Concussion Incidence In Equestrians: A Self-report Survey

Abstract

PURPOSE: Equestrians are at high risk of concussion (CONC): per hospital records 45% of sports-related traumatic brain injury (TBI) in adults were related to horseback riding, dwarfing other causes. The second-leading cause of sports-related TBI was falls or hits from contact sports. However, little is known about incidence of CONC in equestrians who were not seen by medical professionals and it is likely that CONC rates are under-reported. Our purpose was to survey equestrians about their history of concussive-like injuries. METHODS: Subjects were recruited via email and social media using a snowball technique. Participants were provided with a definition of CONC and then completed a survey of their equestrian experience and CONC history. Incidence was expressed per 1000 hours of riding exposure. RESULTS: 205 subjects (198 women) reported an average of 26.5 ± 14.4 years of riding experience. A total of 708 CONC were reported, with the majority (563, 80%) occurring while riding a horse. CONC incidence while riding was 0.47 ± 1.15 per 1000 hours, with riders reporting a mean of 2.75 ± 4.48 CONC (range of 0-50); 88% were due to falls. Only 30 equestrians (15%) reported never having been concussed. Of those who were concussed at some point, the average number of CONC was 4.07 ± 5.60. The most common mechanisms were due to bucking (23%) and while jumping (22%). Riders reported wearing a helmet at the time of injury 84% of the time. Only 45% of riders indicated that they had reported a CONC to a health professional, while 33% indicated that they had not reported their CONC symptoms to anyone. CONCLUSIONS: Our data confirm that equestrians have a high CONC risk, per self-report, as expected when athletes collide with the ground with great force due to height and speed. For example, the all-injury incidence for skiing has been reported as 0.6/1000 hours, and for motorcycling as 0.14/1000 hours. The incidence reported by equestrians for CONC alone is similar or greater than the all-injury rate of those activities, respectively. Equestrians are at high risk of CONC relative to other activities. The high number (20%) of CONC occurring while not riding highlight the need for good safety practices not only while riding but also while handling horses.