Chris Hall runs the Downtime Podcast, and a chance interview with top racer Katy Curd started him wondering if we, as ‘normal’ mountain bikers give enough thought to concussion – or rather to what happens when we all take a digger and brush ourselves off. Should we be taking our injuries, and ourselves, a little more seriously? That’s what Chris set out to find out…

OK, so most people wear helmets these days, and hopefully a good number of us have some first aid knowledge, but do we know enough about concussion?

Let’s face it, hitting your head is a fairly likely occurrence at some point in your mountain bike career, and as riders, we often see it as a badge of honour to get up after a big smash, dust ourselves down, and carry on riding. Could it be that this attitude is putting us at risk and exposing us to some potentially serious consequences? I for one think it is.

While recording an interview with World Cup racer Katy Curd, I started to learn about some of the detrimental effects that arise from multiple bangs to the head. Katy has spent most of 2017 working on rehabilitation from two crashes during the 2016 race season, and her struggle left me wanting to learn more. So, I got in touch with Katy’s coach, Adrian Stokes from Pure Body Balance, a Corrective Exercise Specialist and a rider himself, who has been helping Katy with her rehabilitation, to have a conversation about how we should be dealing with a bang to the head. This is what I found out.

The consistency of the brain is jelly-like, making it very delicate. When you suffer an impact to the head, the sudden deceleration can cause the brain to collide with the inside of the skull, and for the brain tissue to stretch and compress. This causes inflammation, which is a chemical process, and the result of that process can lead to the disruption of Tau proteins. When Tau is disrupted in this way, it can build up in the brain, and block the pathways along which information travels. The more concussive (or even sub-concussive) impacts that you have, the more these Tau proteins can build up, potentially leading to a condition called Chronic Traumatic Encephalopathy (CTE), a progressive degenerative brain disease that can result in memory loss, confusion, depression, anger, and progressive dementia. We are starting to hear more about CTE as the scientific understanding improves, initially in boxers, then American Football, and now in cycling. In fact, the BMX rider, Dave Mirra was diagnosed with CTE after his tragic suicide, potentially caused by the depression that can be present in CTE sufferers.

Any bang to the head can start to cause damage inside our brains, and when you’ve had a crash, you are likely to have reduced your ability to ride well, making the chance of another crash even more likely. When your brain has been damaged by an impact, that damage can be exacerbated hugely by further impacts, however small, to an already inflamed and traumatised brain.

So it’s becoming more clear that bangs to the head, and especially repeated bangs to the head, are not good for us, so what should we do about it?

Firstly, if you or a friend have a crash and hit their head in the process, STOP RIDING! If it’s safe to do so, get off the trail, and if not, then have someone stand further up the trail to stop any other riders approaching.

Next, ask some questions like ‘what happened?’, ‘can you remember crashing?’. Look out for hesitation, or difficulty answering your questions. Check for symptoms, and remember they may not be immediate, and can appear over the coming hours or days. Here is a good way to remember some of the key symptoms – CRASH.

C – confusion or loss of consciousness
R – ringing in the ears
A – amnesia/memory loss
S – seeing stars
H – headaches

Other symptoms may include nausea and vomiting, delayed responses, appearing dazed/drunk or feeling fatigued. Also don’t forget to look out for delayed symptoms (these could be months after the impact) like irritability or personality changes, sensitivity to light/noise, sleep disturbance, depression or issues with taste or smell.

If any of the following symptoms are present, then you should contact the emergency services immediately:

• Repeated vomiting
• A loss of consciousness lasting longer than 30 seconds
• Changes in behaviour, such as irritability
• Changes in physical coordination, such a stumbling of clumsiness
• Disorientation or difficulty recognising people or places
• Slurred speech
• Seizures
• Vision disturbances or dilated pupils
• Lasting or recurring dizziness
•Symptoms that worsen over time
• Large bumps or bruises on areas other than the forehead in children

So let’s say you’ve had a crash, hit your head, and you or your friends have made an assessment and decided that the emergency services are not needed, but that you shouldn’t ride any more. What do you do next?

First off, don’t ride or drive your car home. Find a friend who can help you get back home safely and legally. Next, make an appointment with your Doctor to get checked out. It is really important to seek medical advice, as it’s clear that the issues associated with concussion, and even sub-concussive impacts can be severe. Your doctor should be able to give you guidance on when and how to get back to riding, however, Adrian provided this advice:

‘The standard guideline is to wait 10 days, 80-90% of non-complex single concussions are resolved in that time. When those 10 days are up, and IF you are feeling symptom free, then you can start getting back out on your bike, but take it slowly and make sure you are with friends who know what has happened and can keep an eye on you. Keep the ride short and gauge how you feel. If it doesn’t feel right, then stop. If everything feels good then you can build up over time to where you left off.

If after 10 days you still have symptoms, or when you start riding again it doesn’t feel right, it’s time to go back to your Doctor for advice, and potentially for a referral to a Neural Specialist.’

So, are we taking crashing seriously enough? I don’t think so. As more and more scientific research highlights the potential long-term damage we can do to our brains, even with small impacts, we need to appreciate this, and look after ourselves and our riding buddies. It’s also worth noting that children’s brains are even more sensitive to the forces created by an impact. So if you’re taking your little rippers out, then please be especially careful.

Hopefully this gives you an idea of what to look out for, and how to deal with it if you or a friend hits their head, just remember CRASH!

I’m not a doctor and don’t pretend to be one, so if you have hit your head, please make sure you seek medical advice, and remember ‘If in doubt, sit it out’.

If you would like to listen to a conversation with Adrian Stokes from Pure Body Balance on this topic, then head to http://www.downtimepodcast.com/concussion-special/

To listen to a conversation with someone who has experienced the effects of concussion, have a listen to our episode with Katy Curd here http://www.downtimepodcast.com/episode-16-katy-curd/

If you want to get in touch with Adrian to discuss any issues you may have, then you can reach him via https://www.purebodybalance.co.uk/