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Cycling: head injuries ignored because of entrenched macho culture

Competitive road cycling is a demanding and unique sport. One where crashing is inevitable – especially at the professional level.

While the risk of head injury is relatively low in cycling – approximately 5-13% – compared to contact sports such as rugby, the consequences of a head impact when riding at speeds of over 40 kilometre per hour can be life changing or worse.

Yet too often, riders are helped back onto their bikes following a crash, without a clear examination for head injuries. And little seems to have changed in the past three years since the high-profile case of Latvian cyclist Tom Skujins – who was allowed to continue racing at the 2017 Tour of California while showing clear signs of head trauma.

Even in the recent 2020 Tour de France, French rider Romain Bardet crashed on stage 13 and was cleared to ride the remaining 90 km by race medics. This was despite showing clear signs of concussion. He was later diagnosed with a brain haemorrhage.

Cycling’s world governing body, Union Cycliste Internationale, UCI, regulations state that: “any rider with a suspected concussion should be immediately removed from the competition or training and urgently assessed medically”. Yet this is rarely enforced in road cycling, at any level.

Head injury in other sports

In other sports, visible efforts and new policies are being developed to help tackle this issue. In the 2019 Rugby World Cup, for example, the implementation of the head injury assessment protocol was more prominent than ever, with fans witnessing the use of this in the competition.

Cricket has also introduced concussion substitutions to minimise risk to players. And some football teams have now imposed heading bans at youth level.

Siya Kolisi captain of South Africa wearing a head bandage.
The head injury assessment is a series of checks used in elite rugby to determine whether or not an athlete is suffering from concussion and if they can return to the field of play. FRANCK ROBICHON/EPA

Seeing these measures in place at professional and grassroots levels helps to normalise safer injury management and raises awareness of traumatic brain injuries. It also empowers athletes to more readily disclose any concerns about potential head injuries.

Yet cycling remains a leading example of athletes sacrificing their bodies for sporting glory. Indeed, new research reveals a significant numbers of competitive cyclists would compete following a concussion – or mask it to continue in a competition.

These athletes are often then celebrated for competing through injury and are usually met with cheering fans – all of which only serves to reinforce a vicious cycle.

Cycling problems

Of course, traumatic brain injuries and concussions, can and do have life changing impacts. And many high profile athletes have been forced to retire as a result – often living with the aftereffects of brain injury for a long time to come.

But part of the problem within cycling is that there are no internationally agreed concussion management protocols in place. This risks the health of the athletes at all levels of the sport and fails to protect young aspiring riders as they work their way up the ranks.

Colombian rider Sergio Andres Higuita sits on the floor after a crash
Colombian rider Sergio Andres Higuita sits on the floor after a crash the 15th stage of the 2020 Tour de France cycling race. Sebastien Nogier/EPA

The management of injuries in cycling is also frequently sacrificed to the entrenched “hardman” culture of the sport and the macho environment of professional road cycling.

The structural makeup of cycling also jeopardises safe injury management. Races are rarely stopped for medical assessments after crashes and during high-profile multi-day races athletes must complete all stages to continue in competition – withdrawal is seen as an absolute last resort.

Challenging attitudes

A shift in the way the media reports crashes and injuries would help. Framing riders as heroes for removing themselves from competition, rather than praising athletes for putting sporting glory before their health, would be a first step. This would help to increase awareness and protect the long-term health of the athletes – and would also hopefully lead to action by the sport’s governing bodies.

This is important because the current situation not only puts pro cyclists at high risk of injury, but many amateur athletes also model their behaviours, training and style on their professional idols. And with limited protocols in place around head injuries, it’s likely they’ll turn to the culture of the sport – and what their idols do – for guidance.

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