Do Cycling Helmets Protect us from Concussions?

By Cheryl Wylie, MSc (PT)

You’re having a fantastic race when it happens – you clip your tire on the curb and down you go. You consider it a minor crash, but you do hit your head on the road when you land. Luckily you were wearing your helmet and when you look at it after it’s just scuffed.

What would you do in this scenario? Would you seek medical attention? Questions similar to this were proposed to competitive cyclists in recent research led by Dr. Jack Hardwicke, a former racing cyclist, who investigated helmet use and it’s perceptions in sports-related concussions. Many respondents, 64.7%, said that in the event of their helmet cracking following a crash, they would seek medical assistance. But nearly half, 47.2%, said they would not do so if their helmet was only scuffed, and only 44.7% would if their helmet never contacted the ground. This low reporting is not unique to cycling, as it’s predicted that as many as 50% of concussions go unreported across all sports.

Understanding Concussions

When we have a crash, we put our bodies through linear and rotational forces. If those forces are experienced in the brain, it can alter the way our brain functions and result in a concussion. Concussions can be caused by direct blows to the head or indirect blows to the neck or body (with or without loss of consciousness). This initiates a neurotransmitter and metabolic cascade with blood flow changes and inflammation affecting brain function. This brain is then left in an energy crisis which can last for hours, days or even weeks. We believe this crisis, along with other physiological processes, contribute to the physical, cognitive, behavioural and emotional signs and symptoms seen in individuals with a concussion.

Do Helmet's Protect us from Concussions?

Unfortunately, as cyclists, we may have been lulled into a false sense of security that helmets are designed to protect us from concussions. In recent research by Alfrey and colleagues, it was found that helmet’s reduced serious head injury, including facial fractures and skull fractures, however the incidents of concussion did not vary between those who were wearing a helmet and those who weren’t. Although helmets are required for preventing serious injuries, we need to understand their limitations.

Currently, the standard helmet drop height onto a flat anvil test, as used by the Consumer Product Safety Commission, produces an impact velocity of 22.5km/h. While this may meet the needs of most recreational riders, it is questionable whether they afford the same level of protection at the higher speeds seen in racing. In addition, this type of test only accounts for linear forces, and does not take into account the rotational forces we see with real life crashes.

Emerging Helmet Technologies

Two leading technologies have emerged however that do promote a reduction in risk of concussion to cyclists. The first is the multi-directional impact protection system (MIPS), which has a slipcover inside the helmet allowing sliding between the head and helmet on impact. The second is the WaveCel, which uses an angular impact mitigation (AIM) system with an inner lining to absorb accelerations during impact. Both of these products show promising research to reduce rotation forces on the brain, however we must recognize most current research is done in house, lending to potential bias, and that it is difficult to test the wide variety of angles and velocities that can occur with real life falls, especially when extrapolating it to paracycling.

Recognizing a Concussion

When we have a crash, it is going to be up to you and your coach to determine if a concussion may have occurred.  Although there are individual differences, common signs and symptoms of a concussion are seen across the board and can be looked for:

• Headache / Pressure in head

• Dizziness and balance problems

• Nausea or vomiting

• Fatigue / drowsiness

• Sleep disturbances

• Vision changes

• Sensitivity to light or noise

• Ringing in the ears (tinnitus)

•  Seizure

• Neck pain

• Problems with smell/taste

• Brain fog

• Difficulty remembering and focusing

• Slower information processing

• Trouble thinking clearly or finding your words

• Difficulty making decision or plans

• Behavioural changes light depression, anxiety, irritability, aggression or impulsivity

Not all signs and symptoms occur immediately though, and symptoms can be delayed for up to two days after injury.

Early Concussion Management

Rowan’s Law came into effect in Ontario in 2019 to guide coaches and athletes on early concussion management. If a concussion is suspected, there are some important early steps you want to take:

1. Stop Sports Activities: When the brain is in an energy crisis, as seen early on after a concussion, it is more “vulnerable” to subsequent trauma. This means that relatively minor second blows to the head may produce more severe or irreversible changes in brain function. Because of this, it is incredibly important is to stop active sport to allow this energy crisis to resolve.

2. See a Healthcare Provider: The evidence is stacked up on the value of speaking to a qualified healthcare provider as soon as possible after sustaining a concussion. Clinics such as the Greenbank Concussion Clinic are designed to provide you access to neurologists within 72 hours, and Vestibular and Neurology clinics across Canada are great resources for early management that don’t require a physician referral.

3. Relative Rest: In the past, you may have been told to rest for weeks in a dark room after a concussion. New research indicates relative (not strict) rest is more beneficial. This means you can do activities of daily living along with light physical and cognitive activity such as walking and reading in the first 48 hours. After this, you can systematically advance your intensity with the assistance of a qualified healthcare professional.

4. Reduce Screen Time: For the first 48 hours, you may also find it helpful to reduce screen time or to take frequent breaks when using screens. For most individuals, auditory stimulus is tolerated well, so listening to music or podcasts are fine during this time.

Special note: Avoid taking medications (especially non-steroidal anti-inflammatories (NSAIDs)) within the first 48 hours as it may mask symptoms.

Brain Injury Canada put together the Concussion Awareness Training Tool which combines all assessment and early intervention into a single page handout, which I highly recommend be part all athlete and coach toolkits. In addition, a free course is available for high performance athletes to provide you with information you need to take an evidence-based approach in responding to and managing concussions.

Concussion Recovery

Concussion recovery will look different to each person, and especially different for athletes where there are larger aerobic and physical demands to return to. Be sure to work with a concussion therapist and follow the return-to-sport protocol as outlined in Rowan’s Law when returning to any sport. Healing Vertigo Physiotherapists have undergone advanced training in concussion management and treatment. Reach out today if you believe you have experienced a concussion. 

Resources

• Ontario Brain Injury Association

• Parachute

• Concussions Ontario

• Brain Injury Canada