New Discussions on Mitigating Concussions

WORDS: DR. BARBARA BLASKO, ShowMD CEO and Emergency Medicine Physician

A STUDY RELEASED by the Journal of Neurological Focus found that horseback riding caused the most traumatic brain injuries out of any sport—and they account for a whopping 45.2% of sports-related traumatic brain injuries (Winkler et al., 2016).

At least 30 million Americans ride horses competitively (McCroy, 2005). Sports-related traumatic brain injuries are estimated to affect 300,000 to 3.8 million people annually in the United States.

Risk of concussion and fatal injuries for equestrians is comparable to other high impact sports like football, hockey, rugby, and motorcycle and auto racing.

Head and brain injuries are responsible for the majority of serious head injuries and death among equestrians, with the number of occurrences being underreported. The concussion rate is thought to be somewhere between 3% and 91% (McCroy, 2005). The vastness of this range is because many riders choose not to seek medical attention after an injury so that they can remain in competition or they do not want to appear weak or injured (Bixby-Hammet & Brooks, 1990).

The culture of the equestrian world encourages riders to get “right back on the horse”—an outdated trope resulting in many riders not being properly evaluated for concussion signs and symptoms. These decisions can lead to the rider returning to competition prematurely, without addressing the possible brain injury that may have occurred (McCroy, 2005).

Interestingly, rider experience level did not influence concussion rates and 78% of riders had never been educated on signs and symptoms of head injury, let alone how to treat one (Kuhl et al., 2014). Less than one-third of the riders studied had a medical professional clear them to return to riding after sustaining a head injury.

New scientific research and medical strategies have been developed for post-concussion treatment. These protocols can help reduce healing time and help alleviate many of the symptoms that riders with head injuries may experience. These newly developed strategies include: supplements, exercise, thermal treatment, and stimuli management.

As always, check with a medical professional regarding your personal treatment protocol, but these new observations in treating TBIs are very interesting:

While many supplements have been studied to determine if they are effective post-concussion treatments, only Omega 3, Vitamin D PLUS creatine, N-acetylcysteine, and melatonin have been shown to improve post-concussion symptom scores thirty days post-injury. Acetaminophen or ibuprofen can be taken for pain relief along with these supplements.

New evidence has shown that early introduction of moderate to mild exercise, such as stationary bike or walking on the treadmill can have a positive impact. The concept behind this is that mild exercise will increase blood flow to the brain and to the site of the injury. This will promote healing and repair of the damaged tissue and decrease overall recovery time. Physical therapy is also recommended, particular in those patients that have inner ear symptoms (dizziness or vertigo). This can include coordination and balance activities, visualization techniques, and cervical spine and vestibular rehabilitation.

Though strict stimuli limitation was recommended per previous guidelines, that is no longer the case. New research indicates that a gradual increase of regular activities as soon as twenty-four hours post-concussion is appropriate as long as the activity does not make the symptoms worse. Should external stimuli be irritating to the patient, ear plugs or noise-canceling headphones and sunglasses are recommended to reduce irritation.

A 2022 study showed that immediate head and neck cooling reduced recovery time by up to 4 days. For cooling measures, a high powered portable cooling system using a silicone cap was used and applied within 10 minutes of when the injury occurred. Though this particular cooling measure may be hard to replicate, the overall takeaway is that immediate cooling of the brain can reduce recovery time and any leftover side effects.

The prevalence of head injuries among equestrians is significant and important to address.

These new guidelines and protocols should help alleviate symptoms and improve recovery time, allowing riders to literally get back on the horse.

SOURCES: Bixby-Hammet, D.M. & Brooks, W.H. (1990). Common injuries in horseback riding: a review. Sports Medicine, 9, 36-47. • Kuhl, H.N., Ritchie, D., Taveira-Dick, A.C., Hoefling, K.A., & Russo, S.A., (2014). Sports Health. 6(2), 136–138. doi: 10.1177/1941738113508073 • McCrory, P.M. & Turner, M. (2005). Equestrian injuries. British Journal of Sports Medicine, 48, 8-17. • Winkler, E.A., Yue, J.K., Burke, J.F., Chan, A.K., Dhall, S.S., Berger, M.S., Manley, G.T., & Tarapore, P.E. (2016). Adult sports-related traumatic brain injury in United States trauma centers. Neurosurgical Focus, 40(4), 1-12. doi: 10.3171/2016.1.FOCUS15613

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