'It's All Downhill from Here': A Scoping Review of Sports-Related Concussion (SRC) Protocols in Downhill Mountain Biking (DHI), with Recommendations for SRC Policy in Professional DMB.

Introduction: Downhill mountain biking (DHI) is a form of cycling and does not currently have a specific sports-related concussion (SRC) assessment.

Objective: To review the extent, range and nature of research investigating SRC in DMB, provide a summary of key literature findings relating to its identification and management, and then develop a SRC protocol specific to DMB.

Design: Scoping review as per recognised methods.

Setting: Literature-based. The following databases were searched: MEDLINE, EMBASE, Scopus and Web of Science, with no restrictions on date. Results were limited to the English language.

Participants: Six articles were included in the review from 64 identified articles. The article had to specifically include an analysis of adult downhill riders for inclusion.

Outcome Measures: Study type, study group (amateur/professional), concussion incidence, concussion assessment and recommendations.

Main Results: Concussion incidence was identified as between 5-23%. No study outlined a trackside assessment of cyclists or a protocol for return to play where SRC was identified. Several authors identified that riders often continued to participate despite the presence of a concussion. No sport-specific SRC assessment was determined for DHI, and a SRC assessment was therefore developed.

Conclusions: This review illustrates the lack of studies and formal protocol in SRC assessment for DHI. In light of this, we propose a three-stage framework specific to the sport to best identify a concussion and act where appropriate while minimising disruption to competition. This framework involves assessing the cyclist on the 'sideline', a second assessment post-event in the medical room and a third assessment the following day. A SRC consensus meeting specific for DHI is suggested with an identified need for updated guidance from UCI, requiring possible rule changes for the sport.