Mountain Bike Concussions Explained [Podcast #129]

On this Episode

With concern about concussions and traumatic brain injuries growing in sports like football, we explore how the bike industry is poised to deal with this serious issue. We start our conversation by explaining what concussions are and how they are caused. Then, we talk about how bike helmet designs seek to address the risk of concussions, and what this risk could mean to the future growth of mountain biking.

A transcript of this conversation can be found below.

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Jeff: Hey everybody welcome to the singletracks podcast. My name is Jeff and today Greg and I are going to be talking about head injuries among mountain bikers. This is a pretty serious subject but one that we think we can share some good information about, but we have to say at the very beginning here that we’re not doctors. Obviously we are mountain bikers, and so as such we’re not giving any kind of medical advice or treatment advice or anything like that. So just take what we have to say as information only. And again this is information that we have gathered in our research and experience. So we’re going to be talking specifically today about concussions and traumatic brain injuries. What the symptoms and signs are, what some of the causes are, and then the things that are being done to prevent or treat those injuries. We did a similar podcast episode about helmets where we dived into some of this but this is going to be a more detailed discussion. So let’s get started. So to start off Greg, what is a traumatic brain injury or TBI?

Greg: Basically TBI cover all sorts of impacts and injuries to the brain it can be minor up to very serious. According to Wikipedia TBI can result in physical cognitive social emotional and behavioral symptoms. And you know you can easily recover completely or it could lead to permanent disability or death. So TBI is a pretty broad term.

Jeff: Yeah definitely. And it’s a term we’re hearing in the media these days as well, especially as it relates to football players. There’s been a lot of research and there have been cases of people who are injured who have exhibited a lot of these behaviors that weren’t really understood before. You know people’s personalities seem to change. And yet there’s a lot of things associated with TBI that we’re seemingly just starting to discover. So let’s drill down a little further. You know most people aren’t going to get a full on traumatic brain injury the first time out mountain biking, but what about concussions–these seem to be a little more prevalent. What is a concussion?

Greg: So basically a concussion is often referred to as a mild traumatic brain injury or TBI for short. But usually you just hear people say concussion is the most common type of TBI. It’s generally defined as a head injury that results in a temporary loss of brain function. And this can be a very small loss of brain function. It doesn’t need to be much to qualify as a concussion. You know potentially if you hit your head really hard and you have a headache you could have a concussion. But the level of concussion does vary on a pretty big scale. So you’ve got relatively minor ones, and potentially more serious ones.

Jeff: OK. So what causes a concussion? When you hit your head, why do you get concussed.

Greg: So basically you want to think about the brain as basically floating in your head and there’s a bunch of fluid around your brain that essentially keeps it from rattling around too much. But if you hit your head hard enough, or sometimes you don’t even need to hit your head to get a concussion, like whiplash or something of that nature. It jars or shakes the brain inside the skull. So if your brain is floating in the skull imagine your head stops really suddenly and your brain keeps moving. Think about your Newtonian physics. It smashes into the inside of your skull. It bounces back and forth inside of there which is not excellent. Another possible cause of concussion that I just learned this morning while I was using research, is rotation of the brain inside of that cranial cavity which can tear some of the brain’s fibers. So basically your brain moving around in your head is not awesome.

Jeff: Yeah I’m getting a little squeamish just thinking about that. That’s just kind of weird-ing me out. All right. So what are some of the short term effects? You mentioned some of those but how do you know when you have a concussion what happens?

Greg: So again this can vary wildly depending on the concussion. So I’m going to read through you a quick list of potential symptoms; most of these are pulled straight from webMD and run from more severe to less severe generally speaking. So you can lose consciousness in a blackout; if you do that, you’ve probably had a concussion. You can lose your memory, forget events. You have other physical symptoms like nausea and vomiting, headache, fuzzy or blurry vision, dizziness, sensitivity to light or noise, balance issues, or you could feel tired or have no energy. There are also other cognitive issues like not being able to think clearly, not being able to think as quickly as you normally do, not be able to concentrate or remember new things. Your emotions can get messed up, you can get upset or angered, sad, nervous, all sorts of unusual things for yourself.

Greg: You can have other things to do with sleep like you could sleep more than usual or you could sleep less than usual or you can have a hard time falling asleep. It’s just interesting that a lot of the symptoms you know are either end of the extremes of the spectrum. So if you’re really happy or really sad or something like that, well maybe not really happy. But you know major changes you know could indicate a concussion.

Jeff: Yeah, it seems to impact everything which I guess makes sense because your brain controls your body and your emotions and everything. So it’s all kind of tied together.

Speaker 2: Yeah I mean there’s a really good story on the site that I recommend everybody read. It’s a two parter that Michael Paul wrote about his friend Mark who had a pretty serious TBI. And that story is a great look at sort of the immediate effects but also the long term effects these things could have, because lots of times the symptoms don’t just happen right away and then go away. It can have some serious long term effects on your brain. And this is generally called post concussive syndrome, the basic long term things that happen to you. So the big things you want to look for, or all that you could experience rather, are primarily changes in your ability to think, concentrate, and remember. You can have changes in your personality such as becoming angry or anxious. You could have changes in your sex drive, dizziness, lightheadedness, motor function issues, and other things. So those are big long term deals.

Jeff: Yes. So once somebody has a concussion, you know be it a mild one or a more serious one, what are some of the treatments that doctors are going to recommend?

Greg: So the doctor will generally do you know some diagnosing type things they might do things like an MRI to rule out other issues like a brain bleed or other issues related more serious TBI. But after that there’s not a heck of a lot that can be done other than just rest and not overexert yourself. Sometimes you need to be watched shortly thereafter by a family member at home. But if it’s really serious you might need a stay at hospital for a while. But essentially after that that it boils down to not overexerting yourself. This is both mentally and physically. Taking time off from you know big physical activities like biking and possibly time off from work or reducing hours at work. But part of this depends on how long term the issues become. I mean being in the bike industry, hopefully I’m not jumping ahead here, but I’ve known quite a few people who have had serious TBIs and it will impact their work for six months, a year. Like, they will literally only be able to concentrate for say four hours at a time or six hours at a time and won’t be able to work a full schedule. Depending on your job that can be a really really big deal.

Jeff: Yeah, I was going to relate a story about someone I know in the industry who was racing enduro and had a crash, got a concussion and then yeah ended up missing weeks of work. And part of the treatment was basically I mean I don’t I don’t know the full details but it sounded like it was sitting in a dark room for hours at a time and yeah basically like letting your brain rest and repair itself. And then this person came back to work but then was still experiencing issues and had to do another two weeks in the dark room. So yeah it sounds very unpleasant to say the least. So it’s something that we want to avoid. In doing this research., I found that concussions are actually pretty common among cyclists or at least they happen to more cyclists than to people who play football for example.

Jeff: And as I mentioned you know early in the episode, right now we’re hearing a lot about this as it relates to football and the NFL particularly. But in the USA about 47,000 people suffered from traumatic brain injuries due to football, whereas there were about 86,000 people who had head injuries due to a cycling accident

Greg: Was this over a one year period, or a certain period of time?

Jeff: Yeah. This is a one year. This was in 2009. And part of that may be that there are more people who ride bikes than play football, which is totally legit, but it also got me thinking about the nature of the crashes that cyclists are involved in. And you know, you can get going a lot faster on a bike than you can run down the football field.

Jeff: You know, football players are fast but they’re not as fast as bikes, and we’re typically crashing into fixed objects like the ground or a tree or a rock whereas you know football players come bouncing off of another meaty football player. So yeah. that just gives you an idea of how serious this problem is, yet it’s not getting the same media coverage as the football traumatic brain injuries. Greg you actually have had your share of concussions, a concussion or multiple concussions?

Greg: Well that’s actually part of my story. So my most significant head injury was when I was working at a camp in Colorado one summer by guiding. I was waiting for my group to show up because they were late, and I was jumping my bike off of an embankment next to sort of like our meeting spot. And the next thing I remember is being in a bathroom in a nearby building, looking at my face in the mirror covered in blood, thinking that was not a great thing. And then the next thing I remember after that is being in the bike shop next door, looking at our weekly schedule and trying to discern what day of the week it was. And pretty quickly I was like, all right this is not great. I made my way up to nearby ropes course where my girlfriend was working at the time and by that point I figured I had a concussion, you know a pretty serious one. So they stabilized my head and neck called 911, I got an emergency ambulance ride to Denver. Got the MRI I mentioned to check for brain bleed and that’s where it turns interesting. You know the doctor asked if I had had a concussion before and I was like well you know what counts as a concussion? I’m not really sure. I never had done this before. You know and it turns out I’ve likely had many concussions. Having grown up skiing, snowboarding, mountain boarding, mountain biking, if you hit your head and blackout even briefly it’s a concussion. I have done that many times. You know, hitting your head and getting a severe headache, probably a concussion. It just doesn’t take a heck of a lot. Really an issue with concussions and TBIs is that they can have a cumulative effect over time, even if you only have say, you know, a quote unquote minor concussions to medium concussions. This one I had was a pretty serious one but I still bounced back pretty quickly. But if you have a lot of those, you know you can cause serious brain injury and depression and it can lead to big issues like Dave Mirra had. So for me personally that was followed by time off the bike and off of work. Immediately after I had a pretty bad headache. But really aside from a headache, I was pretty much better in like a week or two. You know most of my memory from that day ended up coming back like when it was happening I lost like you know I didn’t know what day that week it was. I lost all memory of what had happened that day. Most of that day is coming back to me, except I still can’t remember some things like hitting the ground. I don’t remember that actually happening. And there’s a bunch of time I don’t know how much time after the event that I don’t remember. So while you know it was a scary deal, I feel pretty fortunate to have recovered from it. But at the end of the whole thing the doctor’s advice was, “All right. You cannot get another concussion ever.” I get it right now. So it’s a serious deal.

Jeff: Yeah. And so far, knock on wood, you’ve held up on that right.

Greg: I mean nothing major but again like, you know I mean even if you hit your head on a cabinet door, you could concuss yourself you know. So I mean I probably had some minor things since then, but nothing major. But I just never know what’s going to happen.

Jeff: Yeah I hit my head a lot because I’m tall. Like I’ll be in a crawl space or a basement or something and bang my head on a pipe. So yeah you can’t avoid hitting your head. That’s a tough one. All right. So what are we doing in the cycling industry, specifically as it relates to helmets? What are some of the technologies.? One of the things that we hear a lot about is something called MIPS. That’s an acronym, M-I-P-S. What is MIPS? What does the acronym even stand for, I probably should know this but I don’t.

Greg: All right. It turns out that MIPS stands for multidirectional impact protection system. So basically it’s good at keeping you safe. OK.

Jeff: They drop the D.

Greg: They’ve got a hyphen in there. Multi hyphen directional. So I guess that’s why they’re going with MIPS and it sounds better I guess MIDPS would be pretty difficult to say .

Jeff: So what is it? How do they actually implement this system?

Greg: So basically MIPS is a thin plastic liner that goes in the helmet. It’s basically between your head and the helmet. So basically what this technology is trying to help with our rotational forces, and what they call oblique impacts. So back in the day a lot of impact technology and research was done with straight on impacts to head, that almost never happens at mountain biking. If you think of yourself going through the air and falling off your bike you generally hit the ground at angle and that’s what MIPS is designed to help with. So when you hit that angle impact, the low friction layer in the helmet–that’s a plastic liner–allows the helmet to slide relative to the head, according to MIPS. Basically that means that your head should stay in the same place and the helmet should rotate around your head instead of moving your head. That’s the core of it.

Jeff: Yeah. Does MIPS… I’m trying to… it’s been a while since I’ve really inspected a MIPS liner. Does it move in more than one direction or is basically able to just slide sort of back and forth or kind of go side to side as well?

Greg: So my understanding of it, and somebody correct us if I’m wrong, is MIPS can rotate all the directions of the helmet but there are some things we’ll get to some other technology in a second. MIPS doesn’t prevent like straight on issues like that a normal helmet has to deal with that. So it could like rotate forward or back, side to side, anywhere around that plane essentially is my understanding of it.

Jeff: OK. Has there been any research to show how effective this is? Does anybody know if it actually works?

Greg: MIPS says they’ve done research and it works. There’s a lot of controversy surrounding that, so you know it’s a bit of a debate. The problem with a lot of these technologies are a), they’re new, b) their application in mountain biking is pretty small in the world of all things science you know. So to actually get like real scientific studies to happen on these things you know maybe 20 years and then by that time there will be a new technology you know. So it’s debatable. Another common question is well the scalp and the hair of the head are basically designed to do the same thing. Your scalp sort of moves over your skull. And that’s essentially what MIPS does. And people are like, well doesn’t that make MIPS, what would be a good word for that…

Jeff: Yeah, redundant. I mean, yeah we’ve got, we had MIPS built into our scalps already perhaps.

Greg: So MIPS debates that, or disagrees with that. So they say that you know the scalp doesn’t help enough and MIPS helps a heck of a lot more. So it’s much more substantial.

Jeff: So why isn’t MIBs incorporated into every helmet? Seems like a pretty simple solution and something that maybe while it’s not… Nothing out there is going to prevent a concussion, we should say that. But perhaps it helps. Yet it still isn’t standard on every single helmet. Why is that?

Greg: I don’t know why that is. I mean the answer is it costs money. But to me it’s like you should pay whatever needs to be paid to keep your your head in one piece. Because we’re talking serious stuff here. If you mess up your brain, nothing can be done you know. So I think there should be something like this every helmet, in my personal opinion but we’re still going to see it partially because of money. If you look I see like a Walmart helmet that’s like 25 bucks. A lot of MIPS implementations could cost more than that just for that MIPS to the helmet so you know if you’re talking about doubling the price of a Walmart helmet, the average mom buying a helmet for her, you know five year old kid. I mean it might be too much money I guess. But it seems important me.

Jeff: Yeah. Well we’ve we’ve been talking thus far about MIPS brand technology and the MIPS solution. But there are others out there that seek to do something similar to sort of slow down or redirect those rotational impacts. What are some of the other companies that are working on that, and what do their solutions look like?

Greg: So the reason MIPS is so ubiquitous right now is because basically they’re not they’re not a helmet company. You know many companies license that technology and put it in, so you could see MIPS technology and helmets from all sorts of companies. The other major examples we find in the bike industry are from a specific helmet brand doing their own thing, and I found at least three of these, which is pretty impressive. So one of these is POC’s spin technology. We just saw this at Interbike and it’s a pretty ingenious implementation because it’s so simple. Basically they use a silicone bladder inside each helmet pad. You know how you normally have a helmet. They basically take those pads, put the silicone bladder in them, and that essentially does the same thing and this allows the helmet to move slightly around your head rather than sticking in place. The helmet is also designed so that your head only contacts the pads, not the helmet shell, which allows them to work. Another technology that I used personally is Kali’s LDL which stands for low density layer. Basically this consists of what they call specially designed this visco elastic padding that’s placed around the interior of the helmet and it’s basically rubber raised dots that contact your head that are sort of hollow in the center. So it’s like a bunch of little doughnuts. But the interesting thing about LDL is that LDL provides a claimed reduction of 25 percent of rotational impact forces but it also reduces low G linear forces up to 30 percent. So that’s something MIPS can’t do. So in like a low G impact straight onto the helmet, the dots will essentially collapse and absorb 30 percent of that, and that’s impact that a standard helmet shell like the general foam will even begin collapsing at that rate. So you know it’s pretty cool tech in my opinion that reduces a bunch of those forces because again the stuff adds up over time. So MIPS can’t do that. A final one which sounds pretty similar to LDL is Leatt’s Turbine 360 technology. And again they’re made from sort of like a gel-like, plastic material which remains soft and pliable until impact and then it hardens like a lot of these other pads that we’re seeing. According to Aaron, the technology reduces rotational acceleration in addition to absorbing energy during impact similar to the LDL. And Leatt claims it can reduce up to 30 percent of head impact at concussion level and, reduce up to 40 percent of rotational acceleration to head and brain. So there’s a bunch of people trying new things which I think is encouraging.

Jeff: Yeah, even the NFL is getting serious about this, and they are investing at least a hundred million dollars in the next few years to reduce brain injuries among their players. They recently wrapped up testing of 32 different helmet designs that were, you know, seeking to improve safety among the players. And there was one helmet that actually came out on top and did better than all the others. And it sounds like it may be rolled out to more and more players as we go on. But it’s called the the Vicis or the V-I-C-I-S and it’s a really unusual design. It’s not like any of the cycling helmets that we’re using today in that it doesn’t have a hard outer shell. It’s actually a soft outer shell and I haven’t gotten my hands on one, but I imagine it’s similar to some of the like stuff you would see in elbow pads or knee pads, but it’s it’s around your head. And the interesting thing about this is even though it is the design that they found to be the safest, there was already an NFL player who got a concussion wearing one of the helmets, actually like in his first game out in the helmet, he got a concussion. So this technology doesn’t prevent concussions. Nothing can. But it’s interesting to see that there are these new designs and things that aren’t even in cycling yet. The interesting thing too is this helmet costs $1,500 to make. So perhaps this technology will trickle down to cycling and mountain biking. But for now it seems to be only at the highest levels of the sport. But again that’s a good thing that people are looking at this and hopefully it’ll trickle down to us eventually. So beyond helmets are there other things Greg that can help prevent or reduce the likelihood of a concussion.

Greg: I found this really interesting looking device. Actually, I saw it posted on NSMB.com so shout to those guys. It’s still not on the market yet it’s being tested. Basically it’s a concussion prevention collar and the idea came from studying bighorn sheep and woodpeckers who hit things with their heads really hard. And basically those animals increase the pressure in the cranial cavity. The critical vault that holds the brain and thereby preventing from like shaking around to have that slashing motion we’re talking about. So basically the collar provides slight compression on the jugular vein, increasing the volume and the pressure. I can’t imagine you can increase the volume of the blood in the cranial cavity. It’s got to increase the pressure in the cranial vault, thereby reducing the sloshing in the brain at impact. And they claim an 83 percent reduction in the number of torn brain fibers in a standard concussion model, which sounds promising. But they still have not begun human trials yet. So some wild stuff out there.

Jeff: Yeah that’s really interesting. I’ve always wondered that too. How do Woodpecker’s manage to not just pass out from banging their heads against trees and stuff all the time. So yeah that seems like a unique approach. Okay so we’re seeing with football again these traumatic brain injuries and concussions are really… People are starting to get worried, and particularly parents of kids who play football. We’re seeing youth participation in football decline year over year. Some of the stats I pulled showed that in the last decade participation among kids has gone down by 25 percent. And we’re even seeing NFL players retire early because they don’t want to get any more concussions. The sport is just too dangerous for them. So is there a risk, or what is the risk to mountain biking if we don’t make it safer? If we don’t get in front of this concussion problem?

Greg: Yeah I’m interested to hear your thoughts Jeff. But a tough thing with mountain biking is it’s a dangerous sport. You know even though we try our hardest to eliminate some of the most common serious injuries and I would say TBI is one of those, you know freak things could still happen. I had a pretty freak accident the other day that gave me a scare. I’m still not certain if I’m 100 percent ok or if I have to have a surgery or where the situation is, we’re just sort of wait and see. You know and I’m heading in for my second surgery on a knee that I injured skiing. And it’s just like these are dangerous things we’re doing. And you know our actions have consequences as we do them. But if anything biking can be good training grounds teach the effects of natural consequences based on our actions. But what are your thoughts. What are the potential ramifications?

Jeff: Yeah I mean, I think I’m afraid that if it becomes more common or you know we’re not able to slow this down… I mean look, the reason that concussions might increase is if kids are trying to do the things they’re seeing on YouTube, and are taking more risks than maybe they need to. You know when we started mountain biking it was perhaps a less dangerous sport. I mean I don’t know. I have no way to back that up, but yeah I would love to see data on if concussions are increasing. And if they are, I mean I think we looked at football and we see that at some point people say you know, it’s not worth it. You know and we see we’ve seen in the media. Some players who have had these injuries go on to do terrible things. You know Aaron Hernandez, clearly from his concussions over the years that really damaged him mentally and you know led him to do some some things that he maybe otherwise wouldn’t have done. And you know we’re seeing that with some of the top mountain bikers as well. So I don’t think it’s far off to think that we could see a decline in mountain biking if people decide that it’s just not safe. And fortunately the helmet companies are addressing this. But yeah I mean we can never we can never fully eliminate it. And I’m the last one to say that you should stop doing something because it’s dangerous. But there has to be a point where you just say you know it’s not worth it. The benefits don’t outweigh the risks.

Jeff: I think one of the potential difficulties talking about mountain biking in general is there are so many different breeds of mountain biking, sorta like you referenced Jeff. Whereas football is basically you know it’s it’s pretty cut and dried what the game of football looks like. You’re right now as we record this podcast the guys are in the desert in Virgin, Utah and are practicing for Red Bull Rampage. You know that is sort of like the pinnacle of like danger in our sport. So if anything I see rampage style riding taking more of a hit and say average trail riding. You know it’s all in mitigating sort of your risks and how much risk you’re accepting yourself.

Greg: And one thing we haven’t mentioned, I may have, I referenced Steve Mirra earlier if you guys haven’t read about Dave Mirra, definitely look him up. He is one of the forefathers of BMX riding but he took his life about a year ago and in the post-mortem autopsy they found that he had severe chronic traumatic encephalopathy (CTE.) Which is essentially accumulation of TBI injuries, which is what we’re talking about here. So that led to severe depression in his case. So a lot of this stuff that’s happening, coming out of football is also coming out in the more extreme sports. And you know we’re having these dialogues like what can we do about this, like this is a big deal.

Jeff: Yeah. Well it’s interesting too you mentioned rampage which is going on right now and last year the controversy was that, you know rampage is just too dangerous. And you know why are we still doing this and why are we making the athletes go through this stuff, you know, just to get a paycheck at the end of the day. What’s really interesting is this year the conversation has shifted the other way. You know Red Bull made some changes to the event to perhaps make it safer and people are mad. They’re wishing that it wasn’t as safe. I mean these are probably… these have to be two different groups of people, hopefully not the same people that want it both ways. But yeah it’s it’s definitely an ongoing debate.

Greg: Yeah no easy answers here.

Jeff: Yeah. So how can riders avoid traumatic brain injury? I’m reminded of one of my favorite Jerry Seinfeld bits about helmets which we’ll play for you right now

Jerry Seinfeld: [There are a number of things you can] point to as proof that the human being is not smart… the helmet is my personal favorite. The fact that we had to invent the helmet. Now why did we invent the helmet? Well because we are participating in many activities that were cracking our heads. We looked at the situation; we chose not to avoid these activities, but to just make little plastic hats so that we can continue our head cracking lifestyles. The only thing dumber than the helmet is the helmet law, the point of which is to protect a brain that is functioning so poorly, it’s not even trying to stop the cracking of the head that it’s in.

Jeff: So people are going to continue to mountain bike, including both of us obviously. What are some of the things that we can do to mitigate the risk of you know, getting a concussion or ultimately a traumatic brain injury?

Greg: The first thing you can do is to ride within your limits. And this is basically… I mean this could be its own discussion, but understanding your limits. And what a healthy risk is and what isn’t. And you know if you don’t want to get hurt, try to minimize your risk as much as possible. Maybe that’s bypassing the jump, you know maybe it’s not putting your life on the line. Like just ride safely. But when you ride, you’ll always want to wear a helmet. This is step number one. Don’t ride without a helmet. Don’t ever arrive without a helmet. And preferably use a helmet that provides maximum protection. As we mentioned earlier, a lot of brands, or some models within those brands won’t have MIPS technology or similar, mainly as a pricing concern. And I would just encourage you to shell out a few more bucks and get the helmet with the anti rotational technology. Maybe you can’t afford say like that $250 to $300 Smith helmet, but you can get helmets with MIPS technology for 50 bucks. Like I looked it up. So we mentioned that in a recent article on the site somewhere. But you can get it for not too much. So consider that. Consider wearing a full face helmet in some situations or a helmet with a removable chin bar. And these are just new type of helmet we’ve seen on the market where, it’s basically an enduro helmet you can take the chin bar on and off. We’ve written about them on the site. So check that out the Bell Super 2R and 3R are sort of the quintessential ones. If I had had a chinbar on my helmet, I probably wouldn’t have had that major concussion. I missed my helmet and hit on my face, and if I hadn’t hit my face, who knows. So consider that.

Jeff: Yeah that was in that article you referenced early on about Mark who had a serious concussion. And I think part of his doctor’s recommendation was to wear a full face helmet. So we rode with him you know, on a mostly like I mean cross-countryish ride. There was a lot of climbing and you know nobody had full face helmets on. But he did because that was what his doctor said because he couldn’t get another concussion or he would be in even more trouble. So it’s a good endorsement. But otherwise yeah it’s pretty simple: ride within your limits and always wear a helmet. Those are the two basic things you can do. Beyond that, it’s really not in your control. So, I don’t know if that helps or hurts people but yeah. At least know that those are the things you can do, and you do your best if you can check those two boxes. So finally what are the signs of a concussion?. How do we know if something serious has happened after a crash on the trail.

Greg: Well if you hit your head significantly, get medical attention. Like go to your doctor. Don’t just assume it’s going to be OK. Go get it checked out. I always recommend mountain bikers carry some sort of medical insurance. The lower the deductible and out of pocket max that you can afford, the better. But that’s not always possible I know. But hopefully you’ve got some sort of medical coverage that will make going to the doctor as easy of a pill to swallow as possible. You know even if you think you might just have a concussion, you know it’s very possible you have a more serious TBI like a brain bleed which could lead to death. So get it checked out, get the MRI. Bite the bullet and just you know play it safe. You don’t want to mess around with that stuff.

Jeff: Yeah. And like Greg mentioned early on, you know there are a number of different symptoms. So if you’re experiencing any of those., that’s a good clue that you should probably seek medical attention. And also don’t think that you know, oh I had a crash like two weeks ago, you know I don’t need to go to the doctor because it’s already happened or whatever. If you’re experiencing problems still that, you know, you think might be tied to that, it definitely makes sense to go check it out and be sure. Because there could have been some damage that you weren’t aware of at the time, but that could have more long term effects. Well cool. That’s all the information we have about concussions and traumatic brain injuries. If you’d like to learn more about helmets that are designed to reduce the chances of concussions or if you’d like to read Mark’s story about his traumatic brain injury be sure to go to Singletracks and search the site. That’s all we have this week, we’ll talk to you again next week.