Crashing, injury, and even hitting your head have long been considered accepted risks in the sport of mountain biking. But as the evidence mounts on the long term risks of even minor head injuries, Hannah wonders whether we ought to be thinking again about risk and responsibility when it comes to protecting our heads, and whether pro-level concussion protocols could help all of us.
Knowing the risks.
If you’re an American mountain biker reading this, perhaps you’re already clued up on the long term risks of head injury and concussion, since in the world of American Football this is big news. The NFL is now taking concussion risks so seriously that it’s taken to labelling helmets to grade them on the basis of how effective they are at reducing injury, so that teams and players can make better informed choices about their equipment.
As far back as 1994, the NFL created the ‘Mild Traumatic Brain Injury Committee’. In 2007 a hotline for players being forced to play contrary to medical advice was created, although it took until 2016 for the NFL to admit a link between football and Chronic Traumatic Encephalopathy (CTE). There’s now a whole ‘Play Smart Pay Safe’ initiative aimed at reducing injuries – not just ones to the head – and making the game safer. Data is collected, trends are examined, and rules are changed. Of course, there are some numbers driving all this: in schools, participation levels in American Football are reported to be falling as concerns about concussion mount, and there have been some costly legal settlements.
There’s been a human cost too: football fans have seen CTE posthumously confirmed in a number of cases of suicide by former players. It’s a pretty sobering story: elite athletes crippled by personality changes, dementia and depression as a result of head injuries sustained during activities we considered good for health.
Cycling Playing Catch-up
Mountain biking, and professional cycling more generally, seem to be lagging behind. There’s still a great deal of emotional debate around helmet compulsion, despite all the evidence showing that forcing people to wear helmets is bad for general population cycling – it reduces participation, making this statistically safe form of transport a less popular choice. In competitive sport and mountain biking however, where the nature of the activity (increased speed, bunch riding, technical trails) increases the risk of falling off beyond that which your average pootle to the shops presents, the wearing of helmets isn’t really a point of debate. Which helmet might protect you best is under increasing scrutiny, and you should read Barney Marsh’s article on MIPS from Singletrack Issue 121 if you’re interested in that debate.
Even if you’re wearing a helmet when you hit your head, you’re not in the clear, and it’s perhaps less well understood what happens and what you should do about it. Chris Hall wrote about the topic having interviewed Katy Curd, asking whether we’re taking crashing seriously enough, and offering some advice as to what to do if you do crash on your head (or your neck – you don’t have to hit your head to be at risk, it’s your brain bashing around inside your head that’s the problem).
However, hearing pro-riders at Bike Park Wales recently in a Q&A session, it was clear that there’s more that could be done. Certainly, individual riders need to have the information they need about the risks of head injury, so that they can make informed choices about their own health. There can surely always be more awareness raising taking place. And hey, you’re reading this, which is a start.
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Riders at work.
But what about the professional riders, who are, effectively, at work. We all expect our employers to look after us and not expose us to undue risks, so shouldn’t pro-riders have similar expectations of being supported and protected? And what about younger riders, who might be hoping to make a career of riding? It’s easy to see how a racer could make poor decisions in an effort to please sponsors (or even parents), who may well have shelled out considerable expense to get a rider to a race.
One professional who knows all too much about the potential effects of a concussion, or repeated concussion, is Katy Curd. She’s only just returning to racing after two years of rehabilitation, and the effects of her head injury are still with her. She is grateful that all her sponsors supported her during her time out from racing as she sought to recover:
“I really am SO grateful for all my sponsors who stuck by me through the two years I wasn’t competing, I guess they could see I wasn’t just sitting on the side line not doing anything, hopefully they knew the commitment I was putting in each day to try and get back to racing again but I really wouldnt of been able to keep pushing or have the same motivation behind me if I didn’t have the backing from all my individual sponsors who helped through everything. Everyone always asks me if I ever feel pressure from any of my sponsors and I can honestly say no, I have never felt any pressure from any sponsors of mine and it means the world to me that they have stuck with me through everything. “
However, that support came after Katy made the decision to race while already concussed – after the damage had been done, and became apparent. What about in the adrenaline high of race day?
Tahnee Seagrave said: “You’ve got like 16 year old kids who turn up and race their first World Cups, smash their heads in, they’ve been knocked out for a good 30 seconds and then you see them racing the next day. You talk to them and you’re like ‘why are you here?’ and they’re like ‘oh well I’ve got to race’. It’s like ‘no, you don’t’. It’s not the end of the world missing one race. Get better or you’re just going to get worse.“
Vero Sandler added: “A lot of kids think it’s cool, like ‘I was concussed yesterday when I was racing’. It’s so not cool.“
In hindsight, Katy says “I guess there’s just not enough advice out there, like people do hit their heads and don’t know [the risk] – I certainly never knew it – I wish someone had told me ‘don’t bloody race your bike’“.
Levels of protection.
Depending on what event you’re doing, you might find yourself being given this level of protection – or you might not. The EWS and Crankworx have introduced new protocols in the last couple of years, while the UCI says its protocol is under review. Athletes displaying signs of concussion in EWS or Crankworx races are banned from further participation until cleared by a doctor, and the rules on this are covered in specific protocols for dealing with concussion. Both organisations seem to recognise that athletes may not be best positioned to make choices about whether or not to compete.
Darren Kinnaird, Crankworx General Manager, says:
“Developing policies and procedures around concussions, and head injuries in general, has been a big focus of ours over the past few years. We take it incredibly seriously. Our main goal in developing a specific protocol that we applied across the Crankworx World Tour was to protect our athletes, both in the short and long term. There are still so many questions around head injuries – sometimes an injured rider can seem healthy and still feel good, but that’s just the surface. There are many layers to these types of injuries that need to be looked at and monitored closely. A lot of the information that’s come out about brain injuries is so new – there’s a lot of learning still to be done. But in order to protect our athletes as best we can, we wanted to be at the forefront of this movement. We worked on developing what’s become our concussion and head injury protocol through the 2017 season and put it into practice at the start of 2018. So far the response from athletes, fans and the industry has been incredibly positive.“
Chris Ball, EWS Managing Director said:
“One of the main reasons we initiated the concussion protocols is to remove the decision making process from the rider and their team. In order to please sponsors etc, it might be tempting for a rider to want to push on with a race when it’s really not in their best interest to do so, this way we can make that decision for them based on solid medical advice. Once a rider is removed from the race, they can’t then return to competition until they show us a doctor’s letter proving it is safe for them to do so. “
It’s also encouraging to hear that the EWS is collecting data about injuries, and that that this will be released for use in studies. Chris Ball says:
“We’ve been conducting a medical survey for the last two years to not only better record and understand the injuries at our races, but to learn how to prevent them. We’re looking for correlations between things like trail design and weather conditions and how they contribute to injury rates and the types of injuries sustained. Once the survey results are all collated we’ll be publishing it publicly and it will be a free resource for anyone who wants to learn more about injuries and concussion in enduro racing.“
Back to the NFL
Looking again to the NFL, it’s possible to see why this kind of data might be useful: it recently conducted a ‘targeted intervention‘ with seven teams that had higher concussion rates than was normal, with a reduction in concussion rates subsequently taking place in six of those teams. It’s currently hard to imagine such a coordinated and data reliant intervention taking place in the professional cycling arena, especially with such a fragmented set of event organisers and ruling bodies, and as yet the UCI does not have such a robust set of rules as the EWS or Crankworx – meaning that Downhill World Cup riders may not be being given the same level of protection. Certainly, Katy was left to make her own decisions about whether to ride:
“If I could go back I obviously would now sit out of the race but I just wish it had never been my decision to race”
“When I took both my falls, I went directly to the medics and both times I was told I had concussion, or mainly Jake [Ireland, her partner] was told as I wasn’t quite all there, I had concussion but both times I was never told I couldn’t race. I was however asked on race day by the UCI if I felt ok and if I felt good enough to race, so they knew I had concussion but left me with the decision as to whether I felt ok enough to race. So ultimately it was my decision. Of course being a racer and getting wrapped up in the world and pressures of racing I went ahead and raced. Not knowing back then what I know now about head injures so of course went ahead and raced literally putting my life on the line. If I could go back I obviously would now sit out of the race but I just wish it had never been my decision to race, I just wish with the doctors/medics/UCI team knowing that I had concussion less than 24hours previous to race day, that they were the ones who could of made the decision and told me I wasn’t allowed to race. “
The UCI told us that their rules are currently under review (though we’ve had no word on what form this is taking or the proposed timescale) but with just a single line in the current rules covering the matter (13.3.064 Any rider with a suspected concussion should be immediately removed from the competition or training and urgently assessed medically) there would appear at present to be a less comprehensive approach to the management of head injuries than in the EWS and Crankworx. As additional clarification, the UCI Press Office told us:
“Under the UCI Medical Regulations, the organisers of UCI registered events have the responsibility to provide medical staff and equipment to ensure the health and safety of riders and all involved in the event. The UCI official doctor’s remit is to carry out checks of compliance with the UCI Regulations on the medical services provided by the organisers. This stands as the overarching framework to deal with signs or symptoms of a concussion on riders.“
The difference in approach seems to be borne out in race experience. Katy says:
“I know for the EWS and Crankworx events they have doctors on site and as far as I know if you fall and hit your head the doctors run a full concussion test with you and if you are showing signs of concussion they are the ones to say you can not race, which I think is the right way to go. I would love to see this in the downhill as well. I won’t go into detail but yet again I experienced similar treatment from the doctors/medics on site this year, still after a big fall the decision is still left in the hands of the rider as to whether they feel fit and well enough to ride. I know at the end of the day, riders are being paid a lot to race down a hill on a bike but knowing the consequences its not worth potentially a career ending injury. It took two years of my life from one stupid decision and I would hate to see that happen to anyone else.“
Your head in whose hands?
Taking responsibility for your own safety is sensible – and you do it every time you get on a bike. But that’s not to say that our governing bodies can’t do more. Would a NFL style helmet grading influence your buying choices? Would knowing that you don’t need to be knocked out to be concussed help you assess your own fitness to ride? Would knowing that there are long term implications for both physical and mental health resulting from repeated minor head traumas nudge you into a prudent approach to self care? Quite possibly.
Our pro athletes perform for our entertainment and adulation. Their performance requirements push forward the technologies that we get to experience on our own bikes. Perhaps we all – fans, sponsors, brands, media, event organisers, governing bodies – owe it to them to ensure that they get the benefit of some of the workplace protection that the rest of us take for granted? And in turn, perhaps we all might benefit from the research and development that could follow? After all, what’s more important – a few grams shaved off your components, or the well-being of the grey matter in your head?
It’s great to see that the EWS and Crankworx are taking the issue seriously – let’s hope that the UCI review catches up soon.
If you want to know more about what to do if your friends crash, the risks associated with head injury, or the experience of living with the after effects, check out the following links:
- Lorraine Truong
- Dave Mirra
- Downtime Podcast What To Do Concussion Guide PDF
- Downtime Podcast
- Consider doing a trail first aid course
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