We can improve medical care standards in women’s professional cycling

Text by Claire Rose: I believe there are deficiencies in the standards for medical support in women’s professional cycling, and that we can work together towards real solutions. There are teams and events with fantastic doctors and medical support, but there are many teams that offer no medical support to their riders. Alongside incidences of poorly managed concussions by race and team doctors, there is general ignorance of other well-known conditions such as relative energy deficiency syndrome (RED-S). There are other examples where rider welfare and recovery is not a priority, and too often riders are financially penalised for not performing while sick. 

The UCI does have some clear guidelines on promoting health and prevention screening but what is not clear is how well teams and event organisers adhere to them. Athletes need to be healthy to perform at their best in any sport. It is easy to recognise that an athlete’s career can be ended by significant injury or illness. However, in a sport where contracts often only last for a year, even a minor injury or illness without adequate medical support or unsupportive team management can lead to a lack of results and difficulty in finding a contract for the following season.

An athlete’s health can also be put at risk by training or competing when they are not medically fit. This is more likely to happen if they don’t have appropriate medical input and the pressure is on the athlete to decide when to return to play, the help they get doesn’t link in with their team, their medical needs are poorly communicated or not understood by the team, or they are under conflicting pressure to return too early from team management.

I want to share my experiences as a professional rider like you, and as a medicaldoctor: I recently retired from racing following recurrent pericarditis (inflammation of the lining of the heart) and inflammatory arthritis. I have since returned to my original career as a doctor. My condition was misdiagnosed from the start by both my family doctor (who was not a specialist in sports medicine)and my team doctor. It was only when I saw a rheumatologist privately who also specialised in sports medicine that I was diagnosed with an inflammatory arthritis. 

The rheumatologist insisted I get an urgent cardiology exam, as my heart rate was abnormally high even just riding easy, and I was getting out of breath going up the stairs. My family doctor refused to make the referral, as I was now riding a little again. I believe they did not understand that I would normally be able to ride for 5 hours at 200W, whereas at the time I was struggling to even do an hour at 160W. Again, I sought a private referral to a cardiologist who specialised in sports medicine and I was lucky to be able to afford the care.

At the same time, I was told I had to attend the team training camp. Whilst I was under no pressure to ride to the rest of the team’s schedule and the focus was on my recovery, it seemed that no one truly understood the potential seriousness of the situation. I was at risk of damage to the heart and abnormal heart rhythms resulting in sudden death by riding with possible heart inflammation. From my own medical knowledge I was aware of this, but at the same time was consistently being told that I would be fine and that the team were planning for me to be back racing by the end of the month. I felt that I had to be back training as quickly as possible.

The private scans and tests finally led to the correct diagnosis of pericarditis. I had been reassured so many times that nothing was wrong, but nothing was further from reality. I was upset at not being able to ride or do any training for the next few months, but equally, I was relieved that I didn’t have to continue putting my body under huge stress every time I rode my bike.

I came under pressure from the team to end my contract after the diagnosis. I made it clear to the team that I didn’t want to, as at that point the cardiologist and rheumatologist were very positive that I would recover for the second half of the season. Despite my contract clearly stating that the team would continue to pay a salary through illness or injury, I stopped getting paid. Communication with the team completely broke down. I know some of you know how stressful this situation can be, but thanks to The Cyclists’ Alliance, the issue was resolved.

Today as a physician and former racer I can reflect on the possible outcomes. What if I had a family doctor that understood sports medicine? What if I had a team doctor who had been more aware about the potential seriousness of my heart condition? What if I had a team that was more invested in health care for its riders? Would I still be racing with the rest of you today? 

I don’t know the answers, but what worries me more is what if it had happened to someone who didn’t understand the risk of potential heart inflammation? What if they had just listened to the reassurance of their family doctor andteam and not received the right help? What if they hadn’t been able to afford the private consultations? What if they hadn’t known who to ask for help? 

My experience, alongside those of friends and teammates, highlights the need for change. The UCI provides clear guidelines on promoting health and prevention screening for women road cyclists. This includes annual tests that should be conducted by either a rider’s team or their national federation, concussion guidelines, and that the national federation should be responsible for helping a rider seek medical help if their team does not have a doctor. 

However, it is not clear how many teams follow these rules and women’s teams are not absolutely required to have a doctor. At the same time, whilst the UCI advises event and team medics to ideally have some experience in sports medicine, it is not a necessity. I recently heard the story of a gynaecologist providing medical oversight, but at a men’s race!

What can we as fellow riders and The Cyclists’ Alliance do to change this? To start, we will soon publish helpful articles on some common medical issues in the women’s peloton, and introduce an information “hotline” to help members find the medical care they need. We will address the inconsistencies in medical care within teams and at events by looking at the current levels of support within the women’s peloton, and offer real solutions for the future. There are many issues that need to be addressed, but on a positive note it seems that there are teams willing to make important cultural changes. For example, our colleagues at CCC-Liv are honouring the contracts of any rider affected by concussion. 

As a rider, your health and welfare should always be put first. As a former rider – and today as a doctor – we can work together to make sure you enjoy a healthy career.

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