After the Fall: How pink is your concussion? (What women riders need to know.) - The Horse Owner's Resource

After the Fall: How pink is your concussion? (What women riders need to know.)

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The veterinarian didn't know what hit her. What she did know, when she woke up, was that her head had hit the concrete barn aisle floor when the horse she was treating spooked. She struggled to sit up. 

Days later, after being checked out at a local hospital, the incident still haunted her. And as if having a head injury wasn't enough, her life became complicated with doctor appointments, missed days from work, and nagging concerns that the injury might have longer-term repercussions for her health and her career. Or, it might have been so mild that there was no need to worry at all.

She didn’t know what was ahead of her. And she didn’t know how long it would take to know if she was going to be all right. 

• • • • • 

Raise your hand if you're ever suffered a concussion--whether from riding a horse or a car accident or any type of mishap.

If you didn't raise your hand, how do you know you've never had a concussion?

And did anyone ever mention to you that men and women react differently to head injuries?

No, we didn't think so. But that's about to change.

Sport and medical science have exploded in recent years with new statistics on traumatic head injuries and the mechanical engineering properties of helmets designed to prevent them. Much of the information centers on or is sourced from football, and most of the data has been collected from tests on helmets made for and worn by men in contact sports--or from crash test dummies and anvil drop tests.

Meanwhile, much of the data on traumatic brain injuries in women is coming from a very different source: by studying women who are victims of domestic violence. Women athletes tend to be bypassed in the research, but there's hope that that will be changing soon--and that equestrians can play a role in that change.

According to one analysis of equestrian sports, concussions comprise from 9.7% to 15% of all horse-related injuries seen in hospitals for evaluation. Those injuries range from common sprains and dislocated fingers on up. But since many more victims with minor symptoms of a head injury never bother to go to a hospital to be treated after they fall off a horse, their injuries don’t make it into statistics. Only the more serious injuries get counted. 

What we do know is that equestrian sports hold the dubious honor of having the highest mortality of any sport. More riders are injured than skiers and football players and race car drivers combined.

If you're a number-cruncher or a dataholic, here's a treat for you. A study published in 2015 in the journal World Neurology presented an across-the-board analysis of relevant studies of equestrian injuries. Compiled primarily by neurological surgeons at Vanderbilt University's Sports Concussion Center, the study looked for data on both functional traumatic brain injuries, such as concussions, and less common (but even more debilitating) structural traumatic brain injuries in equestrian sports, such as fractured skulls and hemorrhage in and around the brain.

Gender and statistics in equestrian sports injury data

The researchers regretted that gender data was lacking in most of the studies they reviewed. While data may seem to suggest that female riders receive head injuries more often than males, arguments can be made for the fact that women generally outnumber men in horse sports anyway, and that women may be less resistant than men to the suggestion that they go to the hospital to be checked out. Women may also be more likely to wear helmets than men and sometimes take fewer risks. On the other hand, women often don’t like to complain, and may have compelling reasons to want to avoid hospitalization so they can care for children (or horses). As a result, they may refuse medical attention.

The injured people in the study were also not all riders; in one study from Kentucky, one third of patients had been bystanders, including spectators at horse events. In another study, 29% of injuries were from horse kicks rather than falls from the saddle. Who was most likely to be injured? Amateurs, young females, and older male professionals, depending on the study criteria, had the highest risk.

While gender data may have been lacking or inclusive in these tallies of equestrian brain injury, what happens after the fall or kick is influenced by gender. And that is really where today’s story begins.

• • • • •

Pink Concussions

Of significant importance to equestrian sports is compelling evidence that women experience concussions differently from men, and that they have different recovery times and different severity or duration of symptoms, such as headache or blurred vision. 

Based on this new body of research, a new organization is dedicating itself to educating women to both prevent brain injuries and to cope with the after effects when one occurs. 

Meet Pink Concussions, an educational organization that hopes its information will benefit equestrian sports, and that equestrians, in turn, will bring them their stories of what it means to suffer head injuries, whether mild or severe, as a result of contact with horses or participation in equestrian sports.

Headquartered in Connecticut, Pink Concussions, hosted the first medical conference dedicated solely to traumatic brain injuries in women in 2016. While the organization is deep into medical research, it also has a practical side, and offers three key points to make us all think differently about concussions:

  • Women concuss at high rates than males in sports with similar rules;
  • Women report a higher number and more severe symptoms than males in both civilian and military research; and
  • Women have longer recovery periods than males including higher rates of Post Concussive Syndrome (PCS).

Given those three facts, one would assume that there is plenty of information available to women and girls on how to avoid concussions, what to do if you think you have one, what to do if you are present when a woman receives a brain injury, and what the aftercare for a woman with a head injury might be.

However, that is not the case. Concussion is an example of a brain injury with a gender difference, and yet reference material and medical guidelines do not specify gender differences. 

Right now, Pink Concussions executive director Katherine Snedaker is assembling an equestrian advisory committee, and hopes to host an equestrian sports panel at the organization’s next conference, the PINK Concussions Symposium at the World Brain Injury Congress 2017 in New Orleans. 

Snedaker said that women need to be aware of the cumulative effects related to concussions, as well. Repeated head injuries, even mild, may build up. 

Pink Concussions supports women with traumatic brain injuries with three support groups on Facebook, including one for caregivers.

Sometimes it seems like horse industry organizations prefer to focus on overall safety and injury prevention rather than to report their statistics--if they even have them.

Equestri emptor.

In their defense, when a rider parts company with a saddle, he or she becomes the concern of the medical community, and the outcome of an injury--major or minor--may never be reported back to the horse show organizer or the sport governing body. 

Equestrian sports organizations that do want to know are forced to consult medical statistics, rather than sport statistics, often by way of admission stats for hospital trauma units. If an injured rider isn't admitted as a patient, little or no information about the diagnosis, let alone the long-term followup, ever finds its way to a data set.

Until recently, safety around horses centered on the panacea of wearing a helmet. A false equivalency developed: If riders would just wear helmets, the sport would have a better image and fewer accidents would happen.

But a funny thing happened around the same time that helmets became mandatory for many sports, and in common use by many more riders.

More attention has been given to the injuries suffered on the ground, especially by professionals like veterinarians, grooms and farriers. In addition, "jockey science" has come into its own to record the health problems and job-related injuries of professional race riders.

Do we need to wear helmets on the ground? Professional emergency response educator Rebecca Gimenez, PhD, recently conducted an exploratory survey for veterinarians and vet technicians. As director of Technical Large Animal Emergency Rescue, she is concerned about veterinarians who don’t wear helmets when trying to free horses from entrapment. 

“Emergency responders show up and put on their helmets,” she said, bemoaning the fact that veterinarians rarely even have one available, if they wanted to put one on.

What can we do?

While it may be early days, awareness can pay off. What most women don't know is that their gender means that they experience concussions differently from men, so spread the word. And, that it's not enough to feel safe in the saddle under your helmet, given the high number of horse-related injuries that occur when people lead, bathe, load, handle, treat, shoe and just watch horses.

We’ve never had so many resources to keep us informed, but sometimes the information we need is hard to find. Congratulations to Pink Concussions and the medical community around it for seeing a need and responding to it. 

To learn more:

The study mentioned in the text is:

Functional and Structural Traumatic Brain Injury in Equestrian Sports: A Review of the Literature
Scott L. Zuckerman, Clinton D. Morgan, Stephen Burks, Jonathan A. Forbes, Lola B. Chambless, Gary S. Solomon, Allen K. Sills
World Neurosurg. (2015) 83, 6:1098-1113.
http://dx.doi.org/10.1016/j.wneu.2014.12.030

That paper lists more than 60 references, primarily related to injury in equestrian sports.

Read more about equestrian safety, helmets and brain injury on The Jurga Report:

Neurologists' New Guidelines for Sports Head Injuries; Georgina Bloomberg Falls at Syracuse, Seeks Treatment Later

Not Just Natasha: Florida Accident Another Reminder to Wear Your Helmet

Strap It All On: Protecting Your Head Requires More Than a Helmet (But That's a Start)

New Connecticut Legislation Would Require Riding Instructors to Be Certified in CPR, First Aid and Concussions

Are Equestrian Safety Issues Riding Between the Lines of PBS' Frontline "League of Denial" Exposes on Head Injuries?

New York State's Equestrian Helmet Law Amended to Age 18

Risky Business: British Horse Vets Injured More Often than Firefighters, Study Shows

Equestrian Injury: A Trauma Surgeon Shares His Stats

Should veterinarians wear helmets?

Equestrian safety research: What kind of rider falls and doesn't feel it?