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David L. Stanley
Concussions: It is time bike racing took them seriously

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David L StanleyDavid Stanley is an experienced cycling writer. His work has appeared in Velo, Velo-news.com, Road, Peloton, and the late, lamented Bicycle Guide (my favorite all-time cycling magazine). Here's his Facebook page. He is also a highly regarded voice artist with many audiobooks to his credit, including McGann Publishing's The Olympics' 50 Craziest Stories and Cycling Heroes. And there is his masterful telling of his bout with skin cancer, "Melanoma: It Started With a Freckle".

 


It was the 2011 Tour de France. Stage 5, from Carhaix to Cap Frehel, and Tom Boonen went down hard. Head first; no martial arts breakfall, no combat roll – Bam! head first. As do athletes in every sport, Tommeke insisted he was fine and wanted back in the game. Post-race reports mentioned that Tom was not himself; he was rolling about in the peloton, not speaking clearly, and definitely not in control of his senses. 

Yet, he finished stage 5, and started and finished stage 6. It wasn’t until stage 7 that the issue came to a head. Fabian Cancellara (Leopard-Trek) and Carlos Barredo (Rabobank) dropped back to the Quickstep Team car and spoke with Boonen’s DS, Wilfried Peeters. They let Peeters know that Boonen was out of sorts, and a danger to himself and the peloton. 

Boonen visited the team car three times that day. One visit, he was given painkillers. On his second visit, Peeters reminded him that if he stopped racing for the day, his Tour de France was over. Boonen rolled back into the peloton. The third time, Peeters told that Boonen that if he did step off the bike, he would support his decision. Boonen decided to stop racing. 

Tom Boonen

Tom Boonen at the start of the third stage of the 2011 Tour de France, before his terrible crash. Sirotti photo

The day after he withdrew, Tom spoke with the media. 

"This wasn't just a grazed elbow. This is my head," said Boonen. "Yesterday, I saw footage of the crash. I went down head first, without putting my hands out. There was no other choice. I might have reached the finish, but it wouldn't be responsible. I rode on automatic pilot in a stage that was the perfect one for an injured rider, but not for me.

"I was a danger for the other riders, too. I think I suffered a concussion. Noise, colors... I couldn't stand them. A honking car that passed was echoing a thousand times in my head. Yesterday was a dark day - due to the rain - and maybe that's why it went better.

"I didn’t sleep well last night. I threw up this morning. Maybe, starting the stage didn’t seem like such a good idea. That's cycling. If you can put on your racing number, you can race."

Professional athletes have indomitable will. 

Bernard Thevenet

Bernard Thévenet crashed badly in the 1972 Tour de France and had temporary amnesia. Still he got on his bike and finished the stage. A few days later he won the Mont Ventoux stage.

Nor was the 2011 Tour de France kind to Chris Horner.

"It was obvious Chris hit very hard. He finished the stage and I think basically he's OK physically … But we're taking him to the hospital to have a scan. He doesn't really know where he is right now or what happened. We'll see what the results are but I fear the worst," said DS Johan Bruyneel. 

"Basically, he’s okay physically." Give that a think – if the one organ that controls everything is damaged, you are not "okay physically." Those five words speak volumes to how concussions are viewed within the sport. 

The exam Horner received was cursory. There was no enforcement of the doctor’s professional opinion. According to a report in the French daily L’Equipe, Horner lost consciousness but insisted on remounting his bike and continuing the race. Tour doctor Pascal Rivat was quoted in L’Equipe, saying: "I said what I thought (that he should stop). I let him continue, but I never left his side."

Horner said he still doesn’t remember any of that crash.

"I’ve watched it on video and what makes me realize how out of it I was, is how I kept asking this same rider every two minutes the same question. ‘How far from the finish?’ We were about 250 meters from the finish and I kept asking. It’s like the kid in the car asking ‘Are we there yet?’ over and over. I just had no idea."

Those incidents were ten years ago. From four years ago, we remember the crash of Tom Skujiņš, the Latvian pro who came off his bike at the 2017 Tour of California. This crash was caught on camera. It illustrates one of the major issues in professional cycling, a lack of an established and enforceable protocol when a suspected concussion happens. Skujņš, wobbling all over the road after his crash, should never have been allowed to remount his bike. But no one was there to perform an exam, no one there to speak sense to Tom. Link to crash video.

When it comes to head injuries, athletes are the worst evaluators of their situation. No surprise; the organ that does the evaluating is damaged. 

I am not a neurologist, yet I speak from my own experience.  I’ve had three concussions: one from a pre-helmet era ski racing crash, one from getting kicked in the head during soccer practice (I was a goalkeeper), and the third from a crash on Detroit’s Dorais velodrome. 

After that crash, I drove myself home, 80 miles on the freeways. I awoke in the middle of the night to a pounding headache, found myself puking in the bathroom, and as I lay on the floor, I realized I had no reasonable recollections of how I got home. I could remember the crash, I could remember that my helmet was in pieces, the load-out of my gear, but the drive? Not so much. I felt terrible for a week, the dizziness and light sensitivity another two weeks after that. 

On March 8, 2021, Kiwi George Bennett (Jumbo-Visma) crashed in stage two of Paris-Nice. In the video, you can see Bennett, clearly dazed, stumble to his feet, grab at his head, totter about, drop his broken helmet, nearly fall, and teeter as a soigneur comes up with a new helmet. Two members of the medical team arrive promptly and they chat for several moments. Bennett gives them a thumb-up, they return it, and he returns to the peloton. 

After the stage, DS Grischa Niermann said: "I don’t know how George is, he was okay after the crash but he crashed quite hard, broke his helmet. But he was able to continue and luckily he could come back to the peloton."

"He was okay after the crash." No, Grischa, he most likely wasn’t. Just because you can’t see the injured body part, it does not mean that the body part is not injured.

Of all sports, none are as difficult to administer as cycling. Cycling is a rolling arena; different with each event. Races cover perhaps 260 km in one day. From the head of the peloton to the tail may well be 3 km. The road surfaces vary from velodrome perfect to L’enfer du Nord. There are bollards and islands and roundabouts and fans and parked cars and fences everywhere. The racers race at speeds up to 120 kmh. When you consider the logistics of staging an event, you should be gob-smacked that people are still willing to stage a one day event, let alone a stage race.

Yet, they do, thankfully. Bike races are magnificent spectacles. That’s why people flock to see them. That is why it is incumbent upon the organizers and sanctioning bodies to protect the athletes to the fullest extent possible. Athletes are not disposable assets. 

It’s not easy. Until very recently, no football player in the history of the NFL ever said, "I think I got my bell rung. Sit me down." A boxer, kayoed by a vicious hook in the 4th round, regains consciousness in the locker room, and hops to his feet, ready to continue to bout. Professional athletes get to the very top of their sports because they are genetically gifted physical outliers, they are willing to endure immense discomfort, and they have a level of mental toughness that is immeasurable. 

The perfect scenario for a newly brain-damaged athlete to insist "I’m good to go!"

The UCI does have a protocol. The new concussion protocol states that an athlete suspected of sustaining a sports-related concussion (SRC) should be subjected to a road-side assessment in the case of a broken helmet or an observed large impact. This road-side assessment includes asking the rider whether they are experiencing either a headache, nausea, dizziness or double vision and whether their symptoms are mild, moderate or severe. Two or more symptoms of mild severity, or one symptom of moderate or greater severity, should be interpreted as a likely SRC, the protocol states.

Maddocks questions, such as asking the rider what day it is and what race they are in, are also included, as an assessment of the spine and neck, whether the athlete is in any pain in these areas and whether they have a full range of active pain-free movement.

All good, but as we see, without a mandate, the protocol is not doing its job. 

1. Assign several specially trained assessment experts to the race, each on a moto. Their only job: to arrive quickly on the scene when summoned by first responders to assess the potential for head injury. 

2. Not all crashes are seen on home TV. Yet, remember that a TV director sits in front of a bank of monitors to choose the shot of the moment. Assign a specially trained commissaire to watch all the screens and call for the assessment team. Think soccer’s VAR and American football’s video review referee.

3. We need education. Educate the directors sportif so that, they too, realize the severity of concussion. Directors, many from an earlier generation, were brought up on the idea that you can tough out a head injury. They need to learn that there is nothing funny about concussion, that an athlete is not less of an ‘hardman’ because they have an unseen injury. 

4. Everyone aligned with the teams must be trained in on-the-spot awareness and assessment. Soigneurs and mechanics are the first on nearly every crash scene. Train them. Allow them to hold athletes off their bikes until the medical professionals arrive. Indemnify them against damages. Reward them when they properly assess an athlete and call for the experts. Protect them against a disappointed DS who wants the star back on the bike, no matter what. 

5. Will mistakes be made? Will there be athletes who are fine to continue? Of course. What to do when the experts determine that it is safe for an athlete to continue? Allow them to motor-pace back to their place in the peloton. 

The Hippocratic Oath – "Do no harm." It is time for pro cycling to take that oath as their own. We get one brain, and one brain only. Your head is more important than a race: any race, the Tour of Flanders, the Tour de France. A pro might get 6 chances to win the Ronde. But they get only one brain. 

This isn’t sock height, or how far handlebar extensions can reach, or where the nose of your saddle can be in relation to your bottom bracket. This is about the organ that designs socks and forges aluminum and invents ceramic bottom bracket bearings and manages heart rates, and O2 and CO2 levels, and invented language and song and art—our body: fearfully and wonderfully made.

The most valuable assets on every cycling team are the athletes. The most valuable asset for each athlete? Their brain. Brain damage is real, it is insidious, and it is cumulative. It is time for the professional bicycle racing governing bodies to come together and institute a meaningful and enforceable concussion protocol that puts the athlete’s best interests first. 


David Stanley, like nearly all of us, has spent his life working and playing outdoors. He got a case of Melanoma as a result. Here's his telling of his beating that disease. And when you go out, please put on sunscreen.

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