Concussion: The invisible injury

There’s been a lot of talk about concussion in collision sports such as AFL and Rugby League. Often we do not consider that concussion is an occurrence that can happen in many sports, this no more relevant than in Mountain Biking.

There is a cycling saying that it is not ‘if’ you fall off your bike, but ‘when’ you fall off your bike. As fun and adrenaline pumping as this mountain biking is, things can go pear shaped very quickly.  Just check out Pinkbike’s fails of the month - cringe worthy!

WHAT IS CONCUSSION?

When you take a violent blow to your head and neck or upper body this can cause your brain to slide back and forth forcefully against the inner walls of your skull causing inflammation and possible bleeding.

The most severe repercussion from a head trauma can be massive internal bleeding that if not addressed immediately can lead to death.  Fortunately, this is rare, but it does happen.

Generally a concussion will cause bleeding in and around your brain, symptoms can be subtle and difficult to detect, careful observation of a fellow rider after a heavy fall is critical.

It is important that once you, or your riding buddy are aware that a serious trauma to the head has taken place, you stop riding immediately, or get to the nearest pickup point.

WHAT TO LOOK FOR:

Symptoms may include any number of the following:

  • Loss of consciousness

  • Memory loss of the event and the period after

  • Drowsiness

  • Confusion – sometimes not immediately

  • Headache

  • Dizziness and visual disturbances

  • Ringing in the ears

  • Nausea

  • Vomiting

  • Slurred speech

  • Delayed response to questions

  • Appearing dazed and foggy

  • Fatigue

Note:  Symptoms can hang around for hours, days or even weeks!

HOW TO AVOID CONCUSSION

The best way to avoid concussion is to stay upright!  Make sure you have the skill level and the right bike under you for the terrain you are on.  But, let’s be honest you don’t get better if you don’t push yourself out of your comfort zone, right?  So, we jump a little further, pin it a little faster and rail it a little harder.  And, in these cases, where there’s a good chance that at some point you may become well acquainted with the ground, you want the appropriate protective gear. Including the trusty old helmet.  The beauty of a helmet is that in most cases it’ll save your life or prevent a seriously sore noggin. But if you happen to hit the ground hard enough or at the wrong angle your gelatin textured brain will still get shaken to hell and back through the cerebrospinal fluid inside your skull.

*  It is recommended that after a heavy fall you replace your helmet as it may not work so well second time round.

TREATMENT

The following are general guidelines on when someone should seek immediate medical advice after a fall.  The affected person may not be of sound mind to make the necessary decisions, so their riding buddy, partner or family member may be the one who needs to make the call.

  • Vomiting and nausea

  • Loss of consciousness

  • Memory loss

  • A continually worsening headache

  • Changes in behavior, such as irritability

  • Impaired coordination

  • Confusion or disorientation, such as difficulty recognising people or places

  • Slurred speech or other changes in speech

  • Seizures

  • Vision or eye disturbances, such as pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes

  • Lasting or recurrent dizziness

  • Difficulty with mental function or physical coordination

  • Symptoms that worsen over time

If an injured rider, assessed by a medical practitioner, is given the all clear it is still recommended they be woken every 4 hours on the first night after the trauma to make sure that all symptoms are stable, if not, to the emergency room it is!

RECOVERING FROM A CONCUSSION

concussion head brain.jpg

Kevin on recovery…

My best piece of advice would be to rest, relax and to not get back to your work too quickly.  Do not get back to your sport until you’re healed.  It’s so hard to know how long you need to take off but you go and talk to somebody to find out.  The hardest thing to do is to take that action to go and really get checked out by a doctor, it’s what I didn’t do.  As an athlete the last thing you want to do is to have someone tell you that you can’t participate in your sport.  I wish that I had taken the right steps.”

Not unless a concussion is severe enough to be causing further complications, there is no treatment. However, after an injured person has been thoroughly assessed by a medical practitioner and given the all clear, there are things that can be done to help the body and brain speed up the healing process.

  • Rest, relax and sleep – No riding other than on a stationary bike. Boring, I know!

  • Reduce stress

  • Take Longvida Curcumin, this natural anti-inflammatory factor is derived from the spice turmeric and can be absorbed into the brain  

  • Take fish oils – essential for neural health

  • Take part in regular exercise, but not any that will put you at further risk of trauma

  • Use your brain, make it think, play games, do puzzles, mind teasers – this will help regenerate damaged pathways and stimulate new connections

The hardest thing for us riders, because the sport is just so damn fun, is staying off your bike.  You should not return to riding while signs or symptoms of a concussion are present and it is only safe to do so once you have been medically evaluated by a health care professional.

Lastly, when the headaches have subsided and the mind is clearing it’s not uncommon the neck and shoulders start killing!  Often concussion goes hand in hand with whiplash type injuries and other neck or shoulder trauma. Initially these are far less important, unless your collarbone is sticking out of your chest and you are quickly bleeding to death! (can happen, but unlikely). Deal with the concussion first then have your musculoskeletal ailments attended to as these too can lead to poorer bike handling, pain, discomfort and generally make riding and life less enjoyable – nobody needs that!

If a second impact should occur in a week or two following the initial injury serious fatal bleeding is far more likely to occur. Firstly, do not put yourself at risk (read below), and secondly, if you do ride and fall, seek medical aid immediately, even if you think you feel all right.  

Those having suffered from concussion are 50% more likely to develop epilepsy in the five years following the injury, and post concussion vertigo and headaches may last for weeks or months after a trauma.  It is also possible with multiple concussions that irreparable damage and impairment may occur to certain parts of the brain - boxing and UFC type sports are good examples of this!

Riders and officials involved in any activity, be this competitive or recreational should make themselves familiar with the signs and symptoms of concussion to enabling them to assist others and even perhaps recognise these signs in themselves should an incident occur where a head trauma could lead to a concussion.

Concussion is serious!  Look after yourself and your fellow riders.

Bring on the Aussie Gravity Enduro Champs!

Written by Steve Moore, Musculoskeletal Therapist avid Road Cyclist and crazy Mountain Bike rider for the 2016 Gravity Enduro National Championships powered by SRAM - http://www.mtba.asn.au/event/enduro-national-champs/

Disclaimer: This article is for educational purposes only and is not a substitute for medical advice, assessment and treatment by a qualified practitioner. Your outcome after a head injury is your responsibility and neither Steve Moores, SA Integrated Therapies, Inside line MTB or Gravity Enduro SA takes responsibility for your outcomes based on this article.