Pro Continental team UnitedHealthcare are leading the way in diagnosing concussions mid-race, pulling their riders out of races if they show signs of brain injury

Broken bones, pulled muscles and strained tendons. All injuries that you would associate with professional cyclists, but head injuries are often somewhat under the radar.

Collision sports such as rugby union and American football have made strides in recent years in identifying concussions and removing players from the field of play once head injuries have occurred.

Such time consuming tests as carried out in these sports would not be practical to carry out in the hustle and bustle of a professional bike race, but now second tier American cycling team UnitedHealthcare are leading the way in streamlining brain injury tests.

“In professional cycling, if you can’t make a decision in under five minutes, your day is over,” UHC team doctor Michael Roshon told Outside Online.

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So, UHC have designed a cognitive test that can be carried out after a mid-race crash without impeding too much on a rider’s chances of catching back up with the race.

While in rugby a team can substitute a player temporarily while he or she undergoes extensive cognitive examination, in cycling a rider’s race would likely be over if they were to undergo a full concussion test.

Even after conducting the tests, as Outside Online’s Aaron Gulley reports, the call would likely be down to a judgement call by a health professional.

UHC team doctors will conduct a series of tests with each rider before the season starts to establish a set of baseline figures. Tests include judging balance on two feet and on their dominant foot on hard and soft surfaces.

The doctor will then tell the rider a list of five words, which they are asked to repeat later, and then a series of five or six numbers that they then must repeat backwards.

Chris Horner was withdrawn from the 2011 Tour de France with a head injury after riding 15 miles of stage seven with concussion (Watson)

Chris Horner pulled out of the 2011 Tour de France with a head injury after riding 15 miles of stage seven with concussion (Watson)

When it comes to a raceday check after a rider takes a spill, the doctor will ask the rider their name, date of birth and address. One fail here and their day is over. Next the rider is asked if they feel dizzy, agitated or sensitive to the light.

Then the athlete is asked to repeat the initial balance and cognition tests to analyse the results against the baseline. Any decrease in performance would lead to the athlete’s withdrawal from the race.

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“It always comes down to a judgment,” Roshon adds, “but these tests, and especially the comparisons to an individual’s normal results, help us make the decision less subjective.”

University of Pittsburgh Medical Center Concussion Program director, Dr Mark Lovell, concludes: “It’s a very tricky injury to diagnose. Chemical changes in the brain from an impact can take up to 12 hours to manifest. Our advice is always: When in doubt, sit them out.”