In our cycling practice, we have helped hundreds of Florida cyclists after a bike crash. The most common injury we see after a cycling accident is a concussion.
What is a Concussion & How are They Classified?
A concussion is a type of mild traumatic brain injury or mTBI. According to the World Health Organization, TBI is the leading cause of death and disability in individuals below the age of 45. In 2013, the Centers for Disease Control and Prevention (CDC) estimates that 2.8 million TBI-related emergency department visits, hospitalizations, and deaths occurred in the United States. In 2012, an estimated 329,290 children (age 19 or younger) were treated in emergency departments for injuries that included a diagnosis of concussion. Car accidents, bicycle accidents, falls, and sports-related injuries are common culprits of concussions.
A concussion is a type of TBI caused by a sudden bump, blow, or jolt to the head or body that causes the head to rotate and move rapidly back and forth stretching and damaging tiny, fragile, nerve fibers, called axons, in the brain. Contrary to what many people believe, a concussion is not a “bruise” to the brain after bumping the head. It is an actual disruption of brain function. Brain injuries are classified into three categories: mild, moderate, and severe. Classification depends on criteria present at the time of injury such as loss of consciousness, alteration in mental state, and structural damage to the skull. A concussion is classified as a mild traumatic brain injury; not because the injury is minimal or insignificant but because the injury occurs either without loss of consciousness or, if one loses consciousness, less than 30 minutes, and leaves the skull intact because there is no penetration of the skull and/or brain. In fact, there is often no outward physical sign of injury to the head itself because of the mechanism of injury. The damage is inside.
Concussion Myths & Tests
This “invisible” injury often leaves a person unsure whether they have sustained a concussion after an accident or fall. Several myths (discussed below) surrounding concussion also contributes to one’s uncertainty. There is a lot of valuable information out there but there is a lot of misinformation as well. All of this combined can leave a person wondering, how do I know if I have suffered a concussion? Many people will start their journey to discover if they have suffered a concussion by utilizing a free concussion test online. A concussion test or concussion quiz online can help a person identify and quantify their symptoms, the severity of their symptoms, and length of time their symptoms have persisted. Every person is unique, and every head injury is unique. Sustaining a concussion can result in a wide range of symptoms including memory loss, blurred vision, dizziness, balance disorders, confusion, sensitivity to light and sound, headache, nausea and vomiting, changes in sleep patterns like fatigue, insomnia, or excessive sleepiness, changes in mood, irritability, crying spells, sadness, anxiety, and depression, trouble concentrating, focusing, finding words, and communicating, etc. Despite the wide range and variation of symptoms, a well-written, “do I have a concussion quiz,” available from a reputable and knowledgeable source can be a valuable tool to help evaluate the likelihood of concussion.
Despite massive concussion research and efforts to educate the public of this serious, yet highly misunderstood, public health threat, several myths surrounding concussions still exist. One myth is that you need to lose consciousness to sustain a concussion. That is simply untrue. In fact, most people who sustain a concussion do not lose consciousness. Others may lose consciousness for a mere matter of seconds. An unawareness of your surroundings, confusion, or altered mental state is a form of losing consciousness. Loss of consciousness does not need to rise to the level of being knocked out cold for several minutes. According to the International Concussion Society, less than 1 in 10 people with concussion lose consciousness on impact and 90% of sports-related concussions occur without the individual losing consciousness.
Another myth is if you were wearing a helmet during your accident or fall, you were protected from a concussion. This is one of the most dangerous myths. Traditional helmets are not designed nor intended to protect against a concussion. Traditional helmets were designed to protect against skull fractures. Many people are wearing traditional helmets when they sustain a concussion. Traditional bicycle helmets, popular with kids and adults, are not designed to prevent concussions. Even the newest technology implemented in bicycle helmets does not guarantee it will prevent a concussion. Manufacturers of this technology advertise that the technology can minimize but not remove the risk of concussion.
What if a person did not hit their head? This myth teaches a person could not have sustained a concussion because they did not strike their head in an accident or fall. This is completely untrue. Blows to the body (especially the torso) can result in concussion. A concussion can be caused by a sudden bump or jolt to the body that moves and rotates the head, like whiplash from a car accident, falling down the stairs, running into someone, falling off a bicycle, tripping or falling, being shaken violently, etc.
A person may also second guess whether they have sustained a concussion if they feel “fine” the next day. Some concussion symptoms are immediate, but some can develop over days to weeks after the accident. This is because a concussion is just the start of what doctors and scientists call the neurocascade after concussion. It simply means that the initial injury sets in motion a series of biological and chemical reactions deep inside the brain that may not be seen or felt for days or even weeks after the initial injury.
Finally, a person who has gone to the ER after an accident or injury and had an x-ray or MRI performed that was normal is often sent home without a diagnosis of concussion. The truth is x-rays and MRIs are not sensitive enough to detect the functional changes occurring deep inside the brain after a concussion. An x-ray is used to determine broken bones or a skull fracture. An MRI can reveal the structure of the brain but not how the brain is functioning. It is unfortunately not uncommon for a person with a concussion to have normal results on these diagnostic tests and be sent home with a missed concussion diagnosis.
Be Sure to See Your Doctor if You are Experiencing Symptoms of a Concussion
With all the myths surrounding concussion, it is normal for a person to second guess and wonder, do I have a concussion? If you have been involved in an accident or fall, if you are experiencing the symptoms of a concussion, or you have completed a concussion quiz or concussion test online and think you may have sustained a concussion, it is important to see your doctor. Even though there is no single, definitive concussion test, your doctor can diagnose a concussion based upon your mechanism of injury and your symptoms.