There is no such thing as “just” concussion

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I was lying on the ground, sucking in a huge gasp of air to replace all that had been rudely knocked out, not really sure of what had happened. One moment I was riding toward the one really tiny simple jump on a fairly tame piece of singletrack ten minutes from home. The next, my leisurely Sunday afternoon solo mountain bike ride was brought to an abrupt end as I found myself lying in the dirt with little idea of what had just gone wrong.

Whatever it was, one thing was obvious – apart from the fact that my landing technique needed work – I’d fallen hard and broken that fall with my head.

The thoughts started whirring about what the consequences could be. Laying there for a minute making a mental tally of the damage seemed a sensible move and the realisation that while it hurt I could move and get up was one heck of a relief. It could have been so much worse.

I glimpsed at my mountain bike to see if I could safely ride it, slowly with one arm, to the nearest road where in a post-crash call I’d arranged for my husband to pick me up. He grabbed my bike, put it on the roof and helped me ease my way into the car, taking my helmet off for me as he did. I saw his face go a little pale as he looked at the damage to it. That was the moment that a trip to hospital was no longer a question, but a certainty.

It was onto hospital, X-rays, CT scans and the intimidating neck brace. Luckily after a few hours came the sheer relief of being allowed to take off the brace and the news that there was nothing broken and nothing drastic showing up in the scans of my head. I would just have to deal with concussion.

Why you should always wear your helmet! #airgonewrong but I’m fine.

A post shared by Simone Giuliani (@sim1giuliani) on

I was buoyed by a wave of relief at how lightly I seemed to have got out of that one. After a couple of days of taking it easy, I thought,  it’ll be fine. Turns out I was wrong.

Those post-accident delusions

At home that night I was already optimistically starting to think about maybe still doing the Ella ride up the back of Mt Donna Buang planned for the following weekend. It was one I’d been helping organise on a favourite route, with a fantastic bunch.

The back of Mt Donna Buang delivering the goods for the Ella CyclingTips ride today. ????: @besnz #ellarides #repost

A post shared by Ella Cyclingtips (@ellacyclingtips) on

With such a tempting ride on the cards it was hard not to buy into the mindset of toughing it out and getting straight back into it — a mindset which so often prevails in sport. But when I went to my regular doctor the next day those thoughts of a quick return to riding were firmly put out of my head.

Second impact syndrome, with its high fatality risk, wasn’t something I wanted to even think about opening myself up to. No riding for at the least six weeks was the verdict so a month and a half of planned fun evaporated. Thoughts still focussed on being able to get back on the trainer in a couple of days to maintain some fitness.

But as the days from the accident passed and as the pain from the beaten up shoulder and neck started to ease, the thoughts that I had come through a relatively solid accident unscathed – because it was just concussion – quickly started to dissolve as I lived with what “just concussion” could feel like.

Yes, I was lucky to not be dealing with worse, but as time went by the last thing I was worried about was my dwindling fitness. It was all I could do to just hold myself together and keep some tiny semblance of a work and family life. The symptoms weren’t going anywhere fast and there was more to worry about than whether or not I could ride my bike.

Headaches, nausea, spider webs or blurred patches before the eyes and the inability to concentrate on more than one thing at a time – a bitter blow for a proud multi-tasker – and complete physical exhaustion after small mental or physical efforts.

Work was confined to short bursts from home. Not only could I not concentrate but after a little while I couldn’t even see the screen properly. There was no way I could rely on my self-editing skills at this point, so my extremely helpful colleagues without question jumped in to cover gaps, take on the time-sensitive work and cast an eye over what I had done before it went out.

The biggest shock was when, a week after the accident, feeling like I had made considerable progress, I pursued an interview with the trail blazing ultra-endurance racer Juliana Buhring after she had decided to restart the 5,500 kilometre Indian Pacific Wheel Race after having to stop for a medical emergency.

https://cyclingtips.com/2017/03/julianas-buhring-restarting-indian-pacific-wheel-race-1100km/

There were no shortage of questions to ask, plus, she was such a friendly and easy-to-talk-to interview subject with a compelling story to tell. Nevertheless, I got off the phone completely shattered. Just the concentration required to engage in half an hour of conversation was enough to make me want to go to bed, turn off the lights and shut out the world.

I had the concentration of a gold fish. All of a sudden Twitter was my favourite medium — it’s hard to lose track of your train of thought when you’ve only got 140 characters to play with.

And it was hard to talk about the crash and the concussion. I told the people at work that needed to know, but initially didn’t really make much mention of it to that many others. It was hard to explain – perhaps even to myself. Once the bruises on the side of my face cleared there was no visible damage and no clear-cut, simple explanation that it’s broken so needs this many weeks to heal before use.

If I’m being honest with myself, there was also more than a hint of embarrassment both about the accident and that I couldn’t find a way to overcome the after-effects. Plus, I just didn’t have the energy as every conversation and social interaction, be it in person or on social media, took a toll so it was easier just to avoid those that weren’t absolutely necessary.

Wishing for a broken collarbone

It’s been enough to make me wish, more than once, that I had broken my collarbone instead. There seems little worse to me than in any way damaging one of the things most precious to me: my ability to think. In the past, when facing illness and injuries that have stopped me in my tracks, I’ve been able to mentally find a path through, work out ways to function and keep my spirits up. It isn’t easy to think your way through the difficulties when it’s your brain that’s the issue.

Not only could I not problem-solve easily, but it was hard to simply find a way to explain my situation, or sometimes even remember to do that one simple task one of my children had asked me to help with. Even the slightest distraction was enough to make me forget. I didn’t feel like myself and hated the fact that the inability to remember or complete tasks made it constantly feel like I was letting everyone down – family, colleagues, friends and myself.

The way my mind was operating felt like the difference between watching a professional cyclist glide effortlessly uphill on her light responsive bike and watching an overweight, unfit rider on an old heavy steel bike with three gears turn red and sweaty as they strain every fibre of their being to make it to the top. The two riders may both get there in the end, but one in a much slower and messy fashion, with nothing left in the tank to then take on the next hill further up the road.

It’s now more than six weeks since the accident and I still mentally have more in common with the unfit steel-framed-bike rider, but at least those metaphorical mental muscles are slowly starting to redevelop. Sometimes there is the ability to get to the top of that first hill and at least have the energy to contemplate taking on a second.

I don’t know how long it’ll be until I feel back to normal and how long it will be before my doctor gives me the okay to ride my bike. But I do know I’ll be taking it cautiously and there’ll be no pushing to do it a second before the medical all-clear.

I’ll never put the word “just” in front of concussion again

It can be hard to accept that your mental function is impaired and keep your chin up through the process – in fact studies have found that the incidence of depression increases with patients who have suffered a concussion. But for me it probably would have been easier if I had have been better prepared. Prepared for what the symptoms could be and with more knowledge that it could be a drawn-out process.

There is undoubtedly an increasing awareness of the potential ramifications of concussion in sport generally and cycling at the professional level, demonstrated by reports like that of Nacer Bouhanni being withdrawn from competition for an indefinite period following a recent concussion. There has also been plenty of guidelines published about concussion management. However, as most are targeted at sport management my view was still coloured by a perception that “just” having concussion was somehow the easy way out with the main ramification not being able to ride for a while.

I was clearly not alone in this. Time and time again people said to me “Aren’t you lucky to get out of that crash with out any breaks and only concussion?!”, as if concussion were a triviality. It’s something also expressed too often in social media, with tweets to concussed athletes along the lines of “glad it was nothing worse”. I suspect those like Carmen Small who are still dealing with the impacts of concussion months after a crash, and trying to do whatever they can to overcome it, see concussion as anything but a trivial injury.

Next up #electroshock therapy… we are trying everything and hopefully something works! #concussionssuck #usoc #otc

A post shared by Carmen Small (@smallscoaching) on

That’s part of the reason why I felt compelled to write this. It’s just my experience, and many have had an easier run with concussion and many a much harder one. But it is an issue that has an impact on professional and recreational athletes alike and something that can certainly have ramifications right across your life. Since hitting my head so many others have told me stories of dealing with the impact of a concussion. The hardest to hear being of those who initially weren’t given the required support to recover and years later are still wearing the impact.

Those stories highlighted the importance of awareness and understanding of the potential implications and seriousness – not only by the injured person themselves but also those around them. Certainly my experience is that while dealing with concussion my judgement about capabilities and injury management has been well below its best.

In hindsight I could have done much better in those early stages, but know that I would certainly have done much worse without sensible and supportive people around me. This has left me with no doubt about the importance of strong guidelines and education for dealing with concussion in both professional and recreational sport. If ever there was a time that clear-cut, well-thought-out procedures and controlled decision-making was desirable it’s when you are dealing with a concussed person.

Shortcuts just aren’t worth it when it comes to your head so if presented with the possibility of concussion, follow the guidelines set out by authorities: seek medical attention and please don’t ever, ever brush it off as “just” concussion.

 You can find the USA Cycling concussion guidelines here and the Australian Institute of Sport and Australian Medical Association website on concussion can be found here

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