UCI sets new, more cautious concussion protocol

Injured riders could face a much clearer path back to racing next year when it comes to concussions. The Union Cyclist Internationale (UCI) set out its new recommendations for sports-related concussion (SRC in UCI speak) today.

Concussions are a prevalent concern in all types of mountain biking. Newly minted elite men’s downhill world champion Reece Wilson chose to sit out all four 2020 World Cup rounds after a hard fall in training. 2018 elite women’s XC world champion Kate Courtney has publicly campaigned for concussion awareness after her own injuries.

Better tracking and longer recovery times: UCI’s new recommendations

The UCI panel made several recommendations to improve rider safety. These range from assessment to longer recovery times and better tracking of injuries over time.

A first recommendation calls for better training for non-health professionals to recognize signs of potential SRCs. These people could include coaches, Sport Directors, mechanics and other riders, who are often the first person on the scene dealing with an injury. For mountain biking, this is particularly true in spread out disciplines like XCO and XC marathon, but it applies on the road and track as well.

RELATED: Fly through Kate Courtney’s brain for concussion education

These non-health professionals should be trained to assess and monitor changes in the athlete’s condition (feeling stunned or dazed, trouble with balance, headaches, slurred speech, changes in vision) and make quick, educated decisions to remove riders from racing when necessary.

After initial assessment on scene, the UCI is calling for more clearly defined follow up assessment paths. There is also a recommendation for compulsory notification of all SRC events in racing to the UCI Medical Director. For the former, this includes post-race examination using SCAT5 concussion assessment tool, to be repeated the following day. Mandatory reporting of SRC’s is intended to address the potentially serious effects of repeated SR events on the long-term neurobiological health of athletes.

Recovery times have also been set, and extended. Athletes will not be allowed to return to competition for a minimum of one week after symptoms have cleared, including a period of complete rest between 24 and 48 hours. For juniors, the delay before returning to racing post-symptom is a minimum of two weeks.

Rules to take effect in 2021

Today’s recommendations are expected to be made official early in 2021. The UCI Medical Rules will be amended when the UCI Management Committee meets in January 2021 in Belgium.

“The issue of sports-related concussion was one of my priorities, along with the misuse of tramadol, when I arrived at the UCI in 2018. Cycling now has guidelines that set out the various phases involved in dealing with SRC (initial assessment, diagnosis, recovery, and return to competition),” says UCI Medical Director Professor Xavier Bigard. “This protocol applies to all disciplines while taking their specific characteristics into consideration. It will make it easier to trace individual SRC cases and better understand their place in cycling traumatology.”

UCI’s full document of sports-related concussion (SRC) protocol recommendations.

UCI’s complete statement on new concussion protocol recommendations (Dec. 10, 2020)

The Union Cycliste Internationale (UCI) today published a new sports-related concussion (SRC) protocol that will apply to all cycling disciplines on the UCI International Calendar from the 2021 season.

The protocol is the result of a review and work conducted since 2019 by a group of international experts (doctors, scientists and neurologists) under the supervision of UCI Medical Director Professor Xavier Bigard.

SRC increases the risk of neurocognitive impairments (effects on the memory, speech and reaction speeds) that need to be recognised and dealt with promptly.

The protocol takes its inspiration from the 2017 Berlin concussion consensus statement, a common set of rules that lays out a series of measures and tools for quickly identifying SRC and taking care of athletes, and which each sport may adapt to its specificities.

The protocol sets out recommendations that are tailored to the sport of cycling, where responses to SRC – which is estimated by research to account for between 1.3% and 9.1% of injuries – vary significantly across the eight disciplines (road cycling, track cycling, mountain bike, BMX Racing, BMX Freestyle, cyclo-cross, trials and indoor cycling).

The main difficulty that cycling faces is the time it can take to reach injured riders and the ability of first responders to remove them from the road or track, confirm the diagnosis and make a quick decision (withdrawal from or return to competition) that is in the interests of the rider and other participants. Road cycling, mountain bike (cross-country Olympic and Marathon) and track cycling (Omnium) are the disciplines most at risk in this sense – in contrast to BMX Racing, BMX Freestyle, Trials, Indoor and other track cycling events – where response times are short and doctors have the time they need to diagnose SRC.

In responding to this problem, the protocol recommends that non-health professionals (in particular coaches, Sport Directors, mechanics and riders) be trained for recognising the signs of suspected SRC since they are very often the first people on the scene after a rider falls. The protocol details the signs that need to be looked out for in assessing the condition of the athlete (feeling stunned or dazed, trouble with balance, headaches, slurred speech, changes in vision) and in taking an appropriate decision in an optimal timeframe, either roadside or trackside. Training resources in the form of symptoms cards will be published to help non-health professions detect the signs of suspected concussion.

If these signs are detected, the diagnosis will need to be confirmed by the race doctor. In the absence of any initial signs pointing to SRC, the rider should be monitored by the medical service. A standard examination comprising, among others, tests of orientation to time and place (Maddocks questions) and balance, may be conducted at any time.

In all cases, the rider should undergo a more thorough examination after the race using the SCAT5 tool, comprising a neurocognitive approach. This examination would also be repeated the following day.

The protocol also sets out the recommendations for a rider’s return to competition. Athletes suffering concussion should have a period of complete rest of between 24 and 48 hours and not return to competition for at least a week after their symptoms have cleared up (two weeks in the case of juniors).

Under the protocol, a compulsory notification of all SRC events to the UCI Medical Director is part of the recommendations that are made. Medical and scientific research has shown that repeated SRC events can have serious neurobiological consequences for athletes. Aside from enabling monitoring, the medical declaration of an SRC event would enable individual traceability of SRC and improved assessment of their prevalence across cycling’s various disciplines.