Commentary: Changing cycling’s concussion culture

SAN JOSE, California (VN) — By now, you’ve likely viewed the gut-wrenching video of Toms Skujins’s crash during Monday’s stage of the Amgen Tour of California. Skujins, 25, slammed the asphalt while zipping down from Mt. Hamilton in the waning miles of a stage that he won just two years ago. In a scene that fans of boxing and NFL football know too well, Skujins sprung to his feet. He then began to wobble, as if his legs were made of Jell-O.

And then, to the horror of viewers back home, Skujins climbed back onto his bicycle. Members of the race’s neutral support team helped him back on. Then, he continued riding down the hill.

To those of us watching on television, it was obvious that something was terribly wrong with Skujins. Communication was spotty along the road, as cellphone service cut in and out along the hulking mountain. One medical car was already ahead of Skujins, while the other was far behind. Skujins rolled along in no-man’s land for what felt like a painfully long period of time. As Cannondale manager Jonathan Vaughters explained in a video, he spent a frantic few minutes calling his communications director and other staffers. He finally reached team director Tom Southam on the phone to tell him to catch Skujins and remove him from the race.

The entire episode underscored the challenge cycling still faces with head injuries. Riders are often free to continue participating in the race even if they are suffering from a concussion. The sport can try to create rules to curb this problem. But nothing less than a cultural shift will prevent instances like the one we saw Monday from happening again.

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Questions over safety and post-crash protocols swirled through the race on Monday night. Should the neutral service mechanics have stopped Skujins? Should there have been a medical car nearby? Tuesday afternoon, race officials finally addressed the incident. Jean-Michele Monin, the race director, explained that only a doctor, referee, or team official could have ordered Skujins to stop, not the neutral service providers, who have no medical training. Even if a neutral service mechanic did have medical training, he said, it’s doubtful that a rider would follow the orders of a guy sent to fix his flat tire.

“The role of neutral assistance is to repair bicycles. The role of the medical staff is to repair people,” Monin said. “You’re not going to ask a SRAM mechanic to be trained medically because maybe they will then not be focused on the mechanical side. It would be fantastic, in an ideal world, for them to help out. But they wouldn’t be doing their two jobs 100%. Everyone has a specific role on the bike.”

In background conversations I had with neutral service staffers and their moto drivers, the perspective was often repeated.

“You wouldn’t want a doctor fixing your flat tire, you wouldn’t want me telling a rider he can’t race,” said one.

The perspective may come across as callous, especially given the very public and grotesque nature of Skujins’s wreck. Yet without a specific rule change on the part of the UCI to require medical training for mechanics and neutral drivers, this situation is unlikely to change. And new rules may not do much to prevent a situation like the one we saw on Monday, so long as riders want to win.

I first reported on concussions in cycling in 2012 for a story in The Wall Street Journal, and have followed the sport’s protocols with head injuries since then. The UCI has adopted the Standardized Assessment of Concussion (SCAT 3) guidelines. Many teams now carry laminated note cards that explain how to assess a rider for a head injury. Members of USA Cycling’s national team who suffer head injuries must take an online cognitive test before returning to racing.

Yet cycling’s hard-man culture still exists, and it is far more powerful than any UCI bylaw or laminated card. When a rider crashes during a race, his (or her) immediate reaction is to still jump back on the bicycle and continue racing. The sport could enact new rules to try and curb situations like the one we saw on Monday. The only thing that is going to eliminate this problem is a complete change in culture, similar to what the sport has seen with performance-enhancing drug use.

In my reporting in 2012 I heard various stories of athletes who suffered head injuries and kept riding, sometimes to their own detriment. They came back to the sport too soon, and suffered the consequences. Pro cyclocross racer Amanda Miller suffered five concussions as a junior alone. After her sixth, she lost weeks worth of memory. This week we spoke with reigning U.S. champ Megan Guarnier for our podcast about her head injury. Guarnier admitted to having come back to the sport too soon after the wreck.

In an informal survey of present and retired riders at the Tour of California’s start line, most said they had, at some point, suffered a head injury. Some said they continued riding afterward. Riders told of zigzagging across the road after a crash. Sky rider Ian Boswell said he was unconscious for five minutes after suffering a head injury ahead of the 2010 Tour l’Avenir. He raced the next day, and had to carve out a section of his helmet to accommodate his swollen ear.

Kiel Reijnen hit his head in a pileup at the 2014 USA Pro Challenge, and suffered from memory loss and cognitive problems for days. Two weeks later, he traveled to race Pennsylvania’s Bucks County Classic, and arrived at the race with little more than his bike shorts, having forgotten the rest of his gear at home. “It wasn’t anybody’s fault but mine to make that decision to race,” Reijnen says. “Clearly I wasn’t thinking straight.”

Reijnen won the race.

Andrew Talansky said that this practice is simply instinct; something drilled into riders throughout their lives in the sport.

“You get up and check yourself over. If you think you’re OK, you try to get rolling again and deal with everything else later,” said Talanksky. He suffered a concussion in 2010. “The most obvious reason people stop is if something feels broken. The head injury, if they’re a bit out of it, they might not recognize it. You need somebody external to say that’s enough.”

Changing this culture would undoubtedly take years to accomplish, and perhaps even changes to the rules. If a rider sat down after a crash, could he reenter the race the following day if he was deemed to be OK? The change will also need to come from within. Can directors convince riders to abandon their ambitions in the wake of a crash? Can riders train themselves to react with extreme caution after falling off the bike, rather than with the frantic desire to catch back on? Will teams ever grant riders a pass on bad results in order to recover from a head injury? Could we see a day when Toms Skujins simply walks over to the side of the road and forgets about the stage win? Time will tell.

This story has a happy ending. Skujins may be out of the race, but he’s already tweeting about his injury. Before the start of Tuesday’s stage, he met with the team to wish them luck.

“Toms is doing OK,” Talansky said. “He’s smiling.”