From Reality to Fiction: Concussions in cycling with excerpts from #WheelerNovel

According to the National Health Service, a concussion is the sudden but short-lived loss of mental function that occurs after a blow or other injury to the head. The medical term for concussion is a minor traumatic brain injury, and while it’s the most common, it is considered the least serious type of brain injury.

Personally, I disagree. Any brain injury is serious and should be treated as such.

The most typical physical signs of concussion are nausea, constant or recurring headaches, inability to properly control motor skills or balance, a change in ability to see/smell/taste, dizziness or hypersensitivity to light or sound, a shortened attention span or distraction, difficulty focusing or understanding directions, and speech difficulty such as finding the right word.ponferrada-spain-27th-sep-2014-crash-pictured-during-the-women-elite-e813cf

In terms of racing, Johnathan at Doc Edwards Health & Fitness writes: “A cyclist shaking off a crash while lying on the side of the road has a split-second choice: get up fast because the peloton is speeding away, or quit.”

You see it in just about every race: riders go down in a pileup or skid off the road. Some are obviously injured and stay down, while others jump up and ride off even though they’re bleeding.

In Wheeler, Women’s Elite racer Loren Mackenzie is no stranger to concussions and their effects; she wrote her Bachelor’s thesis on the subject. Then, she crashes at the Giro Rosa Prologue in Kamnik, Slovenia.

The yellow warning line appeared under her tires again.
Don’t go wide out of the turn. Don’t go wide. Loren grabbed at the brakes and banked aggressively into the right-hand turn that would bring her back to the start/finish line.
The rupture of her front tire rang out across the square like a gunshot. Her bicycle flipped over, sending her head first into the tarmac. The force of the impact separated her from her bike, and she slid across the ground and into the metal barriers.
Cold aluminum was poking her in the ribs as Loren opened her eyes with a groan. What the hell…? Her ears were ringing, and there was a metallic taste in her mouth. She wiped her gloved hand under her nose. I’m bleeding. She gasped. Get the fuck up! Get up! You can’t continue if you don’t get up!
Loren crawled out of the twisted metal barricades and struggled to stand on shaky legs as pain and dizziness narrowed her vision. She stumbled the few feet to her broken bicycle and slung it over her uninjured shoulder to limp the few remaining yards to cross the finish line.
She collapsed to her hands and knees, trembling and spitting out blood. Strong arms gently encouraged her to sit up.
“Easy now.” She looked up as Felix put his arm around her waist.
“No, I’m fine,” she mumbled, as she tried to pull away from him.
“You are not fine, ma bien adoré. I will not leave your side,” he whispered as he helped her lay on the stretcher. Paramedics pushed him out of the way as one clamped a neck brace around her throat. His tense brown eyes followed her to the ambulance.

You can watch the video of the prologue here, and you can see how close the riders are to metal barriers as they come out of the final turn.

Who is responsible for making the decision to continue in the race after a serious crash?

Should it be left up to the rider, who may not be thinking clearly; the race doctor, who doesn’t know the rider well enough to have a baseline; or the team director/manager in the team car at the back of the race, who would not be able to get to the injured rider for several minutes – and by then the rider has no chance of reconnecting.

There’s no perfect answer, and often riders will continue in the race and suffer, only to be evaluated by the team doctor later.

In Wheeler, team director, Felix Lalonde, and their soigneur, Aria Rabbicci, tried to talk Loren out of continuing, but she was adamant about not leaving her team.

“There is a flight leaving Kamnik tomorrow morning,” he told her. “We’ve arranged to have a UCI doctor escort you home.”
“No,” Loren shot back. “I’m not leaving.”
He twisted his neck to see her. “Yes, you are. You cannot continue in your condition.”
She hissed as she sat up straighter. “Yes, I can. I know the protocol. I remember answering all their fucking questions.” He quickly brought the car to a stop on the side of the road and turned around to glare at her.
“Yes, you know the protocol. You know it well enough to supplant it.”
“I have to be conscious enough to fake it!” Loren groaned and rubbed her temples with her fingertips. “That doesn’t even make sense.”
“Even if you take the time trial, it won’t make any difference,” he muttered and turned back to the road.
Aria’s concern was obvious in both expression and tone. “Are you certain you should continue? It is nine days. I do not think it is wise.”
Loren closed her eyes. “I can’t let them down.”

Loren knew what happened and in her desire to keep racing, she denied any concussion symptoms; choosing instead to suffer in silence through the next 9 stages of the Giro Rosa. Although the effects faded in the weeks that followed, another blow to the head not long after sent her world spiraling out of control.

USA Cycling and the UCI have developed better protocols for assessing athletes with head injuries. Teams like TIBCO-SVB have gone one step further and have begun to use an app from Sway Medical, which utilizes balance and reaction time tests to assess athletes before and after an injury.

Even with new protocols and technology on hand, the decision is often still left to the rider in the heat of the moment.

Were this technology available back in 2015 when events in Wheeler took place, Loren’s story may have been much less dramatic!

Links:
https://www.nhsinform.scot/injuries/head-and-neck-injuries/concussion#introduction
https://cyclingtips.com/2014/04/cycling-and-concussion-is-it-time-to-stop-ignoring-the-dangers/
http://www.medicineofcycling.com/blog/medicine-of-cycling-releases-concussion-guidelines-for-cyclists/

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