What do we already know?

Concussion is a mild traumatic brain injury caused by a direct or indirect force transmitted to the brain

  • Around half of people affected by concussion have ongoing symptoms for months or years

Cycling activities include road of track racing, BMX, mountain biking, commuting, and triathlon

  • Nearly 1 in 10 injuries from cycling is concussion

Helmets reduce effects of serious head injury through protecting against skull fractures, head lacerations, and penetrating injuries

  • However, not all helmets offer protection against the rotational and shearing forces that often cause concussion

Current evidence and guidelines on concussion have focused on contact sports

  • There is a need for cycling-specific concussion evidence and guidelines


What did they want to know?

The goal of the study was to determine knowledge, attitudes, and behaviours towards concussion in cyclists, coaches, and managers and to examine gaps in knowledge.


What did they do?

Short online survey distributed to cycling clubs, businesses, and organizations in New Zealand

  • Asked about participation in cycling activities, knowledge about concussion, attitudes, and behaviour with regard to helmet use, return to sport following concussion, seeking of medical treatment, and personal concussion history

672 respondents

  • Were actively involved in cycling as a participant, coach, or manager
  • Average age 48.6 years old (range from age 16 to 82)
  • Cycled for 18.4 years on average and for 7.6 hours in the past week


What did they find?

Concussion frequency

Nearly 60% of participants had experienced at least one concussion


Knowledge of concussion

General knowledge of concussion was high, as well as knowledge of most concussion symptoms

  • Those with prior concussion history were more likely to have higher levels of concussion knowledge


Seeking medical treatment and return to sport

97% agreed that a person should seek medical treatment after injury but only 1 in 3 had always done so in the past (difference between attitude and behaviour)

  • Barriers to seeking medical treatment included not knowing if their injury was severe enough, ability to drive, concerns that doctors would not be able to do anything, and not realizing they had experienced a concussion

56% agreed people should wait until symptoms resolved before returning to cycling and 56% would actually wait until symptoms had resolved (agreement between attitude and behaviour)


Helmet use

98% always wear a helmet when they cycle

  • There was high knowledge that helmets help to absorb the impact of a fall and reduce the risk of a skull fracture
  • Only 13% were aware that helmets were not able to prevent concussion

90% agreed a helmet should be replaced after a fall, but 37% had continued to ride in a helmet after a fall (difference between attitude and behaviour)

  • Reasons for not replacing a helmet included cost, seen others riding in damaged helmets, and lack of perceived need to replace if no obvious damage

Only 1 in 5 participants had been taught how to fall to reduce the risk of injury


What does this mean?

Cyclists generally have a high level of knowledge about concussion, but knowledge about the function of helmets was low

  • Cycling-specific public health messaging is needed, as well as promotion of new helmet technology (e.g., MIPS) designed to reduce the impact of rotational and shearing forces
  • Training on how to fall to reduce risk of injury should be widely available

Although cyclists agree medical treatment should be sought after injury, very few actually do so

  • As well, sports concussion guidelines are frequently developed from research on contact sports
  • Concussion guidelines that consider the unique needs of cyclists (e.g., not wanting to lose time in a race after a fall, concussion from rotational forces) are needed




O’Reilly, M., Mahon, S., Reid, D., Hume, P., Hardaker, N., & Theadom, A. (2020). Knowledge, attitudes, and behavior toward concussion in adult cyclists. Brain Injury, 34(9), 1175-1182.


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