Falling unconscious after a Stage 1 crash, stretchered to hospital, and suffering a contusion (bruising) of the lung, Tony Martin should not have continued racing the next day at the Tour de France.
Such is the mythology of cycling that serious injuries are routinely brushed aside by the rider involved, in the interests of team goals and romantic notions that this is a sport for the hardest of the hard.
In what other sport do participants continue on with fractured bones, serious sprains, or having scourged off half their skin on hot tarmac?
Cycling is, and always has been, a sport of suffering and perseverance; an effort to best the obstacles presented by our fragile bodies.
So the mythology goes: the mind, the will, can and must overcome all, in the pursuit of glory or glorious defeat.
When the body resists, the will must be unbending. Anyone who has trained for anything physical knows the good pain, that transcendent state where you’re pushing past your mental limits, and cyclists thrive on it.
Cyclists will not easily say no.
In this masochistic context, it’s not surprising Tony Martin was back on his bike in Stage 2, having limped across the finish line after falling heavily a few kilometres from the finish line in the chaotic closing stages of Stage 1.
But reports that Martin blacked out on the team bus after his crash should have rung alarm bells.
That’s a clear cut sign that Martin suffered a serious concussion, or to use the more widely accepted medical term, a Mild Traumatic Brain Injury (MTBI).
The short term effects of concussion include headaches, dizziness, blurred vision, memory loss, confusion, and inability to concentrate.
These symptoms can last for several days. Is it really safe for a rider with a brain injury to continue on in a race as physically and mentally demanding as the Tour de France?
If Martin is not at his sharpest he’s a liability to himself and the rest of the peloton.
It only takes a momentary lapse in concentration to clip a wheel or miss your line into a high-speed corner and crash again.
That would be really dangerous: the risk of longer-term damage to the brain is significantly higher for repeated concussions.
It’s a condition known as second-impact syndrome, which causes rapid swelling to the brain and raises the risk of chronic brain damage.
This is why footballers are often forced to miss several matches after suffering a knock to the head – another impact could cause serious long-term harm.
There’s plenty of medical research on the medium and long-term effects of these types of brain injuries, and it isn’t pretty.
Long-term studies of NFL players show that they are three or four times as likely to suffer from neurodegenerative diseases like Parkinson’s or Alzheimer’s as the general population.
So head injuries are serious, and if you suffer one you really should make sure the symptoms have passed before you resume the activity that gave you one.
That Tony Martin was back on his bike the day after a concussion severe enough for him to lose consciousness seems crazy to me.
Even in a sport that prides itself on being the toughest, it seems a step too far.
When you’re talking about a significant risk of long term brain damage, it seems to me that the team medical staff owe it to the rider to tell him to stop.
The days of riders risking their long-term health on the advice of team doctors should have ended.
There was a time when riders couldn’t say no to the directors and doctors who cared more about winning and sponsors than the riders under their care.
Those days resulted in EPO, blood doping, and criminal charges against the likes of Eufemiano Fuentes.
This is a different matter entirely, but the fact remains that Martin’s team should have been more cautious, and more willing to protect the rider’s health at the expense of his and the team’s ambitions.
The fight against doping is synonymous with the fight to protect riders’ health.
Martin himself probably wanted to keep racing. He is a star rider, and would not want to let his team down, especially before the stage four team time trial. Pain can be denied.
It’s also understandable that Omega Pharma – Quick-Step would want to keep a rider of Martin’s power and ability in the race.
What should also be understandable is that some things are more important even than the Tour de France.
Brendon
Guest
Tough buggers, Speedway motorcycling is another where blokes will smash themselves up and go again the next day.
Minz
Guest
If he had visceral injuries (like the lung!). there's a good chance that it's more shock that's made him pass out rather than concussion - let's not assume that it's just the team/doctors being irresponsible! In that picture he looks awfully pale, which may indicate some level of shock (I've seen people with many fewer injuries than him pass out from the shock, multiple times even, and they looked similar to him in the photo).
JoJo
Guest
Glad to see someone wrote about this. I was also sickened seeing Tony Martin start stage 2 - after losing consciousness twice the day before and riding in stage 2 with a bloodied back. I am sensitive to this as my husband had a bad bike crash 2 months ago, his neuro docs advised him to stop biking, etc. for a few weeks and to stop playing hockey and other contact sports entirely. He has had several concussions over the years.
Abdu
Guest
Don't be sorry, you're spot on and I never knew he had such a good record in TTT's. I was just being facetious. Good call.
Justin Curran
Roar Rookie
Nice work Dr Tim, sounds like you've done your research for this one. Big talking point in AFL circles in the last couple of seasons. Certainly the approach taken with Tony Martin would not appear consistent with the approach taken by other elite impact sports such as AFL or NFL.
tony meadows
Guest
Sorry to contradict you Abdu but must point out that they only need to support CAVENDISH on the climbs,he's more than capable of doing his bit in the TTT,and a good one at that .Watch and learn.
Zeb Woodpower
Guest
The ITV podcast was suggesting that 'man up' should be changed to 'G up' in reference to G Thomas riding with his hairline fractured pelvis, Martin on the other hand is the 'toughest' of the two. Tippett in the AFL suffering several concussions in a row started a conversation but riding at 60km/h and crashing while concussed is simply daft. Martin should pull out and rest before focusing on winning the rainbows in the TT again.
Abdu
Guest
I too am amazed that cycling can have a Haemocrit test a decade ago but still is in the dark ages when it comes to concussion. I would not be happy knowing that a woozy guy was riding in the bunch with me. He was a risk to the other riders, let alone himself. The OPQS doctor and DS should be sanctioned, but then again we are talking about the UCI and ASO running the sport. He's not going to help that much in the TTT when they have to slow for Cav anyway...
Tim Renowden
Expert
Thanks Tristan, Yes, it's a big deal in rugby obviously, and also in Aussie Rules - one recent example is Demons player Rohan Bail who missed a few rounds earlier this year overcoming a series of knocks: http://www.melbournefc.com.au/news/2013-04-12/bail-bounces-back-after-concussion-bout I've experienced a few concussions in my time (mostly from bike crashes, but a couple from my younger days playing junior footy) and bounced back fine, but I know how unpleasant it is at the time. Definitely wouldn't want to be racing the day after.
Tim Renowden
Expert
Thanks all, I read an interesting article last week about bike helmets, helmet standards, and how effective bike helmets are (not) at preventing concussion: http://www.bicycling.com/sites/default/files/uploads/BI-June-13-Helmet.pdf (sorry for the PDF link) There's some interesting technology (MIPS) being developed by several helmet manufacturers aimed at reducing the rotational forces in a bike crash which are a major cause of concussion. This is something that obviously affects all cyclists, but most of us don't have the problem of having to get back on the bike the next day.
HardcorePrawn
Roar Guru
Good read Tim, I couldn't believe I was seeing Tony Martin on day two after all that had happened to him. He should have been resting at the very least, or more likely in hospital. He also had distinct bloody patches on his back soaking through onto his jersey. I can only assume that OPQ want to keep him in the race, even if he has no impact on the Corsican stages, so that he can still compete in the time trials. However, I do think that it can be a case of "damned if you do, damned if you don't" in these situations. During the Giro the Roar published another article decrying Bradley Wiggins for disrespecting the race, this was after he pulled out with a bronchial infection. Had Martin dropped out after his crash might we instead be reading someone else's piece about him not being a team player or tough enough for the tour?
Lee Rodgers
Expert
'Being hard' is something Jens Voigt does very well, and there for me is the limit. What Martin did and what he was allowed to do was beyond that limit. I'm the same as you on this Tim, it kind of sickened me to see him out there.
Kate Smart
Expert
Great read, Tim. Sporting teams do need to put the health of their athletes first and in any other sport, Martin would have been forced out of the event. How can you allow someone who has passed out twice to continue riding. I also think it's interesting, talking of riders who ride on with injuries, the palpable pain that Geraint Thomas was in yesterday. He looked absolutely awful. Obviously, his injury is not related to his brain and perhaps not on the same level as Martin's, but I do think allowing riders to ride on when they are clearly in pain does make them a danger to themselves and the rest of peloton. As you said, a rider who suffers a lapse in concentration can create chaos. There is also the issue of doing even more damage to their bodies. Being tough is all good and well, but there is a point when toughness is confused for sillyness.
Tristan Rayner
Editor
Hi Tim, This is exactly what Clyde Rathbone is talking about today with rugby. We've given him the headline of head injuries being rugby's great threat. http://www.theroar.com.au/2013/07/02/rathbone-head-injuries-represent-rugbys-greatest-threat/ It's probably true - and his article about brain damage and protecting the brain are equally relevant here to Martin, and all athletes, from professional to (rank!) amateur. Nice read. Tristan Editor.