|
Head Injuries in Triathletes
Allen DeLaney, MD, ME
Mary DeLaney, PT
There are two kinds of bike riders. Those who have crashed and those who will crash!
This year several friends and clients suffered head injuries during training and racing. The most recent was at the end of August. Momentary inattention in a pace line, on a tri bike with forward weight distribution, he hit the front brake first, and Nils hit the ground head first, was briefly unconscious, received a fairly severe facial injury requiring 20 stitches, and ruined a good helmet and sunglasses.
First and foremost, Nils’ helmet possibly saved him a more severe head injury requiring surgical decompression and an uncertain outcome. Second, his bicycle helmet really didn’t protect him against facial injury. Third, his glasses probably caused the majority of his facial lacerations, but since they were polycarbonate, the lens did not break, and so he was spared eye injury. Last, and not least, Nils took our professional advice and is taking time to recover from his brain injury.
The facts:
- The most common serious cycling injury causing death or serious disability is a head injury.
- The force with which you strike the ground is proportional to the square of your speed. You go twice as fast, you hit the ground 4 times harder.
- Risk of serious injury is only partly related to your speed, as you can experience serious or fatal head injury practicing wheel stands.
- USA Cycling, UCI, and USAT require buckled helmet use.
- Mandatory cycling (and motorcycle) helmet laws dramatically reduce the availability of cadaver donor organs for transplant.
- Regular use of a buckled bicycle helmet reduces your risk of a serious head injury in a bike accident by about 75%! Also, IF you are in an accident and are struck by a car, you are 14 times more likely to die if you are not wearing a helmet.
- Bicycle helmets do not protect you from facial injury.
If you search the internet, you will find arguments suggesting helmets actually increase certain injury rates. We know from personal knowledge that simply is not true. The head injury statistics in states with mandatory helmet laws are an overwhelming argument for helmet use.
There are a few other things you should know about helmets. Buy helmets certified by the ANSI. Foam is the energy-absorbing material and also only good for one crash. Helmets with coverings glued to the underlying foam may provide increased protection. An unbuckled helmet is worthless in a crash. Helmets have a limited lifespan. After 3-4 years you should get a new one. The foam, over time, degrades and becomes brittle.
MTBI is a brain injury that results in temporary loss of normal brain function caused by a blow to the head. Cuts or bruises may be present on the face, but often there are no signs of trauma. Many people assume that concussions must involve loss of consciousness, but that is not true. Concussion or Mild Traumatic Brain Injury (MTBI) is a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma.
People with concussions often cannot remember what happened immediately before or after injury, and may act confused. MTBI can affect memory, judgment, reflexes, speech, balance, and muscle coordination. Nils had brief memory loss, and does not remember his accident. Even mild concussions should not be taken lightly. Brain injury experts emphasize that although some concussions are less serious than others, there is no such thing as a "minor concussion." In most cases a single concussion should not cause any permanent damage. A second blow to the head before the brain has completely healed does not have to be very strong for deadly or permanently disabling effects. This is called the “second impact syndrome.”
Previous recommendations about returning to sport understate the time needed to recover. Not only should you have no symptoms at rest, but higher brain function must be completely normal before you are completely recovered. This may take one day or 6-12 months. When you feel completely normal, then progressive trials of activity should not cause dizziness, headache, ANY problem with balance or coordination, or post-activity sleepiness. If you aren’t thinking 101% clearly while exercising, STOP! IF you have any of the MTBI symptoms, then you are not recovered, and must wait and rest. You may exercise only below the point of causing any symptoms, and must, above all else, avoid another blow to your head! There is no medical agreement yet on the best test to use to determine if you are completely recovered. Medical advice is best sought from an expert in brain injury.
When you have a bike wreck, one question is whether or not expert medical advice should be sought immediately. Obviously, any significant laceration means a trip to the ER. Facial lacerations heal well if treated expertly within 6 hours or so of the injury. The tremendous blood supply is the force behind fast healing, but also responsible for even minor facial lacerations making you look like you were on the loosing end of a swordfight. IF the cut is through the skin, or involves the eye, ear, or nose, then seek medical attention ASAP.
With regard to head injury, symptoms determine the diagnosis of concussion. Lack of memory of the accident, headache, confusion, and loss of fine motor coordination are all good indicators of the need for a trip straight to the ER. Another reason to be safe rather than sorry is the phenomena of epidural hematomas. With an epidural hematoma, the injured cyclist may appear to be OK, but continued bleeding inside the head can result in death. There may be as little as 30 minutes to make the diagnosis and start surgical decompression. This happened to an actress last winter in a skiing-related head injury. She and her companions refused medical care initially, and thereby doomed her. Oh, she wasn’t wearing a helmet!
In summary, simply wear a buckled helmet! If you have kids and make them wear helmets, but you don’t, then what do you expect them to do when you are not around. That’s right! They will follow their parents’ example and ride without a helmet.
|
|
