Be Aware of Concussion in Cycling

By Kari Studley, PT, DPT, CYT

Concussion awareness has received a lot of attention recently in the news outlets and medical community. It is common to think of sports like football, lacrosse and other contact sports as major risk factors for concussions. However, when considered based on a clinical definition, cycling contains just as much, if not more, of a risk factor for it.

The American Academy of Neurology defines concussion as a “clinical syndrome of biomechanically induced alteration of brain function, typically affecting memory and orientation, which may involve loss of consciousness.”1 In normal terms, it means a concussion is a brain injury caused by movement to/within the skull that causes short-lived brain function impairments with or without losing consciousness. A “biomechanically induced alteration” can be the stereotypical direct impact to the head, face or neck. More importantly, it can also be a direct impact elsewhere on the body with a force transmission to the head.

A concussion is not a minor diagnosis. It is technically a “mild” brain injury. In my opinion, a brain injury to any extent is still an injury and should not be taken lightly, especially, if there is a history of previous impact to the head or concussion. As mentioned earlier, a concussion is actually a syndrome of symptoms that need to be diagnosed by a doctor or a trained professional. Generally they will make their assessment based on the physical, cognitive and behavioral symptoms related to the incident. This will also guide their recommendation for appropriate return to activity (cycling).

There are several great resources available to help educate about concussion symptoms and recommendations for return to play. My personal favorites are the American Academy of Neurology Concussion Guideline1 (found at, Medicine of Cycling Concussion in Cycling Consensus statement2 (with a convenient printable handout), and the Center for Disease Control’s “Heads Up” campaign3 ( ). Remember, a fall off the bike is like being hit and should be treated as seriously as “traditional” contact sports with a suspected brain injury or mechanism.

Another interesting aspect related to concussion is the consideration of its potential effect to athletic performance and other parts of the body. In their new study comparing college athletes who had sustained a concussion compared to non-concussed matched peers, Lynall et al4 found that those who had experienced a concussion were significantly more likely to have suffered an acute lower extremity musculoskeletal injury compared to their non-concussed peers within the following year. Also of interest, was that these concussed athletes were almost twice as more likely to sustain an acute lower extremity musculoskeletal injury post-concussion compared to their pre-concussion state. The theory for an increased injury rate being that the brain is unable to coordinate movement as effectively due to impaired dynamic postural control and reduced muscle action responsiveness from a concussion injury.

Although this study looked at Division I college athletes, their findings can have huge implications for cyclists, as cycling is a sport dependent on lower extremity coordination and motor control reflexes and response. It certainly gives us something to think about when considering how quickly it may be safe to get back on a bike after a concussion.

Bottom line: an injury to the head is a big deal regardless of how “minor” the incident may seem to be and is always worth getting checked out by a trained professional. Help educate and care for others if there is concern or reason to suspect a head injury. Remember, you don’t have to lose consciousness to have a concussion. It is possible to walk and talk after and while experiencing a brain injury. Exercise caution when getting back on the bike or resuming sports after such an occurrence — a second (or multiple) brain injury is often a lot more serious and not worth the risk.


1. American Academy of Neurology. “Summary of Evidence-Based Guideline for Sports Coaches and Athletic Trainers: Recognizing Sports Concussion in Athletics.” 2013

2. Abramson AK et al. Medicine of Cycling: Concussions in Cycling Consensus Statement 2012.

3. Center for Disease Control. “Heads Up” to Brain Injury Awareness.

4. Lynall RC et al. Acute lower extremity injury rates increase following concussion in college athletes. Medicine and Science in Sports and Exercise. ACSM. May 2015 (published ahead of print)

Kari Studley, PT, DPT is a 2013 Masters Cyclocross World Champion, a 3-time National Cyclocross Champion and one day STP rider. With over a decade of endurance cycling experience, she specializes in cycling biomechanics and injury prevention at Corpore Sano Physical Therapy ( in Kenmore, Wash. Corpore Sano PT is an orthopedic and sports physical therapy practice specializing in treatment of overuse injuries and sports performance. Contact 425-482-2453 or

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