What Cyclists Need to Know About Concussion Symptoms

Early in my cycling career, I was told there are two types of cyclists. The first are those who have crashed and the second are those who are going to crash. The general thought is that if you ride a bike long enough, sooner or later you'll be drawn to earth by gravity in a most unfriendly way.

Typically, cyclists think of crash injuries as broken bones and road rash. Those injuries are visible. If the crash involves head impact, a broken helmet and loss of consciousness, the cyclist may consider the possibility of a head injury. Even with physical evidence, many cyclists will make light of getting their "bell rung," "seeing stars," or "feeling woozy." Too often, they will ignore these symptoms and get back to riding as soon as possible.

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The Story of a Crash

A cyclist was making a left hand turn onto another road that T-intersected the road on which the cyclist was riding. The cyclist had the right of way. A motorist rolled up to the stop sign at the intersection, did a quick look and proceeded to aggressively accelerate into a left turn. The vehicle broadsided the cyclist.

The cyclist sustained several injuries and was sent to the emergency room in an ambulance. He ended up with stitches in his chin, broken bones in his left hand and a broken right wrist. Remarkably, the injuries were not worse and he was released that day.

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His bicycle sustained damage, but there were no marks indicating impact to his helmet.

Over a week after the accident, the cyclist had surgery on his left hand. After surgery, doctors put him on Percocet for pain relief. Within a day he thought the medication was making him light-headed. He decided to stop the medication to see if he could relieve the symptoms that seemed to be getting worse.

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Within a day of stopping the medication, he felt terrible. He felt so bad that he went to the local urgent care. Concerned that he might have had an undiagnosed head injury, they sent him to have a CT scan to look for a concussion. They also ordered an EKG to check his heart.

The CT scan didn't show any blood and the EKG was relatively normal, so the injury was nearly overlooked.

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Concussion

In the end, however, the cyclist was diagnosed with a concussion. After the diagnosis he began the process of recovery from a brain injury. Some of the things he learned in his journey may help you too.

Loss of Consciousness

Concussions can occur even when there is no loss of consciousness.

Head Impact

Just because your head didn't hit the ground, a rock or any other object doesn't mean that you do not have a concussion. Concussions can occur when there is violent head and neck motion, including whiplash. What happens with whiplash is that the violent action slams your brain against the inside of your skull, causing an injury.

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CT Scans

Not all concussions show up on a CT scan. It is possible to have a concussion when the CT scan is "clean".

Delayed Symptoms

Symptoms of a concussion may not appear for hours, days or even weeks after the initial blow to the head or blow to the body.

Doctors

Know that not all doctors are aware of the guidelines for treating concussions. For example, a surgeon that specializes in hand, foot or knee repair may not be knowledgeable about concussions. If you think you have symptoms of a concussion, follow up with a neurologist.

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Symptoms

Symptoms of a concussion generally affect four major areas:

• Mental: The ability to think, concentrate and remember.
• Physical: Physical symptoms not limited to headaches, dizziness, nausea, vomiting and fatigue.
• Emotional: Mood and emotions can be affected. It's not unusual to feel depressed, irritable or even anxious. You may feel like crying for no reason.
• Sleep: Normal sleep patterns may be affected. For example, you may have difficulty falling or staying asleep.

Return to Cycling and Thinking

Returning to physical activity too soon can increase the risk of further complications or prolong the recovery. Other risks include depression and a cognitive degeneration.

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It was once thought that only premature physical activity delayed the recovery from a concussion. It is important to realize that a return to mental activities can also delay recovery. Examples of mental activities include problem solving in a work situation, learning new skills, or taking tests in school.

Take it slow both physically (intensity and duration of exercise) and mentally (limit work and school hours) early in the healing process.

Recovery

Unfortunately there is no standard timeline for recovery from a concussion. Just because you didn't lose consciousness doesn't mean that you will heal more quickly than someone that did lose consciousness.

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It is important to expect some set-backs in recovery and know that recovery is not a linear process. Major set-backs should be discussed with your health care professional.

If you think you may have a concussion, consult with a neurologist or other medical professional that specializes in concussion. This expert may help you better understand your injury and speed up the recovery process.

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