busted lidBy Alissa Wicklund

In addition to the physical benefits, studies have shown that exercise can improve mental acuity. Research shows that individuals score higher on tests of cognitive function, such as memory, concentration, and reasoning, after thirty minutes on a bike or other aerobic activity. Indeed, cycling may have contributed to the Theory of Relativity, as Albert Einstein was quoted as saying “I thought of that while riding my bicycle.” This increase in mental acuity is at least partially attributable to the complex thinking abilities that are utilized when cycling. A cyclist must concentrate on their surroundings, utilize visual cues, and maintain balance, for example. However, as all cyclists know, the rewards from cycling and exercise do not come without risk. Cycling accounts for a large proportion of Emergency Room visits in the US and produces more concussions in youth than football. As a Neuropsychologist at the Orthopaedic & Spine Center of the Rockies Regional Concussion Center, I frequently see cycling-related concussions. I often get asked why there are so many head injuries, despite the fact that helmet technology and awareness are in the forefront of most cyclist’s minds. The answer: there is no such thing as a concussion-proof helmet. Helmets are terrific at doing what they were originally designed to do, preventing skull fractures and serious brain injury. While they may mitigate the force from impact when a rider crashes or falls, they cannot prevent the brain from rotating or accelerating and decelerating in the skull, resulting in concussion.

A concussion is an injury that disrupts how the brain normally works. You do not have to lose consciousness to have a concussion and the majority of concussions do not result in a bleed or swelling of the brain. In concussion, the force and trauma of the injury causes cell dysregulation. This dysregulation is often experienced as physical, cognitive, and emotional symptoms, such as headache, nausea, dizziness, blurred vision, light and sound sensitivity, fatigue, confusion, memory problems, concentration difficulty, irritability, and sadness. Although most individuals see symptom resolution within a week or two, others can suffer from dizziness, balance difficulty, headaches, and cognitive changes for weeks or even months.

The first step of concussion management is prevention. Young riders (ages 5-24 years) have the highest rate of non-fatal cycling injuries, accounting for a large percentage of all bicycle-related injuries seen in the Emergency Room. Although helmets cannot completely prevent concussion, a properly fitted helmet is crucial to cycling safety because it can diffuse the force if impact occurs and prevent more severe brain injuries. Additionally, active lighting, reflective clothing, awareness of terrain and surrounding dangers, and following the rules of the road can all reduce chances of injury.

If, despite these safeguards, a concussion is sustained, it may be difficult for you to ride home safely. If you experience loss of consciousness for any amount of time, have significant head or neck trauma, develop seizures, persistent vomiting, severe or worsening headache, significant disorientation or inability to speak or swallow, a bystander or fellow rider should call 911 or you should go to the ER immediately. In instances where you feel headache and fatigue, but without any other symptoms, you may choose to be evaluated by your primary care physician or a healthcare provider with experience in treating concussion. Examination by a healthcare provider soon after your injury is recommended to help guide recovery and ensure that you have not sustained other serious neurologic or physical injuries.

Early intervention, proper evaluation and treatment recommendations are essential for concussion management and can help prevent lingering symptoms. An appropriate balance of rest and activity is important during recovery and a gradual return to physical and cognitive activity is recommended. A focus group of experts on medicine in cycling developed a step wise return to sport protocol with specific recommendations for competitive cyclists. For example, start with low impact stationary biking and gradually increase intensity and duration. If this is accomplished without symptoms, introduce intervals, hill workouts or higher intensity. Next steps include group rides, sprints, climbs or pacelines. Each step increases the amount of physical and cognitive exertion, and should be achieved without symptoms before progressing (see usacycling.org/concussions.htm for more information). Physicians, Certified Athletic Trainers and Physical Therapists can assist with or supervise exertional protocols. The Orthopaedic & Spine Center of the Rockies, Regional Concussion Center has services for evaluation, management and rehabilitation of concussion to help you safely return to cycling.

A concussion is a treatable injury with proper management. Take steps to protect your head and brain. Hit the road to enhance your mental acuity. You may find your Einstein moment while out on the road!

Alissa Wicklund, PhD, ABPP is a Board Certified Neuropsychologist who specializes in evaluation, treatment and management of concussion. She is also a (very) amateur cyclist, who enjoys road and mountain biking with her family. More information on the OCR Regional Concussion Center can be found at www.orthohealth.com/our-specialties/sports-concussions-neuropsychology, or by calling 970-419-7227. Dr. Wicklund is also available for consultation and education on concussion for Cycling groups in Northern Colorado.