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Lizzy Banks: ‘There’s no book for how you treat concussion, but there should be’

The EF Education-TIBCO-SVB rider was out with concussion for most of 2021 and says more needs to be done to help riders who get them.

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Not enough is being done to highlight the risks of — and help riders recover from — concussion, according to Lizzy Banks.

With regular crashes, concussion is not uncommon in professional cycling and studies have shown it makes up between 1.3 and 9.1 percent of injuries in the sport.

Banks spent most of last season on the sidelines after suffering a concussion last March. She was only able to return to racing this season, following another delay due to COVID-19, after a long rehabilitation period.

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The EF Education-TIBCO-SVB rider has been vocal about the challenges she has faced in her recovery, from being unable to read a book, and has experienced difficulty with standing and also talking to people. The 31-year-old says that the lack of information for riders who have suffered a concussion means that she has become the point of contact for others.

“I got a message — because my inbox is inundated with messages — from a rider saying, ‘Lizzy, are you able to help? Because I’ve had a concussion, it’s pretty bad, and I’m going be out for a bit.’ I’m getting these messages and I’m just a rider,” Banks told VeloNews. “The reason I’m getting these messages is because there’s no education. There’s nowhere for people to go, there’s no book for how you treat concussion, but there should be.”

“We have the knowledge, we have the understanding, but if we want to change the culture you need to educate people.”

Banks suffered a concussion after a crash at last year’s Strade Bianche. She finished the race but soon started noticing symptoms of what she later would realize was a concussion, including difficulty with her vision and sensitivity to bright lights.

In the weeks afterward, she struggled with coordination and suffered from dizziness, leading her to bump into things at home and regularly dropping things. For months, she was unable to watch the television or look at her phone, and standing up and speaking to someone was something she couldn’t do for more than a few minutes at a time.

Thanks to rehab she recovered, but concussion has ended the careers of several cyclists. Many have not spoken publicly about their experience and Banks says she feels a sense of responsibility to others to spread her knowledge.

“I feel by talking about my concussion, doing a podcast about it, and putting stuff on social media, I can educate people about how bad it can be,” Banks said. “Most of the time when people get a concussion, they disappear off the face of the earth because they can’t use their phone like Christina Siggaard. She got an awful concussion, tried to race again, and then she was horrendously ill and she never came back.

Also read: The CrashCourse Concussion Story Wall launches to raise awareness about brain injury

“Loretta Hanson had a concussion talked about it and is back and better than ever. Ian Boswell is another great example of somebody who did talk about it. But often people have concussions and just disappear off the face of the earth and so you never hear about it and you never know the lessons.”

Another rider who has discussed their experience is Carmen Small, who was Banks’ sport director last season. Small suffered a career-ending concussion following a crash at the Ronde van Drenthe in 2017 and endured daily headaches and other symptoms for years afterward.

“She shared about her crash and said she tried to come back too soon. She had really awful vertigo like I did and really struggled with her mood. She said she couldn’t be around people because mood is a huge thing that gets affected in concussion,” Banks said. “She really struggled and then she came back too soon and then just had to stop, and she quit.

“I’m so grateful to her because she was so helpful and so understanding because she’d been through it. I was really grateful to have someone to check in on you and say like, ‘it’s going to get better.’ Because trust me, it’s fucking shit.”

Better protocols and roadside tests

Though she is happy to help those that ask her, Banks doesn’t want to be the first port of call for riders suffering from concussion, or post-concussive syndrome — the name for when concussion symptoms last longer than the usual recovery process and what Banks had in 2021.

The topic of concussions is receiving a growing amount of attention in cycling, and across the sporting spectrum. High-impact sports, such as rugby, have been taking major steps to improve the response to hits to the head and addressing concussions in players.

Cycling has begun its own fightback and issued its first concussion protocol at the end of 2020. The 14-page document details how to identify symptoms, how to test for concussion, and what to do if a rider is showing signs of having one.

Also read: Romain Bardet left with ‘small hemorrhage’ after Tour de France concussion

It also gives a brief overview of the return to racing, stating that if a rider is free of post-concussive symptoms after a week then they can racing again. However, it stops there and provides no information on what to do if a rider continues to have post-concussive symptoms.

“I think the protocol itself is useless. We need education. Everyone’s like, ‘oh, it’s great. we’ve got a concussion protocol,’ but it’s not really fit for purpose,” she said. “It’s a protocol about not getting back to the races, but it’s not ‘this is how we’re going to treat it.’

“There are really simple things that you can do to like, assessing the vestibular system, and treating vestibular problems. But people don’t do it. One of my teammates was like,’ oh, I had three crashes last year, and now I get dizzy when I’m in a car.’ And I’m like, ‘well, you should probably do this vestibular rehab.’ People don’t because the education isn’t there. There definitely needs to be an actual treatment protocol but there isn’t.”

While there is now at least a protocol for recognizing if a rider is concussed, there are still some challenges in implementing it. In the mele of a crash, it’s not always clear if a rider has hit their head and, in the rush to get them back on their bike, symptoms can be missed.

Ellen van Dijk completed Paris-Roubaix last year following a heavy hit to her head. She received a substantial assessment in the race’s media center after the race and was later diagnosed with a concussion. While she returned to racing soon after, she was still feeling the effects of it in December.

Time is of the essence in a race, and the time it takes to do a full assessment is a challenge. Banks believes that technology could be the way to go in improving this and points to eye-tracking technology that has been tested in rugby since early 2021.

The current devices are in their infancy and are not yet ready for roadside assessments.

“It assesses your visual tracking and within 10 seconds it can tell whether or not there’s a concussion, because visual tracking is one of the first things to get affected that you can actually test,” Banks said. “The problem with concussion is that it doesn’t always show up immediately. Over the first 48 hours, symptoms can start to develop.

“If we were to have a device like this, which is being trialed in rugby — and obviously rugby has a lot more money than cycling — then it’s something that you could use by the side of the road. I was talking to a company last week called HIT, which makes a small device that you can stick on the back of a helmet, and it measures a hit against the ground.

“Realistically, we know when somebody’s taken a hit, but it’s not about that. We saw with George Bennett when he hit the ground [at Paris-Nice 2021], he clearly had a concussion, and everybody seems to deny he had a concussion. He was so adamant he was fine, and he clearly should not have gotten back on his bike. The problem is bike racers simply don’t understand the impact, they just want to race. I’ve been stupid enough in the past to just get back on my bike and you see the impact of that and you learn your lesson. You realize that at the end of the day, it’s just a bike race, and there are plenty more, but you’ve got one brain.”