Concussions in Cycling: Knowledge and Attitudes


A big change in sports is that concussions are no longer just laughed off as getting your bell rung. However, knowledge and attitudes about concussions can vary greatly across different sports. Let’s take a look at what cyclists know and think.

Bagioli and Kwiatkowski
Crash for Bagioli and Kwiatkowski

I started out cycling in the mid-80s in the earliest days of cycling helmets, with the nearly 900 g Bell Biker strapped to my noggin. Since then, cycling helmets have improved massively in lowering weights down to less than 1/3 while greatly improving protection, ventilation, and looks.

At the same time, scientific awareness about head injuries has undergone a similar revolution. No longer are concussions or traumatic brain injuries restricted to clear overt trauma like with car accidents and actual head injuries. Improved imaging technology has permitted greater insights into what is actually happening within the brain.

Finally, another major improvement is that society is actually understanding concussions and willing to talk about it in the open. For example, I have colleagues who are studying traumatic brain injuries from domestic violence, where causes can include both head injuries but also excessive shaking.

Hurst et al. 2019

In cycling, the risk of head injuries and concussions are obviously high. Not just in cycling but most other high-speed or risk sports (skiing, skateboarding), helmets are now just something that participants put on without a second thought.

But just because we strap on a helmet, it doesn’t mean that we’re immune from concussions or that we are fully conversant on their symptoms and consequences. Therefore, I was part of a research group that performed an online survey to study what the collective knowledge and attitudes about concussions are amongst cyclists across a wide range of abilities (Hurst et al. 2019). Descriptive studies like these are important because the first step in developing countermeasures is to understand the issues and gaps that you’re dealing with.

Stephen Cheung showing how to wear a helmet with class

Here was the study design. A shout-out to the Pez readers who participated in this survey in 2018!

  • 1990 responded to the online survey. Note that racing was NOT a requirement, and the survey was also open to support staff (e.g., coaches, directors, medical support). All disciplines of cycling were permitted.
  • The survey was adapted to cycling from the RoCKAS survey originally designed for field sports.
  • Section 1 involved demographics and concussion incidences. Sections 2-3 concerned concussion knowledge, including 20 questions about potential symptoms (10 true, 10 false) and 13 knowledge statements. Section 4 consisted of attitude questions.

What’s the Score?

What were the results from this survey?

  • We were hoping for a really diverse sample and we got it. We had at least 45 participants from each continent, and riders of all disciplines, racing interests, abilities, and experience levels. As an example, we had ~50% who didn’t race (935) through to 101 elite/professionals. Meanwhile, around 75% were athletes with the remainder in other cycling roles.
  • About 26% of participants responded that they’ve experienced a formal concussion diagnosis. Interestingly, 32% reported that they suspected a concussion that wasn’t formally diagnosed. This represents a huge gap between suspected and formal diagnosis, which should be a red flag for both better education and policies for obtaining formal medical assessment. It could also represent a gap in accurate assessment of concussions.
  • Mean score for the concussion knowledge index was quite high (25.9 out of max 33). The most common incorrectly identified symptoms were “sharp burning pain in neck” (true, 39.9% correct), “weakness in neck movement” (false, 42.5% correct), and “abnormal sense of smell” (false, 47.8% correct). The most misidentified statements concerned imaging showing direct evidence of concussion (false, 44.9% correct) and people with one concussion being more likely for subsequent ones (true, 72.3% correct).
  • In terms of attitudes, a large majority (>90%) agreed with statements about the: 1) importance of education about concussion signs and symptoms, 2) information on concussion prevention, and 3) not participating in events while experiencing concussion symptoms.
  • Of major concern were the risky behaviours/attitudes which had high responses. Notably, 16.3% responded that they continued participating in a cycling event even despite experiencing concussion symptoms. Furthermore, 18.7% responded that they would hide concussion symptoms from others to continue participation.


The biggest highlight and finding from our study was that, in an international and diverse group of cyclists, concussion knowledge was generally pretty good. This suggests that education about the basics has been well done.

Where the biggest shock came was that, despite a good knowledge base, the attitude towards actual safety concerning concussion is still lacking. It’s a very sharp contrast that a very large majority (91.8%) agreed that it’s important to discontinue training/racing when experiencing concussion symptoms, 16.3% still DID continue, and an even higher proportion would hide symptoms to continue.

Thus, we concluded that the focus shouldn’t be on just more education on the fundamentals of concussion, but examining the systems whereby there exists incentives to continue cycling even while experiencing concussions. This is of course the much more difficult route than just more education, and will involve many layers and levels of stakeholders within the sport.

Ride safe and have fun!

Concussion for Van Garderen in la Vuelta


Hurst HT, Novak AR, Cheung SS, Atkins S (2019) Knowledge of and attitudes towards concussion in cycling: A preliminary study. J Sci Cycl 8:11–17

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