Getting back on your bike after a concussion

by Cheryl MacLachlan

You’re riding. Then, you’re in the hospital, unsure of how you got there. It sounds like a textbook concussion story. But for Melanie Sandwith, a cyclist from St. Thomas, Ont., things weren’t so straightforward. “I went for a casual gravel ride with a training friend. We found ourselves on a rutted-out part of a rail trail that we commonly ride,” she says. “I hit a rut and landed on my head a few metres from my bike. I do not remember anything else until I arrived at the hospital.”

Even though Sandwith, a founding member of the Railway City Cycling Club, helped develop its concussion protocols, she wasn’t told she had a concussion and didn’t take the hit to her head as seriously as she should have. “Being as stubborn as I am, I didn’t feel it was necessary to rest. I insisted my husband take me to a concert we had tickets for that night,” she says. “Once the show began, I realized I had made a huge mistake.” After calling her doctor the next day and being diagnosed with a concussion, her symptoms worsened during the next few weeks. She felt so confused and exhausted that despite being an avid endurance athlete, she was too tired to even consider returning to training.

What causes a concussion?

A concussion can be caused when the brain hits the skull. It can happen without a direct blow to the head. A sudden stop or twisting can hurt the brain. A concussion can occur without the loss of consciousness. “There are all these misunderstandings that you have to be unconscious to have had a concussion,” says Peter Glassford, a cycling coach and registered kinesiologist in Collingwood, Ont. “Someone crashes and they jump back up instantly and want to keep riding to prove they’re OK. You see videos and someone gets hurt and the message is to walk it off and get back in the game, but the reality is it’s a bad idea.”

So, what should you do if you think you’ve had a concussion?

While a physician has to diagnose a concussion, cyclists should know what to look for. “Concussion symptoms can vary, but the main ones are headaches, dizziness, nausea, blurry vision, difficulty with cognitive tasks and changes in sleep or mood,” says Emily McKenzie-Picot, a physiotherapist and cyclist in London, Ont.

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As awareness has grown around the potentially long-lasting effects of concussions. So has the need to take them seriously. “Concussions can be a huge, huge issue,” Glassford says. “Many of my clients are executives, parents, people who have lots of responsibility in their lives along with being athletes, so it’s bigger than not racing bikes anymore. They can’t take care of their kids or they can’t go to work.”

Recovery and expectations

Luckily, most athletes recover quickly. “The good news is approximately 80 per cent of concussions seem to resolve in the first few weeks, and another 10 per cent in the first few months,” McKenzie-Picot says. “Only about 10 per cent of concussions last more than three months, at which point we classify them as post-concussion syndrome.”

There is no one-size-fits-all answer for how long it will take to get better. Cycling should be something you only add back in after being able to go about other daily activities without symptoms. “Make sure you can get back to work or school before you try to return to sport,” McKenzie-Picot says. Overdoing things early – going to a concert, for instance – can make the recovery process harder.

Step-by-Step – Getting back in gear

Your eventual return to riding and racing should be based on a gradual, step-by-step process. “The Return to Play protocol is a great structure based on current best practices that guides an athlete back into sport,” McKenzie-Picot says. “The idea is to create a graded return to activity that is safe and manageable and does not bring on concussion symptoms.”

Each of the six steps in the Return to Play protocol, which was designed for contact sports but can be adapted to cycling, moves an athlete closer to competition. If symptoms come back, an athlete stops, rests and returns to the previous stage. Starting with easy riding on the trainer (to minimize stimuli and the need for balance), the stages should build in terms of duration, intensity and risk. Athletes shouldn’t get too concerned if they have some trouble progressing. “It’s rare that someone moves through all six stages without having to go back a bit,” McKenzie-Picot says.

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For Sandwith, the process had its ups and downs. “After a few months, I started riding easy on the trainer,” she said. “I wasn’t able to ride outdoors because of bad balance, which lasted until the spring. I had good days, and I had bad days. I had to monitor myself to not push too hard physically or my symptoms would return.” After about 10 months, Sandwith was back to her training and racing self.

In terms of riding and racing, there’s no reason for cyclists to assume the worst. McKenzie-Picot says, “Concussions are a manageable injury, but they do require treatment, even if it’s just taking a bit of time off and following a graduated return to activity.”

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This article originally appears in Canadian Cycling Magazine’s August / September 2020 issue.