UCI approves concussion protocol

Team AG2R La Mondiale rider Frances Romain Bardet reacts at the end of the fifth stage of the 72nd edition of the Criterium du Dauphine cycling race 153 km between Megeve and Megeve on August 16 2020 Photo by AnneChristine POUJOULAT AFP Photo by ANNECHRISTINE POUJOULATAFP via Getty Images
Romain Bardet suffered a concussion during the Tour de France (Image credit: Getty Images)

The UCI announced on Thursday it has formally adopted a protocol for the rapid assessment of sports-related concussions (SRC) specifically for "fast-paced disciplines of cycling, such as road cycling".

Concussions represent between 1.3 and 9.1 per cent of cycling injuries, according to the UCI, and it is a challenge to properly diagnose concussions in the middle of a road, mountain bike or mass-start track event.

The new guidelines adds training of non-medical staff in spotting signs of a brain injury, with the UCI planning to publish symptoms cards to help team staff and riders understand what to look for.

The protocol was authored under the guidance of UCI medical director Xavier Bigard along with sports medicine expert Jeroen Swart, Mitchelton-Scott team doctor Roger Palfreeman, British Cycling's Nigel Jones, Team Ineos doctor Neil Heron and two other medical experts, Thomas Fladischer and Helge Riepenhof. It was finalized at the UCI's September Management Committee meeting and will be formally added to the UCI Medical Rules at the next meeting in January.

"The issue of sports-related concussion was one of my priorities, along with the misuse of tramadol, when I arrived at the UCI in 2018," Bigard said in a UCI press release. 

"Cycling now has guidelines that set out the various phases involved in dealing with SRC (initial assessment, diagnosis, recovery, and return to competition). This protocol applies to all disciplines, while taking their specific characteristics into consideration. It will make it easier to trace individual SRC cases and better understand their place in cycling traumatology."

The protocol recommends that the first people to respond to the scene of a crash - usually sport directors, mechanics, other riders or coaches, check the riders for any obvious sign of concussion - feeling stunned or dazed, trouble with balance, headaches, slurred speech, changes in vision.

Two or more mild symptoms or one moderate to severe would indicate a high probability of a concussion and would trigger further evaluation.

The UCI's policy should help prevent situations like the one in this year's Tour de France, where Romain Bardet (AG2R La Mondiale) raced some 90 kilometres on stage 13 after a crash. He could hardly stand but was put back on his bike and finished the stage only to be diagnosed later with a 'small haemorrhage' on his brain.

If a concussion is suspected after the initial quick assessment, further evaluations would include a series of questions to assess cognition including 'What day is it' and 'What race are you in'. The next step is assessing any injury to the neck or spine and finally, a brief memory test by repeating words (eg. 'Person. Woman. Man. Camera. TV').

Other steps include a balance test, testing if the rider can repeat numbers backwards, and delayed recall of the same memory test words five minutes after the first assessment.

The protocol also specifies how long riders must wait before returning to racing based upon the severity of their injury. The full protocol can be read here.

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