Of course no amount of safety equipment or tech can make our sport 100% safe. So here’s the latest advice on how to spot and treat a suspected concussion and why we all need to follow it.
What is a concussion? Stupid question, it’s when your friend tries a new feature, hits a tree and then can’t remember which trail he’s on or who won Hardline (it was cancelled, if you’re reading this in A&E). We’re being flippant, but until this year the government couldn’t really do much better than that, with no UK-wide definition across different sports. To say concussion was overlooked would be an understatement.
Since March though, and thanks to a report by Parliament’s Digital, Culture, Media and Sport Committee released in March, we have new official guidelines on how to spot concussion and what to do about it. British Cycling now describes a concussion as “an injury to the brain resulting in a disturbance to brain function,” with symptoms including headache, dizziness, concentration problems or balance disturbance.
This is an important step because sports and their governing bodies are increasingly looking to mitigate risks from head injuries and prove they’re doing everything they can do to make things safer… and prevent litigation. The first step is to get a definition of concussion, so changes can be made to the sport and behaviours altered.
“It’s really helpful because people are still in the same headspace about it, as they were years ago,” says Katy Curd, who suffered from concussion while racing elite level downhill. “Even the other day I spoke to someone who’d had a massive crash, broken their helmet, and just got back on the bike and rode again. With a broken bone you can feel it, but a concussion, we just don’t know what’s going on.”
Running through the new guidelines is this key takeaway message, “if in doubt, sit them out,” meaning if there’s even a chance you, a friend or race partner has a concussion they’re done riding for the day. No ifs, no buts. This is because the brain needs time to recover after an impact, if it’s not given that chance then repeated injuries to the head have been shown to cause more serious problems like chronic depression, pain, anger, or even Chronic Traumatic Encephalopathy (CTE).
How can you tell there’s a chance of concussion? British Cycling says most concussions don’t lead to a loss of consciousness, with only 10% of people blacking out. This makes it a really unreliable metric for working out if one has occurred. Instead you need to look out for the following signs or symptoms:
- A dazed, blank or vacant look
- Lying motionless on the ground, slow to get up
- Unsteady on feet, balance problems, falling over and/or poor coordination
- Loss of consciousness or responsiveness
- Confused, not aware of events leading up to the injury or surroundings
- Grabbing/clutching of head
- Tonic-posturing (raising of the limbs)
- Seizure (fits)
- More emotional/irritable for that person
- Check their helmet for visible signs of damage
On top of that you need to ask the patient themselves if they have a headache, dizziness, mental clouding, visual problems, fatigue, “pressure in the head” or sensitivity to light or noise.
Using the latest technology
Following the guidelines above should be the first port of call for anyone assessing a suspected concussion, but there are now a host of tech innovations that help too. The latest is from HIT Recognition, it’s a little button-shaped sensor that attaches to your helmet to record impacts. We’ve seen wearable crash detection before of course, with Specialized’s ANGi working as an effective crash detection monitor. The latest HIT+ builds on that, offering live live data to your phone including G-Force impacts and rotational force. It then gives you a traffic light warning system to tell if the impact has been light, medium or hard, with the hardest red-flag impacts automatically calling your emergency contact.
Live data is extremely important because it lets riders decide whether they’re likely to have suffered a concussion or if they’re at risk of making things worse, explains Euan Bowen from HIT. “It’s doing more than this though, it’s a log book of all the impacts you’ve received, because what you’re doing on the bike is cumulative,” he says. “So in the same way you might have sore legs and DOMS after a big ride, if your head hurts the next day you can look back and see how much G Force you encountered on your ride, and maybe rest up for 48 hours.”
The goal is to educate riders, help them make informed decisions about their riding and improve the safety of the sport, Euan says. “We’re not there trying to use scare tactics,” he says. “This device isn’t gospel, it’s not going to tell you when you can and cannot ride. It’s about putting the data and information into your hands so you can decide.”
Euan had the idea for HIT+ while working on his final degree project at Napier University, before developing it into a fully fledged business with applications across many sports including mountain biking. Since then HIT+ has been honed with thousands of hours of testing to make sure the data being sent to your phone is really representative of what’s happening to your head when you ride.
“That was the first step, validating the G Forces,” Euan says. “Then we took that to the medical profession and medical journals from different sports and replicated those tests to find similar G Forces they’d found doing the same activities.” In short, benchmarking the product against medical studies.
The next step is to collect anonymous profile data from users (with permission, of course), to try and spot trends, before giving the data back to the end users. This could build a picture of which helmets are doing a good job and which are disproportionally involved in concussions.
How to treat concussion
No amount of safety equipment or tech can make our sport 100% safe of course, so here’s how to treat a suspected concussion. To start with, no more riding for the rest of the day. After that you should be monitored for the next 48 hours for more serious signs of concussion, which include…
- Severe neck pain
- Deteriorating level of consciousness (more drowsy)
- Increasing confusion or irritability
- Severe or increasing headache
- Repeated vomiting (vomiting more than once)
- Unusual behaviour or a change in their behaviour
- Double vision
- Weakness or tingling/burning in their arms and/or legs.
If any of the above is going on you need to get to A&E sharpish, something Katy Curd wishes she’d done. “ I didn’t even know the signs to be aware of,” she says. “I took a hit to the head, then I went back out and did the same thing, another knock to the head. Then four months down the line that’s where everything hit me. I now work the latest British Cycling guidelines into my coaching, check out katycurdcoaching.com.”
Back in 2019 the EWS (now EDR) published the results of a survey asking 2,000 EWS enduro riders to detail their rate of injury. Concussions were reportedly mild, and instances rare, with 0.6% of riders competing in the 10 EWS race events during 2017 and 2018 seasons experiencing one, or one concussion for every 263 EWS rider races.
That sounds great, until you consider that many concussions go undiagnosed, meaning the real number was probably far higher. Just as worryingly, a little over a third of riders with concussions simply carried on racing.
“Riding with a concussion is just the worst thing you can do,” Euan from HIT says. “The brain is the only organ in the body that has to do its own damage assessment. This means it can be very bad at it. The risk of crashing again if you’re riding with a concussion is hugely increased because your brain might not be up to speed,” he says.
Recognising the importance of concussion is heading in the right direction though, Euan says, with governing bodies and riders becoming better informed. “It’s trying to get to a level where a head injury is seen in the same way as any other injury.”
The latest BC guidance is part of that process. It means riders at a race, event or club ride would be compelled to stop after a concussion, and spotting one in the first place will be much more straightforward. Our advice then is, as always, Just Get Out and Ride. But do it safely, and armed with the best helmet you can afford and the knowledge of what to do should something nasty happen.