Concussion in Equestrian Sports

I am a huge believer in wearing a helmet each and every time I get in the saddle. I believe that this is due in part to sustaining two serious concussion during my days of show jumping, and a less serious one whilst out trail riding. Helmets are designed to decrease “the acceleration of the head upon impact, thereby decreasing both the brain-skull collision” (1). While helmets do not prevent concussion, they can help to prevent more serious injuries.

What is concussion?

Concussion is essentially a temporary form of traumatic brain injury (TBI) where there is a temporary change in neurological function. The risk of severe TBI is decreased by a whopping 50% with the use of an equestrian helmet. Alarmingly though only 25% of equestrians regularly wear a helmet. With the wide variety of comfortable, breathable and stylish helmets now on the market, there is really no excuse for not strapping on a helmet. Read about my favourite helmet here.

Helmets are built specifically for different sports based upon the injury patterns which are prevalent in that sport. This is why it is particularly important that you wear a helmet which meets the recognised standards for your sport.

Concussions can occur any time there is a rapid change in direction or acceleration. This means that your head does not actually need to sustain an impact in order for concussion to occur.

To understand the mechanics of concussion it is important to have a basic appreciation of anatomy. The brain is essentially floating in the skull cushioned by cerebrospinal fluid. During a collision (ie a fall) the brain “moves at a different rate than the skull… this discrepancy can result in a collision between the brain and skull” (1).

What are the symptoms of concussion?

• headache
• dizziness
• blurred vision
• confusion
• fogginess
• nausea
• loss of consciousness
• fatigue

I clearly (pardon the pun) remember my first concussion. We’d been at jumping training session at the pony club on a my new horse Gilbert. I wasn’t quite used to his tendency to swerve away from the jump in the last few strides. Apparently I forced myself to get back on and be lead to the float. Like a CD stuck on repeat, I would ask my mum ‘What happened’, she would explain that I’d had a fall, I’d then become teary and ask if Gilbert was ok. Shortly after she had reassured me that he was fine, I’d once again ask what happened. I also can recall the difficulty I had staying awake during my classes.

How often are horse riders experiencing concussions?

There does not appear to be a consensus about the rate of concussions in equestrian sport. But one thing is clear, the frequency is likely to be under reported. A study conducted in 2014 found that almost half of the riders surveyed at an event had experience a concussion during their time riding. Of these riders almost 75% did not seek medical clearance to determine readiness to return to riding (2). Similarly a 2016 surveyed 1833 riders and found that 71% had symptoms of concussion following a fall and that of these 44% were then diagnosed with concussion (3).

An examination of Emergency Department presentations in America found that between 1987 and 1988 a total of 92763 ED presentations were related to horse riding injuries. Of these 18.5% were related to concussions (4).

Interestingly once an athlete has experienced a concussion, they are 4-6 times more likely to experience a second one at some point in the future. This is significant as the effects of concussion can be cumulative. This was well publicised in the 2015 Will Smith movie Concussion which followed the story of neuropathologist Dr. Bennet Omalu who first discovered the damaging effects of the repeated head trauma and associated concussions experienced by American Football players.

Returning to Riding:

In America, any competitor who sustains a concussion or looses consciousness at a USEF event, cannot return to competition until cleared to do so by a medical professional. Equestrian Australia has recently brought in similar rules for eventing. Unfortunately the decision to adopt rules is voluntary in other disciplines.

Dr Reena Ellis (from https://journeyofanamateureventer.wordpress.com/) is an Anasthetics Trainee who in addition to being a competitive event rider also works at equestrian events a large part of which involves assessing people is diagnosing concussion and determining whether competitors are able to continuing riding at that event.

“Concussion is a serious business and one which has previously often been disregarded in horse riding. Awareness within event organisers and medical staff is now on the up, and if you are riding at an affiliated event there are now normally clear rules about when you can ride again after a concussion. You might think you’ve just bumped your head and but don’t dismiss even a mild concussion, if not treated properly if can have long term effects on your cognitive functioning. Take the advice of medical staff in any situation where you think a concussion might be a possibility, and reduce your risk as much as possible by never getting on a horse without a helmet. Your brain is fragile, protect it and protect yourself.” Dr Reena Ellis.

Be sure to check out this great video produced by the USEF with Neurosurgeon and equestrian Dr Lola Chambless https://www.usef.org/learning-center/videos/concussions-signs-symptoms-helmet-safety

References:

1. Helmets and Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions

2. Concussion History and Knowledge Base in Competitive Equestrian Athletes

3. Prevalence of Concussion Symptoms in Equestrian Athletes, Is it underreported?

4. Common injuries in horseback riding. A review.

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