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UCI publishes new concussion protocol as other sports face lawsuits from retired athletes

Governing body acts as brain injury charity warns that “cycling is lagging miles behind other sports”

The UCI has today published a new sports-related concussion (SRC) protocol, which will apply to all cycling disciplines on the UCI International Calendar from the start of next season in January. The news comes as a brain injury charity warns that “cycling is lagging miles behind other sports” in dealing with the issue.

It also comes as 70 former rugby union players launch an action against World Rugby and the English and Welsh governing bodies over long-term conditions including dementia which they claim result from concussions sustained while playing the sport, alleging that the authorities failed to adequately tackle the issue.

There have been serious concerns over the effects of concussion in cycling for several years, with one common issue highlighted being that riders involved in a crash in which they have sustained a blow to the head will be allowed to continue riding without having the injury assessed – as happened this year with Romain Bardet at the Tour de France, for instance.

> Team boss lauds Romain Bardet’s “admirable courage” – but should someone have stopped Frenchman riding to stage finish with concussion?

Taking as its starting point the 2017 Berlin concussion consensus statement drawn up by a range of sporting bodies, the UCI’s new protocol follows a review begun last year that was led by its medical director, Professor Xavier Bigard, and also involved international experts including doctors, scientists and neurologists.

According to the UCI, in cycling SRC is estimated to account for between 1.3 per cent and 9.1 per cent of injuries, depending on the discipline in question – road cycling, track cycling, mountain bike, BMX Racing, BMX Freestyle, cyclo-cross, trials and indoor cycling.

Road and track cycling, as well as mountain bike, have been identified as the disciplines in which it takes most time to reach injured riders and for first responders to make a diagnosis and determine whether they should be allowed to continue in the event.

“In responding to this problem, the protocol recommends that non-health professionals (in particular coaches, Sport Directors, mechanics and riders) be trained for recognising the signs of suspected SRC since they are very often the first people on the scene after a rider falls,” the UCI said.

“The protocol details the signs that need to be looked out for in assessing the condition of the athlete (feeling stunned or dazed, trouble with balance, headaches, slurred speech, changes in vision) and in taking an appropriate decision in an optimal timeframe, either roadside or trackside. Training resources in the form of symptoms cards will be published to help non-health professions detect the signs of suspected concussion.

“If these signs are detected, the diagnosis will need to be confirmed by the race doctor. In the absence of any initial signs pointing to SRC, the rider should be monitored by the medical service. A standard examination comprising, among others, tests of orientation to time and place (Maddocks questions) and balance, may be conducted at any time.

“In all cases, the rider should undergo a more thorough examination after the race using the SCAT5 tool, comprising a neurocognitive approach,” the UCI adds. “This examination would also be repeated the following day.”

The protocol also details recommendations relating to when a concussed rider can return to competition, including a complete rest period of 24-48 hours and not returning to competition for at least 1 week after the symptoms have gone, or two weeks in the case of juniors. It also recommends compulsory notification of SRC events to the UCI’s medical director.

Professor Bigard said: “The 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.”

> Two-time Swiss road race champion says she was pressured to ride with concussion

Cycling has “an unacceptable level of risk,” says brain injury charity

Quoted in Sportsmail this morning, Luke Griggs, deputy chief executive of brain injury charity Headway, said that “Cycling is lagging miles behind other sports” when it comes to dealing with SRC.

“The risks of suffering a second crash, and putting yourself and others in more danger, are obviously far higher when a rider is concussed. It is simply an unacceptable level of risk,” he said.

The newspaper also made reference to the case of Kelly Catlin, the American team pursuit world champion, who took her own life last year, aged 23, with her family speaking off how her personality changed after she was concussed in a crash.

> Family of track cyclist Kelly Catlin donates her brain for research into concussion

 “Kelly did not have any underlying mental illness,” explained her father, Mark.

“The concussion changed her behaviour profoundly. She became moody, prone to fits of anger and bouts of depression. That was in part due to severe headaches and frustration with an inability to train.

“She felt she was going crazy. She felt trapped by expectations from family, friends and team-mates. Unable to meet those perceived expectations, she ended her life.”

He added: “I am not aware of anyone talking to her coach regarding a return to competition protocol and how it should be managed. There was a complete failure of communication. Her death is an indictment of a medical infrastructure that fails our finest athletes.”

GB Cycling Team’s top medic “surprised” at lack of protocols when he joined

Dr Nigel Jones, formerly doctor for the England rugby union team and who became head of medical services at the Great Britain Cycling Team in 2017, told Sportsmail he was “surprised at the absence of robust policies” after switching sports, leading to him drawing up procedures to deal with concussion.

“In rugby you have to be symptom-free before you start your return-to-play protocol and we have put something similar in place,” he explained.

Dr Jones, who was involved in the working group that formulated the UCI’s new protocol, outlined some of the issues specific to road cycling.

“The first thing that happens when somebody crashes in a road race is a panic to get them back on the bike as quickly as possible,” he said. “If you had a concussion car and a rider crashed, they would go into it and have a head injury assessment.

“If it is deemed the rider hasn't had a concussion, the car tows them back into the peloton. Then you are not having that panic that if someone falls and they are not back on their bike within 30 seconds, it is stage over.”

Lawsuits could result in “astronomical payouts” warns specialist solicitor

Besides rugby union, rugby league and association football are also expected to become involved in lawsuits relating to long-term damage caused by concussion but one solicitor specialising in brain injury cases has warned that such cases can take years to be decided – and could result in “astronomical payouts” having to be made by governing bodies.

Referring to the case relating to rugby union under the law in England and Wales, Ipek Tugcu, Senior Associate in the Brain Injury Team at the law firm Bolt Burdon Kemp said: “To win, the players must prove that they suffered brain injuries because the Defendants (World Rugby, Rugby Football Union and Welsh Rugby Union) failed to take reasonable steps to protect them from the known risk of brain injury. What is ‘reasonable’ will be determined by the information known, or ought to have been known, at the time of the events.

“This is not easy, and will require consideration of volumes of documents to identify what information was available on the risks at the time and evidence from independent medical experts regarding the link between the players’ brain injuries and any failings.

“It wouldn’t be unusual for this to take years,” she continued. “A legal action of this magnitude is bound to have significant implications for athletes, especially rugby players, suffering from brain injuries. If successful, it will set a precedent for others to come forward relying on the similar grounds.

“The impact on rugby’s governing bodies would be astronomical – the financial payouts per athlete could easily reach six-figure sums or more, as they will need to cover all injuries and financial losses suffered due to the injury.

“Money aside, I would expect very swift and robust changes to be made to the game to fill in any gaps which could leave the governing bodies open to more legal action,” she added.

Simon joined as news editor in 2009 and is now the site’s community editor, acting as a link between the team producing the content and our readers. A law and languages graduate, published translator and former retail analyst, he has reported on issues as diverse as cycling-related court cases, anti-doping investigations, the latest developments in the bike industry and the sport’s biggest races. Now back in London full-time after 15 years living in Oxford and Cambridge, he loves cycling along the Thames but misses having his former riding buddy, Elodie the miniature schnauzer, in the basket in front of him.

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RobD | 3 years ago
1 like

Would it not be possible to fit some kind of small G force sensor to the rider's helmet? If the sensor registers an impact above a specified level, it's instant assessment by the doctor etc, with how a riders time is given to be decided. There needs to be the removal of ambiguity for this kind of thing, as soon as people with any vested interest in the rider carrying on etc are involved it isn't impartial enough.

jollygoodvelo replied to RobD | 3 years ago

You'd think this would be fairly easy to implement really - as ever it's not the falling that hurts, it's the landing, and the high-speed slides along the ground are less of a problem than sudden stops against a wall or a pile of crashed bikes in the road.

F1 has a similar system - a light that comes on at the front of the cockpit if the sensor registers a deceleration over a certain level so medical crews are aware of the risk of brain injury.  Not sure what the level is; apparently it doesn't always go off even for some very big crashes (where the energy is often dissipated over a longer period).


Gkam84 replied to RobD | 3 years ago
1 like

Specialized already have a crash sensor, you may have seen riders with it before. I don't think it would take much to change it to have a function to alert the race medical team via an iPad or similar to a rider that needs to be checked because of a certain force.

kil0ran | 3 years ago
1 like

If we set aside whether a rider should be allowed to ride the next day after a big crash for the moment, surely the solution is to apply the 3km rule for stage races? You fall, any sign of head injury and you get a ride in the broom wagon to the finish and take the time of the largest group. Then you get properly assessed in a clinical setting by an independent medical professional, who decides whether you can start the next day. For mountain finishes the solution is probably to award the time of the largest group crossing the line. 

What this does is buy the team/medical personnel time to properly assess the rider without unduly affecting their chances in the race. We all love a crash/chase back/almost win story (MvdP in one of the Spring Classics last year springs to mind) but I'd be happy to forego that for rider health. 

Brightspark | 3 years ago

I have had concerns about the way head injuries are treated at all levels of sport. It is dissapointing that it is only the threat of finacial payouts that is leading to any form of change, instead of the well being of competitors.

A few years ago, I did try and raise the question within timetrials and road racing, with which I was involved with. I was very uncomfortable with the idea that riders who suffered a head injury were not properly identified and treated. They were instead supposed to make their own way to hospital. I am particularly minded of the rider who fell and banged his head on the Aldermaston course, drove himself to hospital, then collapsed and died of brian injury while checking himself in.

There were a number of objections to my view, with questions about what is deemed to be a head injury and how would non-medical people spot it. Plus there is an honest belief that making helmets mandatory would solve the problem as figures quoted by the pro-helmet lobby are quite compelling. 

The answer to the first question is any blow above the neck, and to the second, that helmets may well reduce superficial injuries but do not appear to prevent internal brain injuries caused by the brain moving by either rotation or straight acceleration causing hemoraging.

I sometime wonder that if we banned helmets, then when injuries do occur that they are more obvious and so are taken more seriously. (cue trolls and pro-helmet brigade)

The article also talks about the return period. As someone who has suffered head truma in a bad crash during a road race (I was unconsious for 5 hours and was ambulanced to hospital), I think, with hindsight, that I probably returned to competition too soon and my health suffered consequently. Even after over a decade, I still feel a bit silly and get bad headaches from where I hit the ground. 

I would have been nice to have had more monitoring by the health proffession. I hope that what we are now learning about head injury, its aftermath and mental health will improve the care and rehabilitation of those affected as well as raise awareness as to the short and long term affects.

For too long, there has been a belief that a blow to the head/ a knock out/ a right hook, or even a slap around the head, will just leave you feeling a bit woozy but you will soon be back on your feet, just like in the movies. But real head injuries are not like that.

BTW, If there is any concern that there has been a blow to the head, then dial 999 and call an ambulance.

bobbinogs | 3 years ago

Am I reading this right in that the UCI response is just to send those people (with the most to gain by a rider getting back in the saddle) to recognise concussion?   If so, sounds like a box nicely ticked with nothing actually changing.  Lot of words though, so might have to reread it 

Gkam84 replied to bobbinogs | 3 years ago

Some of us in cycling are trained in certain areas of first aid including concussion protocols that services like the police and fire service use before medical crews arrive but are actively discouraged for saying anything by mangers and riders alike. I was even once told to "go away" by a race doctor by referring a rider to him after a stage to be checked for concussion...

kil0ran replied to Gkam84 | 3 years ago

It's basically the whole Mourinho-Eva Carneiro thing. Let's face it, most DS are pretty volatile dictators and even if they don't explicitly tell their team members not to follow this protocol many still will out of fear of losing their jobs.

Just like it should be in football, these injuries must be independently assessed by a suitably qualified medical professional, not by someone with a vested interest in the "rider continues" option.

Gkam84 replied to kil0ran | 3 years ago

This is exactly right, but how do we do that in a sport that you can't blow and whistle and stop? You can't just sub someone in either.

It's easy in most sports, blow the whistle, have a break, pull the person to have checks, if ok, they return, you can't do that in cycling. They'd be 10km up the road before you were cleared at least. So you are out of the race anyway. You can't do any protocols on the bike hanging onto the medical car. 

I've just seen the comment above about travelling to the finish to be checked over and if clear, you can ride again the next day without penalty? That would be and make no doubt about it, it would be taken advantage of. 

The only way I could see that working, say in a grand tour, yes you can travel to the finish, get checked, but returning to the race, you take the time of the lantern rouge, forfeit all points in competitions. So you don't have a tired GC rider going down in an accident and "playing" on it...

So if that was the rule, people are going to continue on without being checked...

I honestly can't see a solution apart from independent medical professionals travelling with every team, when the mechanic jumps out, the medic assigned to your car goes with them. Teams would refuse to back that or pay for it. Races couldn't afford it either...

mdavidford replied to bobbinogs | 3 years ago

No - it's saying that since those people are likely to be first on the scene they should be trained to look out for and flag potential concussion. That doesn't mean that riders wouldn't also be assessed by neutral medical officials just because the team say they're OK - 


In the absence of any initial signs pointing to SRC, the rider should be monitored by the medical service. A standard examination comprising, among others, tests of orientation to time and place (Maddocks questions) and balance, may be conducted at any time.

It does seem a bit wooly as to what would trigger that monitoring and testing though.

mattsccm replied to mdavidford | 3 years ago
1 like

Tricky one. Morality v arse covering. 

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