‘It’s All Downhill from Here’: A Scoping Review of Sports-Related Concussion (SRC) Protocols in Downhill Mountain Biking (DHI), with Recommendations for SRC Policy in Professional DMB

Abstract

Introduction: Downhill mountain biking (DHI) is a form of cycling and does not currently have a specific sports-related concussion (SRC) assessment. Objective: To review the extent, range and nature of research investigating SRC in DMB, provide a summary of key literature findings relating to its identification and management, and then develop a SRC protocol specific to DMB. Design: Scoping review as per recognised methods. Setting: Literature-based. The following databases were searched: MEDLINE, EMBASE, Scopus and Web of Science, with no restrictions on date. Results were limited to the English language. Participants: Six articles were included in the review from 64 identified articles. The article had to specifically include an analysis of adult downhill riders for inclusion. Outcome measures: Study type, study group (amateur/professional), concussion incidence, concussion assessment and recommendations. Main Results: Concussion incidence was identified as between 5–23%. No study outlined a trackside assessment of cyclists or a protocol for return to play where SRC was identified. Several authors identified that riders often continued to participate despite the presence of a concussion. No sport-specific SRC assessment was determined for DHI, and a SRC assessment was therefore developed. Conclusions: This review illustrates the lack of studies and formal protocol in SRC assessment for DHI. In light of this, we propose a three-stage framework specific to the sport to best identify a concussion and act where appropriate while minimising disruption to competition. This framework involves assessing the cyclist on the ‘sideline’, a second assessment post-event in the medical room and a third assessment the following day. A SRC consensus meeting specific for DHI is suggested with an identified need for updated guidance from UCI, requiring possible rule changes for the sport.

The downhill race for a Rainbow jersey. The Epidemiology of Injuries in Downhill Mountain Biking at the 2023 UCI Cycling World Championships using the International Olympic Committee Consensus: A Prospective Cohort Study

“…There have been recent calls for action around the diagnosis of concussion within DHMTB. [49] Our findings highlight a lower incidence of concussion injury (n=3) in racing compared to training (n=6), arguably linked with the diagnostic challenges of making this diagnosis. [49] Our findings raise the question of whether there is a link between neck strength and concussion in individual sports.…”

“…[49] Our findings highlight a lower incidence of concussion injury (n=3) in racing compared to training (n=6), arguably linked with the diagnostic challenges of making this diagnosis. [49] Our findings raise the question of whether there is a link between neck strength and concussion in individual sports. [55] Compared with male DHMTB athletes, female DHMTB athletes were found to have a significantly greater RR of neck injury.…”

“…However, the reported incidences of concussion vary significantly within MTB cycling, with an incidence as low as 5% being reported; this incidence is arguably linked to diagnostic challenges and variability in course styles and competition demands across MTB disciplines. [5, 35, 49] Some authors have reported that female athletes are more susceptible to concussion and have more prolonged symptoms after concussion. [50] Among female cyclists, 3.7/1000 hours had a concussion incidence rate within the race, similar to the overall 3.9/1000 hours seen in enduro racing.…”

A call to action: the need for concussion assessment and diagnostic protocols for use in the different elite cycling disciplines, including paracyclists

“…All individual cycling disciplines (and subdisciplines) need to develop a concussion diagnosis and assessment protocol unique to the individual demands of their sport. Some of this work has already begun with initial protocols developed in the road, 5 downhill mountain biking 6 and track cycling, 7 but this needs to be expanded into the other cycling disciplines, particularly the para-sport events. This work should be coordinated by the UCI, being aware of the individual cycling discipline regulations, which may require rule changes, with appropriate monitoring by the UCI to ensure that any non-compliance with the new protocols or abuse of the system is appropriately penalised.…”