Concussion in sports is usually a topic that’s hottest in the world of contact sports. However, given the nature of horse sports, and the propensity for falling off a horse, concussion in horse riders often goes undiagnosed.
A traumatic brain injury such as concussion is an invisible injury. Because of this, it gets less attention despite potentially more severe consequences than other injuries. This, coupled with the common school of thought that you should remount your horse as quickly as possible after a fall to avoid a confidence knock, can be a recipe for disaster.
What is concussion, and how does it happen?
Concussion is a type of brain injury that can occur after a head injury or a forceful knock to the body. Even without a direct blow to the head, face or neck, concussion is still a risk when a blow is received elsewhere on the body and an impulsive force transmits through to the head.
Even the force of falling off a horse and landing on your feet can be enough to cause concussion in horse riders.
“Concussion shouldn’t be feared as it can normally be dealt with by quality and appropriate care at home,” explains sports therapist Katy Stephens, owner of Bouncing Back Injury Clinic. “What is more serious is diffuse cerebral swelling, also known as second-impact concussion.
Concussion can occur even without a direct blow to the head.
(Image credit: Alamy)
“This is a second concussion that occurs minutes, days or weeks after another episode of concussion that has not yet healed. It’s particularly dangerous if the first concussion wasn’t diagnosed and key professionals aren’t aware of the initial injury.”
According to a recent interview study by mental health charity Riders Minds, concussion awareness in the equestrian community is lacking. In an example from the new concussion in horse sport research, one participant said she did not know she was concussed and carried on. Her recovery took two years and nine months.
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Long-term effects of repeated episodes of concussion include memory loss, persistent headaches, brain damage, depression and Alzheimer’s. If you suspect you or someone else are suffering from concussion, seek medical attention immediately.
Symptoms of concussion
Symptoms are the effects someone might feel if suffering from concussion. These include:
drowsiness
headaches
nausea and/or vomiting
blurred vision
change in emotional responses
sensitivity to light
ringing in the ears
issues with balance
Medium to long-term effects might include changes in sleeping patterns, anxiety and/or depression and memory problems.
While these symptoms can present immediately, they can also be delayed in onset. Therefore, it is important to monitor a potential sufferer for a few days after a fall and seek medical attention if any of these symptoms start to develop.
Signs of concussion in horse riders
The signs aren’t always obvious when observing others, and according to the NHS and British Equestrian (BEF) include the following. Seek immediate medical attention if you notice any of these signs:
poor performance
a blank expression
struggling to balance
slow reactions
slurred speech
inappropriate emotional responses, such as laughing or crying without explanation
taking an unusually long time to respond to questions
acting out of character (often irritable)
confusion or inability to remember events before or after the fall
“If you are teaching a rider who has a fall and you are unsure whether they have concussion ask them some long- and short-term memory questions like ‘which pony are you riding today?’ and ‘what did we learn in our lesson last week?’” says Katy.
“Make sure you know your riders so you can identify any behaviour or personality changes which could be symptomatic of concussion.”
Awareness is especially important if you are riding with a child. Children are more susceptible and vulnerable to concussion because their brains are smaller and have more room for movement within their skull.
Annual statistics from the NHS showed that from 175,000 admissions that had a primary diagnosis of concussion, 33-50% of them were in children under the age of 15.
How equestrian sporting bodies deal with concussion
BEF has extensive guidance on monitoring and managing concussion in horse riders. The guidelines were released in March 2023.
British Showjumping (BS) brought in new concussion protocols this year that include a 21-day suspension to prevent competitors from returning to competition when they could still be vulnerable. They will also alert other British Equestrian member bodies of the suspension dates.
British Dressage (BD) told H&H it follows the same protocols as BS, including suspension date sharing.
Riders showing signs of concussion should not remount.
(Image credit: Emma Herrod Photography)
How long after concussion can you ride a horse?
While remounting after suffering an innocuous fall can be a positive step to help regain confidence, if the rider is showing any signs or symptoms of concussion they should not remount, and should instead seek immediate medical attention.
“Sixty-one percent of coaches have seen a parent pressure a young person into remounting after a fall,” says Katy. “It is important to be able to recognise the symptoms of concussion and prevent riders from remounting or remove them from the saddle if you have any doubts.”
In case of concussion, BEF’s guidelines include extensive advice on returning to the saddle and outline specific stages of recovery. According to this advice, a rider who has suffered with concussion should:
Commit to complete rest for at least the first 48 hours post-injury and limit screen time
Resume sport-specific exercises with no risk of head injury, such as walking/jogging, horse grooming or practising riding position, not before seven days post-injury
Resume training drills, such as resistance training, groundwork and yard chores, not before 14 days post-injury
Return to supervised riding of a suitable horse in calm, non-competitive conditions not before 21 days post-injury
Return to regular riding following the previous stage when ability and confidence are restored
Concussion is not an easy injury to diagnose, but if you are in any doubt as to whether someone you know has suffered from it following a fall then they should not be allowed to ride a horse until they have sought medical advice.
A horse owner and rider with more than 20 years experience, Bethany has been writing for equestrian publications since 2017. Over the course of her career, she has reported from major British Riding Clubs and British Dressage championships, covered Badminton Horse Trials and interviewed equestrian sport’s best athletes. Her work can also be found in Country Life, The Field and Breathe magazine.
