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How to recognise concussion in horse riders – and when it’s safe to get back in the saddle

Bethany Stone Bethany Stone

    • 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.

    The aftermath of a fall from a horse at a green and white oxer. The female rider has been thrown against a green jump wing and is still holding the rein of her skewbald horse in her left hand. The poles have been knocked down.

    Concussion can occur even without a direct blow to the head. 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.

    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.

    Rider and friend walking horse back after fall

    Riders showing signs of concussion should not remount. 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.

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