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head trauma and eventing--cumulative effects, how big an issue?

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  • head trauma and eventing--cumulative effects, how big an issue?

    Obviously head trauma including concussions is a problem in all equine sports, but in eventing the risks of a fall are higher. As a neuroscientist it has always concerned me that there could be a cumulative effect of all the falls I have taken over the years (none of which have been bad and I've never to my knowledge had a concussion).

    Some interesting discussion on this topic has occurred on the "armchair quarterback thread", but I thought it deserved it's own thread. Here is a recent CNN article on chronic traumatic encephalopathy (CTE) in a football player:

    http://www.cnn.com/2017/11/16/health...-bn/index.html

    And a link to the article being discussed:

    https://academic.oup.com/neurosurger...nyx536/4616608

    How big a concern should this be in eventing? (Realizing the that we can't compare to football, where some are getting their heads knocked around on just about a daily basis). Not necessarily CTE, but post-traumatic brain damage and cognitive issues?

    Is there anything we can do to minimize the risks? (Besides not event). I am hoping blackwly and fordtraktor will join the discussion.

  • #2
    It is a risk...just like all sports. I have a good friend who suffered depression and other long term complications that came after several minor head injuries. She didn’t put it together until long after the fact. I think education of the risks is one of the best things we can do. Wear good helmets but more than that....when you get your bell rung....STOP. Take it easy for longer than you think as you are now at a higher risk. Before we knew of the risks....how many of us climbed back on and kicked on? Be aware of the risk...be aware of the symptoms and be more aggressive at preventative. Which may mean NOT riding right away. This is easier for those who do not make a living with horses.....and why those that do, need to be smarter. Have disability insurance...have owners who are educated and supportive...but in the end, their livelihood depends on their health and they need to take care of it! Rest on the front end loses less time than if they have a second fall.
    ** Tact is the ability to tell someone to go to hell in such a way that they look forward to the trip. ~Winston Churchill? **

    Comment


    • #3
      Based on the information we have regarding prevalence of brain trauma and riding, this is a HUGE issue. I know those statistics are quoted elsewhere and are not difficult to find with the help of Google.

      Helmet design is hugely important, of course, and I sometimes wonder if our current helmet design limits the protection provided. Would it be safer to have a helmet that resembles those worn in other sports, which might not conform to our fashion sense? I really do not know. I defer to the experts.

      Comment

      • Original Poster

        #4
        Originally posted by Winding Down View Post
        Would it be safer to have a helmet that resembles those worn in other sports, which might not conform to our fashion sense? I really do not know. I defer to the experts.
        Good question. I bought one of those low profile Ovation helmets that get recommended on here quite a bit. All I can say is those who have recommended them must have never fallen in one! I didn't feel that it had nearly the protection of my tried and true Tipperary helmets, which is what I am sticking with, at least until I find another brand that fits.

        And remember those "cone head" helmets? I don't remember who made them but they were suppose have more protection. I think one reason they did not succeed was because of the terrible name! I bought one on Zulilly but it didn't fit (no returns unfortunately).




        Comment


        • #5
          This thread is kind of my 'fault' but its an issue I think about frequently and read about often. A friend went through a major, life altering injury a couple years ago and its brought the issue home even more.

          However, I'm by no means an expert.

          The things that have come up in the past few years though are ... sobering.
          • Riding helmets save your life by preventing skull fractures but do little to prevent actual concussions. Some ski helmets include MPIS technology with internal crush padding that decelerates the head on impact. I've only found one riding helmet on the market that has this, only available in Europe and NOT a major manufacturer. Not GPA, not Charles Owen, not Samshield, not IRH, not Uvex etc
          • Asking someone with a concussion to make decisions on whether they should ride or not is NOT REASONABLE. Likewise, asking someone with a likely concussion to decide if they need to seek medical attention is NOT REASONABLE. We need to develop a culture of stepping in and intervening.
            • Why do I say this? Personal experience. I'm about as knowledgeable about concussions and 2nd impact as any layperson could be expected to be. I took a significant hit to the face in the saddle. Poll to nose, direct hit with no martingale and almost blacked out in the saddle. I got off bleeding, took my horse in and put on a martingale, got back on and schooled the behavior quite aggressively. Afterward I drove almost an hour home, told my husband I was fine and didn't need to see a doctor. It took until the next day for my nose to stop bleeding. I was NOT competent to make any of those decisions. There were people there that day. They saw me, admitted later they knew I was concussed.
          • Its not just a head hit that can give a concussion. Anything that causes a whiplashing or high speed direction change of the head can do the same. Come off and land hard on your back, butt or even feet? you could actually have a concussion. Horse spooks and dodges hard? Same. Hard buck? Same. Bad jump, like the ones where you end up hanging over the shoulder and struggle back up? Same.
          • Its all cumulative. My joke about horse people is that they never admit how many concussions they've had, only the ones they gave in and were dragged to the doctor for.
          The stories of the T-Rex Eventer

          Big Head, Little Arms, Still Not Thinking It Through

          Comment


          • #6
            Synthesis...I wasn’t advocating that the rider who hit their head should know to take it easy....BUT those around them should. We had a younger rider take a fall at an event in warm up. She was allowed to continue BUT her trainer told her mother NO. As much as she wanted to
            let her get on and go back out for her confidence, she had hit her head and the trainer thought it wasn’t worth the risk. This TRAINER is educated and passing on sound advice. THAT is what I meant.
            ** Tact is the ability to tell someone to go to hell in such a way that they look forward to the trip. ~Winston Churchill? **

            Comment


            • #7
              I don't ride anymore but have a few thoughts from watching a different sport that has also had to deal with potential concussions in participants, NASCAR.

              It took, IMO, longer than it should have for NASCAR to address driver safety but once they did, they jumped in both feet first.

              Some of the driver safety changes wouldn't make sense in eventing such as head-neck restraint systems to prevent "whiplash" type injuries.

              But, their protocol after a crash I feel would make sense in eventing. When a driver wrecks, whether the car gets back to the garage on a wrecker or is driven, the driver *and* his helmet and head-neck restraint *must* go to the infield care center for evaluation; the driver, under current rules, is out of the race and can no longer continue regardless of the results of the evaluation at the care center.

              If a driver is diagnosed with a concussion, there is a protocol that NASCAR has defined before the driver can drive again although not all feel the protocol is sufficiently strong enough.

              Last year in the middle of the season, one of the most popular drivers, Dale Earnhardt Jr, suffered a concussion, raced a few more races, went to see a Dr about troubling symptoms and Dale didn't drive for the rest of the season until *he* and his team of Drs felt it was ok.

              Half way through this year, Dale announced he was retiring, in part, I am sure because he has had numerous concussions in his career and after last year's scare, he knew he needed to stop. There were other factors involved, I am sure, in his decision but mostly the realization that each concussion ups the risk factor. He chose to take that risk this year on the track so he and his fans could say 'farewell' but he is stepping away before he needed to performance-wise.

              I think eventing could learn from this that if a rider falls, the rider is withdrawn and evaluated by on-site first responders. Any questions and potential further eval at a hospital could be discussed. If a concussion is diagnosed, have a procedure in place that would encourage the rider to follow through on whatever treatment and some type of eval prior to riding in another recognized event.

              This wouldn't catch all the problems but maybe more of the visible venues which hopefully would trickle down to the smaller, unrecognized venues.
              If you see your glass as half empty, pour it into a smaller glass and stop b*tching

              Comment


              • #8
                I appreciate this thread, though I am far from an expert on neuro issues so I can only provide the voice of anecdote, one among many I am sure. I defer to those who actually know what they are doing. I can just describe my experiences and what my neurologists have told me over the years (I've moved around so I've gone through 5).

                I will repost the gist of what I did in the other thread:

                "I have had serious effects from multiple TBI since I was 21. I had 2 bad head injuries within 2 years and my occasional migraine turned into chronic daily migraine and cluster headache.... Also, my memory isn't what it used to be though I don't yet struggle with it. Still, I used to have a photographic memory and don't any more.

                I am 36 now and still living with the daily effects, which impact my life significantly. I see a neurologist/headache specialist in Chicago and have tried everything...never with lasting success. He is convinced my riding accidents messed up the way my brain signals, something like hyperactive neurons over firing, and now it has been so long there is little hope it will improve significantly.

                Still I have been able to push through it to become a successful attorney, mom and farm owner so I am not crying poor me....it is just a fact. I try not to fall on my head any more but you know how horses are...I managed to do it twice in the last year.

                My DH does get kind of antsy after I have a significant fall, wondering why on earth I want to keep doing this, but he knew it was part of the package when we got married and is OK with it. I have drastically changed the kind of horses I ride and my willingness to get on anything with 4 legs, though. And my willingness to pay someone else to do the "firsts" on young horses. Unfortunately my skills started to outweigh my nerve by a considerable amount once I had kids.

                i wasn't eventing or even jumping for either of my 2 worst head injuries, FWIW. I was a young pro riding 10-12 greenies a day and the risk adds up."

                I don't event at high levels and don't want to, but I still jump, ride alone, etc. I always wear a helmet but I was wearing a helmet during both of my serious accidents. They probably saved my life from blunt trauma but as said above, it is my understanding they are not effective at preventing concussion.

                I do think something like the LandSafe programs would be terrific especially if they help reduce concussion -- I don't know if there are stats on that. I think we as a sport should do more of that. I'd go to one if I could. Still, it can be hard to execute. One of my bad incidents the horse either stepped on my head or kicked me in the head after I was already off. The fall itself wasn't a problem. The other the horse was bucking and fell hard with me still on -- it whipped the back of my head into the ground. I didn't exactly come off and it was over before I even realized we were going to hit the deck. We need to do what we can to minimize risk but I still struggle with what I could have done differently, other than not get on in the first place (which is why I'm more reluctant to deal with a problem horse now).

                I would be very happy to adopt any new helmet technology. I am vigilant about replacing them after a fall, even if I don't think the fall was "significant," if my head might have touched anything. I also don't ride with my hair up/"helmet hair." It seems to me that has to impact proper fit. A low bun with one of those RWR hairnets over it can look pretty much the same.

                As for people not being responsible after concussion, my anecdote is YES. after my first accident, I developed short term amnesia. I got back on the young horse and was walking it around. Rode up to a friend in the ring and asked what horse I was riding. Twice. That's how she knew something was wrong. But I argued about going to the hospital because "I have to ride this horse."

                I didn't really even have an idea I'd been kicked before my mom later noticed my helmet was cracked in two and had a big hoof-shaped divot in the foam.

                But that classic "you have to get back on the horse" mantra.... It's not as much of an absolute as it used to be, thank goodness, but it has been ingrained in most of us since we first climbed in the saddle. After a few decades of seeing that pervading attitude towards falls, we don't even question the wisdom of it.
                Last edited by fordtraktor; Nov. 17, 2017, 01:01 PM.

                Comment


                • #9
                  Originally posted by bornfreenowexpensive View Post
                  Synthesis...I wasn’t advocating that the rider who hit their head should know to take it easy....BUT those around them should. We had a younger rider take a fall at an event in warm up. She was allowed to continue BUT her trainer told her mother NO. As much as she wanted to
                  let her get on and go back out for her confidence, she had hit her head and the trainer thought it wasn’t worth the risk. This TRAINER is educated and passing on sound advice. THAT is what I meant.
                  I figured you weren't advocating it, no worries. The problem is how often I've seen others willing to pass the call to the rider at home and in competition. In general, the unwillingness to make waves over-rides the need to protect the horse and rider, especially with adult riders and even more so with professionals.
                  The stories of the T-Rex Eventer

                  Big Head, Little Arms, Still Not Thinking It Through

                  Comment


                  • #10
                    As a member of the Multiple TBI Club (a group I wish had many fewer members) I recognize many of the experiences described above as they could be my own. And we all are damned lucky that we are able to do all the things we can.

                    An addition to the description of a concussed person not being the best one to decide if they should continue riding: Judging from my own experiences only it's not (just) the desire to continue riding. Rather I think that the atavistic response to a brain injury is to carry on lest our weakness is noted and we are preyed upon. Even in other, non riding situations a conscious TBI victim will deny that anything is wrong. I note this because it isn't just "kick on". It's more deeply rooted (IMHO) and therefore will need to be addressed differently.
                    They don't call me frugal for nothing.
                    Proud and achy member of the Eventing Grannies clique.

                    Comment


                    • #11
                      One of the problems I see--and I may very well be part of the problem here--is that I think there's some value in the "get back on the horse that threw you" mentality. I've taken more dives that I can count, and subjectively I think getting back on has left me with feelings of success and perseverance. The times I haven't, which are of course internalized as massive failures, I can still remember several of even after 30+ years. (Leaving aside what lessons the horse may get from it all.)

                      If there's some good way of evaluating (either as rider or observer) when it's time to hang it up for the day (month? season?) and when to get back on I'd love such a tool. I think the rider is a pretty awful judge of it, but I'm not sure what to look for as an observer absent really clear cognitive weirdness.

                      For what it's worth, a while back I decided on two things, first, that when I take a fall to not just leap back up and get back to it but to stay put for a sec and self-assess (for much more than just head injuries) as best I can, and second, that if there's any sign of a hit to my head to just stop for at least the day. Also to listen to what anybody else has to say if they say I should stop, since recalcitrant TBI sufferers seem to be a common theme. (Or is it just horse people are always like that?)

                      Comment


                      • #12
                        @furgalannie and others, this got me to thinking.

                        [Preface: I have been breaking, training, and riding horses for over 50 years and I am SO blessed to have no discernible TBI. Every time I have had a fall where I rang my bell, I had a CAT scan and sometimes an MRI just to be safe, and my brain has shown no signs of trauma. I count myself as lucky. Very lucky.]

                        So this is a segue into a related concern. I know people who have had serious concussions who went back to riding well before their physician recommended. We can call them careless or lacking in judgment (and they may be that), but for so many of our horse people, they have little choice if they are going to continue feeding themselves and their horses. Most of these young pros, and some of the older ones, have no back up plan if they get injured. The more "famous" ones can carry on through teaching and doing clinics (if able with the TBI) but what about the others? Yes, they should have a financial back up plan, but what if they don't?

                        I wonder if it would be helpful if the USEA came up with a fund to support people with injuries who demonstrate the financial need until they are able to ride again? It would be sort of like a grant program. It would last the duration of what the physician recommends and the recipients would be responsible for documenting that they are complying with medical recommendations. (in other words, no double-dipping into a fund while competing at events or schooling).

                        There are fundraising efforts for catastrophic injures. But I am talking about more subtle injuries, namely TBI. I do not see people rallying around the 22 year old kids who have a few clients and rent stalls in a barn.

                        What about it? A fund for injured riders who have to take some time off?

                        Or does this already exist? (I have been known to overlook the obvious!)

                        Oh, I will join the "wear an ugly helmet club" any day. Heck I will put on anything if it may help keep me safe or help me avoid pain!

                        Comment


                        • #13
                          Some of those things have been addressed on some levels. PRO has disability insurance that goes with its membership and allows riders to buy up for higher coverage. It is probably one of the best things they have accomplished. But it will help a rider in these situations be able to supplement their income when the can’t or shouldn’t ride.


                          The USEF has a lot of information about concussions, including a safety poster you can download for free and post at the barn. It outlines the symptoms etc. They have also done several clinics where you can get base line testing done. I think they make it a requirement for all high performance riders.
                          ** Tact is the ability to tell someone to go to hell in such a way that they look forward to the trip. ~Winston Churchill? **

                          Comment


                          • #14
                            I wonder if the disability insurance is even close to enough? And I agree that the insurance program is one of the best things that organization has done.

                            Comment

                            • Original Poster

                              #15
                              I would really like to do a Landsafe clinic. Although I am a little worried since the somewhat random way that I fall has always worked for me, I shouldn't change things. But you never know what will happen the next time. It would be good to have some tools and more knowledge.

                              Comment


                              • #16
                                How effective is the rule of thumb that if you have a fall and your helmet impacts something, that the helmet should be replaced? And that helmets should be replaced every 5 years no matter what?

                                I've used these rules for quite some time, but wonder how many others do?

                                Is helmet integrity greatly impacted in other ways, such as if you drop it on the ground accidentally?

                                Is anyone aware of any studies taking place regarding materials in helmets that can provide better protection?

                                Comment


                                • #17
                                  Originally posted by KellyS View Post
                                  How effective is the rule of thumb that if you have a fall and your helmet impacts something, that the helmet should be replaced? And that helmets should be replaced every 5 years no matter what?

                                  I've used these rules for quite some time, but wonder how many others do?

                                  Is helmet integrity greatly impacted in other ways, such as if you drop it on the ground accidentally?

                                  Is anyone aware of any studies taking place regarding materials in helmets that can provide better protection?
                                  I replaced a year old CO because it took a really hard knock from being dropped. CO had me send it to them with a description of the incident and even gave me a discount on a new helmet even though it wasn't damaged in a riding incident. I assume they used it for testing the effects of drops. I also replaced one after a fall where observers said my head didn't hit the ground but there was a clear dirt impact area on the helmet. It's nothing to mess around with.

                                  Comment


                                  • #18
                                    Regarding CTE and riding, it would be interesting if horse people started donating their brains to the studies. We certainly see a lot of the symptoms that have been seen in NFL victims. As an aside, I wouldn't trust a doctor who has worked for the NFL on this subject any more than I'd trust a doctor who worked for RJ Reynolds on the effects of cigarettes on your lungs.

                                    Comment


                                    • #19
                                      Originally posted by kcmel View Post
                                      I would really like to do a Landsafe clinic. Although I am a little worried since the somewhat random way that I fall has always worked for me, I shouldn't change things. But you never know what will happen the next time. It would be good to have some tools and more knowledge.
                                      Kcmel, we hosted a LandSafe clinic this past summer. If you do a search you will find a thread on it. I HIGHLY recommend it, even if you just audit, and I started as a sceptic. It will help you think differently about falling and what can be done to enhance safety. Bottom line: LOTS can be done. The most striking thing to me was seeing the change in body awareness and control in the participants over the two days. IMHO, it should be mandatory for eventers.
                                      They don't call me frugal for nothing.
                                      Proud and achy member of the Eventing Grannies clique.

                                      Comment


                                      • #20
                                        Originally posted by Winding Down View Post
                                        I wonder if the disability insurance is even close to enough? And I agree that the insurance program is one of the best things that organization has done.

                                        It’s not bad. If you buy in the higher level I think it pays about 600 a week. I don’t remember for how long but thought even the initial plan with the membership was pretty good. It is really worth the membership and something I encourage many of the young riders. It also has a medical insurance component. It is FAR FAR better than not having anything.
                                        ** Tact is the ability to tell someone to go to hell in such a way that they look forward to the trip. ~Winston Churchill? **

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