Managing the risks of concussion in horse racing

Concussion is rapidly becoming one of the hottest topics in world sport, and it is not only contact sports such as rugby and football at the centre of the debate – equine events are being highlighted too.

Studies show that concussion is 125 times more likely in equine sports than American football, a figure which may shock many people.[i] Almost every jockey who has ever ridden is likely to have been concussed at least once during his or her career – and the dangers to health are clear.

Equus Magazine claims up to 15% of all horse-related injuries seen in hospitals for evaluation are down to concussion – but predicts that because many concussions go unreported the figure could be even higher.[ii]

Even more worryingly, the US National Library of Medicine says head and brain injuries are responsible for the majority of serious equestrian injuries and deaths. [iii] The problems can be particularly acute for younger riders whose brains are still developing. So it’s clear that the sport, at all levels from local pony clubs to international horse racing organisations, needs to take the issue seriously.

How to spot a concussion and do the right thing

One of the biggest problems around concussion is that it isn’t a visible condition and so assessment often depends partly on the honesty of answers provided by the person affected.

In horse riding this is particularly difficult – most riders will want to get back on the horse and competitive spirit often overrides common sense. Moreover, if concussion is ignored then there can be long-term effects.

Brain injury association Headway, a charity which works to improve life after brain injury and also campaigns to help prevent concussion, has published advice for sports organisations, coaches and medical staff on how to recognise and treat concussion in sport.

Here are some of the key points to consider:

What is concussion?

In simple terms, a concussion – or minor brain injury – is a temporary disturbance in the brain’s functioning as a result of a blow to the head. The effects of concussion can leave people with symptom including dizziness, nausea, confusion or an inability to process or retain information, sensitivity to light, and vision distortion.

In some cases an individual may lose consciousness - however, it is important to note that only around 10% of reported concussions involve a loss of consciousness.

How to identify concussion 

Concussions are notoriously difficult to identify. It can be an evolving condition, with the symptoms taking time to display themselves.

Given the difficulty in identifying concussion and the risks of continuing once one has been sustained, the message has to be if in doubt, sit it out!

Headway advises that signs of concussion to look out for include:

• Dizziness
• Nausea
• Unsteadiness or imbalance
• Confusion
• Slurred speech
• Blurred or distorted vision

If any of these symptoms are experienced following a blow to the head, the player or rider should not continue.

What are the risks to riders of ignoring concussion? 

In the majority of cases, there will be no long-term damage caused by a concussion – if treated appropriately with rest and medical assessment. However, occasionally, complications can arise from seemingly minor blows to the head, which is why it is vital that people seek medical attention.

There are significant risks in returning to riding after sustaining a concussion. If a rider sustains another blow to the head before the brain has had a chance to recover, the damage can be exacerbated to the point that it can be – on rare occasions – fatal. This is known as Second Impact Syndrome and it is believed to be most common among children and young adults.

Damage limitation and prevention

Wearing the correct safety equipment, and in particular a properly-fitted helmet, is vital – in fact, it is a legal requirement for children under 14 in the UK and mandatory for riders under competition rules in most equestrian sports.[iv]

However, a helmet is designed primarily to prevent fatal head injuries such as skull fractures. Preventing concussion is far more difficult because it does not necessarily need a strong blow to the head to cause concussion. Forces to the face, neck or check could also be transmitted to the head and cause the same problem. [v]

The eighth annual International Helmet Awareness Day was staged in September 2017 and warned that most concussions in equine sport happen out of competition – and therefore go unreported and untreated. [vi]

So it is vital to instil a culture that riders should play safe and not return to the saddle after a possible concussion.

Dr Lola Chambless, a neurosurgeon at Vanderbilt University in Nashville, Tennessee, and long-time event rider said: "I’d really like us to get rid of the ‘get right back on after a fall’ mentality, because it’s not good if you have a concussion.[vii]

"If you get right back on a horse with the possibility of a concussion, you’re not riding your best, and a second fall can be much more severe. Any secondary concussion that occurs while you’re still recovering from the first is, by definition, much more severe, and potentially (on rare occasions) even life-threatening.”

Dealing with concussion in competition

Guidelines from Headway provide clear information about what to do when a rider suffers a head injury in competition:

What to ask when a rider hits his or her head due to a fall

• What day is it?
• What is the name of the competition?
• In what town is the competition located?
• What was your start time?
• What number is your next fence?

What to do next

If the rider is able to answer all questions they can continue. If not they should be held and observed for at least 15 minutes. If symptoms persist then their competing day is over and the rider should not be left alone. The rider should be transported for medical evaluation.

If the rider loses consciousness for any period of time they should be transported to a medical facility for evaluation.

Top tips for the first 24 hours after suffering concussion

• Do not ride a horse or operate heavy machinery
• Do not drive or ride a motorbike
• Avoid excessive visual stimulation – do not use a computer
• Do not drink alcohol
• Do get plenty of rest
• Do take prescribed medications or Paracetamol for pain
• Go to A and E if you have severe headaches, have blurred vision, start vomiting, have blurred or double vision, have excessive drowsiness or have a fit or convulsion.

How to accurately record and report to insurers

There are significant insurance and legal concerns that go with concussion.

In 2016 a group of 5,000 former American football players successfully sued their sports organisation, the NFL, for 1bn USD, claiming it had covered up the impact of repeated head trauma.

In 2017, three Australian National Rugby League sides were handed record fines for breaching concussion protocols, and in football both UEFA and The FA in England have begun research into the impact of concussion on players who head the ball.

Rugby Union is already taking action after its concussion review was described as ‘not fit for purpose’ by Dr Willie Stewart, of World Rugby's Independent Concussion Advisory Group. [viii]

In horse racing, the Jockey Education and Training Scheme is currently focusing on the issue of riders continuing to ride after concussion.

British Horseracing Authority’s chief medical adviser Dr Jerry Hill warned some concussions can have delayed onset.

“If you ride with symptoms of concussion before it is resolved, it’s like you are riding when you’ve been drinking,” he said.

This makes it even more important for horse riding clubs and organisations to record accurate details of all accidents and falls, including signs of concussion, treatment provided and decisions made over whether they were fit to continue.

Having the right level of insurance in place is vital in all cases.

[i] http://www.telegraph.co.uk/sport/horseracing/12112086/Horse-racing-greats-back-investigation-into-concussion.html

[ii] https://equusmagazine.com/blog-equus/heads-pink-equestrian-concussion-risk-55048

[iii] https://theplaidhorse.com/2016/03/03/top-9-myths-of-concussion-recovery/

[iv] http://www.medequestrian.co.uk/rider-safety/benefits-and-risks-of-riding/concussion/

[v] https://theplaidhorse.com/2016/03/03/top-9-myths-of-concussion-recovery/

[vi] http://www.horseandhound.co.uk/features/10-things-remember-international-helmet-awareness-day-436083

[vii] http://www.horsechannel.com/horse-community/concussion-awareness-for-equestrians.aspx

[viii] http://www.bbc.co.uk/sport/rugby-union/39630540