Allowing Tony Martin to race
Last Post 07/12/2013 11:12 AM by Justin jmdirt. 25 Replies.
Author Messages
Oldfart

Posts:472

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06/30/2013 02:40 PM
With a concussion is criminal.
jmdirt

Posts:699

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06/30/2013 03:34 PM
Does he have a concussion (did they see his brain, was his brain even affected)? If they didn't scan him, we don't know if he actually has a concussion. Since "CONCUSSION" is a huge buzz topic every time someone gets bumped or falls down the docs, by default, say it could be a concussion. Losing consciousness does not necessarily indicate a concussion an/or head trauma.

If they scanned him and there is an indication of a concussion, the concern is a repeat injury. To my knowledge cycling doesn't have a concussion rule so its up to TM if he continues or not.

Now I'm going to go way out here: Based on the photos I've seen it looks like his hip and shoulder took most of the impact. His helmet doesn't even look scratched. I know that doesn't rule out a concussion because there are other forces at play. Just call me photo MD! ;}
lochness

Posts:47

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06/30/2013 04:02 PM
Supposedly he lost consciousness in the team bus? That sure doesn't sound like he shoud be up and about the next day, let alone racing!
madvax

Posts:50

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06/30/2013 04:07 PM
+1 OldFart. Even the NFL has finally gotten wise to the risk associated with a repeat injury. I like Tony Martin and don't like seeing him risk his career over this.

Assessed in the general hospital in Bastia, fractures were ruled out but he was diagnosed with a concussion plus a contusion on his left lung. In addition to that, soft tissue damages to his hip, chest, left knee and shoulder were identified, as was a deep 5cm wound on his left muscles. The team said that this “causes a lot of pain and a problem moving his arm.”

Here is a link to the article with the above quote:
http://www.velonation.com/News/ID/1...rance.aspx
pretender

Posts:40

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06/30/2013 04:19 PM
I, as somebody neither trained in the medical arts nor particularly adept at detecting hyperbole, have no problem letting a grown man make his own decisions.
jmdirt

Posts:699

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06/30/2013 05:11 PM
Lochness, why? I was racing motorcycles and dislocated my ankle (my foot was pointing to 9 but my leg was at 12) the pain made me lose consciousness for several minutes. I bought some Scott plastic boots (yep in the '70s) that evening and raced, with pain, the next day. Was my life in danger? Maybe TM lost consciousness because of the pain in his pelvis, lung, and shoulder.

Madvax, I read that story too but how did they diagnose? If they didn't scan, they don't know. Plus did the doctor actually say concussion or did the team say concussion?

We don't really even know if he has a concussion.
longslowdistance

Posts:661

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06/30/2013 07:10 PM
jm, "concussion" is a clinical diagnosis. In other words, the diagnosis is made by physical exam and history, by a trained physician. The head CT is usually completely normal.
BikeCzar

Posts:53

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06/30/2013 07:41 PM
Are there varying degrees of concussions? If it was a severe concussion he'd still be under hospital supervision.
longslowdistance

Posts:661

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06/30/2013 07:48 PM
Correct.
79pmooney

Posts:1111

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06/30/2013 08:06 PM
Mixed feelings here. I get the "don't let him ride" bit. I get that another head injury (or even a normally sub-injurious blow) will do real long term damage to the brain.

I raced the season after my head injury (yes, months later, not hours later, but mine was life threatening with very real consequences). If the naysayers had the information of today and I was more than a bit player, my racing would have been very controversial. I am glad they didn't. In the picture frame of my life, that season of racing was an important element. I paid a price for it like I did for a number of decisions I made. I don't regret it at all.

Looking at Tony Martin: He has how many TdFs in his body? Maybe seven? Yes George Hincapie and a few others have done twice as many, but they are the exceptions. Next spring, Tony Martin could crash, injure his hip[ and have his racing career ended. Right now, he is strong enough to (maybe in four or five days) ride the pointy end again. That is a privilege very few ever get. He has done a phenomenal amount of work to get there. Let's say he continues and wins a stage. Does some quality work for his teammates. In 20 years as he looks back, is he going to feel he should be suing those who allowed him to ride when now he cannot remember where he left his keys and has to rely on someone to help him, or is he going to think "I'm glad they didn't let me ride the rest of that Tour"?

Remember, we are not talking college educated young men who can drop bike racing and step into an office and live a comfortable life. I don't kn ow Tony Martin, but many of the European racers are closer to our NBA players. Racing is a way out. Not being allowed to continue the Tour is like not being able to continue the playoffs.

Another point, very recent: I come out of my crash a few weeks ago with no concussion. (No I did not get a CAT scan but I have had enough, both diagnosed and not that I am more of an expert than I would like to be.) I remember hitting the road very clearly. The rest of the crash, not at all. After, clear as day. Was able to answer the bystander's questions about who I was, where I lived, etc, easily. My crash two years ago? Likewise. I knew immediately after both crashes that my head/brain was OK. Two years ago, I got the CAT scan and passed it. It is obvious both times that my body shut down consciousness to protect me from observing what was happening to it. A self-defense mechanism like blinking if you will.

Ben
BikeCzar

Posts:53

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06/30/2013 08:10 PM
I know the players in the NFL have individual base line function tests established that they must pass before returning to the field. I thought there was some movement in that direction from Pro Cycling after the Chris Horner incident a couple years back. I don't know if Omega Pharma QuickStep has any such protocol in place or not. All teams should.
79pmooney

Posts:1111

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06/30/2013 08:10 PM
This was supposed to be just an edit to correct this one sentence I had backwards.  You guys get what I meant

"They shouldn't have let me ride the rest of that Tour"?

Ben


Oldfart

Posts:472

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06/30/2013 08:23 PM
If Tony has a concussion, and the news reports say he did, he can't decide. He's not in shape to decide. I know my wife went to work after her concussion 6 years ago. Lasted a few weeks then she was sent home. Has not worked since. No sign of distress to her new that day POC ski helmet either. My best friend is just able to rode about 15 k after three years post concussion. If Tony actually has been concussed he doesn't get to decide, his team doctors do. Maybe his reported concussion is not a concussion.
BikeCzar

Posts:53

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06/30/2013 08:27 PM
Agree, Andy. The athlete will always say he's ok. The trick is protecting them from themselves and their management.
jmdirt

Posts:699

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06/30/2013 09:33 PM
From the Mayo Clinic: "A cranial computerized tomography (CT) scan is the standard test to assess the brain right after injury."

"concussion is a clinical diagnosis": 5-10-20 years ago.

"a trained physician": did they have a neurologist on call?

In April I attended a sports clinic and concussion (TBI) was the main topic. One of the things I learned: you can't diagnose a concussion with a standard neurological exam.

They said that the standard ER neuro test is a good place to start but too many factors affect the results. Is the patient stressed/in shock from the event? One doc said that many auto accident patients will test positive for TBI using a neuro test even if they have absolutely no TBI. They said that CT is the only way to tell for sure but just as with all brain/spinal cord science its difficult. TBI can "hide" so instead of looking for damage they look for irregularities. One of the docs said that they are developing tech/procedures to identify cell damage from TBI. He said that he and his neuro colleagues can identify things that look completely normal to others (as you referred). I just took 12 hours of discussion and summarized it in one small paragraph so don't quote me but you get the idea.

In this case TM might be dehydrated and exhausted which cold be mistaken as positive signs of a concussion using the clinical neuro exam. His injuries would certainly affect his coordination which might also be mistaken as a sign of concussion. He might have been in shock from the pain which could lead one to think that he had a concussion. The team might have told the docs that he lost consciousness so they said "it might be a concussion".

In closing though, the docs at the sports clinic said to always err on the side of caution. If there is any question of TBI, activities that could lead to a blow to the head should be avoided and the person should be closely monitored.
jmdirt

Posts:699

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06/30/2013 09:40 PM
Oldfart, that's really all I was trying to say before I got all wound up: does he even have a concussion?
Cosmic Kid

Posts:1098

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06/30/2013 10:14 PM
All anyone knows was that he lost consciousness, was taken to the hospital (out cold) on a stretcher and was reportedly diagnosed with a concussion.

Based on the available knowledge, and taking it at face value, why would anyone let him race today? Horrific decision by the team management, doctors and even race officials.
Just say "NO!" to WCP!!!!
madvax

Posts:50

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06/30/2013 11:07 PM
According to the Omega Pharma - Quick-Step website, A CT scan was done. Here is the quote from the website:
Omega Pharma - Quick-Step Cycling Team rider Tony Martin crashed during the final kilometers of Tour de France Stage 1 on Saturday. He finished the race, but after the finish he was transported to the General Hospital of Bastia, where he passed a few examinations. The CT scan excluded fractures.
Yo Mike

Posts:263

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07/01/2013 09:39 AM
Hopefully T Martin is and will be OK. Treatment immediately post-concussion is apparently VERY important.

/The CT scan excluded fractures/

Great, but a concussion is a soft-tissue injury.

Tony Martin is no Chris Horner.
Dale

Posts:485

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07/01/2013 09:52 AM
"Tony Martin is no Chris Horner" bwahahaha.... paging the ghost of Lloyd Bentsen


"Treatment immediately post-concussion is apparently VERY important." What is the post-concussion treatment? I thought it was rest and don't go to sleep for the first 12 hours.
longslowdistance

Posts:661

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07/01/2013 06:39 PM
To clarify for those who might be interested, a head CT is obtained after head trauma NOT to make or exclude the dx of concussion. It is to search for and hopefully rule out blood in the head, which is a whole different kettle of fish and, potentially, much, much more serious. (Sometimes a lumbar puncture may be done too, it can be more sensitive for blood, but usually not done in trauma evaluation.) Presence or absence of skull fracture is important to know - certainly would prevent a rider from continuing in the Tour, but it's first and foremost about looking for intracranial hemorrhage.
jmdirt

Posts:699

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07/02/2013 04:02 PM
I saw an old friend on the trail today who now works in the outpatient brain injury program at the (EDIT OUT NAME). She is a PT/OT not a nero doc. I told her about this discussion and she said that with the exception of a few neuro specialist (Cleveland/Mayo clinic and university research hospital) no one is looking at the brain to determine/assess concussions. She said the standard initial exam is questionable because of most of the things we discussed here (shock, stress, fear, exhaustion, dehydration, pain...) but also because some people will have no problem with the exam and end up with issues/symptoms for months. However, it IS the standard (just like anything else some docs are better at it than others). She said that they look at symptoms two to four weeks out to make dx.

She agreed with those who said that TM should not have continued. She feels that even if he doesn't have a concussion, if you lose consciousness, for whatever reason, you should rest not race.

I'm still waiting to hear back from the neuro doc who spoke at the clinic I attended.
longslowdistance

Posts:661

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07/03/2013 12:25 AM
I wasn't aware that he lost consciousness. That is a big red flag.
jmdirt

Posts:699

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07/03/2013 12:31 AM
He could have passed out from the pain of his hip and lung though.
jmdirt

Posts:699

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07/06/2013 04:50 PM
So the guy from the conference is in a stage of peer review and hopes to publish in January. He wants me to wait until then. I'm thinking the same thing you are, why did he say so much at the conference. He said that he wold put me on his mailing list for updates so we'll see what happens. I'll share here as I get it. Anyway, he did say: "Not apples would you diagnose frac (sic) pelvis by asking questions? Your buddy could have uc (sic) from his lung and dehydration." As you can see above I already posed that idea. Me and my buddy Tony Martin! ;}
jmdirt

Posts:699

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07/12/2013 11:12 AM
From the Cleveland Clinic: "Determination of traumatic brain injury relies on clinical history, the constellation of symptoms, physical examination, and appropriate diagnostic testing. The diagnosis of traumatic brain injury should not be based upon a single emergency room test or imaging study alone, but rather combining all available clinical information to assist with diagnosis and management. " That's a pretty general answer but TM obviously didn't receive this type of dx.


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