Giving Up Cycling: Concussion

author : AMSSM
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A concussion is a complicated injury. Recovery can be several days to weeks. There are several things that you can do to minimize future or repeated risks of a concussion.

Member Question

I CAN'T REMEMBER THE CRASH. I turned onto a bike trail and the rest is a blank. I did not hit anything/anybody else, and however it happened, apparently passed out. 

Having done some cursory research on concussions online and from what education I was given by the hospital staff after discharge, it seems to me this is the most serious sort (especially since I lost consciousness). I am also quite disturbed by the lack of recall since I don't know what caused the accident. All I can point to is that both incidents took place while I was on my clip-on aerobars, and I seem to have reduced control/maneuverability on the aerobars. I am very unclear on what the future holds, but I may be giving up cycling entirely since these crashes have taken place too frequently for my taste, and the recovery is killer...it takes forever. 

Any tips on recovery or how to possibly get enough gumption to get back in the saddle? Also, how to prevent more crashes?

Answer from Aaron D Campbell MD, MHS
Member AMSSM

In an effort to avoid complexity, yet explain how complicated this injury can be, a concussion in short is a functional, not structural, traumatic brain injury. It results from a direct or indirect blow to the head, leading to shear forces on the brain. Typical brain imaging will be negative for things like a bleed. Leading theories suggest a complex cascade of neurometabolic processes that includes chemical mediators such as potassium and calcium as well as abnormal energy expenditure in the form of ATP. It is this process and it’s subsequent attempt to heal that likely leads to symptoms. All of this can take several days, where most individuals see resolution by 2-3 weeks, and only a minority are left with post concussion syndromes of varying severity and duration. This makes sense, since any injury will result in a physiologic attempt to regain homeostasis or a return to “normalcy”. Any recovery process can include uncomfortable symptoms.

Regarding symptoms, the presence of a headache, short term memory loss and balance disturbance, have traditionally been the hallmarks of concussion. Many other brain activity type symptoms can also be present such as light sensitivity, emotional lability, confusion, sleep disturbance, and just “not feeling right”. Treatment involves complete brain rest. This means cognitive and physical, where, as cognition resolves, then physical stimulation can occur on a day-by-day basis until complete resolution. Initially, things like computers, TV, text messaging, or reading, in addition to exercise should be avoided. It is not clear to me exactly how long your symptoms lasted, or if you actually lost consciousness, or just don’t remember what happened. I’m also not clear how long it took for you to feel “normal” again. Perhaps these thoughts will help sort out those questions.

Loss of conscious, while important, may not be clinically significant, unless “prolonged”, meaning greater than one minute. This timeframe may be arbitrary, but the bottom line is that a period of prolonged loss of consciousness warrants further investigation into the extent of the head injury for other reasons. Repeated concussions, principally those occurring in individuals who have not been allowed adequate time to FULLY recover from the previous concussion IS considered dangerous, and has lead to the concept of the “second impact” syndrome. This idea is also controversial and many people confuse this with repeat concussions despite full recovery. Evidence, however conflicting, does suggest that repeated concussions, regardless of time allowed to recover, likely leads to long term cognitive deficits and an increased risk for additional head injuries, in addition to longer recovery periods.

Thankfully, It sounds like you have achieved a full recovery without the need for any specific interventions such as physical therapy or medications for symptoms. My concern is that it also sounds like this has happened to you before, possibly on several occasions.

As far as getting back on the bike goes, I’d recommend taking a look at your situation in terms of these points. Issues like the use of aerobars for time trialing involves a separate discussion, but bicycle-handling skills may play a role in injury prevention. Perhaps working with a personal trainer will improve both performance and injury prevention.

Aaron D Campbell MD, MHS
Family & Sports Medicine
University of Utah, Salt Lake City, UT

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date: November 10, 2014

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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