
 I feel like this is just going to push people to hide injury rather than get tested
  • 6 0
 Perhaps for some, but look at Reece Wilson, he wasn't even concussed and decided to sit out the remaining rounds (and rightfully so), as more evidence comes to light about concussion, there will be less people hiding the injury Bec it's so damn scary
  • 1 0
 Sorry...what did you say? I’ve got a slight headache.
  • 1 0
 Not long enough. It should be 30 days at a minimum.
  • 1 0
 All hail the mighty UCI, master of the obvious.
  • 1 0
 One week is a joke. More like a one month minimum
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