Concussion in Cycling: A personal account
Image credit: Mountain Bike Rider Magazine (2017)
While knowledge of sports related concussion has increased over the past decade, research, recognising and treatment of concussion in cycling has only recently starting to be taken seriously. One contributing factor may be the entrenched masculine culture within the sport and a reluctance by riders to speak up and disclose potential head injuries either for fear of their place in a team or being labelled as ‘soft’. Over the past month, I've tried to make some notes (when my brain was working well enough) on my own personal experiences following a recent concussion. Now that things are slowly getting better, I thought I'd write up these notes to provide an honest first-hand reflection on what it's been like dealing with a cycling related concussion. Hopefully, this frank account may empower other riders at all ability levels to be honest and speak up about their injuries.
On the 10th June 2021 I'd booked to go Downhill Mountain biking in Wales. The weather wasn't great, with low cloud and rain, so I'd made the decisions to just keep it chilled and not go too fast and ride well within my comfort zone. Sadly, this cautious approach wasn't enough to prevent an accident.
I was riding down one of the red graded routes which I'd already ridden without issue earlier that morning. However, this time, about halfway down I went round a relatively open right-left corner at about 25-30 kph which had a large smooth slab of slate in the middle of the track. As I exited the first part of the corner the front wheel lost grip on the slate and threw me over the bars and over the edge of the track where I promptly landed on my head and shoulder. It all happened in a split second with no time to react.
I don't recall being knocked unconscious, but on reflection I may have been, for a few seconds at least, as whilst I remember losing grip in the corner and what happened afterwards, I don’t actually remember hitting the floor, just lying motionless afterwards in a huge amount of pain. Thankfully I was wearing a full-face motocross style helmet and a neck brace, otherwise things could have been much worse, but I knew pretty much straight away I'd broken my collarbone. This was painfully re-enforced as I tried to pick my bike up. Unfortunately, it was at this point I realised I’d have to either grit my teeth and try and roll down the hill or get airlifted off the hill, and as I’m terrified of flying at the best of times I wasn't about to get in a helicopter. Thankfully, adrenaline is a wonderful thing and I managed to wince my way down to the bottom. However, it only became apparent I may have suffered a head injury about 20 minutes later, probably when the adrenaline wore off. I suddenly noticed a ringing in my ears and a banging headache and felt like throwing up. Luckily, I had friends there who looked after me and got me to hospital.
Once at hospital and after a 5 hour wait in A & E, I was treated for the fractured collarbone (2 fractures actually, lucky me), but despite me repeatedly telling the doctor my head really hurt and I felt dizzy and sick, I was pretty much ignored. He literally looked at my head pressed really hard on top of my head with his thumb and said "I can't see any damage, sure you'll be fine". Looking back I should have pushed this further, but as I wasn't thinking clearly I didn't question it at the time, but this is all too common unfortunately (I should clarify at this point, I'm a sport scientist who researches sports related concussion for a living, and I’ve had other people described similar anecdotal experiences with doctors). Sadly, with a financially stretched National Health Services, I would argue that only the visible injuries and symptoms often get treated and sports related head injuries often get ignored and aren’t viewed as serious as head injuries caused by road traffic accident, yet an impact to the brain is a serious injury regardless of cause.
After being sent home with my arm in a sling and without any painkillers, over the next 3 days the dizziness, nausea, balance and generally falling asleep constantly, got worse to the point my wife started to get concerned and took me back to hospital to get checked out again. I waited 6 hours this time in A & E, before finally being seen and sent for a CT scan and given a good check over. Thankfully all was clear, but I was formally diagnosed with a concussion at this point and told "if you need to sleep, just go with it and sleep it off". Beyond which, I was given no advice on what to do (if you can call ‘sleep it off’ advice). I guess I'm in a lucky position researching concussion, that I knew what I should and shouldn't be doing (See links at end for advice). Those who don’t have this background would simply be left to their own devices.
Even though I knew what to expect, I wasn't prepared for just how bad I was going to feel. I found it frustrating at times, as people could see the sling and comprehend a broken collarbone and asked me dumb questions like how is it? (bloody painful, do you really need to ask?), but try telling people you've got concussion and feel terrible, again the seriousness and severity of symptoms just doesn't seem to register with a lot of people, probably because there are often no visible signs of what’s going on inside, but also probably due to a lack of understanding in the general public. When you're lying around all day falling asleep all the time or struggling to concentrate and take things in when people are talking to you, I think some people pass it off as you playing on it to get time off work because ‘it’s just a bump on the head’ (trust me after 4 weeks I was crying out to get back to work with boredom).
Over the first two weeks particularly, I really found (and I still am finding, but to a lesser extent) it hard to simply function mentally for any period of time, despite remembering everything that happened that day apart from the actual impact, it's been hard processing things, everything seemed to take longer to sink in. Concussion is often described as feeling like you're in a fog and that’s very true. I felt like I was in a permanent daze and like I'd been on a 3-day bender, but without the booze. I could be sat on the couch “normal” and 10 minutes later I'd realise I'd totally zoned out or fell asleep again, only to wake up and still have that hangover feeling, nausea, dizziness, thumping headache etc.
Something I wasn't expecting though was the emotional side of things. Again, over the first 2 weeks I'd be sat down trying to relax feeling ok (ish), then suddenly I’d just get really frustrated, down and feel like crying and for no particular reason. These feelings have largely resolved now, and I just feel frustrated I can’t do much with a broken collarbone and chronic fatigue.
While the nausea eased off over 2 weeks, the ringing in my ears was ever present and some days still occurs now. Likewise, the tiredness and dizziness have eased up a little, but even nearly 5 weeks on a short walk can still bring on the dizziness again. I tried to avoid screen time as much as possible for at least 4 or 5 days as I just couldn't focus and the advice is to limit this as much as possible over the first few days. However, as I started watching TV and reading a little more, I noticed my eyesight was pretty blurry and I was straining to read my phone or see the TV more than usual. Though this again has largely returned to normal now.
Sleeping was and still is poor, partly due to the ringing in my ears and probably sleeping on and off during the day, but certainly isn't helped by the broken collarbone and not being able to lie down and get comfortable.
Current state of play
Almost 5 weeks on and I'm still having some mild headaches, but generally that part isn’t too bad now, depending upon what I'm doing. On returning to work though it has become apparent that sitting at a computer screen for anything more than an hour is torturous. This does tend to bring on the headaches and I struggle to focus on the task I'm doing. This leads to frequent breaks and ultimately not getting much done (much to my frustration, given the backlog of work I have). Memory can also be an issue at times (though I'm sure my wife would argue this is perfectly normal for me). While I haven't experienced any speech issues, I have found myself struggling to find the right words at times or completely forgetting what I was saying mid-sentence.
I still find physical activities very tiring. Most days I'll walk my son the 10 minutes to school then do a short 30-minute easy walk, after which I often need a nap for half an hour to recover. In the last 2 days though I have managed to get back on my indoor cycle trainer and do an easy 20-minute spin, time limited partly due to fatigue and partly due to the collarbone still being tender when holding the handlebars.
Looking at the positives though, I feel 10 times better than I did 5 weeks ago and every day more progress is made. However, I can’t help feeling that the ‘advice’ I have received from doctors has been extremely poor to non-existent, and only through my own knowledge of concussion have I been able to implement recovery guidelines.
I wanted to write this partly as a record of my own recovery progress, but also to help others understand that concussion can be a debilitating condition that shouldn't be overlooked and needs to be treated appropriately. Symptoms are wide ranging, and their severity will differ person to person, but it’s important to remember not to rush the recovery process and rush back into normal activity. Whilst I'm pleased things are moving in the right direction, I'm know with the ongoing concentration and fatigue issues, it may be a while before I'm back on the mountain bike, but back I will be, in my own time.
If you want further advice on concussion symptoms and suggested return to play guidelines, click on the links below. The return to play guidelines below has been taken from England Rugby, but most recommendations can also be applied to cycling. However, this highlight one of the current concerns within cycling, that the world governing body still doesn’t have its own return to play policy in place.
Update - almost 1 year on.
I thought I'd update this blog after what has been a difficult year. While I would have expected most of the concussive symptoms to have resolved completely by now, I still struggle to concentrate for extended periods and my short term memory is shocking ( I love a post it note these days). One thing I have found most challenging is getting back to my pre-concussion fitness levels. Over the first few weeks and months I suffered with chronic fatigue whenever I tried even low intensity exercise. Looking back, I would say it took a solid 6 months of hard work to get anywhere near close to my previous fitness. Thanksfully, nearly a year on I would say I'm finally there, but cognitive deficits still persist. I think I'm going to be in this for the longhaul.
Stay safe, Speak Up.
Dr Howard Hurst.