Concussions in the Tour de France: Ongoing Challenges and the Push for Safer Protocols
The opening week of the 2024 Tour de France once again highlighted how difficult it is to manage head injuries in a sport where every second counts. Three riders abandoned the race after being diagnosed with concussions, underscoring the gap between the desire to keep competing and the need for proper medical evaluation.
Incidents that Led to Withdrawals
Since the Grand Départ in Barcelona on July 4, eight riders have left the Tour. Three of those departures were directly linked to concussion:
- Clement Berthet (Groupama‑FDJ United) crashed heavily during the opening team time trial.
- Alex Molenaar (Caja Rural‑Seguros RGA) went down five kilometres from the finish of stage 5.
- Torstein Traeen (Uno‑X Mobility), who had briefly worn the yellow jersey, fell on the descent of the Col du Tourmalet the following day.
In each case the rider completed the stage, only to withdraw later that evening after a medical assessment confirmed a concussion.
How the UCI Concussion Protocol Works
The International Cycling Union (UCI) introduced a standardized concussion protocol at the start of the 2021 season, prompted in part by the 2020 incident involving French rider Romain Bardet, who continued racing for almost 90 km after a high‑speed crash.
Current procedures involve a tiered approach:
- Initial roadside check by the first person to reach the rider — often a team mechanic.
- If at least two of the following signs are observed — nausea, headache or neck pain, limb weakness, disorientation, or loss of balance — the rider is withdrawn immediately.
- If fewer than two signs are present, the rider may continue in the medical or team vehicle for a brief sideline assessment that includes simple orientation questions.
- Should suspicion remain, a more comprehensive evaluation lasting approximately 10 minutes is performed, involving memory, concentration, and balance tests.
As Xavier Bigard, UCI medical director, explained to Reuters, “The roadside protocol is much shorter… It’s done in the heat of the moment, so it’s much harder to make an assessment.”
Limitations of Roadside Evaluations
Mathieu Le Strat, medical director of Groupama‑FDJ United, emphasized the practical constraints:
“You have a rider who is stuck in the race and wants to get back on the bike right away, so that’s not easy. Proper concussion protocol takes 10 to 15 minutes and requires multiple tests. You can’t do that on the side of the road.”
Florence Pommerie, chief doctor of the Tour de France since 2010, added that concussion lacks a single defining sign:
“You can’t see it. There is no single defining sign, just a combination of indicators.”
Because some symptoms appear immediately and fade, while others emerge hours later, a rider may pass a quick roadside check only to be diagnosed later after finishing the stage.
Expert Views on Progress and Remaining Hurdles
All stakeholders acknowledge that cycling has taken the issue more seriously in recent years. Pascal Chanteur, vice‑president of the international riders’ union CPA, noted:
“We are now fully aware of this.”
Nevertheless, the competitive nature of the sport creates tension:
- Riders and directors often prioritize staying in the race, especially when contending for overall standings or stage victories.
- The three‑week format means that losing even a few minutes can jeopardize a rider’s ambitions.
- Education remains a “real challenge,” according to Bigard, who stresses that changing culture in a performance‑driven environment takes time.
Summarizing the current state, Bigard told Reuters:
“We are in a situation that is far from perfect, and we are trying to make it as imperfect as possible.”
Moving Forward: What Needs to Change?
Improving concussion management in professional cycling will likely require a combination of:
- Enhanced sideline tools that are quick yet reliable — such as portable neurocognitive apps validated for use in athletes.
- Clearer rules that mandate withdrawal when any doubt exists, removing the pressure to “tough it out.”
- Ongoing education for riders, mechanics, and team staff about the subtle and delayed signs of concussion.
- Greater transparency in reporting incidents, allowing independent review and continual protocol refinement.
Until these measures are universally adopted, the Tour de France will continue to witness riders pushing through pain — sometimes at the cost of their long‑term health. The challenge for the sport’s governing bodies, teams, and medical staff is to balance the thrill of competition with the imperative of athlete safety.
