Sport and concussion: anecdotes, research and action

Yesterday’s Tour de France stage saw one rider abandon with concussion (only after other riders complained he was a danger to them) and another ride to the finish after having fairly obvious concussive symptoms. Many sports have had issues with traumatic brain injury (TBI), and have had to issue increasingly detailed guidance on how to identify TBI, and what to do. Rugby Union, for example, provides a range of guidance to officials to ensure that players with suspected TBI are not permitted to continue. It was reassuring to see one team doctor, Prentice Steffen, of Garmin Cervelo, looking for the same thing in cycling, prompted partly by Julian Dean’s experience after crashing in this year’s Volta a Catalunya.

Both my father and his best friend played contact sports. Both had experiences where they played on through concussion. Both had neurological problems in their sixties. Of course, these problems might have occurred anyway, but the link between moderate to severe TBI and later onset neurological disorders is well-founded.

Watching someone being encouraged to continue to compete after clear signs of TBI disgusts me, and this is what it looked like happened yesterday in the case of Chris Horner (whether such encouragement was implict or explicit). What on earth are medical professionals thinking when they permit such nonsense? Not only do they risk further crashes or exacerbating an original injury, they show how basic medical sense is being overruled by sporting motives. Of course, we can all miss the signs of concussion, but that is why clear guidance is necessary from the top down, and needs to be applied consistently.

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