How to Handle a Concussion in Cycling

Getting Back on the Bike

Once a cyclist has been diagnosed with a concussion and removed from training and competition, regardless of perceived severity, safely returning to cycling is a critical aspect of properly managing a concussion. Return to exercise activity before symptoms have resolved will prolong the time that it takes for the concussion to resolve and potentially lead to more chronic symptoms of concussion including headache, concentration and memory dysfunction, and balance problems.

A cyclist should completely rest from all physical activity (including weight training and non-sport specific crossing-training, etc.) until they are completely symptom-free for at least 24 hours. The time required to become asymptomatic can vary greatly so there is no pre-determined time that a concussed athlete has to rest, as long as they are asymptomatic prior to returning to physical activity. The duration of this asymptomatic period may also be extended depending on a cyclist's past concussion history. Minimizing cognitive stimulation (e.g. school work, computer work and games, etc.) may also be needed if these activities aggravate one's concussion symptoms.

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Ideally, the concussion should be managed by a physician who is experienced with concussion injury and clears the cyclist to start a graduated return to exercise protocol. An example of such a step-by-step protocol could be as follows:

• Step One: Complete rest until no symptoms are experienced for at least a 24-hour period
• Step Two: STATIONARY cycling (not rollers) x 15 minutes at low intensity (e.g. < 60% max HR)
• Step Three: Stationary cycling x 30 minutes at higher intensity (e.g. ~ 75% max HR)
• Step Four: Stationary cycling x 30 minutes at higher intensity (e.g. ~ 75% max HR) with 30 second sprinting at minutes 10, 15 and 20.
• Step Five: Solo riding on road x 30 minutes at steady intensity (e.g. ~ 75% max HR)
• Step Six: Solo riding on road, track or trail x 45-60 minutes at higher intensity (e.g. ~ 75% max HR) with sprinting. Low-level technical riding can be added with BMX and MTB. Light weight-training can also be added at this time
• Step Seven: Group ride with sprints, climbing, pacelines, and normal technical riding.

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Each step of the above protocol should take at least one day in between. If any concussion symptoms re-occur at any step of the protocol, the athlete must immediately stop all physical activity again until they are free of symptoms for at least 24 hours before trying the protocol from step one again! It may seem a frustrating game of snakes and ladders, but remember that rushing the process only prolongs the overall recovery time while putting you at long-term risk for damage.

If an athlete is unable to progress through the return-to-exercise protocol without symptoms, they should be assessed by a physician again.

Given the nature of sports it is hard to prevent all concussions. In cycling, essentially the only way to prevent and/or reduce the severity of a concussion is to wear a properly fitting safety-approved helmet. Remember that helmets are not meant to last forever, and should be replaced regularly or after sustaining any significant impact.

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