Cycling has a concussion problem—one that’s been overlooked for far too long.
In this episode, I sit down with Thomas Fallon, a clinical specialist, a clinical specialist musculoskeletal physiotherapist, sports medicine researcher at Queen’s University Belfast, and PHD candidate in cycling injury epidemiology, to uncover the reality of concussions in the sport.
There is also a written article exploring why concussions are the silent crisis in cycling and what needs to change to accompany this episode.
We dive into why cycling has the highest rate of head, neck, and face injuries among all disciplines but one of the lowest reported concussion rates, what the symptoms are and why they often go unnoticed. We discuss what riders need to know about proper diagnosis and recovery.
From real-world experiences to the latest research, Fallon lays out what needs to change to protect cyclists from long-term neurological damage. If you ride, race, or simply care about athlete health, this is an episode for you.
Podcast outline
Introduction to Thomas Fallon and His Research (00:00)
- Ronan Mc Laughlin introduces Thomas Fallon, a researcher at Queen's University of Belfast, focusing on injury and illness surveillance in professional cycling.
- Thomas Fallon's research includes a large-scale study tracking over a million kilometres of racing and training to assess injury rates and safety in pro cyclists.
- Thomas's work highlights the low reported rates of concussions in road cycling despite high rates of head, neck, and face injuries.
- Ronan emphasises the importance of understanding concussions in cycling and the need for better protocols and awareness.
Thomas Fallon's Background and Career (04:30)
- Thomas Fallon shares his background in cycling, including his competitive career and education in sports science and physiotherapy.
- He discusses his work with the Irish team at the Paralympics and his current PhD focused on developing an injury surveillance system for professional cycling.
- Thomas mentions collaborations with the UCI on injury surveillance projects, including the World Championships and downhill mountain biking.
Thomas Fallon's Personal Experience with Concussions (08:15)
- Thomas recounts his own experience with a severe concussion in France, where he lost consciousness during a transfer between hospitals.
- He discusses the challenges of diagnosing concussions, especially when athletes hide symptoms, and the importance of increasing awareness among younger athletes.
- Thomas presents his master's thesis on athletes' knowledge and attitudes towards concussions, highlighting the willingness of younger athletes to hide symptoms.
- He shares his involvement in developing concussion education programs for underage athletes in Ireland, emphasising the importance of educational content and role models.
Understanding Concussions and Their Symptoms (13:20)
- Thomas explains that concussions are mild traumatic brain injuries caused by blows or jolts to the head, leading to short-lived neurological deficits.
- He describes the pathophysiology of concussions, including axonal shear, chemical changes, and potential swelling in the brain.
- Thomas emphasises the importance of symptom presentation in diagnosing concussions and the challenges of diagnosing concussions in cycling due to the transient nature of symptoms.
- He discusses the role of environmental factors and the need for context in diagnosing concussions, especially in road cycling.
Challenges in Diagnosing and Managing Concussions (19:45)
- Thomas highlights the challenges of diagnosing concussions in cycling, including the lack of on-site evaluations and the need for post-event and next-day evaluations.
- He discusses the importance of providing context to medical professionals to aid in diagnosing concussions.
- Thomas shares an example of a Scottish rugby player who passed a head injury assessment but was removed from play due to symptoms, illustrating the complexity of diagnosing concussions.
- He emphasises the need for a protocol that includes on-site evaluations, post-event evaluations, and next-day evaluations to ensure proper diagnosis and management of concussions.
Long-Term Risks and Complications of Concussions (28:17)
- Thomas explains the risks of having multiple concussions, including the potential for rapid swelling of the brain and severe complications.
- He discusses the link between concussions and chronic traumatic encephalopathy (CTE), a neurodegenerative condition associated with repetitive subconcussive impacts.
- Thomas highlights the importance of managing concussions to prevent long-term complications, including depression, anxiety, and post-concussion syndrome.
- He shares a case of a US track rider, Kelly Caley, whose father linked her suicide to post-concussion syndrome, emphasising the need for increased awareness and support for athletes with concussions.
Cultural and Educational Aspects of Concussions in Cycling (33:40)
- Thomas discusses the cultural component of cycling, where riders were once applauded for toughing out injuries, and the shift towards acknowledging the seriousness of concussions.
- He emphasises the importance of education in increasing awareness about concussions among riders, coaches, and medical staff.
- Thomas highlights the role of riders speaking out about their experiences with concussions in raising awareness and improving management practices.
- He discusses the need for better diagnostic tools and the potential use of technology, such as head impact sensors and video analysis, to improve concussion screening and management in cycling.
Improving Concussion Safety in Cycling (43:20)
- Thomas suggests the need for an injury surveillance framework to quantify and address concussions in cycling.
- He discusses the potential use of head impact sensors and other technological advancements to improve concussion screening and management.
- Thomas emphasises the importance of collaboration between data scientists, medical professionals, and cycling organisations to develop and implement effective concussion management protocols.
- He highlights the need for education and awareness at all levels of cycling, from grassroots to professional, to ensure proper management of concussions.
Practical Steps for Managing Concussions (48:05)
- Thomas outlines the steps a cyclist should take immediately after a crash, including requesting medical evaluation and commencing 48 hours of rest.
- He describes the return-to-sport protocol, which involves gradually increasing activity levels and monitoring symptoms to ensure a safe return to training and competition.
- Thomas emphasises the importance of considering the specific demands of different cycling disciplines in the return-to-sport protocol.
- He discusses the need for a multi-disciplinary approach to managing concussions, including psychological support and a graded return to sport.
Final Thoughts and Recommendations (56:50)
- Thomas reiterates the importance of erring on the side of caution when suspecting a concussion and seeking medical evaluation.
- He emphasises the need for increased awareness and education about concussions at all levels of cycling to ensure proper management and prevention.
- Thomas highlights the role of technology and data in improving concussion management and the importance of collaboration between various stakeholders.
- He concludes by encouraging listeners to prioritise their health and seek medical advice when in doubt about concussions.
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