Brain Injuries in Mountain Biking - Are We Doing Enough?
Lorraine Truong was much like any other 26 year old, pursuing a career in sport - talented, dedicated and devoting her energy into being the best she can be. Except now, unlike many of her professional contemporaries on the EWS circuit, Lorraine has spent the last year unable to ride and is sometimes unable to sit in daylight.
The cause?
The chronic effects of concussion.
The cause?
The chronic effects of concussion.
Anybody who pursues a career in mountain biking is inherently aware of the risks. It's unusual to find a top racer who hasn't broken a bone - it comes with the territory - and when you pitch competitive people on bikes against mountains, accidents will happen. Largely, we accept these risks and for the most part, serious injuries are rare, though finding data and quantifying serious and non-serious injury is a moot subject. Nevertheless, we know what we're getting into when we swing a leg over our bikes.
In the same way that strains, sprains and fractures constitute a scale of injuries that affect bones and joints, brain injuries similarly occur across a range of severity, from concussions, through contusions, to lacerations.
John Waddell was in his prime. Riding for the Intense Tyre/Santa Cruz team, John was a rising star of World Cup DH. Like many of his Aussie peers, John was focused on racing World Cup DH, and succeeding at his chosen sport. At the 2003 Mont Sainte Anne World Cup, John's life would veer in a direction that no one saw coming.
Coming into the infamous 65-foot double jump with too much speed, John got bucked mid-flight. Going over the bars, his head took the brunt of the impact.
 | I suffered severe contusions to the right frontal lobe. An injury which put me in a coma for 26 days. - John Waddell |
Since Waddell's crash in 2003 the sport of downhill mountain biking has progressed massively. The market for mountain biking is bigger, the tracks are faster for TV marketability and the equipment and training knowledge we have has transformed the performance level that athletes are able to consistently achieve. Helmets are better, body armour has been revolutionised, and overall the sport is in a great place. Yet there are areas of this discipline, and mountain biking as a whole, that haven't kept up.
We aren't the first sport to witness first-hand transitionary periods where elements of the sport progress faster in some areas than others. In the 1960's, Formula 1 was at its most exciting and arguably most dangerous. Jackie Stewart, three-time World Champion, knew the dangers of Formula 1 first hand, having seem many fellow drivers die in tragic accidents. Stewart, along with the late, great Formula 1 Medical Officer Sid Watkins, lobbied hard for improvements to be made and in time, Formula 1 evolved from a sport where young men went to die, into a sport where death has mercifully become the exception rather than the accepted.
What is interesting though, is that prior to these changes becoming enforced, Stewart hired his own private doctor to travel with him to all races. Chastised at the time for being 'unpure', Stewart was far from the 'weak' character many claimed him to be; conversely, he was incredibly tough for proving you could both win and be safety conscious. Through his actions, Stewart directly shaped the future of Formula 1 and we'll never know how many lives he indirectly saved.
Of course, the two sports are very different and crashing at 165mph is a whole different world compared to crashing at 40mph. Yet, head injuries don't need an excuse or a certain speed to occur.
| I lay unconscious with tubes coming out of me on a Quebec hospital bed, accompanied by a family member, friends and team manager, Derrin Stockton. As the weeks passed, through movement and stimuli, doctors knew I was improving. My doctors put me in an induced coma to fly me back to Australia. Because I was so restless as my brain improved, I didn't really give it a chance to mend. So being put in an induced coma was the best decision for the recovery process. - John Waddell |
John Waddell spent 26 days in a coma, and has gone on to make a tremendous recovery, even racing the 2007 24hr World Championships. Photo credit: Russell Barker
| I only survived because Derrin Stockton made it compulsory for us to wear helmets which were to a Moto-approved standard. My helmet, getting painted by Red Bull, had only arrived days before Mont St. Anne WC. - John Waddell |
Eventually John returned to MTB, racing marathon events, including the epic 2007 24hr World Championships. His story is one of the most positive outcomes we'll see in sport and furthermore, John's life now has a sense of normality and his future looks bright.
However John's crash, some 13 years ago, should have served as a warning sign. While his injury was indeed at the more severe end of the Traumatic Brain Injury spectrum, as a community we have largely ignored the seemingly lesser injuries of concussion, which, we are now discovering can lead to devastating consequences, as bad if not worse than the more obvious TBI's, if not managed properly.
Sadly, injuries of the brain are often the forgotten injuries of the extreme sports world. The reasons for this are many and technical, but the most simple and obvious reason is that we simply don't appreciate what we can't see - and as yet we don't have any data to know how prevalent they are.
Recovering from a brain injury is not as simple as mending a broken bone, and as mountain bikers racing at Elite level in DH, Enduro and Freeride (and further) are starting to discover, concussion is very much the elephant in the room.
Concussion, from the Latin concutere ("to shake violently") or concussus ("action of striking together"), is the most common type of Traumatic Brain Injury.
One of the biggest problems of putting this article together was the alarming lack of data available on concussions among Elite World Cup DH riders, or any other discipline for that matter.
The issue is further muddled by the fact we are dealing with racers who will choose to race even with the odds firmly stacked against them and the fact that diagnosing a concussion is the job of a qualified healthcare professional.
We spoke to many riders and nearly all said they've raced a World Cup race with a concussion or symptoms aligned with concussion. Furthermore, we aren't just talking about single concussions either. Successive blows to the head can cause equally as much damage even if they are less severe, with the effects being cumulative.
This way of thinking is alarming, but not unexpected. It's time we were aware of the damage that this can do to our long term health.
A simple way of thinking regarding 'cumulative' - rather than simply repeated - blows to the head is that 2+2=22, not 4. Two mid-grade concussions, not too far apart in time, may result in an extremely severe concussion, with potentially life-changing outcomes.
A good analogy is the Richter Scale used for earthquakes, which is a base-10 log scale, with each successive step being not 2x but 10x the severity of the former.
In short, we know riders are racing and competing with concussions and after bangs to the head, we have no idea what is going on inside their brains when they do this rarely and even less so when they do this repeatedly. We don't know how many times they have suffered a concussion, we have no return-to-race program, no formal medical director on site and at the moment, no power to stop them breaking the beam when they are not fit to race.
We aren't the first people to notice this state of affairs and in 10-15 years time, we could have a serious problem on our hands with today's riders having to deal with the most devastating consequences.
After watching countless World Cup DH racers on the Red Bull TV live feed, emergency doctor Colum O'Hare contacted Wyn Masters (a vocal advocate of rider safety on social media), to discover more regarding the safety protocols in place.
| I was driven by Ratboy's injury at the World Champs. There was a lot of mixed information - some good, some bad - that people decided to post. I would be of the opinion that people should be aware of injuries, what treatments are available immediately at track-side, longer-term medical treatments, what rehabilitation would be required etc. In addition, I am pretty sure no one considers concussion in the sport. People are essentially told to 'walk it off'. The nature of the mechanism of injury dictates that this should not be the case. - Dr. Colum O'Hare |
There is unfortunately a legacy of 'toughness' that surrounds sport, and as they say; courage is the finest of all traits, as all others are derived from it. Yet we are talking about people's lives here and riding with a concussion is not a case of riding through the pain barrier, being made of steely stuff or however you want to describe it.
Racing with, or repeatedly suffering from concussions is like playing a game of Russian roulette. Tragically, we have witnessed the mistakes of others to learn from. Ominously, we also have others to 'thank' for revealing what we could be looking at if we don't educate ourselves.
Dr. Bennet Omalu, a forensic neuropathologist who performed the autopsy of Hall of Fame Steelers center Mike Webster in 2002, may have become the star of the Hollywood movie 'Concussion', but he was a safety pioneer first. Webster died at the age of 50 after experiencing dementia and depression, and during the autopsy, Omalu found the tangles of tau protein in his brain, consistent with CTE, which had previously been recognised in 'punch-drunk' boxers.
So far, 87 deceased NFL players have been discovered with CTE on examination. So just what is CTE and why should we be aware of it?
CTE, or Chronic Traumatic Encephalopathy, is a result of repeated concussions or blows to the head. It is formally described as a form of tauopathy, a progressive degenerative disease found in people who have had a severe blow or repeated blows to the head.
For those that dismiss the notion of severe blows occurring when wearing a full face helmet, Dave Mirra was diagnosed with CTE upon his autopsy following his tragic suicide. CTE can technically only be diagnosed via autopsy, although the tell tale signs can be spotted through the use of fMRI (functional MRI), PET (positron emission tomography), and various specialist MRI scans, as well as some more specialised scanning techniques.
However, awareness is key and in the past, many have mistaken the symptoms of CTE, leaving the sufferer ostracized, alone and confused about why they feel like they do.
| After a certain number of blows to your head, nobody knows exactly what number, your brain resets itself and begins to initiate abnormal biochemical cascades that result in the buildup of abnormal proteins like tau. So by the time tau is accumulating, the injury is already done. - Dr. Bennet Omalu |
We all know that blows to the head are not uncommon in DH, enduro, and even general non-race riding (let alone events like Rampage). And serious head injuries aren't just the preserve of professional big, butch male riders taking savage blows.
Lorraine Truong is slight of build, determined by nature and was riding for the BMC global team when, after a series of prior blows to the head, she had a hard impact at the Samoëns round of the EWS in July 2015. Lorraine's story is one of personal struggle at an age where she should be in her mental and physical prime.
| It was in the first stage of the second day, and I think I went over the bars when my front wheel hit a hole or something. I don't remember it really but think I remember going forwards and thinking "It's gonna be ok". - Lorraine Truong, BMC |
Lorraine completed the race and even grabbed an 8th place finish.
| I have a memory of being in the last stage, stopped, with tape all around and thinking: "Where I am? What I am doing?". Weeks later I saw that I gave an interview after my crash, but I have no recollection of it. So in short, I finished the race having no idea how I did it. - Lorraine Truong, BMC |
Since that moment, which was a small crash in a line of prior crashes, Lorraine's life has been transformed into something no-one could have predicted.
| Soon I had to face it wasn't fine at all. The headache was crazy, I needed to vomit all the time, light and noises were driving me mad, I was struggling to speak, my body wouldn't respond, each tiny task was a huge effort, my mind was so cloudy...something was wrong. - Lorraine Truong, BMC |
Tracy Moseley, one of the most decorated rider ever to race a mountain bike, adds some insight into the psyche of athletes, which applies to riders across the board, not just professionals.
| Having studied biology at university, I have always had an interest in the human body and especially the anatomy and physiology and what makes us work. I always had an understanding that hitting your head a second time in close proximity to a first hit was not good...but that was as far as my understanding really went when it came to concussion! I think like most athletes, you often don't think that any of the problems you hear about or potential dangers of our sport will affect you, when things are going well you feel invincible and the drive to succeed and be the best can often overshadow and push away any concerns you have with your health or injuries. - Tracy Moseley, Trek Factory Racing Enduro Team |
A year on from Lorraine's initial crash, life has not improved. With a history of bangs to the head during the three years leading up to that Samoëns crash - bearing in mind the cumulative effect ( crashes often occured outside of races as well) - Lorraine is acutely aware of what she faces and is focused on staying positive, yet that doesn't make it any easier for her.
| Since the crash, I haven't had a day without headache. Going from being a junior engineer - who used to be able to do her mathematical analysis homework while following a class of quantum mechanics - to a person who struggles to write this text, having to look at it with a massive font size to be able to read it and have to take breaks every 10 minutes or so, is a massive change in my life and also in my self-esteem. I was a young rider appreciated for her riding style, with a bright career ahead. Now I'm a woman who walks with a stick. It's hard to hold on. Most of the time I feel very ashamed of myself. Despite all I've learnt and am still learning about brain injury, I still have that inside voice that tells me it's nothing. That if I was stronger I could do more rehab and get better faster. I've only hit my head a bit! But how to fight what your own central computer can't achieve? I often feel crazy and so desperate that the only way I see to make all those symptoms stop is not a way where I am alive. Luckily, my sport doc has always backed me up, is kind and compassionate and allows me to take my time and to rest as much as I can. I also sometimes read or meet someone who's been through the same kind of journey or a doctor who actually understands, reminding me that I am not alone and that all this is not my fault, but that I am wounded. - Lorraine Truong, BMC |
At the top of global cycling and hence mountain biking, sits the UCI. They are indeed aware of the issues that concussion can present. I spoke to Ton Zasada, the UCI medical officer. Ton is not on site at World Cup races but has prepared some documentation for the Local Organising Committees (LOC), which reads like a plan that makes sense. Ton is a decorated GP and has been around the scene for a long time.
| For appropriate clinical evaluation for suspected concussion, for concussion management and return to training and competition, doctors should refer to the Sport Concussion Assessment Tool 3 (SCAT 3). However, the SCAT 3 should not be used solely to make or exclude the diagnosis of concussion in the absence of clinical judgement. A rider may have a concussion even if their SCAT 3 is 'normal'. I want to emphasise that when there is any doubt, then the rider should stop training or competition immediately. Every experienced race doctor will have had at least once a discussion with teams and will remember the pressure they tried to put on us to let the rider compete. There should never be an emotional or commercial argument that affects the medical decision. - Ton Zasada, UCI Medical Officer |
It is clear there are many strands to the web here, not least the commercial interests of teams and sponsors, as Ton continues.
| I think it would be a great step forwards, if the people who are living next to the rider would be paying more attention to the signals of a concussion and undertake action when there is a suspicion. The drive to achieve sport results should not make people blind to this. So an appeal to all the people who are living close to the rider and all the stakeholders may be helpful. - Ton Zasada, UCI Medical Officer |
So why aren't these procedures being implemented by the LOC or medical staff at World Cup DH races and why on the UCI Sport Mentoring program are there no DH riders listed? And are team managers and riders themselves doing enough ? The medical regulations of the UCI medical regulations state:
| At cycling events, it is the responsibility of the team or race doctor, if any, to determine whether an injured rider may continue in or return to the competition. This decision may not be delegated to other professionals or personnel. At all times, the priority must be to safeguard the health and safety of rider. The potential outcome of the competition must never influence such decisions. If the team doctor and the race doctor have a different opinion on whether the rider may continue or return to the competition the rider shall not continue or return to the competition. - UCI Medical Regulations |
Of course, we have focused heavily on racing in this article, but sole responsibility does not just lie with the UCI, EMBA or other organisers. There should be a collective drive towards rider protection and that includes riders themselves being educated about the consequences. A head injury can occur at any point, and as shown in Lorraine's case, her EWS crash was the tipping point on top of other concussions sustained both in and out of racing.
| I'm all for a good show and crashes are a part of the sport for sure, but there needs to be some way to make sure the riders' safety is taken care of properly. The rider is the last person who should be deciding if he or she can ride following a concussion, especially as there's also financial and outside pressure on them already to be competing. And when you hit your head, your brain doesn't work as it should normally, so how can you make a good decision? I hope that some system can be brought in to manage rider safety more effectively and in the near future. - Wyn Masters, GT Factory Racing |
Wyn Masters has been a vocal advocate of more stringent safety procedures, and his chats with Colum O'Hare really prompted him to use his standing to bring this issue to light.
| It was only this year that I realised how much of a serious injury concussions actually are, and with how much respect they should be treated. I had a crash in Lourdes and it caused on-going issues for a month or more, during which time I've done plenty of research and almost feel bad for not knowing how serious these injuries really are; even just one can be enough to cause serious damage and potentially life changing effects, especially if it isn't treated right. The general attitude from what I've seen from my years racing is that following a concussion, you just get on with it and it will be alright. I've seen so many crashes and people with serious concussions within the World Cup racing over the years and even this season. Generally the riders are racing the same or following day. That is just wrong, and for sure the riders need to be more informed of how much risk that poses to their future health and well-being. No race is worth long-term health issues, full stop. - Wyn Masters, GT Factory Racing |
Armed with a better grasp of the problems we face, how can we, as a sporting community, develop a pathway to tackle a problem that might not arise for another 5-10 years, if at all?
While for many riders concussion is a subject they don't want to spend much time thinking about, for obvious reasons, some are looking at the future and life beyond the bike. Chris Kilmurray - coach to a raft of top EWS and World Cup DH riders - understands the mechanisms of head impacts better than most, and takes steps to protect his riders wherever he can. On-site at a lot of races, and a driven, good rider himself, Chris has a clear idea when it comes to this topic.
The SCAT (Sport Concussion Assessment Tool) procedures have helped considerably but as renowned neurologist, Professor Paul McCrory states, these are constantly being redeveloped to match with new research and knowledge.
| We should treat any bang to the head as the worst possible scenario - and there is absolutely no Return-to-Play that day - amateur, elite, child. The reason we treat any symptoms at all as a concussion, is that we have become less certain about our sideline assessment. - Prof. Paul McCrory, member of the AFL Concussion Working Group |
The Return-to-Play pathway is something we can use as a model to build upon. Chris Ball, EWS director is well aware of the risks and has a track record of implementing positive change in mountain biking
| I began work back in January on a database that I intend to grow into an injury monitoring database for our riders. We've invested heavily in this and we plan to educate managers and riders to keep this up to date outside of EWS races as well. The issue is hugely complex and isn't as simple as saying "lets have a doctor on site". I want to build the data first so we know what we are dealing with, and how we can best protect the riders health. In my experience over the years, the biggest problem has been team managers, I have stopped one woman racing a World Cup once (ED: Chris was UCI Technical Delegate), way above my pay grade, but she had been taken out of the medical room by her manager after a massive head injury. - Chris Ball, Enduro World Series |
Recently, AMA Supercross became the first motorised sport in the world to implement a concrete pathway and protocol when concussions are concerned. To compete in the AMA series, every racer must undergo a baseline test before the start of the season. In a recent RacerX article, Asterix health care professional, Eddie Cassilis, gave some insight into what they are doing and why.
| We have a baseline test that every rider has to take. In the event that we find the rider did have a concussion at the race, then we require them to take the ImPACT test and pass that before they can return to the races. If we're trying to determine if the rider had a concussion at the event in the first place, we use what is called the SCAT 2 test. They are taken into our rig - by themselves, parents are not allowed to come with them - and we test memory, short and long term, balance, coordination. We have a minimum score they have to reach in order for us to have confidence that they can race or not. - Eddie Cassilis, Asterix |
AMA Supercross is currently the leading light in managing these situations, and with the introduction of SCAT 3, there are people constantly seeking to improve procedures. However, AMA Supercross is financially light years ahead of mountain biking and we need to be pragmatic.
There is no gospel on managing theses situations, but we must do what we can with the knowledge we have to hand.
| I have to mention that a ton of head injuries, including a lot of Lorraine's, happened out of competition. So to focus as much on EWS and WC racing is to miss a vast amount of rider injuries. That's why I feel focus needs to be on education, a centralised database of info that the manager and rider have to understand that they need to keep up-to-date. Otherwise, for example, you could have a rider turning up at an event, concussed, with no record or knowledge anywhere of that injury. I have also witnessed one of the sports most known team managers allow his rider, who was concussed during training, having not seen medical, race in the afternoon. I was shocked, but again that would have flown under the radar of any doctor. - Chris Ball, Enduro World Series |
There are of course influences that need to be considered as the sports of EWS and DH get commercially bigger. We need to make sure that procedures are followed as best we can, and ad-hoc decisions aren't made.
Riders and teams have sponsor obligations that need to be respected and we can't just witness a crash and rule someone out of competing because it looked 'a bit rough'.
An on-site medical director has many potential benefits, not just medically, and also helps to portray our sport as outwardly more serious, with a correspondng big marketing potential. Bear in mind that in Formula 1, Professor Sid Watkins became a marketable asset in his own right for companies brave enough to embrace a personality that, by default, they couldn't have control over, although in mountain biking there are currently financial obstructions to making this happen, which will require an industry-wide push to overcome.
Racing is a career for the top riders and at every opportunity we should be giving them the chance to go out to do their job, but at the same time, we need to be acutely aware of the devastating effects that concussion and CTE can have on individuals, families and friends. Furthermore, we can affect change from the top down as Chris Kilmurray points out:
| If changing culture is core to a longer-term improvement in concussion 'issues' in the sport, then the top down approach may very well educate the grassroots faster than we think...just like you choose your tyres based on what your favourite rider runs, if the top dogs don't ride when 'zoned', your weekend warriors will be less likely to as well. - Chris Kilmurray, Point1 Athletic Development |
The testing procedure at races needs to be entirely independent and carry ultimate authority. It should be free from sponsor, parent, relative or other influences.
Of course, how we find a team of health care professionals or doctors for the year is an issue that needs to be broached. A rounded, collaborative financial funding model would surely be attractive, and this is a discussion for the main players: manufacturers, major sponsors and other key stakeholders.
The medical science in proven, the desire for improvement in management is clear and as Professor John Pickard states:
| As you know, there is now worldwide concern about sport related concussion - it does not seem sensible for every sport to develop its own guidelines, but it is essential to document the extent of the problem in each sport and the evidence for what components cause the concussion. - Prof. John Pickard, professor emeritus of neurosurgery, Department of Clinical Neurosciences, University of Cambridge |
As far as a route forward is concerned, I believe a five-point-programme should include:
1. Build awareness in the wider mountain bike community of the potentially devastating effect of multiple head injuries, and establish a working group made up of all parties to develop a framework for education.
2. Implementation of baseline testing (fMRI or similar hospital-based test, together with a cognitive SCAT3 ) for UCI World Cup DH riders and EWS riders. This will be voluntary to begin with but all UCI Elite teams and EMBA teams should be actively encouraged to participate. This is repeated every 12 months with spot tests throughout the year in case of crashes outwith races. People are already exploring creative ways of making this financially feasible.
3. Provide on-site medical officers with the ability to make an absolute, final decision on whether a rider is allowed to race or not, based on a SCAT 3 or similar assessment. We must frame this for what it is - a long term health benefit to the rider.
4. Open a dialogue with all key stakeholders to create a feasible solution that also covers new developments in technology or procedures.
5. Build a support structure for riders who may need to take long-term rest from competition due to head injury.
With concussion, it's not a case of what we can afford, it's a case of what we can't afford to ignore. The time for action is now.
1. Build awareness in the wider mountain bike community of the potentially devastating effect of multiple head injuries, and establish a working group made up of all parties to develop a framework for education.
2. Implementation of baseline testing (fMRI or similar hospital-based test, together with a cognitive SCAT3 ) for UCI World Cup DH riders and EWS riders. This will be voluntary to begin with but all UCI Elite teams and EMBA teams should be actively encouraged to participate. This is repeated every 12 months with spot tests throughout the year in case of crashes outwith races. People are already exploring creative ways of making this financially feasible.
3. Provide on-site medical officers with the ability to make an absolute, final decision on whether a rider is allowed to race or not, based on a SCAT 3 or similar assessment. We must frame this for what it is - a long term health benefit to the rider.
4. Open a dialogue with all key stakeholders to create a feasible solution that also covers new developments in technology or procedures.
5. Build a support structure for riders who may need to take long-term rest from competition due to head injury.
With concussion, it's not a case of what we can afford, it's a case of what we can't afford to ignore. The time for action is now.
Descent-World would like thank everyone who contributed to this article, including Farah and Oli from geebeebee media, and Dr. Anthony da Costa (Consultant Neurophysiologist, retd.), but especially Lorraine Truong for her words.
For references or to learn more about concussion, you can use Trip Database and you can also get involved at Love Your Brain.
Join the debate about head injury awareness on social media by using the hashtag #InForTheCount and follow the Facebook page: facebook.com/InForTheCount
MENTIONS: @descentworld / @geebeebee / @mattwragg / @GTBicycles / @trek / @ridebmc /
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Head injuries are no joke. #RipMirra
Brook macdonald got knocked out in dh wc training or qualy, sleeped for 2 seconds and rode on. I hope you're fine brook. we all love you and want to see you in the future racing and smiling. Take it easy.
I for myself will invest in a better helmet next time, for moto and dh. i hope more manufacturers will bring "reusable" helmets like poc, this way it is easier to spend those huge amounts of money for a good helmet.
And good luck to all MMA fighters and boxers
I currently sit in bed in Japan one week after a huge over the bars, with a rather large number of stitches, a broken scapula and cheekbones with zero recollection of anything other than waking up in the ambulance and thinking "this is an ambulance".
I had three separate specialists (neurosurgeon, facial trauma and orthopedic trauma) dealing with me for over six hours in ER until sufficient diagnosis and prognosis could be decided (so they tell me).
I left ER under no illusion by the team that there was to be absolutely no way I should be placing myself in any situation whereby I might receive another blow, however small, to the head. My head swims when I sit up or lay down and I have no feeling in the left side of my face right now, although they say that will come back slowly.
I consider myself lucky that this happened just down the road, near my house, in an RTA (road traffic accident), meaning that I instantly saw it for what it was and is; a very serious brain injury that I should treat with respect.
I will not be back riding trail for at least six months to a year given the prognosis. I am mighty grateful to the excellent staff at Yokkaichi City Hospital for their frank and honest appraisal of what has happened.
Surely, regardless of where such things happen, RTA or UCI WC race, the procedure should follow the same process and knowledge base?
Ride safe and be smart all and enjoy the day! I am; bed is great!
Lucky he realized he shouldn't be doing it part way down and stopped but it could have been a lot worse if he had wrecked again
Oh and speaking of cultural problems, I remember seeing a study claiming that a very big percentage of respondents were willing to sacrifice 10 years of their life if it meant they achieved the top spot in their field. I don't think we can trust people to call it off when they should if there's a lot on the line.
I have 5 brain concussions, two of them -deadly. I just had the luck to be saved. Woke up 4 hours later in the hospital, could remember only my name- no dates, no days, nothing... you just feel empty.
Strong headaches,feeling weak, every bit of sound or light is disturbing. I was laying on my bed for more than a week, could not tilt my head left or right- also, i was constantly puking every single 5 minutes.
Doctor`s response:
1st thing to do- MRI !!!
Even if you have a concussion without any current leftovers, all of the symptoms might appear years later. Imagine you are walking on the street, go down... and that`s it. END of story... Yes, this could happen to as well.
Other symptoms - dementia,paralyzing.....
And yes, this is my current experience. All i can say is- be smart, think twice. Even if you have a minor little suspection or awareness- please go visit a doctor.
Hopefully, you would take my words more serious as they could prevent you buddies for any further bad occasions.
Almost 4 months ago I suffered a very severe concussion.
Laid in the dark silent room for 2 weeks straight, couldn't have lights on or hear any noises, had troubles walking, couldn't balance, felt like I was going to puke 24/7.
I couldn't remember my families and friends names or what had happened.
Now almost 4 months later I still can't work or do much of anything. My memory just starting to get better and my motor skills are slowly coming back.
The doctor has told me that I shouldn't ever ride mountain bikes again, I rode every single day possible and would build on days I couldn't ride.
Needless to say bikes were my life and now I'm lost.
I've spiral fractured my femur, broken my ankle, tore my Achilles' tendon, have torn meniscus in each knee, crushed my hip, broken my collar bone. I've done all this stuff biking, dirt biking, snowboarding, skiing and playing hockey. I would take all those injuries all at once over my recent concussion.
I know J. Bryceland and S. Peat can do wheelies safely without lids, but it is not educational to put it in the Syndicate video watched by my 6yo son...
I just found pics of 21 yr old myself riding in the woods without helmet. Because I couldn't afford a cool helmet so I was ashamed of it.
I wear a helmet when riding, but I ride like I'm not wearing one.
SNELL: 1998 Standard www.smf.org/stds (need to scroll down for a while)
The aptly named Bicycle Helmet Standards page www.bhsi.org/standard.htm
An enlightening, if somewhat self-serving interview that highlights some of those issues: www.bikerumor.com/2016/07/01/pc16-interview-koroyds-case-better-helmet-standards-john-lloyd-bas-jongsma
While PB's article thankfully highlights the issues in managing head-trauma at every level as an important element in recovery, how about looking at what can be done to reduce the likelihood of injury at the moment of impact? What is the aversion within the industry to adopting some of the technologies from motorsports and other areas to get beyond the polystyrene shell that fractures on impact to absorb/dissipate that impact energy?
brainshield.technology
Apparently more effective than MIPS, which is a good start, this is essentially a patch that can be applied to most helmets and reduces the rotational and linear acceleration of the brain upon impact.
Looks like they've done some testing with good results so far:
www.cbc.ca/news/canada/british-columbia/b-c-high-school-football-team-reports-zero-concussions-after-trying-new-technology-1.3386488
www.vancouversun.com/news/simon-fraser-university/patch+could+prevent+brain+injuries/11406803/story.html
phys.org/news/2015-10-brainshield-football-helmet-effectiveness.html
Hopefully we'll hear more of this type of technology, and soon.
cyclingtips.com/2013/04/australian-helmet-standards-what-you-need-to-know
I wont ride with anybody who doesn't wear gear properly.
No technology exists that can completely prevent concussions, we can only reduce the chance of trauma. Are we as helmet manufacturers doing enough? Articles like this help push the discussion, change the conversation about injury prevention and hopefully change the current culture around head injuries.
Manufacturers need to apply every bit of available knowledge and technology to produce products that are the best at reducing the chances of linear and rotational trauma to the brain. No helmet company has a brain trauma expert on staff, therefore manufacturers need to be much more reliant on objective data.
We need to work more closely with academia to collect data about brain trauma and impact energy management. There is a ton of research going on, but there is a huge disconnect between people that produce safety technology and those that research it.
The more we learn and the more we understand, the better protective gear we can provide to the athletes of our sport. That is the goal - to deliver the absolute best available protection to riders.
I say this particular to the males out there as service usage rates for males in mental health is particularly low (Roughly one in five males who need service actually seek it). There is nothing weak about asking for help or admitting that you are struggling. It could save your life. "Man up" is one of the worst phrases in the English language because it assumes that taking risk is akin to being masculine. I disagree. Look after yourself.
#RIPMIRRA
www.singletracks.com/blog/uncategorized/the-long-road-back-from-a-traumatic-brain-injury-part-1
I've had patients that were bedridden for years, lost the ability to speak, and required lifetime assistance with tasks as menial as bathing. Others were totally incapacitated mentally. In many ways, a severe TBI is worse than a spinal cord injury. If you lose your brain's higher level of function, what good is it to have that connection to the extremities?
Wishing the best to anyone who has to go through even a minor brain injury...
Timely for myself, having had a few concussions recently and also witnessing friends recoveries.
It would be great to see a revision of standards and also see helmet manufacturers lead the charge by making the higher end technologies like MIPS the standard.
Hopefully this will lead to better entry level helmets as sometimes (most times?) those new to the sport and those learning to progress are experiencing these impacts on sub standard or 'hand me down' helmets.
a) dont ride until i can afford a new one
b) keep buying cheap helmets (661 comp)
its no 15yo or skate lid, but its not the best. however, i can afford to always have one on my head.
Buy a name brand with all of the correct certifications for your country and replace it every second season or when it cops a good knock.
I'd trust a new budget 661 more than a three year old D3 that's been regularly ridden, transported, dropped, ect.
PS. Everything I've written is based on a very vague knowledge of this stuff so please correct me if I'm wrong!
Wearing helmets is one thing, knowing about the effect of multiple smaller hits is the problem. I've had numerous small concussions from various things, not just bike accidents, and the cumulative effects are currently minor. The odd behavioural issue (I go into my shell and want to be alone for a day or two every now and then) and the odd change in random stuff. Can't drink for example as it gives me massive headaches.
The docs did warn me that any more larger traumas may have worse consequences so I take care of myself but I know others that don't. Decent helmets, keeping hydrated and getting regularly checked out after any crashes.
At the end of the day we cannot know exactly what damage multiple brain traumas do, even the medical experts are learning all the time. Sometimes a bit of caution - resting after a crash for example - while being annoying at the time could do you a lot of good in the long run.
Overall responsibility can not be left with the team - their is a flat out conflict of interest between paying someone to ride a bike and at the same time holding them accountable for the welfare of said rider
@andrewmc is 100% right. Teams have incentive to let that slide. They are responsible for their riders lives, and they're definitely responsible for the expectations that they place on riders who think they have to compete after an injury. They have to be held responsible, and it's the job of the governing body to make sure that the rules preventing these issues are in place. Nobody will have to make those decisions, because there would be no decision to be made.
www.youtube.com/watch?v=204GsqfRlKc
I would also like to point out that these billion dollar lawsuits are against the NFL, not teams, coaches, and trainers. That gives an indication as to who the law finds responsible.
We should also point out that on a stage 3 miles long, seeing every crash is nigh on impossible so on the whole we felt Chris is on the money. He is acting on this issue and his comment regarding the cumulative effect of concussion ( out of race crashes going unoticed or unreported ) is important - as you could get a rider racing with concussion symptoms that would be unbeknown to the EWS race director - in turn leading to another crash. This is not a blame game - just a debate to open new routes forward.
The database needs to happen - creating a rider health profile is the most accurate way of trying to protect them in the long term, along with the SCAT 3 and baseline testing structures at events.
There is no easy answer, other than rely on the teams and riders who are conflicted. Even the system Chris is proposing relies on rider/team honesty so is flawed, but I cannot see a better way.
The biggest hurdle to overcome will be the attitude of the general community. Look at how everyone has praised Rude for competing in the last EWS with an injury, or how dismayed everyone was when Semenuk didn't complete a second Joyride run. Now I don't have inside information on Rudes' accident, and it may have been entirely appropriate as a decision to race, but Semenuk dropped into his run because of that pressure before, thankfully, thinking better off it. As a community I feel that there has to be more of an acceptance of the negative side of injury, and perhaps an injury passport as proposed will be the first step towards that?
I wish Chris the best of luck, along with anyone else working on a solution.
IMHO after any decent blow to the head even if you are not knocked out you should NOT ride again for a couple of days. And you should be aware of the symptoms of TBI (google them) and watch for them closely. I can only wonder how much better my recovery would have been if I had taken it seriously right at the start.
That was the biggest crash in my entire skiing and mtb career, certainly the most consequential. I went to the doctors later that week, and they said I was fine. I didn't know jack sh*t about concussions and I thought I could wait a week and be back on the mountain at 100%... well 3 months and several days spent at the hospital later I was finally able to swing my leg over a bike. Turns out the first doctor was wrong and everything was not "fine". It took me a while to get all my confidence back and be at 100%. I remember I got cleared to ride about 3 days before Sea Otter. I had already registered for the DH so I figured why not... I crashed twice in my run. I was shaking and out of control and every second on the bike the thought of if I crash and get another concussion I could be f@cked for life was always in my head. Yeah, that was definitely a stupid idea. I've broken many bones, but by far the scariest injury I've had is that concussion. And thank god I was wearing a helmet or I would probably be toast.
And those were possibly the worst 3 months of my life. I felt drained, depressed, and my head felt like it was gonna explode. My family and friends all noted how I seemed different, not like myself. It was torture just sitting at home in a constant state of pain staring my bike right in the face.
Point is: There should be more education about head injuries, especially for young riders and WEAR A HELMET. Helmets are cool. Thanks for this article guys.
The longer your head takes to slow down in an impact the less llikely an injury will occur.
With this in mind why not have an airbag system which can inflate around a traditional helmet?
What I'm proposing is if you take the Hovding airbag helmet and made it inflate around a traditional bike helmet so that the rider is protected from both blunt and sharp objects on impact. This would dramatically reduce the amount of deceleration experienced by the head and would help prevent concussions.
Hovding airbag helmet gizmodo.com/is-an-airbag-for-your-head-really-safer-than-a-bike-hel-1557666518
I would love to see helmet companies like Kali come up with new and improved ways of protecting our noggins.
I would imagine eventually a paramedic will make the call that a top pro can't finish a run and people will lose their shit.
Are the spectators and athletes really ready for that to happen?
Sounds like a lack of reporting injuries is holding back on making progress on this. Hey @mikelevy @paulaston how about we get a front page pinkbike poll to raise more awareness and generate some more knowledge on the area?!
A very good friend of mine who used to compete in the X-Games had a career ending concussion a few years back. He said it took years to feel "somewhat normal" again & that for the first year and a half, it felt like he was living in the movie Inception, he didn't know what was real & what was just in his mind.
Some foolish ignorant driver was coming out of a parking lot into the road I was on. My hands were in the drop position of the drop bar so my fingers were not near the brakes.
My gut was to turn right. Unfortunately the sidewalk curb jack knifed my bike and I went over the bars and head first into a "No Parking" signs pole.
Luckily I had my helmet on. The helmet didn't survive but my head did. The next day I went to the doctors and said to look for any symptoms that could be from the head impact.
A week later and I'm doing good. Thankfully.
It's so damn important to wear a helmet. That is only if you value your brain.
Anyway @chrisball and @descent
There are two issues. In competition and out of competition injury BUT you must follow clinical best practice irrespective of whether you know whats preceeded it
Doctors in an ED do a full work up at presentation they dont miss something because it may have been done before they saw the patient and they dont usually take the patients word for it
Here we know if someone gets their bell rung they should be pulled. It does not matter if its the first time in 6 months or 3rd in a week they should be out and no database will change the fact that removing them is the clear guidance they should be in place at present
Granted it makes the series more complicated but solutions can be developed to mitigate that
Serious question...obviously the goal is to avoid serious crashes all together, but do I need to be even more cautious than I had been in the past prior to my first concussion?
I try to ride within my limits, but between bike park trips and weekend shuttles I am guilty of pushing myself more than I should. I really freaked myself out in the few weeks I took-off from the bike post-concussion as I began to closely read about the possible life changing aftermath that comes along with brain trauma.
I like training and Information for individual riders/racers & mandatory qualified EMT personnel at events "with authority to actually preclude further riding" And on the subject of helmets, I like MnMDan's subject of updating requirements for mtn bike helmets. Although the best MIPS helmet won't keep someone from getting back up and causing further brain injury, it's a good start to improve the chances of proper recovery after impact. Lastly, it would be nice to see Bike Parks not rent the cheapest recycled (rider after rider) helmets, especially to those with little experience, or worse, to small children (experienced or not)!
Here in Aus the gov takes its bike helmets seriously and ALL helmets sold have to meet the same standard, no sticker no sellee. Concussion here in aus is becoming a major issue with anthor of our major sports rugby league now having concussion testing done during a game if a player is hit on the head, Dr makes the call after a set of tests to determine if the player is fine to go back, or is sitting out the rest of the game.
maybe similar should be introduced to Bike racing. Have medics and a doc and if a rider goes down then the dr can make the call onsite and medical attention can be arranged straight away. (Neutral 3 party doc not team doc)
There are 3 levels of protection involved here.
1- the shell of the helmet. A composite (carbon, fiberglass, or a mix of the two) will absorb the impact and transfer its energy outward along the shell. Plastic will not do this. Plastic transfers the impact straight across into the foam.
2-the foam. The foam is designed to compress on impact, therby slowing the deceleration of the head. theres more than one kind of foam out there and the best is a multi density foam. Ideally, the foam under the outer shell is more dense, and the foam around the skull is softer. This creates a progressive decel for the brain.
3-the padding. This essentially furthers the decel of the skull making for a softer, more cushioned landingn. Its also important that the padsing allows the helmet to grip the head and not rotate in the evenet of a crash.
Composite shell, progressive foam, and comfy padding: all items to look for.
There are 3 levels of protection involved here.
1- The shell of the helmet. A composite (carbon, fiberglass, or a mix of the two) will absorb the impact and transfer its energy outward along the shell. Plastic will not do this. Plastic transfers the impact straight across into the foam.
2- The foam. The foam is designed to compress on impact, therby slowing the deceleration of the head. theres more than one kind of foam out there and the best is a multi density foam. Ideally, the foam under the outer shell is more dense, and the foam around the skull is softer. This creates a progressive decel for the brain.
3- The padding. This essentially furthers the decel of the skull making for a softer, more cushioned landing. It's also important that the padding allows the helmet to grip the head and not rotate in the event of a crash.
Composite shell, progressive foam, and comfy padding: all items to look for.
There’s an increasing number of young riders, mostly within the new generation of Mountain biking riders, who deal with all types of crashing injuries, as trophies of bravery!
This sub-culture of stupidity, leads to even more (and worst) injuries. This is quite apparent here at Greece, were “speeding the DH trail” is mainly possible due to the high-end DH rig and not due to the rider’s talent/experience.
Of course, it is more than obvious that riding a bike includes some risks. But looking for trouble in order to be accepted as “an accomplished rider” or a “big balls rider” (or a no fear whatever), always counting by the sear number of… crashes, makes no sense (but it will. After some years all those accumulated injuries will remember you, at least every time the weather changes…!).
Destroying your life, just to be cool, it is not… cool. I guess that there has to be some real effort by the DH/Dirt Jump and the rest of communities to educate the youngsters into safe riding. I believe this responsibility fells also upon the shoulders of the relative media by turning their attention upon a safer way to enjoy our sport.
Ridding your bike it an exhilarating experience, whichever clan you are fond of. After the ride, one has to be happy and healthy. So safety first.
So I am wondering what is the best helmet on the market today? Either brand or specific model.
I type this (in pain) as I'm recovering from a Mtb accident I had last December. This resulted in a Traumatic Brachial Plexus Injury that has paralysed my dominant arm, this is a subject that needs more awareness in its own right - not for now.
I also suffered a severe concussion that put me in hospital for 8 days so I have experience of what Lorraine and many others are going through.
Keep strong people, lifes short - live it and love it
We need to focus on this. People fall behind when they take time off. They means rent money that they can't score from podiums, purses, etc. This is why they race injured. There shouldn't be the punishment there.
I consider myself lucky that I didn't lose teeth or fracture my skull or face. However, after that crash I ALWAYS wear my Bell Super 2R full face helmet. Even on mellow rides on single track that I've been riding for years. It gives me the peace of mind knowing that if I ever mess up and crash like that again, I'll have a better chance of avoiding a concussion or needing facial reconstruction.
I'm convinced that if you are a rider that is pushing yourself riding "enduro" you should be wearing a full face helmet. The speeds that we are obtaining with modern enduro bikes and the structure of our riding is basically the same as downhill riding 10 years ago.
I'm not sure how this can be regulated given that most race crashes are rarely seen by medical staff, and most riders, after crashing, if they can feel all of heir fingers and toes, and move everything, if a rider comes by and asks "are you ok" the downed rider will generally say "yes". I did. Adrenalin is a great thing, but it can cloud good judgement. I'm not sure anything practical but the continuing advancement of gear, can be done out on the race course.
Waht is actually going on in the racing scene and in non racing mountainbiking in terms of concussions and keeping riders from racing with a concussion?
Just came on that article again while listening to the inside line podcast with Jared Graves and looking up if there are any news of Lorraine Truong....
youtu.be/NUtCP7MW_lE
.
Any other bright ideas?
Welcome to the dumbed down north shore.