‘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
:1. Introduction
2. Aims
- Review the extent, range and nature of research that has investigated SRC in downhill mountain biking;
- Provide a narrative summary of the key literature findings in relation to methods for identifying and managing SRC in downhill mountain biking (including a return to play recommendations); and,
- Where absent, develop protocols to identify and treat SRC in downhill mountain biking.
3. Methods
- Specific population group: cyclists, recreational and professional/elite;
- Participants aged 18 years or above and all sexes;
- Participants from downhill mountain biking;
- Research that addresses any aspect of concussion-related to the sport;
- Sources of information could include primary research studies, reviews (including but not limited to scoping reviews, systematic reviews, and meta-analysis), case reports, conference papers;
- Articles written in English.
- Studies not published in English;
- Inability to access the full-text research article;
- Opinion pieces/opinions, commentaries, consensus papers, magazine, and newspaper articles;
- Articles not directly related to downhill mountain biking.
Search Strategy and Databases
- Author;
- Year of publication;
- Journal/source of publication;
- Aims/purpose of the study;
- Study populations, including the performance level of the athletes, included in the study;
- Study design;
- Intervention type and duration (if applicable);
- Outcome measures and details of these (if applicable);
- Important results related to the scoping review research question.
4. Results
4.1. Identification of Studies
4.2. Study Characteristics
5. Discussion
5.1. Concussion Incidence
5.2. Current Guidance for Concussion Assessment
5.3. A Framework for Managing SRC in Downhill Mountain Biking: RIDE-DHI
- (a)
- An assessment for the presence or absence of 12 Immediate and Permanent Removal features that, if present, warrant immediate and permanent withdrawal from the competition;
- (b)
- In the absence of any of the 12 Immediate and Permanent Removal features, a standardised roadside screening assessment, including symptom checklist, medical evaluation, balance assessment and cognitive tests performed by the race doctor and/or team doctor;
- (c)
- Clinical evaluation by the race doctor and/or team doctor.
- 1
- Convulsion;
- 2
- Tonic Posturing;
- 3
- Suspected loss of consciousness;
- 4
- Confirmed loss of consciousness;
- 5
- Cleary dazed;
- 6
- Ataxia;
- 7
- Oculomotor signs;
- 8
- Rider not oriented in time, person or place (TTP) or fails to complete orientation questions;
- 9
- Definite confusion;
- 10
- Definite behaviour change;
- 11
- Identification of any sign or symptom of concussion;
- 12
- High risk features.
- ○
- What is the name of this race or track?
- ○
- How far are you from the finish line?
- ○
- What is the name of your racing team? An alternative if not part of a race team: where is the race taking place (city and country)?
- ○
- What position are you seeded/what is your order in this race?
- ○
- What is your coach’s name?
5.4. Future Direction
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Search Strategy
1 | Brain Concussion/or concussion.mp. | 15,156 |
2 | sport.mp. or Sports/ | 65,467 |
3 | 1 and 2 | 2992 |
4 | mountain biking.mp. | 180 |
5 | Downhill mountain biking.mp. | 12 |
6 | 4 or 5 | 180 |
7 | 3 and 6 | 4 |
1 | Brain Concussion/or concussion.mp. | 18,109 |
2 | sport.mp. or Sports/ | 116,043 |
3 | 1 and 2 | 6765 |
4 | mountain biking.mp. | 210 |
5 | downhill mountain biking.mp. | 9 |
6 | 4 or 5 | 210 |
7 | 3 and 6 | 10 |
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Author, Year | Study Title | Type of Study | Sport | Amateur/ Professional | Concussion Incidence | Concussion Assessment | Continued to Participate? | Recommendations | Notes |
---|---|---|---|---|---|---|---|---|---|
Kronisch, 1994 [31] | Traumatic Injuries in Off-Road Cycling | Retrospective, cross-sectional survey | Cross-country, downhill and dual slalom mountain biking | Amateur | 5.6% (3/54) | - | - | - | - |
Kronisch, 1996 [32] | Acute Injuries in Off-Road Bicycle Racinig | Descriptive, prospective | Off-road/downhill mountain biking | Professional | 25% (4/16) of those injured overall (3624) | - | - | - | 5/834 specific to downhill injured overall. Most serious injuries occurred in DHI. |
Kronisch et al., 1996 [33] | Acute Injuries in Cross-Country and Downhill Off-Road Bicycle Racing | Retrospective Analysis | Downhill mountain biking | Professional | 9% (1/11) | No | - | None | - |
Becker et al., 2013 [16] | A Prospective Study of Downhill Mountain Biking Injuries | Prospective survey | Downhill mountain biking | Amateur and Professional | 5% (23/494) 249 cyclists, 494 injuries | - | 2 cyclists with concussion | Improved protective equipment and safer downhill trails | Higher injury rates among professionals |
Clark et al., 2021 [34] | Do Mountain Bikers Know When They Have Had a Concussion and, Do They Know to Stop Riding? | Retrospective Survey | Downhill mountain biking | Professional | 6.9% (15/219) diagnosed 12.8% (28/219) concussion symptoms OR 1.24 for downhill vs. cross-country | SCAT 5 via anonymous survey post-competition | 67.5% Yes | Event organizers should implement mandatory sideline concussion protocols & encourage mountain bike advocacy groups to develop concussion sensitization programs that will educate riders | 1/3 did not recognise concussion 5× risk of concussion in sponsored athletes |
Willick et al., 2021 [35] | The National Interscholastic Cycling Association Mountain Biking Injury Surveillance System: 40,000 Student-Athlete-Years of Data | Prospective study | Downhill mountain biking | Amateur (Student Athlete) | 23.6% | Not documented | Not documented- 71.3% of all injuries were unable to continue (not only head injury) | None- alluded to ≥4 weeks exclusion for confirmed concussion | 55.5% of all injuries occurred while riding downhill Concussion commonest injury |
Stage | Aim | Activity | Goal |
---|---|---|---|
Initial Rest Period. Should Be Symptom-Free and Have Returned to School/Work/University Activities before Progressing to Stage 1. | |||
1 | Symptom-limited activity | Daily non-symptom-provoking activities | Gradual reintroduction of work/school activities |
2 | Light aerobic exercise | <15 min of duration. Walking or stationary cycling at a slow to medium pace. No resistance training. | Increase heart rate. Heart rate to be less than 70% of maximum. |
3 | Sport-specific exercise | Less than 45 min in duration. Cycling drills on smooth terrain. Sprints on stationary bike. | Add movement. Heart rate to be less than 80% of maximum. |
4 | Non-contact training drills | Less than 60 min in duration. Harder training drills, e.g., introduce downhill terrain at submaximal effort or obstacle courses/sharp turns on smooth terrain. Begin progressive resistance training. | Exercise, co-ordination and increased thinking. Heart rate to be less than 90% of maximum. |
5 | Full contact practice | Following medical clearance, participate in normal training activity | Restore confidence and assess functional skills by coaching staff. |
6 | Return to sport | Normal mountain bike training and competition. |
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Share and Cite
McLarnon, M.; Boyce, S.H.; Fisher, N.; Heron, N. ‘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. Int. J. Environ. Res. Public Health 2022, 19, 12281. https://doi.org/10.3390/ijerph191912281
McLarnon M, Boyce SH, Fisher N, Heron N. ‘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. International Journal of Environmental Research and Public Health. 2022; 19(19):12281. https://doi.org/10.3390/ijerph191912281
Chicago/Turabian StyleMcLarnon, Michael, Stephen H. Boyce, Neil Fisher, and Neil Heron. 2022. "‘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" International Journal of Environmental Research and Public Health 19, no. 19: 12281. https://doi.org/10.3390/ijerph191912281