Concussions are a significant portion of athlete injuries in professional cycling but diagnosing them in a sport where there are no time-outs requires a rapid assessment.
Even with improvements in helmet technology such as MiPS, even the best helmets aren't always effective at preventing concussions.
Pro riders have had much better care and caution when it comes to concussions since the UCI approved a specific protocol for checking riders who have crashed for signs and symptoms of a concussion in 2020. The protocol is based on the SCAT5 standardized tool for evaluating concussions but modified for cyclists.
Earlier incidents such as a crash from Toms Skujins in the Tour of California, and Chris Horner and Tom Boonen during the 2011 Tour de France led individual teams to adopt their own concussion protocols until the UCI agreed upon an official guidance.
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The protocol has three stages: first, the initial assessment immediately after a crash, then a post-race follow-up and another on the day following the injury.
During a rapid screen, a rider is asked if they have a headache, nausea, dizziness or double vision - two or more mild symptoms or one moderate to severe indicate a possible concussion.
A rider may then be asked a series of questions to test their memory:
What day is it?
What race are we in?
How many km to go?
What was your last race?
Who is the DS in this race?
Who won yesterday (stage races)
Correct answers to all of the questions indicate a low probability of concussion and the rider would likely be allowed to continue. However, since racers may get questions wrong and not have a concussion, other tests are performed: checking for a pain-free range of motion of the neck and spine.
Another memory test where ten words are read off to the rider and they have to repeat as many as they can, three times. A score of 20-30 (1 point for each correct word) gives the rider a green light in the absence of other red flags.
The rider may be subjected to a balance test and delayed recall of the previously read words. Any stumbles or inability to recall more than four words raises suspicion of a concussion.
Laura Weislo is a Cyclingnews veteran of 20 years. Having joined in 2006, Laura extensively covered the Operacion Puerto doping scandal, the years-long conflict between the UCI and the Tour de France organisers ASO over the creation of the WorldTour, and the downfall of Lance Armstrong and his lifetime ban for doping. As Managing Editor, Laura coordinates coverage for North American events and global news.
