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Concussions in Cyclists

Concussions in Cyclists
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Added on April 16, 2014

Recently there's been a lot in the media about the frequency and long-term effects of concussions in the National Football League, but did you know the sport with the largest number of concussion-related emergency room visits is cycling?

There were 46,948 emergency room visits due to concussions from football–and 85,389 visits by concussed bicyclists, according to a 2009 study by the American Association of Neurological Surgeons.Actually, the frequency of concussions is even higher since many victims never go to an emergency room or seek treatment.

A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way the brain normally functions. A helmet absorbs some of the impact and helps to protect the skull, but the brain is still traumatized by being slammed into the skull. The three most common symptoms reported by people suffering concussions are headache, balance problems or dizziness, and double/blurred vision. Symptoms of a concussion can fall under four categories: cognitive, physical, emotional and sleep. Cognitive symptoms include difficulty thinking clearly, feeling slowed down, difficulty concentrating, and difficulty remembering new information. Physical symptoms include headache, fuzzy/blurred vision, nausea, vomiting, dizziness, sensitivity to noise or light, balance problems, and feeling tired or having no energy. Emotional symptoms include irritability, sadness, being more emotional than usual, nervousness or anxiety. Sleep symptoms include sleeping more or less than usual and difficulty falling asleep.

Symptoms may not occur immediately after the concussion. They can be delayed until hours or days after the injury. Some people who have suffered concussions are unaware that the symptoms they are experiencing are related to the concussion.

Concussions are diagnosed by a neurological examination that includes assessing memory and concentration, vision, hearing, balance, reflexes, coordination, and strength. A CAT scan can determine if there is intracranial bleeding, but not all concussions include intracranial bleeding.

If cyclists fall on a ride and hit their head, signs of a concussion can include appearing dazed or stunned. They may be confused, unsure of where they are riding, moving clumsily, answering questions slowly, or demonstrating mood or behavior changes. They may show signs including amnesia, not being able to recall events prior to or after the fall. Loss of consciousness may occur, but this is not necessary to be diagnosed with a concussion. In fact, some of the worst concussions do not involve any loss of consciousness.

Cyclists should not resume riding after hitting their head. Medical assessment should be performed. Immediate attention is needed if the headache worsens or does not go away, or if there is any weakness, numbness, decreased coordination, vomiting, nausea, slurred speech, drowsiness, seizures, worsening of confusion, agitation, unusual behavior, or loss of consciousness.

If cyclists return to riding while still having concussive symptoms and fall again, suffering a second impact, they risk severe injury, even death. They could also be dangerous to other riders as vision, concentration, reflexes and coordination might be compromised.

Treatment for a concussion involves rest and removal from stimulation such as loud noises, bright lights, reading, computers and gaming. Most patients with sports-related concussions recover within 7 to 10 days. However, about 10 percent of people with concussions continue to experience symptoms beyond this period and are diagnosed with post-concussion syndrome.

Physical therapists are involved in the treatment of these patients, who often respond to a program of symptom-monitored, progressed exercises. Balance activities as well as eye exercises (for tracking, coordinating the movement of both eyes to a single point, and focusing on objects while the head is moving) are often included in treatment.

Concussed athletes often have exaggerated increased heart rates and/or blood pressure in response to exercise, so aerobic activity is gradually incorporated and closely monitored.

When the concussion symptoms have resolved, returning to cycling should be done in a step-by-step, symptom limited program. It would not be good for recovering concussed cyclists to take their first ride with a big group on busy roads. There should be approximately 24 hours (or longer) for each stage and cyclists should return to the previous stage if symptoms recur.

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