One of our regular RBR readers submitted this article about his recent experience with multiple concussions, one of which resulted in a dangerous brain bleed with stroke-like symptoms, which includes some questions at the bottom for the rest of our readers. If you’ve had a concussion related to cycling (or even otherwise), we’d be thrilled if you’d answer these questions or at least tell us about your concussion experience in the comments. Be careful out there!
By Richard Randolph
Getting older as a cyclist is not without its rewards and challenges. Rewards, you wonder? Certainly, you become freed of the more youthful temptation and possible necessity for some to chase down every rider who pulls away on the climbs or worse the flats. You also do not have to purchase that new sleek, aero, pro-style bike that is worth more than the family car. You can tell your riding mates that if Campy 10-speed gearing was good enough for the likes of Coppi, Hinault or Lemond, it is good enough for you. Suggest you omit mentioning the first two with anyone under 30 to avoid blank expressions and validation that you are nearly as ancient as the Tour de France.
What about the challenges? Well, it does hurt, admit it, that the less experienced young’uns are riding away from you. Do you simply deal with this via the purchase of that sleek UCI-legal bike? Or do you undertake a series of incremental steps such as going lighter than air with your tires (helium perhaps; alas, not hydrogen: remember the Hindenburg!), lower cockpit height for improved aerodynamics and newly generated lower and upper back pain, dimpled rims so you better slice through the air wall or perhaps a more aero helmet that feels like a sweat box within ten miles on a normal summer day? There is no end to the number of ways that you can, due to the marketing messages of the bike, component, helmet and clothing manufacturers, convince yourself that you can cheat the aging process, now matter how marginal the gains in time and speed.
I came to abruptly realize this spring though, that there is one dimension that the over-40 aged male and over-50 aged female cyclist cannot cheat. That is your brain’s normal rate of atrophy with age. Not only are there gender differences on the onset of this process of cellular diminution of brain volume, but also of the regions in the brain where the atrophy is most observable (see American Journal of Neurology 2000 study).
For men, this relates to the posterior parts of the right frontal lobe and the cerebellum. This reduction in brain volume within a nearly unchangeable skull means there is with age more space within the skull surrounding the brain. In a sedentary life style free of jarring of the brain, that increased, unoccupied volume seldom poses a problem. But factor in a bike fall or a collision with a car, the result may well be a concussion, or worse.
For the first half century of my 54 years as a cyclist, I was lucky enough to never have had even a minor fall while on my bike. I recall going over the handlebars once in the 1970’s, but I was on gravel and I had slowed to a crawl before I did so.
But in the summer of my 50th cycling anniversary, my luck ran out at age 73. I had a car suddenly pull out iin front of me. The rescue squad arrived in minutes to find me unconscious. Fortunately, my front-damaged WG11 helmet protected my brain as the subsequent CT scan showed. My concussion was mild with the only symptom being a headache for two days.
Four years later, this February, as I transitioned from a road just before a construction area to an adjoining bike path, I did not see a band of sand on the cutout which caused my front wheel to slip out. The front of the same model helmet as I wore in 2021 hit the concrete and broke in the same spot as before. I was unconscious again for a minute or two.
I knew I had received a concussion, because I had a headache for three days, during which I again took Tylenol. Other than that symptom, I felt fine. I did not call for a rescue squad at the time, but did inform my family physician when I returned from vacation about the accident.
Then last month, in a deep discussion about the current state of the US with my riding buddy of some 19 years, I kept riding straight at a spot where normally we turn left. But he turned left as usual, crossing right in front of me. Wearing a MIPS equipped helmet, my head hit the asphalt, resulting in my being unconscious for a couple of minutes.
The rescue squad came and administered again as in 2021 the standard concussion neurological exam and I was fine except for a very sore right hip. Wearing a different make helmet than during the previous two incidents but still highly rated, I found that my helmet had a linear ridge line on its lower back right side of the helmet.
This altered spot on the helmet would prove to line up exactly with a brain bleed (hematoma) I would subsequently develop. The onset of headaches that evening and queasiness upon my awakening the next morning indicated unmistakably that I received another concussion. I let my physician know that I had crashed again when, after the headaches subsided in severity, they returned. They were now accompanied not by nausea, a commonly cited concussion symptom but by diarrhea.
I met with my doctor three weeks after the fall and he proposed that I had a possible broken vertebrae. X-rays revealed that I only had normal aging of the vertebrae. Within 18 hours of that visit I would be in the back of a rescue vehicle on the way to the same local university hospital as in 2021 because I had lost the ability to use my left leg and left arm.
The admitting physician in the ER was convinced I had experienced a stroke. A CT scan quickly determined that would turn out to be some 550 ML of blood surrounding my brain’s right side had pushed my brain over the to left side of the skull and the pressure of the blood had created the stroke-like, fortunately temporary loss of left arm and left leg functions.
A burr-hole drilled into my right skull at the exact same spot where my helmet was damaged enabled plastic tubing to begin draining this blood. Three days later, I received a MMA procedure (middle meningeal artery embolization), designed to seal the chronic subdural hematoma that was caused by the April 17 accident. I am still slowly recovering now and am advised to only ride indoors until a further CT scan later this month.
My neurologists have told me to limit my cycling during the past three weeks to indoor, minimal resistance spinning. In ten days I will meet again with my medical team following another CT scan to determine whether my brain has further reverted to a central position in my cranium.
We will also revisit whether I am advised to continue to limit my cycling to indoors for the foreseeable future or whether I want to undertake the risks of even careful cycling on earthen bike paths. I am leaving on July 6th to watch several stages of the Tour de France and would like to be able to ride a rented bike on Voie Verte, routes I know well, to see these stages. But if more rest and less cycling risk is advised, I will just make do with driving to remote spots to see the Tour. My sense if that I will be advised to do no outdoor cycling for several more months.
What lessons are to be gained for you from these three concussions and from my subsequent neurological procedures?
- Know the immediate and longer term symptoms of a concussion such as a severe or increasing headache, fatigue, loss of consciousness, restlessness or agitation, double vision, weakness, tingling or burning in the legs or arms, seizure/convulsions, dizziness, and nausea, vomiting or diarrhea. Look and check in to see if subsequently there are any of these concussion symptoms such as balance problems, trouble falling asleep or sleeping, pressure in head, neck pain or tenderness, effects from electronic screen sessions etc.
I suggest every cycling keep a list of the immediate symptoms written down on a small sheet that is inserted into one side of the handlebars. That way you a convenient check list its at your fingertips if you or someone else should take a bad fall. For a comprehensive list of symptoms see page 3 of the UCI (Union Cycliste Internationale) Sport Concussion Assessment Tool on the UCI website. - If you experience a concussion after a fall and you are older than 40 as a male and 50 as a female, give serious thought to have a CT scan done on your brain. If you have experienced another concussion within the previous year, make sure that you have a cranium CT scan as soon as possible. The sooner the better.
- Be aware that there is no bike helmet currently on the market, whether with MIPS, ERT, WG11 or Wavecell technology, can prevent an aging brain from being jostled at impact, potentially resulting in a (hematoma. Therefore, choose a helmet that comfortably fits your head and your budget, provides the ventilation you desire, tightens with a chin strap in a manner that feels comfortable and secure for you and is the weight you desire.
As for which is the safest helmet, the various somewhat similar testing methodologies deployed by VA Tech, the Research Institute of Sweden Road Safety Trust, or the Legacy Research Institute (Portland, OR) provide no evidence that any helmet technology is superior to its peers. Whatever you do, don’t just rely on a cyclist’s paid recommendation for your next helmet. She/he is paid to endorse the product. The testing organizations are not.
Here are some questions about concussions for other RBR readers. I’d love to see your answers to these in the comments. Please feel free to give us your detailed concussion stories too, if you have any.
- How many years have you been cycling?
a) 0-5
b) 6-10
c) 11-20
d) 21-30
e) 31-50
f) 51 -90
- What is your birth gender?
a) Female
b) Male
- Based on reflection and some of the symptoms listed above, how many concussions have you experienced while cycling:
a) none
b) 1
c) 2
d) 3
e) 4
f) 5 or more
4. How many CT scans have you had following a concussion:
a) none
b) 1
c) 2
d) 3
e) 4
f) 5 or more
5. Did one or more concussions alter in any way your mode of road riding? Check all that apply
a) abandoned riding on the road, except on rare occasions
b) added more electronic technology to my bike to make me feel safer on the road
c) switched to wheels with wider rims and wider tires for better traction
d) switched to riding only gravel bikes for better braking and traction
e) switched to riding an e-bike
Been riding bikes since the mid-60s and have only hit my head one time. If I was confused it was very minor. I have had two major concussions from other sports.
My worst happened in my late 20s and I had a headache for over one year from a crash while skiing. It was a face first fall so only a full face helmet would have had a chance to provide protection. I proved Vaurnet wrong as my “unbreakable” glasses broke. I eventually did have an MRI. I did not limit any activities post concussion. Looking back my doctor was no help.
One change you may consider is switching to riding a non-powered recumbent tricycle. I am 67 and have bilateral denervation in my legs and balance issues, including being very shaky getting on and off a traditional bicycle. Several yers ago, after I took a tumble on my bike after hitting an oil slick on a damp day – broken thumb, abrasions, and dented helmet but no concussion, my neurologist strongly urged me to switch to a tricycle (she initially suggested not riding outdoors at all, which was not a viable option). As the neurologist put it, the parts of my body that work, work well and help me to compensate for my deficits and I shouldn’t risk taking a chance of screwing them up. Riding a tricycle is definitely different, but I’ve come to enjoy it just as much as I did writing a traditional bicycle. I don’t go as fast, due to age, a much heavier platform (bike was ably 19 lbs, trike is 39), and three wheels, but still I’m still out riding and enjoying the world. it’s also a great conversation starter and far more comfortable on a long ride than being in a saddle. Trikes are more cumbersome to transport, and, as a result, I have one in Maryland with reduced gearing from stock for short, steep Hills, and another in South Carolina, where we have a beach home. In South Carolina, I regularly tell people I have the fastest beach chair on the island. On the island I often do a group ride where I’m the one tricker and can keep up with the 13-14 mph pace, only falling behind on the final sprint to lunch.
How many years have you been cycling? 31-50
What is your birth gender? Male
Based on reflection and some of the symptoms listed above, how many concussions have you experienced while cycling: 2
How many CT scans have you had following a concussion: 1
Did one or more concussions alter in any way your mode of road riding? Didn’t start racing
Hi Tom. Sorry for the delay in getting back to you, but I did not ever see your comments and your relies to my article in RoadBike Rider until now.. Thanks for providing me with your feedback on this important cycling health issue.
All the best,
Rick
[email protected]
I have had about a dozen mTBIs, five of which resulted from cars hitting my bike. (Another was a solo bike crash, and the rest from X-C skiing and inline skating). My most series crash was being doored but had a minor concussion then. I was unconscious for about a half hour after my solo crash, and was kept overnight in the hospital with a brain bleed, but I recovered very quickly. After ALL of my mTBIs I had minor consequences and was back riding within a week. My most obvious persisting symptom is memory – specifically remembering names of people and things, streets, etc. But that could just be age (I am over 80 now).
These are my answers to your survey:
How many years have you been cycling?
f) 51 -90
What is your birth gender?
b) Male
Based on reflection and some of the symptoms listed above, how many concussions have you experienced while cycling:
f) 5 or more
4. How many CT scans have you had following a concussion:
e) 4
5. Did one or more concussions alter in any way your mode of road riding? Check all that apply
Mainly being more VISIBLE and audible with bright clothing, lights, horns. And being more vigilent.
e) switched to riding an e-bike
I did buy an e-bike but have now switched back (battery is dying!). But what relevance does this choice have to the mTBI discussion? My e-bike is a single speed and not faster than I normally ride. But I do see many inexperienced ‘cyclists’ riding much too fast on heavy e-bikes. Possibly they have more mTBIs.
79, male, riding over 50 years. Have had 3-4 concussions with three broken helmets, one mashed foam. Had 1, possibly 2 CT scans. Was never unconscious but had a 20-30 minute blank period after one crash. Had 2 within 7 months; was installing a drop ceiling in the basement and could not figure out how to measure and cut correctly. That and headaches told me it was time for a change. Three of my concussions were a result of riding in a group/paceline with people I didn’t know who did unsafe things. Since then, I stopped doing group/club rides and only ride with 1-2 people with whom I am well familiar. Ten years and counting.
I’ve been pretty lucky over the years in not having many falls, and I haven’t broken any bones. My wife sadly has had a few falls that have broken bones and caused one concussion. We’re still doing several month long self-contained bicycle tours each year (staying in hotels, not camping).
How many years have you been cycling? Over 50
What is your birth gender? Male
Based on reflection and some of the symptoms listed above, how many concussions have you experienced while cycling: 0
How many CT scans have you had following a concussion: N/A
Did one or more concussions alter in any way your mode of road riding? N/A
Been riding for 13 years, female, took bad fall on railroad tracks, resulting in concussion and minor brain bleeding. I am 73, usually road ride, 3500 miles per year.
Had 3 post injury CT scans . brain bleed resolved completely in 10 days, been 5 weeks since accident . Still have vertigo, headaches which really limits mobility, driving, and activity.
My partner is adamant that I must give up cycling, this was 3rd concussion in 13 years
.
How many years have you been cycling? – 55 (age 75 male)
Based on reflection and some of the symptoms listed above, how many concussions while cycling: —
one very mild, causing slight confusion for 1-2 minutes (steering tube spontaneously sheared off tandem fork crown). I was wearing a first generation Bell helmet, and continue to always wear a helmet.
no CT scan – could you even get one in the early 70’s?
I’ve always been a cautious rider, albeit three broken clavicles, and there was nothing I could have done to prevent either that mild concussion, or the clavicle fractures.
Went down a few years back on a paved ramp to the trail that had for first time silted over. Was pretty much out of it for about seven hours. Huge bruises to my thigh and face. What kept me from begging a ride to the hospital was my “Da Brim”. Obviously I hit my head (the bruising and the memory loss), but I think my sombrero is what saved my head more trauma. Hardly intended for such a purpose, this goofy looking sun protection likely cushioned my impact enough to keep me alive.
I believe in helmets for cyclists and won’t even test ride my bike around the block without it mine. My head may be hard, but the contents are likely, at 77, more like melon interiors.
Started riding seriously about 25 years ago. I am a 73-year-old female. I have never had a concussion. I was once hit by a car but the most serious injury was a neck sprain. I always wear the best helmet I can find, and am a somewhat cautious rider. Never raced, never feel competitive with others, somewhat cautious descender,. I have toured extensively (2x across North America, once mostly by myself, plus lots of shorter trips). I have had a few falls, but none that caused any noticeable injury. Most were in the early days of my cycling. I have had lots of brain MRIs, thanks to a low grade brain tumor in 1998. I had one CT after the car encounter, but that was because there was a possibility that the neck sprain was a spinal column injury. Fortunately, it wasn’t.
Prior to starting an intended century ride, I changed a flat and forgot to secure the quick release. A mile out the axel came unseated and my chain locked up. The next thing I knew I was picking myself up dazed and with a loss of memory as to the crash experience. I was wearing a helmet, and Garmin shows I was traveling at 17-mph when the impact occurred.
For the next four weeks I continues long rides, but I would periodically feel a ‘buzz’ in my head. A month after the crash and after a 90-mile ride I became a bit disoriented and felt sick. Urgent care commissioned an MR which revealed subdural hematoma, and by ambulance they took me to the hospital where a neurologist removed 8 ounces of blood and the ICU monitored me for a few days.
The damage was on the opposite side of the impact – as the injury came from the brain bouncing back to the other side of the skull. I was 58 then, and they tell me that due to a shrinking brain as we age, we have a gap within our skulls that we didn’t have when we were young. That gap can cause the brain to be backlashed upon an impact. (I had equally hard hits in high school football with no problems.)
The operation was early July and they instructed me to be off the bike for the rest of the year as they periodically checked up on me with CTs. I’m male, 68 now, and I’m currently riding at least 10,000 km each year. This experience caused me to insist on a quality helmet and to keep the speed down during descents, around sharp curves, and other hazards.
1. f) 51-90
2. b) Male
3. c) 2
4. a) none
5. no change other than being more cautious
My first concussion was over 45 years ago and was the result of a road racing crash. Back then, we were using “leather hairnet” helmets; Mine was a Kucharic with extra padding, but still offered limited protection. I went over the bars and was knocked unconscious briefly, but didn’t suffer any serious injury. After helping a teammate who had also crashed and was badly cut, I felt good enough to ride back to the start/finish line. Other than some bruising and road rash, I was OK.
My second concussion happened in 2019 during an early spring fat bike ride with a group of women who were all considerably shorter then me. This time, I was wearing a high-end hardshell helmet and riding at the back of the group as the “sweep”. The women all passed safely under a 6″ diameter tree branch that was hanging across the trail, but I didn’t see it (due to a hat visor blocking my vision) and took a heavy hit just above my forehead. The impact snapped my head back pretty violently and I felt it down my spine to the bottom of my rib cage. Fortunately, but I was able to keep the bike upright and roll to a stop. My helmet light was torn off and the helmet was badly cracked, but it did it’s job. I was somewhat dizzy and disoriented for a few minutes, but regained my faculties and finished the ride. I had intermittent headaches, neck and back soreness, and symptoms of “concussion head” for a couple of weeks, but recovered fully.
The only change in my riding has been to be more aware of my surroundings, particularly off-road. That’s important, as I’m doing a lot of gravel riding these days.
1. f) 51-90
2. b) Male
3. c) 2
4. a) none
5. no change other than being more cautious
My first concussion was over 45 years ago and was the result of a road racing crash. Back then, we were using “leather hairnet” helmets; Mine was a Kucharic with extra padding, but still offered limited protection. I went over the bars and was knocked unconcious briefly, but didn’t suffer any serious injury. After helping a teammate who had also crashed and was badly cut, I felt good enough to ride back to the start/finish line. Other than some bruising and road rash, I was OK.
My second concussion happened in 2019 during an early spring fat bike ride with a group of women who were all considerably shorter then me. This time, I was wearing a high-end hardshell helmet and riding at the back of the group as the “sweep”. The women all passed safely under a 6″ diameter tree branch that was hanging across the trail, but I didn’t see it (due to a hat visor blocking my vision) and took a heavy hit just above my forehead. The impact snapped my head back pretty violently and I felt it down my spine to the bottom of my rib cage. Fortunately, but I was able to keep the bike upright and roll to a stop. My helmet light was torn off and the helmet was badly cracked, but it did it’s job. I was somewhat dizzy and disoriented for a few minutes, but regained my faculties and finished the ride. I had intermittent headaches, neck and back soreness, and symptoms of “concussion head” for a couple of weeks, but recovered fully.
The only change in my riding has been to be more aware of my surroundings, particularly off-road. That’s important, as I’m doing a lot of gravel riding these days.