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.

“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.

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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Research has highlighted the need for “vastly improved” awareness of concussion in horse sport – as progress is being made in this area.

Mental health charity Riders Minds supported work on the effects of and recovery from concussion, and the level of understanding of the condition, carried out by researcher Amelia Collins.

A Riders Minds spokesperson said the interview study of female riders “highlighted the lack of education around both the symptoms and the severity of concussion as a brain injury and misdiagnosis from professionals, leading to delayed care and prolonged recovery time”.

“Findings show that prolonged concussion recovery is not only physical but psychological, social and identity-related,” the spokesperson said. “Many riders reported cognitive and emotional changes such as poor concentration, low mood and mental fatigue that were not initially recognised as concussion-related and were sometimes attributed to stress or anxiety, which delayed appropriate care.

“A lack of concussion awareness also meant many riders underestimated their symptoms and continued riding or working through them, unknowingly prolonging recovery.”

One participant said she did not know she was concussed and pushed on – her recovery took two years and nine months. Others reported being dismissed or misdiagnosed, but also downplaying their own symptoms.

Concussion in horse sport: more action needed

“A key finding was that cognitive and emotional symptoms, including poor concentration, low mood and mental fatigue, were frequently not recognised as concussion-related,” the spokesperson said. “Riders reported that these symptoms were often initially attributed by medical professionals to stress, work pressures or anxiety, delaying appropriate concussion-specific care. This lack of early recognition contributed to confusion, frustration and prolonged recovery for many participants.”

The study found limited awareness meant many riders ignore warning symptoms, prolonging their recovery; physical issues such as numbness, pins and needles or fatigue were often not understood to be signs of a brain injury.

Ms Collins said: “Being both a coach and a rider, I’ve seen first-hand how often concussion symptoms are minimised. Many riders just focus on pushing through, unaware that this is a serious brain injury that can have long-lasting effects, and that recovery from concussion can be a hard process.

“I’m incredibly grateful to all the interview participants who generously shared their time and insights; this research wouldn’t have been possible without them. Speaking to them was a powerful experience for me and I hope this research helps raise awareness of concussion in equestrian sport. Change starts with education and by sharing these stories, we can begin to turn knowledge into action within the sport, supporting riders as they navigate their concussion recovery journeys.”

Riders Minds says the study shows the need for better awareness of concussion in horse sport, and recognition of symptoms, as well as education on prolonged recovery.

British Showjumping (BS) has brought in new concussion rules this year; any rider taken directly to hospital from a show or in whom medics, officials or organisers suspect a concussion will be suspended for 21 days to prevent competitors returning to competition during a time when suffering a second brain injury could have catastrophic effects.

BS will also alert other British Equestrian (BEF) member bodies, not of medical information but of suspension dates. To request the period be shortened, a rider must provide a hospital discharge sheet or doctor’s report clearing them to compete.

The dangers of a second head injury

“We’re not trying to spoil anyone’s fun but we need to help educate people – especially those responsible for young people in the sport – about the dangers of a second head injury in that time period,” BS CEO Iain Graham told H&H.

A British Dressage (BD) spokesperson told H&H BD follows the same protocols as BS, including reciprocal suspension arrangements with other BEF member bodies as “it is vitally important for the health and safety of all participants, both equine and human, that we follow the correct policies and procedures”.

Head of British Riding Clubs Rachael Hollely-Thompson told H&H anyone who experiences symptoms of suspected concussion, however brief, will be suspended for a minimum of 21 days.

“We ask that they are symptom-free for 14 days before the suspension comes to an end and that they have written confirmation from a registered medical practitioner,” she said. “It’s incredibly important that this rule is followed, across all disciplines, mitigating any risks so that the rider can go on to enjoy future events.”

The BEF confirmed it is researching a centralised system for co-ordinating suspensions across member body activities and directed H&H readers to its concussion hub, at which there is extensive guidance and advice.

• To stay up to date with all the breaking news from major shows throughout 2026, subscribe to the Horse & Hound website

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Any rider who is taken to hospital from or suspected to have sustained concussion at a British Showjumping (BS) competition will be suspended for three weeks – and that information will be shared with other British Equestrian (BEF) governing bodies.

BS has brought in the 21-day suspension rule for 2026 to prevent competitors returning to competition during a time when suffering a second brain injury could have catastrophic effects. The criteria for suspension are if a rider is taken directly to hospital from a show or when medics, officials or organisers suspect a concussion.

BS will also alert other BEF member bodies, not of medical information but of suspension dates. To request the period be shortened, a rider must provide a hospital discharge sheet or doctor’s report clearing them to compete.

British Showjumping concussion rule

“We’re not trying to spoil anyone’s fun but we need to help educate people – especially those responsible for young people in the sport – about the dangers of a second head injury in that time period,” BS chief executive Iain Graham told H&H.

“You may feel you need to get back on and keep competing but the main thing is the long-term effects. The long term is one of the great things in our sport; you can keep competing till you’re 70+ at the top level so we have a long time to enjoy it and missing a couple of weeks of competition isn’t the end of the world.”

BS’s emailing other governing bodies is aimed at preventing riders who have suffered concussion competing in other disciplines during the crucial period. Suffering a second injury before the brain has fully healed can cause significant swelling, potentially leading to permanent disability, or death. The NHS states that anyone suffering from concussion should avoid contact sports for at least three weeks.

“We have been doing this – the BEF is developing a system to share information securely with a requirement that all member bodies share this suspension information, which we have been told should be operational in the next month – and everyone affected has accepted it’s to protect them,” Mr Graham said. “We have to do all we can as a governing body to protect people in our sport.

“We don’t know what happens at home but hopefully we can get more people talking and thinking about head injuries; we have seen a real change in the last 10 to 15 years and people do understand you have to protect your head.”

What do you think about the rule? Write to us at hhletters@futurenet.com, including your name, nearest town and county, for the chance for your letter to appear in a forthcoming issue of the magazine. Letters may be edited for clarity and length.

• To stay up to date with all the breaking news from major shows throughout 2026, subscribe to the Horse & Hound website

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Mouthguards and how they might help in preventing concussion are back in the spotlight, following recent research and developments in other sports.

A Canadian youth ice-hockey study, published in a 2023 issue of the British Journal of Sports Medicine, found players who reported wearing a mouthguard had a 28% lower concussion rate and 57% lower odds of concussion compared to non-wearers.

World Rugby is now recommending that players at all levels of the sport wear a mouthguard, following the concussion and mouthguard-related findings in ice hockey. It has also integrated smart mouthguard technology into head-injury assessments, which means that pitch-side experts can monitor head impact data collected by sensors inside gumshields.

Their role hit the headlines in February, when George Turner became the first player to be removed from a game after his mouthguard sensor reported an impact that could have caused a concussion during the Scotland vs France Six Nations match. He was allowed to return to play after assessment.

British Team Chasing (BTC) is “strongly” recommending all riders wear a mouthguard this season.

“While it’s not a rule, and we’re not absolutely not saying everybody has to wear a mouthguard, we as British Team Chasing – in view of the limited evidence we’ve read – would recommend that people do all they can to reduce their impact of concussion,” BTC working group member Helen Millward told H&H.

She added that from the cross-sport evidence she has read, there is no “conclusive evidence” that it can make a “huge difference”. There is evidence that wearing a mouthguard can decrease risk and possible severity of concussion.

This recommendation came as part of a review of the one-fall-and-out rule. This means that riders who are unseated are not allowed to remount and carry on with their round, which will remain in place – with amendments – this year.

The British Horseracing Authority (BHA) sent a recommendation to jockeys this year, suggesting that they buy a custom-made mouthguard. In parallel, in cases of falls, the BHA is now recording whether a jockey was wearing a mouthguard or not, and whether it was custom-made, so it can track what the association between use and injury might be.

The BHA said that it does not know whether the benefits in ice hockey are sport-specific, and therefore whether they can be transferred to other sports. But anecdotally, some jockeys feel a mouthguard is helpful and that a well-fitted, custom-made mouthguard does protect against dental injuries.

It is a requirement in Irish racing for jump jockeys to wear mouthguards, and the BHA has had conversations about smart mouthguards.

There is other prevention work ongoing in sport and across equestrian disciplines. The FEI announced a “comprehensive review” of its concussion policies last summer, the BHA is progressing a warm-up programme from the Injured Jockeys Fund as a general injury prevention tool, and both have been represented on a working party focusing on helmets and testing standards.

This time last year, British Equestrian (BEF) published new concussion guidelines for riders and the federation is running an awareness campaign this month (March) as the spring competition season ramps up.

Responding to the recent discussions surrounding mouthguards and concussion, BEF chief medical officer Dr Anna-Louise Mackinnon told H&H: “While there is no evidence to prove that wearing a mouthguard will prevent concussion in horse riding, an association between mouthguard use and a reduction in the number of concussions has been found in youth ice hockey.

“Riders are advised to wear a mouthguard, as it will help to prevent dental injuries and may help to reduce the number and severity of concussions, but this is unproven.”

British Eventing chief executive Rosie Williams told H&H that the organisation is working with the BEF to roll out education for riders and connections about the importance of positively managing any concussion symptoms.

“Having been very involved in the research around mouthguards and concussion in rugby, I know the time it has taken to ensure that the research stacks up with the sport’s needs,” she said.

“We will also ensure that all safety equipment, helmets, body protectors and – if the science tells us – mouthguards protect our riders.”

You might also be interested in:

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

Whether you’re a rider, instructor or have a child who rides, do you know how to recognise concussion?

Subscribe to Horse & Hound magazine today – and enjoy unlimited website access all year round

Horse & Hound magazine, out every Thursday, is packed with all the latest news and reports, as well as interviews, specials, nostalgia, vet and training advice. Find how you can enjoy the magazine delivered to your door every week, plus options to upgrade your subscription to access our online service that brings you breaking news and reports as well as other benefits. 

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

We are all responsible when it comes to recognising and managing concussion, was the message from a recent conference on the condition.

The Injured Jockeys Fund (IJF) and British Equestrian (BEF) jointly hosted the inaugural cross-industry concussion symposium at Cheltenham racecourse (27 October). The key point made was the need for a collaborative commitment to concussion education, across the equestrian and racing worlds.

“Racing is fortunate in that we have over 20 years of awareness as to the implications of concussion and we are very keen to share those learnings and best practice with other equestrian disciplines,” said IJF chief executive Lisa Hancock.

“What was so encouraging today is that while we all know the logistical challenges this creates, everyone seems to want to work together using education and communication to improve things for the 1.8m people that ride, regardless of skill, age or discipline.”

IJF chairman William Norris KC added that the charity is “very well placed” to help others in equestrian sport develop and follow good practice.

“Everyone needs to understand and follow good practice, partly because it’s the right thing to do and partly because that is the way in which they can discharge their legal duty of care,” he said. “It won’t be an overnight fix; it is a question of developing ways of educating and sharing our experiences across equestrian sport generally.”

Racing has specific guidelines surrounding identifying concussions in riders, baseline testing and recovery – but these only apply to jockeys. The BEF introduced general concussion guidance for all equestrians this year (2 March).

British Horseracing Authority (BHA) chief medical adviser Dr Jerry Hill stressed the importance of promoting “collective responsibility”.

“You can’t have medical staff being the only people concerned,” said Dr Hill. “You need the support of other colleagues across the equestrian spectrum, particularly decision-makers and funders, as some of the changes we need are structural. If you are the doctor, or first-aider, you need the support of the organisation behind you.”

Anna Louise-Mackinnon, lead medical advisor at the IJF and the BEF’s chief medical officer, added: “One of the key issues is that concussion is largely invisible, and it is often not treated in the same way as a broken limb. And yet correct diagnosis and recovery are vital to the rider being able to return to safely continue participating in their sport in whatever they do and at whatever level.”

A change of attitude from riders trying to “beat the doctor” by attempting to “cover it up”, to understanding how times have changed and using help on hand, particularly at the IJF’s centres, was also raised.

One cost-effective suggestion was to have cross-discipline social media campaigns.

Racing industry concussion practitioner Rosy Hyman said: “We know that if you return too quickly, you are at a much higher risk of another injury. So, the key focus must be what we call the four Rs – recognise (the signs and symptoms); remove (the injured person from all horse-related activities); recover (until all symptoms have been resolved); return (to ridden activity through a gradual, stepwise process).”

Concussion: ‘ongoing collaboration needed’

British Equestrian Trade Association chief medical officer Dr Diane Fisher told H&H that as a major trauma consultant, she welcomes the new collaborative attitude within the industry.

“It’s been a very long time coming in equestrian sport,” she said. “Traumatic brain injuries are at best temporary in the form of concussion and at worst life-ending or life-changing. Shared learning is vital to ensure the best advice, guidance and care can be given consistently across disciplines.

“I can tell you that there is nothing more soul-destroying than answering the, ‘what if’ questions from patients and their families when preventable injuries occur or are more serious than they may have been if readily available safety equipment had been used or correct assessment treatment and guidance had been followed, or both.”

She added: “It is not however enough to publish a guideline and hope it changes behaviour and attitude to injury. It is an important first step.

“There is a professional and personal accountability to actually deliver. Embedding the advice will need ongoing collaboration, consistent messaging and training across the board.”

• What do you think? Send your thoughts to hhletters@futurenet.com, including your name, nearest town and country, and for the chance for your letter to appear in the magazine

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Subscribe to Horse & Hound magazine today – and enjoy unlimited website access all year round

Horse & Hound magazine, out every Thursday, is packed with all the latest news and reports, as well as interviews, specials, nostalgia, vet and training advice. Find how you can enjoy the magazine delivered to your door every week, plus options to upgrade your subscription to access our online service that brings you breaking news and reports as well as other benefits. 

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

The FEI will carry out a “comprehensive review” of its concussion policies and guidelines as new evidence is published.

This month the Concussion in Sport Group published its “consensus statement on concussion” in the British Journal of Sports Medicine. The work, which was presented at the sixth International Consensus Conference Concussion in Sport in October 2022, is made up of 10 systematic reviews and methodology, carried out by more than 100 researchers and clinicians, with the aim of optimising the care of athletes at all levels of participation who have, or who are at risk of, concussion.

The statement includes new and updated protocols to help better identify and manage sports-related concussion. It features new evidence-based strategies for returning to sport and education, early exercise and treatment recommendations, approaches to prevention, and a call for a working group to be set up to guide further research into potential long-term effects of concussion on health.

The FEI said in light of the new recommendations, which it supports, it will conduct a “comprehensive review” of existing policies, implement necessary changes to align with the latest scientific consensus, and ensure dissemination of this information to stakeholders.

An FEI spokesman told H&H the publication of the statement signifies a “momentous milestone in commitment to athlete safety”.

“This collaborative endeavour, bringing together sports organisations and healthcare practitioners, ensures that the policies shaping our sports are firmly grounded in robust scientific evidence,” the spokesman said.

“In our pursuit of a common objective – to create a safe and enjoyable sporting environment for all – and as both fields progress, our safety measures must evolve in tandem to keep pace with these advancements, so that our athletes can grow and thrive with confidence.”

British Equestrian (BEF) published new concussion guidelines for riders in March (news, 2 March). BEF chief medical officer Anna-Louise Mackinnon told H&H the organisation welcomes the new consensus statement.

“We have been working on our recently published advice and protocols with this in mind. We will review the publications and provide updates if required,” she said.

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Subscribe to Horse & Hound magazine today – and enjoy unlimited website access all year round

Horse & Hound magazine, out every Thursday, is packed with all the latest news and reports, as well as interviews, specials, nostalgia, vet and training advice. Find how you can enjoy the magazine delivered to your door every week, plus options to upgrade your subscription to access our online service that brings you breaking news and reports as well as other benefits.

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

Riders will not be allowed to get back on and continue their round after a fall, in new team-chasing rules being trialled this spring.

The new rule covers riders unseated on course – horse falls already result in elimination for the combination – and it is being introduced “on a trial basis” for the 2023 spring season.

A notice from British Team Chasing (BTC) said the decision followed discussion with those involved “in all aspects” of the sport, including event organisers, officials and competitors at novice, intermediate and open level.

“This change is introduced to assist organisers and competitors with rider safety during the competitions, but will be subject to a more detailed full review ahead of the autumn ’23 season, which will include analysis of data from the spring season’s events,” said the notice. “The rule change is therefore introduced on a trial basis only at this stage.”

Riders who take a tumble on course are “immediately eliminated and must retire”. If they continue and jump a further fence, the whole team will be eliminated. BTC also recommends competitors who suffer a “heavy fall” should see an on-duty doctor before leaving.

The announcement sparked mixed responses on social media.

BTC chairman Philip Cowen told H&H the new trial rule follows “careful consideration and reflection in recent months by British Team Chasing”.

“Although the sport has always been well known through the equestrian world for its thrills (…. and occasional spills), there is also a strong desire to ensure that team chasing retains its unique characteristics,” he said. “Not least where the camaraderie of a team with a ‘have-a-go’ approach at any level within the sport can produce a great deal of fun and ultimate success for those riders, and all without the burden of a weighty and overly detailed rulebook.

“It is equally important that as the sport evolves for the future, events are able to be organised and hosted in a manner which is both safe and responsible in the light of today’s medical standards and safety research.

“Ultimately rider safety and horse welfare are of paramount importance to the success of individual events and the sport as a whole.”

Mr Cowen added that BTC will undertake a “thorough review” of rider fall data from fixtures this spring, prior to making any further announcements.

“In particular we look forward to engaging with competitors at all levels within the sport, alongside event organisers, officials and spectators over the course of the next few weeks,” he added.

“That thorough review will ultimately inform how best to address all of these factors for the continued wellbeing and success of the sport in the longer term.”

Team chaser Jess Powell, who is a doctor, was among those to comment.

“As a bad rider I’m devastated as I’ve managed to get two top 10 finishes after remounts – leading,” she said.

“As a doctor who used to cover equestrian events I applaud British Team Chasing. I did several 15- and 30-minute checks at BE [British Eventing] events for what looked like innocuous falls and picked up raging concussion in the riders.

“There will always be another day, it’s not worth risking early onset dementia or serious traumatic brain injury,” she said. “Don’t get me wrong as a rider who grew up in the 80s and 90s constantly falling off ponies this can seem extreme, but with [my] work hat on – 100% the correct call.”

BTC has also updated its hat and body protector standard rules for this season, to fall in line with BE, the Pony Club [PC] and British Riding Clubs [BRC].

Hats must be tagged with a BE, PC or BRC-approved tag and must not have a fixed peak. Only hats that meet the following standards will be accepted: British and European PAS 015 (2011) or VG01 040 2014-12 – both with a BSI Kitemark or Inspect IC Mark; American ASTM F1163 2004a onwards with SEI mark, Snell 2016 or 2021 (no other mark is needed with Snell) or Australia and New Zealand AS/NZS 3838 2006 onwards with SAI Global mark.

All competitors must also wear a body protector British Equestrian Trade Association (BETA) 2009 Level 3 standard (purple label) or BETA 2018 Level 3 standard (blue and black label). An up-to-standard body protector is also required when competitors are wearing air jackets of any make.

From 1 January 2024 body protectors meeting the 2009 standard will no longer be permitted for use – the BETA 2018 label will be the only accepted standard.

• Read the updated British Team Chasing rules in full [PDF]

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Horse & Hound magazine, out every Thursday, is packed with all the latest news and reports, as well as interviews, specials, nostalgia, vet and training advice. Find how you can enjoy the magazine delivered to your door every week, plus options to upgrade your subscription to access our online service that brings you breaking news and reports as well as other benefits. 

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

Rising British star Izzy Palmer is back in the saddle and looking forward to an exciting 2023 following a “freak” accident before the new year.

Izzy spoke to H&H about the importance of listening to your body and looking after your head as she returns to riding.

The grade IV para rider, named as one of H&H’s stars of Christmas a few years ago, has had numerous international wins, and has competed up to prix st georges level in able-bodied classes.

“It wasn’t the start of the year that I had planned or expected, it was a bit of a freak accident,” said Izzy, who hit a fence and was knocked out in a fall at home.

“You know the risks when you do a sport like riding, you just don’t think it’s going to happen to you. I banged my head and was unconscious for a fair amount of time, and had a seizure. I remember seeing the ambulance arrive and having a trip with the blue lights and sirens.

“I was very lucky. I did suffer with concussion after the fall, which took me a bit longer to recover from than I initially thought.”

Izzy credited the World Class programme and the Injured Jockeys Fund’s Jack Berry House with helping her in her recovery.

“That was really good as it made me much more aware about listening to my body and not rushing the process before I was ready, and of the symptoms I was feeling,” she said, adding that it is “crucial not to rush it”.

“It was really interesting as I did a baseline SCAT5 [concussion] test a month before my fall, which was really fortunate as the teams then had something to work from.”

The 22-year-old added she believes that her Champion hat saved her life.

“I don’t think I would be in the position I’m in now if I hadn’t had my hat on,” she said.

“I looked at it afterwards and there were two marks where I banged my head. If my hat hadn’t taken that impact and that was my head, I think it would be a very different story. I genuinely think my hat saved my life that day.”

Izzy also credited her trainer Sophie Wells for keeping her top mare, the nine-year-old Je Suis Adiva (“Frenchie”), owned by Adiva Stud, going while she focused on her recovery.

“It was amazing to be back on,” she said, adding that she feels “very lucky” her injuries were not worse and it feels “great” to be getting fit again.

“I’d missed riding so much. Sophie has done an amazing job of keeping her going and getting her fit, it’s just a case of me catching up now.”

The pair were selected for Addington CPEDI (16 to 19 March), but felt it was a little too soon. All being well, they are targeting Hickstead CPEDI in May, followed by Hartpury, the gold semi-finals at Wellington and Aintree later in the season.

Their longer term aims include Paris 2024, plus European and world championship selection as well as future Paralympic Games.

Izzy added that the whole experience has highlighted how important it is to listen to your body.

“Someone said to me during my recovery, ‘you’ve only got one brain’, and it’s so true,” she said.

She added that horsey people – herself included – have a tendency to want to downplay injuries and get back on, when that is not the right way to deal with a head injury.

“It was highlighted to me that I didn’t want to take any risks in saying, ‘it feels fine’ when actually it didn’t,” said Izzy.

“It was a case of being completely honest about the symptoms I was feeling and being constantly aware if anything increased or triggered those.

“Going back to work, starting riding again and having quite a busy lifestyle, I’m definitely making sure I listen to my body.

“My disability [Izzy has cerebral palsy] and the effect that has on my brain already is another factor to take into account. It’s been an interesting experience and I just feel very, very lucky.”

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The first unified concussion guidelines designed specifically for riders across all equestrian disciplines are unveiled by British Equestrian (BEF) today (Thursday, 2 March).

The six-page guidelines feature easy-to-follow information about concussion in horse riders, and a “return to riding” pathway. The idea is that these give clear, up-to-date guidance, based on the latest understandings of concussion in sport, in a way that makes sense for riders and those around them, such as coaches or parents.

The launch is the first step in an awareness-raising campaign that will run throughout 2023.

BEF chief medical officer Anna-Louise Mackinnon told H&H it is “hugely important” the guidelines are aligned across the disciplines, to prevent confusion.

Dr Mackinnon added that those involved in the project have “dug deep” into the latest research and what is happening in other sports and countries to develop the guidelines.

Learnings shared at the sixth International Consensus Conference on Concussion in Sport, held in Amsterdam in 2022, played a key role in this.

“We’ve even tried to align it to the advice given out in horse racing,” she said. “Some of the educational projects we are going to be doing and developing over the next few months are completely aligned with horseracing and using much of the same material.

“From the point of view of rehabilitation and return to ride, it’s massively important [that advice is aligned across equestrian sport]. Otherwise we are just going to have riders doing all sorts of different things and everyone getting a bit confused, so it needs to be the same – and also aligned with all other sports.

“Not only have we looked at what we’ve been doing within equestrian sport, but we’ve looked at other sport – grassroots sport and the grassroots advice that will be coming out from the Government.”

The guidelines were produced in response to the Government’s concussion action plan (news, 13 January 2022). This, in turn, followed a Government inquiry that called for UK-wide protocols on dealing with head injuries and improvement in how sporting injuries are reported (news, 12 August 2022).

The overarching aim is to address concussion in sport to help reduce risks and potential long-term effects associated with head injuries.

The new BEF guidelines are aimed at participants at all levels of equestrian sport and provide detailed information on managing concussion from the time of injury to a safe return to riding.

The return to ride pathway gives specific examples of equestrian-related situations and at what stage in a person’s recovery they might be ready to return to these. For example, walking a course, grooming and yard chores. The guidelines do not replace medical advice.

BEF chief executive Jim Eyre said the member bodies have been “really engaged and are committed to the responsible management of concussions”.

“Anyone in the equestrian industry is welcome to download the guidance from our website and adopt it as their own, so we all take responsibility for our participants and their long-term wellbeing,” he added.

Ashleigh Wallace, BEF athlete health lead for the World Class Programme, is the driving force behind the project.

“Developing concussion protocols for our World Class Programme riders has

been a priority of mine, but the opportunity to use expertise, insight and knowledge – all backed up with science – to produce relevant guidance that applies to everyone is hugely gratifying,” she said.

The BEF member bodies have welcomed the news.

British Dressage sport operations manager Lou Jones told H&H: “Fortunately, serious accidents involving head injuries are comparatively rare in dressage, but we fully support this initiative and will be consulting with our organisers and officials to ensure that the guidance is followed, with appropriate measures put in place to deal with such eventualities when they do occur.”

British Eventing (BE) chief executive Helen West added that BE takes concussion “extremely seriously and fully supports the BEF” in these guidelines.

“Concussion is something we must take seriously,” she told H&H, adding that BE operates a strict medical suspension policy regarding head injuries and concussion.

“When it comes to our horses we don’t think twice about getting the right treatment and giving them time. But when it comes to ourselves we sometimes overlook this and the campaign to raise awareness of the signs and treatment of concussion can only be a positive step in the right direction.”

British Showjumping (BS) chief executive Iain Graham told H&H that BS has been involved throughout the process and is “fully supportive of the guidelines and the need to raise awareness”.

He added that it’s not just about the time people are in the competition arena, but spreading awareness of the signs, symptoms and what to do, for when people are training or riding at home.Olympic eventing team gold medallist and Badminton winner Laura Collett said this campaign is “really welcome”.

“Concussion is something we just don’t take seriously enough in equine sport. We wouldn’t think twice if it was a welfare issue with our horses, so why should we risk our own health and wellbeing?” she said. “Having experienced major brain trauma and concussion first-hand, I’d urge everyone to take the time and read the guidance, educate themselves and use the resources provided. We all have a part to play, however you enjoy horses.”

• Read the BEF’s new unified concussion and return to riding guidelines [PDF]

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New virtual reality headset technology is to be trialled in British racing as a tool for managing concussion.

The technology, NeuroFlex, measures a person’s eye and head movements as they carry out simple tasks. It is the result of 30 years of research by Mimi” Galiana, NeuroFlex’s chief medical officer, and is being used in the South Australian Football League and Australian Super League. It will also be used at this year’s FIFA World Cup in Qatar.

The hope is that it can be used as an objective way of measuring jockeys’ brain health over time, which could help with decisions on returning to riding, and have benefits long after a jockey retires.

“I’ve been extremely impressed and delighted with how seriously this is being taken within the horseracing community,” NeuroFlex executive director Grenville Thynne told H&H.

As the technology works with virtual reality goggles and a laptop, it makes it portable for pitchside – or on-course – tests, which take around eight minutes.

Dr Thynne added that the key part of this technology is that it works on an individual basis and gives an objective assessment, to help those involved in recovery care make an “informed decision about whether a rider is ready to return to riding”.

“The most important part of this is the pre-season health baseline,” he said, explaining that this gives an individual-specific benchmark or “dashboard” for each person to be measured against in future.

“When we talk about humanising or personalising this process, if you have your own dashboard that means if you suffer a fall you can be monitored back to your healthy baseline, over what period of time it takes to get there, on an objective basis. And that dashboard stays with you for life.”

He said this means that for retired jockeys, should they start to feel effects from falls in future, they have that “digital dashboard” of all their previous tests to refer to.

A team from NeuroFlex’s head office in Australia is in the UK to train a select group of medical clinicians in using the technology, before baseline testing of jockeys starts this year. Training will take place at the Injured Jockeys Fund’s Oaksey House Rehabilitation and Fitness Centre.

“Given the high-risk nature of our sport, British horseracing takes concussion very seriously, with robust protocols in place to ensure the highest standards of care and attention for our jockeys, and dedicated rehabilitation support provided by the Injured Jockeys Fund,” said a British Horseracing Authority spokesman.

“It is essential that we remain at the forefront of scientific research and innovation into how concussion is managed, which includes examining the potential benefits of technological solutions, alongside ensuring engagement with colleagues from other major sports around the development of shared guidance and protocols.”

Managing concussion: new ratings system for riding helmets in the pipeline

LEADING researchers into sporting concussions are on the verge of bringing a ratings system to riding helmets.

Virginia Tech doctors Steve Rowson, Stefan Duma, Mark Begonia and Barry Miller spoke at the Equestrian Symposium in Virginia, US (11-12 August), about the STAR (Summation of Tests for the Analysis of Risk) ratings system for riding helmets.

In short, the STAR value is the theoretical number of concussions someone would sustain wearing that helmet if their on-field exposure matched laboratory impact tests.

The ratings correlate with real-world injury rates; the lower the STAR value, the better the star rating, with five stars the highest helmet rating. It is designed to complement existing helmet certifications and fill in the gaps relating to concussion risks in horse riders.

“With the same impact, there can be very different biomechanical responses between helmets. We felt a responsibility that everyone should have this information,” said Dr Rowson. “Not all helmets are the same just because they meet a [pass/fail] standard. That’s true for skull damage, but not concussions.”

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Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

How the Injured Jockeys Fund (IJF) tailors its concussion rehabilitation specifically to getting riders back in the saddle, and what possible new technology is in the pipeline, were under the spotlight at the charity’s conference.

IJF head of clinical services Anna-Louise Mackinnon and racing industry concussion practitioner Rosy Hyman spoke about active recovery techniques in the IJF toolbox.

“Hand-eye coordination is important in all sport, but it is really important for racing,” explained Ms Hyman.

She added that when race-riding, jockeys are constantly taking in information – from eyes, ears and the small balance points from their position on a horse – and need to be able to filter what is important.

Dr Mackinnon explained how active techniques that focus on rehabilitating the balance, vision and movement system (vestibular-oculomotor rehabilitation), which can be affected by concussion, are used by the IJF.

Trained specialists use exercises that challenge riders to focus on specific points – for example, beads on a string, along with balance and hand-eye coordination exercises. The idea is that it helps prepare jockeys for what they go through when returning to race-riding, such as blocking out distractions to see a stride.

“We need jockeys to be able to focus on one point even when there’s a really busy crowd,” said Dr Mackinnon.

The industry is also looking into technology such as saliva tests and a system called NeuroFlex, where the subject’s eyes and head position are measured while they perform simple tasks using a virtual reality headset.

Its benefits would include level of detail and objectivity in both assessments and measuring a jockey’s progress.

British Horseracing Authority chief medical adviser Jerry Hill gave an overview of some of the latest developments in concussion.

These include the Government’s action plan (news, 13 January), microRNA biomarkers – which could potentially be used in a similar way to a lateral-flow test, and the possibility of an in-ear device that can measure brainwaves.

“Premature return to sport increases your chances of an unrelated injury,” said Dr Hill, also reminding the conference of the severity of sustaining a secondary blow when already concussed.

“You are more likely to fall off. And if you return early, you are probably not going to be very good at your sport.”

‘Not just a bang on the head’

Riders Minds has launched a “head first checker” in response to a study by Charles Owen and University of Sussex MSc student Charlotte Ricca.

The study, which involved more than 1,000 riders, found 58% of concussed participants reported a significant increase in depression and anxiety scores after their fall.

The findings were released in conjunction with Riders Minds, which launched its “head first” campaign and checker to encourage equestrians to “rethink” concussion as “not just a bang on the head”. The aim is to educate riders about signs of change from their “normal”.

“Riders Minds has found 25% of riders have suffered from depression, and [this new research] indicates that riders who have experienced five or more concussions are twice as likely to suffer from a mental health condition as a result,” Riders Minds director Victoria Wright said, adding that the research also suggests this does not always happen immediately; it can be six months to a year after the incident.

The checker can be found at ridersminds.org/Get-support/head-first-checker

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Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

Riders are being encouraged to “re-think” concussion – and the effects it can have on mental health — in a new awareness campaign.

During national Mental Health Awareness Week (9-13 May), equestrian mental health charity Riders Minds has revealed its new “Head First” campaign.

A Riders Minds spokesman said the project had been launched following the “concerning” results of a study by Charles Owen, which revealed six in 10 riders suffer from depression after a concussion. More than 1,000 riders took part in the study, carried out last year by University of Sussex MSc student Charlotte Ricca, which also found that 30% of riders who suffered from depression went on to continue to suffer from prolonged mental health problems.

As part of the campaign Riders Minds has created the “Head First checker”, a comprehensive tool to allow people to identify any signs of change, including to brain function and mental health, and the early warning signs to look out for. The tool incorporates four key areas; cognitive changes, mood/behaviour, physical signs and altered sleep pattern.

“More than 25% of riders have suffered from depression, and riders who have experienced five or more concussions are twice as likely to suffer from a mental health condition as a result. The importance of protecting our heads and monitoring signs of concussion/mental health is vital,” said Riders Minds chair Victoria Wright.

“We also know that a mental health condition following a head injury does not necessarily occur immediately afterwards, it can take six months to a year after the incident to take effect. The objective of Riders Minds has always been to support the mental health and well-being of all equestrian people and we feel extremely proud that the connection between mental health and head injury has finally been brought to light in the equestrian industry like it has in rugby, American football and other high-impact sports.”

Mental health specialist Sylvia Bruce, who is responsible for the Riders Minds’ website content, added that the campaign aims to get equestrians to “re-think” concussion in horse riders as not “just a bang on the head”.

“It’s a brain injury. And, if our brain is injured, our mind can be injured too, with potential far-reaching implications on our mental health and wellbeing,” she said.

The Head First checker and mental health support can be found at www.ridersminds.org.uk.

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Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

More awareness around minor traumatic brain injuries in children is needed, including the importance of rest and not dismissing the condition as “just a bit of concussion”.

A published study has suggested that persistent post-concussion syndrome (PPCS) – when concussion symptoms continue beyond the expected recovery period after the injury – is underdiagnosed in children. Parents of 205 children aged eight to 15, who attended hospital after a mild traumatic brain injury six months to three years before the research, completed a survey used to measure the severity of symptoms. It was found that 25% were suffering from PPCS, which had not been previously diagnosed. PPCS symptoms can include headaches, difficulty concentrating and irritability.

Shai Efrati of the Sagol Center for Hyperbaric Medicine and Research in Israel, who led the work, told H&H PPCS in children is often missed and symptoms can be blamed on behavioural or mental health issues.

“It means we are not looking for PPCS in children. In adults, we seek the cause for cognitive decline, but in children they are told they have a mood problem,” said Dr Efrati.

Dr Efrati said children need to be given more time to recover after concussion.

“We need more awareness that after a mild traumatic brain injury, you are more at risk of developing PPCS. I would like more screening when a child is discharged from hospital with concussion; they should be re-evaluated a month later to make sure their symptoms have resolved and if not, they should receive treatment.”

Major trauma consultant Diane Fisher, the British Equestrian Trade Association’s chief medical officer, told H&H she believes language around concussion needs to change.

“People say, ‘It’s just a bit of concussion’ and we need to remove the word ‘just’. Concussion is a traumatic brain injury – and changing the wording changes how a parent is going to view that injury,” said Dr Fisher, adding that children should rest, without screen time.

“Watching television is one of the worst things you can do – for the brain it’s like running a marathon. While recovering, you want the brain not to have to function very hard,” she said.

The Pony Club’s concussion guidance includes a flowchart and a rule that following a concussion diagnosis, a child must not ride for three weeks.

Pony Club chief executive Marcus Capel, who is part of the British Equestrian concussion (BEF) working group, told H&H there are plans for more rider concussion education in the Pony Club, and the BEF working group is producing a pocket guide – similar to those used in rugby – which will include guidance for children.

“Sometimes a parent might want the child to get back on after a fall, but we want to empower coaches to use our guidance and say, ‘In my opinion, they shouldn’t get back on and I want them to get checked by a doctor,’” said Mr Capel.

“We also want to empower riders so they learn when it’s right not to get back on, and to be able to say if they’re not feeling OK.”

In November BETA launched a rider accident reporting form to collect information, which is hoped will inform design of safety equipment. The form is available online or via a QR code and asks people to provide details of any accident that they were involved in, and, if possible, supply images or video of the helmet and/or body protector worn at the time. The form can be completed here.

“We want all injuries reported even if it’s a case of ripping a fingernail off – we want everything. Then we will have our own database across every single horse sport and we can look at what is actually happening, right now we don’t know because equestrians are not the best at going to hospital,” said Dr Fisher.

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Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

Air vests are officially recommended for cross-country in international eventing fixtures for the first time in 2022.

This new recommendation is just that – it is not a compulsory requirement, and body protectors to the correct standard must still be worn.

“We can’t make it mandatory yet for two reasons,” FEI medical committee chairman Mark Hart told the eventing risk management seminar (22 January).

“One, we don’t have enough definitive evidence to show the beneficial effect, and if there is any potential downside.”

He added that the FEI has started to contact other sports, including motocross and car racing in this area, as it looks further towards protection for the neck, chest, back, abdominal organs and shoulders.

“I think more research needs to be done. I think the preponderance of evidence is that air vests probably do help a majority of the time,” said Dr Hart.

“As we know from seat belts, there are rare cases where seat belts actually are deleterious. You have to look at the overall benefit of a particular safety measure, knowing that it’s not going to work in every situation.”

H&H has contacted British Eventing to ask whether it will be recommending air vests for cross-country in national classes.

Dr Hart also spoke of upgrades to the FEI rules for provision of medical services at events. In essence, this is moving towards ensuring qualified professionals with certain skills are on duty for each phase, rather than choosing medical cover based on job title. These are recommended for two years, before they have to be followed, and will become mandatory from 2023.

There is also a move towards continued monitoring of riders who have had a fall, throughout their time at a venue. At the moment, riders must be checked by the medical officer after a fall – regardless of whether they fell in training or competition – before they get back on a horse or leave the venue.

With concussion in riders “high on the radar”, Dr Hart said there is a responsibility “to check in on” riders throughout their time on site.

“We know that a lot of concussions are missed,” he said. “The hard part is that we cannot always diagnose a concussion in the first five minutes. Sometimes concussion symptoms come on 30 minutes later, even that night or the next day.”

He added that bleeds on the brain also “don’t always present right away”.

“I think we need to get two parts of this concept. One, we do have measures to immediately assess whether somebody has had a serious concussion or not,” he said.

“But secondly, [realise that] this is a dynamic process and I think we have to change the medical response to those people who fall, who possibly had a concussion, [and that they] have to be evaluated throughout their time on the venue.”

He said time-frames have not been specified; the key message is that someone can “look great after a fall”, but there remains a “responsibility to check in on them”.

Dr Hart also indicated that the FEI is looking at the potential of concussion blood tests in the near future.

“It’s fascinating,” he said. “My day job is as a cardiologist and we use blood tests to look at damage to the heart every day.”

He added that there are tests already, some of which look for markers indicating brain injury immediately after suspected concussions, and some used hours later.

“I think blood tests will be very important, but there’s a lot of research that has to happen to correlate that with the clinical scenario that’s happening, and what we do with the results once we have them,” he said. “We are definitely working on that.”

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Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

A major drive to improve understanding, treatment and prevention of sporting concussions is hoped to benefit riders.

The Government has published an action plan, following an inquiry by the Department for Digital Culture, Media and Sport (DCMS) select committee. The inquiry called for UK-wide protocols on dealing with head injuries and improvement in how sporting injuries are reported (news, 12 August).

The wide-reaching plan focuses on four areas: research, education, health and technology. The overarching aim is to improve understanding, awareness, prevention and treatment of concussion in grassroots, educational and elite sport.

Concussion is a hot topic in the horse world, owing to the increased risk associated with riding, and a number of recommendations will have a direct impact on equestrians.

The Government’s independent concussion advisor, Laurence Geller, is working to ensure concussion in sport injuries is treated more effectively though NHS treatment pathways, and that the safety of those that take part in all sports at any level is improved by June 2022.

“All of us recognise the importance of sport in our lives. Whether professional or amateur, whatever age or skill level, we want to enjoy our sports while being protected from the potentially life-changing impacts of head injuries,” said Mr Geller.

“By making the game safer, we make the game better for everyone. But it’s not about changing the rules, it’s about working with experts from the medical profession, science and technology to devise protocols, knowledge, and equipment to allow us all to continue playing the sports we love.”

The recommendations also include a shared set of protocols around concussion in sport, plus requirements for sports that receive public funding (through UK Sport and Sport England) to make use of these, once developed, in the way they see fit. As British Equestrian receives funding, it will be involved in this.

The DCMS is also asking sports to convene with player associations to discuss training, with a particular stress on long-term welfare.

A sports concussion research forum has also been formed and will be asked to identify technological advancements to mitigate concussion that can be translated into practical improvements by autumn 2022.

British Equestrian chief executive Jim Eyre told H&H that athlete health has been “one of the pillars” of the World Class equestrian performance strategy over the last five years, and a key element of that as the development of concussion screening and management guidelines across the disciplines at all levels.

“The project launched by DCMS is welcomed as it provides opportunity to review our approach across the member bodies, but also gives weight to our ongoing commitment to improve rider safety by exploring equipment improvement and other preventative initiatives. Of particular interest is how we manage injuries occurring when training and in our youth athletes,” he added.

“We hope to provide an aligned approach to raising awareness of concussion and providing education across the board. Early recognition of the signs and removal from sport to allow sufficient recovery are key areas to develop across our entire equestrian landscape.

“We are starting our work by convening a working group across a number of equestrian organisations in mid-January so we get an understanding across all disciplines, from amateur to elite, of the scope of the issue and we can then feed into the wider group. Ultimately, we’ll make a collective mission to educate on the importance of managing head injuries and concussion across the British equestrian community.”

Ash Wallace, equestrian World Class pathway athlete health lead, told H&H: “We are in a unique position in equestrian sport where we have men and woman competing together and on equal terms. This is hugely relevant as research informs us that females are more susceptible to concussion, two times more than males and in horse racing 3.6 times more, but most of the research in concussion so far has been in male sports. In collaboration with DCMS and other national governing bodies, we could be at the forefront of studying and ultimately understanding why this is the case.”

A British Horseracing Authority spokesman added the organisation was delighted to respond to the inquiry and “welcomes the ambitious set of actions outlined within the Government’s response to the select committee’s report”.

“British racing has had robust concussion protocols in place for our jockeys for some time,” he told H&H. “[We are] working with Government and other sporting bodies on the next steps of the report as British sport works collectively to build a better understanding of the issue of concussion and improve participant welfare.”

‘Act on ability to hold organisations to account’

Brain injury charity Headway has welcomed the response, while also calling for increased scrutiny.

“The DCMS committee’s criticism of sport was clear, accusing it of ‘marking its own homework’ due to a lack of scrutiny from Government,” said chief executive Peter McCabe.

“We are pleased to see the Government has accepted most of the committee’s recommendations and that its involvement is needed to ensure sport adopts a cohesive, consistent approach to concussion in sport.

“Nonetheless, this response is a little underwhelming in terms of the urgency and level of Government involvement.

“Immediate action is required to build on the progress we’ve made to date – particularly at grassroots level where we need an evolution of attitude when it comes to head injuries in sport.

“For example, shared concussion protocols will help to reduce inconsistencies in the way head injuries are identified and dealt with in sport, but protocols are only of value if they are properly implemented and understood.

“The Government’s response does acknowledge that the development of protocols will not change behaviours on their own and we welcome its commitment to leading a campaign to ensure everyone involved in sport is concussion aware.

“But we also call on the Government to increase its scrutiny of governing bodies and act on its ability to hold organisations to account if meaningful change does not happen immediately.”

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A rider who suffered multiple fractures and severe concussion in a fall at home wants to spread as much awareness as possible, of head injuries and the importance of wearing a correctly fitted safety helmet.

Sandra Murphy was jumping her own horse Tilly over small fences on 17 July when the mare tripped and went down. Sandra suffered a fractured shoulder, collarbone and vertebrae, as well as the head injury, but believes that had she not been wearing her helmet, recently fitted and brand new, she would not be here.

The founder of Equidiet and the BAME Equine and Rural Activities Focus Group told H&H she had just finished filming for a television programme and was jumping one last double.

“It was only 70cm, as I’m no hero!” she said. “Tilly jumped in big, and it should have been two strides but she went ‘Is it one or two?’, went to jump and just fell over it.

“It was a miscommunication; I can’t blame her, I more blame myself.”

Sandra hit her head on the floor, was knocked unconscious, and was taken to hospital in an air ambulance. She credits her assistant Lara Holden also for saving her life, as she came straight over with an oxygen canister after the fall; Sandra, who is in remission from cancer, also spent six weeks in hospital with Covid early this year and needs the oxygen while her lungs recover.

“She saved my life as I’d stopped breathing,” Sandra said.

Doctors at first did not realise the extent of Sandra’s injuries and sent her home but two days later, she was in agony and called her GP.

“They sent me back to hospital, where I was diagnosed with the fractures and the concussion,” she said. “I was speaking really slowly, and couldn’t form words; I said to the doctor, it felt like I had a blancmange in my head, it was awful. I had real pressure pain in my head and he said ‘That’s concussion’.”

Sandra had never suffered concussion before, and had not realised the full implications.

“The doctor explained it all, and how careful you’ve got to be,” she said. “It’s a brain injury, and you have to look after your brain. I won’t be riding for a long time as you only get one head.”

Sandra added that although she has always been a strong advocate of wearing appropriate headgear, this incident has reminded her once again just how important this is.

“Whatever you’re doing, I don’t care; wear one,” she said. “There’s no excuse not to have one on, and your brain’s so precious and so easily damaged. My Uvex helmet saved my life; I would not be here today without it.

“The thing I want to get across to people is, no matter what you’re doing, wear one. I was at home, jumping 70cm, and I trust my horse to the end of the earth; she’d never buck me off or anything but she tripped and fell, it was one of those things.”

Sandra also thanked the Lincs & Notts Air Ambulance, for which she had raised money while undergoing chemotherapy for cancer, two years ago.

“I had braids in my hair; my hair was my crowning glory and losing it was very hard but every time a braid came out, someone sponsored it and I raised £500,” she said. “That’s what got me through, and knowing I was helping other horse people.

“When you’re riding in the middle of nowhere and a road ambulance can’t get there, they will come and rescue you. I want to thank them so much.”

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AN inquiry into concussion in sport is calling for UK-wide protocols on dealing with head injuries, and improvement in the reporting of sporting injuries.

The Government’s Digital, Culture, Media and Sport (DCMS) committee launched the inquiry following increasing media attention on the “growing evidence” that there is a link between taking part in sport and developing dementia later in life, and aimed to examine whether this issue needed Government intervention. Following the conclusion of the inquiry, which included evidence from health professionals, experts and sporting bodies, a report was published last month in which recommendations were made.

These include NHS England reviewing how it collates concussion data and ensuring doctors have patients’ full medical history available to better inform treatment. The report also recommends that the Government immediately mandates the Health and Safety Executive (HSE) to work with sport national governing bodies to establish a national framework by July 2022 for reporting injuries, and establishes a research fund and a specialist group to review emerging science on concussion.

“The Government has delayed taking action, deferring to the numerous sporting bodies. We recognise sport will never be, and can never be, 100% safe. However, the Government has a duty to ensure that sporting activity, at every level, bears no unnecessary risk. We recommend it establishes a UK-wide minimum standard definition for concussion that all sports must use and adapt for their sport,” read the report.

Medical Equestrian Association (MEA) chair Megan Hardman told H&H the report is “very valuable”, and data collection is important, but added that in equestrian sport, a “culture change” is needed around riders returning to the saddle too soon after injury.

“At grassroots level we need riders to destigmatise head injuries so there’s not that bravado that you have to get straight back on. It’s that real ‘battling through injury’ mindset and being ‘brave’ – we see it in all equestrian sports,” she said.

“As doctors we might say to a rider ‘you need two weeks of no riding’, but once that person walks away from that event we have no control over what they do. Unless they really buy into it and believe what you tell them, we can’t force them to do it.”

Dr Hardman added that as a result of the report the MEA and British Eventing (BE) plan to produce guidance to be handed out to riders at events on what to do following a head injury.

“We already provide advice cards but it’s not explicit enough for riders in my opinion,” said Dr Hardman. “What we need is something that says ‘do this’. We also plan to have someone from the Injured Jockeys Fund to talk to us about what we should be doing with these people and why it helps them so the MEA and BE are putting out the same message.”

British Equestrian chief executive Jim Eyre told H&H the organisation and its member bodies are “committed to upholding the highest standards” of welfare for all, and takes the risk of neurological injuries and concussion “extremely seriously”.

“With the FEI, we have taken a proactive lead in this area and share their aim of reducing risk and improving management of injuries, with each member body having its own protocols to manage falls with the risk of concussion,“ he said.

“While riding helmets will help to protect riders from significant head injury trauma, we recognise they may not protect from concussion. Therefore, concussion as part of athlete welfare is regularly reviewed at all levels, from Pony Club to BEF’s world class programme. “We recognise more can always be done in terms of awareness and education, and we welcome the DCMS report and look forward to the follow-on work with UK Sport and the HSE”.

The British Horseracing Authority provided evidence to the DMCS inquiry and a spokesman told H&H the organisation “welcomes” the report.

“Discussions with the Government have already been undertaken on this subject and we look forward to continuing that work, as well as engaging with other sporting governing bodies, to understand what role British racing can play in the implementation of the report’s recommendations”.

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Find out more about this inspirational combination who competed in Bicton four-star – the horse people had given up on plus the rider who is fighting an ongoing battle following a fall in 2017

A combination have defied the odds to not only compete at Bicton Horse Trials, supported by Chedington, last week, but to also jump clear around the CCI4*-S cross-country track.

Twenty-one-year-old Emily Mustow shares with us her rollercoaster story, along with that of her Bicton ride, Annie Finch’s Prime Time II…

“I started eventing when I was about 12 years old on a little Connemara pony, and I just fell in love with it – I remember thinking then, ‘I’m going do this as a career’ and, of course, everyone laughed, because I had only just done my first BE80. I left school to pursue my dream and at 16 I got Prime Time II, or ‘Fred’ as he is known at home.

“Fred has taken me from strength-to-strength. He is a tricky horse to ride and that’s the only reason why I got him – he was written off by professionals with them saying he wasn’t going to be good enough. He’s just really big, really strong, and a little bit arrogant, and sometimes you just have say to him ‘OK, there you go’. I often ride him on the buckle end of my reins, because he doesn’t like it if you try and organise him too much – he just says ‘no, I’m going here, leave me alone’.

“He’s a legend and I’ve built a partnership with him – I think I was his last hope in life. He’d been here there and everywhere, people had tried everything and he is difficult on the ground too. He’s got massive separation anxiety – you can’t leave on his own, you can’t do this, you can’t do that; he doesn’t like this stable, he doesn’t like that field. We call him the king because you just have to just do everything he wants to do.

“When we started out we were just doing small BE novices and BE100 under-18 classes – I think if someone said to me that at the age of 21, I would be doing a four-star and probably one of the biggest four-stars this year, let alone jumping clear around it, I wouldn’t have believed them. I was happy just to canter up the centre line this weekend!

“I’ve not had an easy journey with him – I’ve been through a lot of injuries. It started when I had a bad fall from Fred at a junior trial at Withington Manor in 2017. It wasn’t his fault – he just slipped and he came up to hit me in the head, fired me headfirst into the sky and then I came down head first into the ground, and I was knocked out cold. I came round shortly afterwards and after a hospital check was discharged to recover at home. And then, just as I was looking at getting back to riding again, I came down with acute appendicitis, so I had to have surgery. Then we went to do our first CCI2*-L at Frickley and he carried me home because I wasn’t quite okay still following my fall.

“Later on that year, all the symptoms of post-concussion syndrome started to hit me – it was horrible. It completely changes your mental state, you’re really angry, sensitive, I was tired, and I got to the point where my limbs started to actually give way underneath me. I went into hospital and I was diagnosed, so I had about a month off riding.

“I was then okay for a few years and I went away to Harry Meade’s and Vittoria Panizzon’s as a working pupil, which was invaluable, but I was still suffering so I came home to give myself a proper chance to recover. Then in March 2020 I got fired headfirst into the floor by a young horse, so the concussion was added to again and then in October I got kicked in the head, so I’m still actually undergoing treatment for my post-concussion syndrome.

“The treatment involves things like viewing exercises – when I got kicked in the head, I lost some sight in my left eye so I still can’t see very well out of it. It’s not been easy.

“But a few weeks ago, Fred sustained a horrific injury in the stable, where he fell over and bashed his hind-quarters. I just remember seeing him walk out of the stable and everyone on the yard saying he must have broken a leg – he was hopping lame. I was so frightened, but Towcester Vets have been incredible – for three weeks they just kept on and kept on and kept on treating him. Fred got infections in that leg and they just kept optimistic and kept trying. It wasn’t easy to keep trying on a 19-year-old horse.

“But they were right and Fred only had one run this season at novice and intermediate level before coming here, so I thought we would just take it phase by phase. And now somehow I’m stood here saying I’ve just gone clear.

“It’s just been a fairytale journey, and I just never, ever thought this would ever happen in a million years. I remember thinking completing my first international was everything and when I crossed the finish line today, I just started crying.

“I owe Fred everything and this was for him, because a lot of people told me not to pursue him, that he wasn’t right for me, he was going to ruin my career and and all that kind of thing and I just kept trying to ignore them. And today I’ve really gone ‘see, he can do it’ – he is just amazing and my best friend.

“He’s the king and goes around at home like he’s a five-year-old, even though he’s 19. He was messing around in the warm-up today, but when I came over the last fence I just burst into tears of joy.

“I’m based at home in Northamptonshire – I felt like I’d failed when I had to give up the working pupil jobs to move home, but without that I wouldn’t be healed enough to be going around this today. Memory is a huge thing for me as I struggle to remember things and remembering that dressage test on Friday was a mission in itself. I’ve got an amazing specialist and my mum Hannah is my best friend – her and my dad David have supported me, no matter what. I’m so grateful to them for all their help, and I just I hope I’ve really done them justice.”

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Read the full report from Bicton in the 17 June issue of Horse & Hound magazine

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A senior trauma doctor has urged people to send injured riders to hospital with the helmet they were wearing as part of a training clinic on potentially life-saving steps anyone can take to help someone with a head injury.

Dr Diane Fisher, who is a rider as well as a trauma consultant attached to both Royal Stoke University Hospital and the Shrewsbury and Telford Hospital NHS Trust, spoke about the simple first-aid actions people can take if a friend hits their head at the yard.

“The part that worries me is the secondary injury — I can’t do anything about the fact you’ve hurt your head, but what I can do is make sure that people know what to do with the secondary injuries,” said Dr Fisher in her “rider clinic” webinar on 28 January, held in association with Champion.

“When someone has had a head injury, their head tends to drop down and their tongue goes to the back of their throat and obstructs their airway so they are not able to get oxygen in and around their body.

“You’ve already got a piece of brain tissue that’s in pain and the last thing in the world it needs is to be starved of oxygen, so it’s really important that as soon as an injury has just happened that we work through the first aid.

“From an equestrian point of view, you do need to check it’s safe for you to get across to that casualty; if you are with people, get someone to catch the horse so he doesn’t come running back over you or the rider.”

She added while the advice is that people shouldn’t remove a person’s helmet if they are not trained, that has to be balanced with whether the person’s airway is obstructed and whether you are going to be able to open that with the hat on.

“If that person is not breathing, then if you need to take the hat off, you take the hat off. Without the airway, there is no question that they will die or become brain damaged from lack of oxygen as opposed to a head injury that may not be that bad,” she said.

“If they are breathing ok and the hat is on that’s fine, leave it alone and leave them where they are. However, if the airway for whatever reason is not open or they are vomiting, you’re going to have to move them to get them onto their side otherwise they are going to choke. It’s a case of dealing with what’s thrown at you.”

Dr Fisher demonstrated a jaw thrust as a way of opening someone’s airway without tilting their head and moving the neck. This involves simply putting a finger each side of the jaw, below the ears, and gently pushing forwards (see tutorial video below).

She urged equestrians — especially at the moment while the NHS is dealing with the pandemic — to be sensible, lunge first if appropriate, and to be realistic about their riding ability. She added trauma teams have seen head crush injuries, which have happened at places such as gates, and stressed that for this reason it is “incredibly important” people wear hats on the ground when dealing with horses as well as when riding.

Dr Fisher also strongly recommended riders download the What3Words app and urged them to take responsibility for having a plan about what to do if things should go wrong. This includes telling someone where you are going hacking and what time you are back, and if you are hacking out with a friend, making sure you both know what to do if anything happens.

“In hospital we are really concerned with mechanism of injury and this is how my Facebook page started as I can’t tell you how many equestrians I’ve seen or know who say ‘I had a touch of concussion’ or ‘I had bit of a bang to the head’ — it’s not, it is a traumatic brain injury,” she said. “It’s not ‘just a little fall’. As equestrians we are quite hard, I think, and we have that [culture] of ‘fall, get straight back on’. I think we are moving away from that now.

“When you come into hospital, we need to know as much as possible about how the accident happened and what that person was like afterwards, so you need somebody to stay with them the whole time while others are going off and phoning for help, or catching the horse.

“If you’re the person standing with them, you need to be aware of: are they making sense; is there any big change in what their pupils look like; are they saying they feel sick or are being sick and are they sleepy. That’s because you may need to upgrade your ambulance call as it’s not unusual for someone to be a bit stunned after a head injury and then suddenly start to deteriorate. At that point, you can ring the ambulance service back and say ‘I know they were awake five minutes ago, but they’re not now’ — that would take you up from a category three to a category one, which is an immediate response.”

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She added that sending a rider’s hat with them to hospital is “particularly important” at the moment because of pandemic restrictions on visitors, and if anyone is able to jot down on a piece of paper what happened to give to the paramedics, that is a real help.

“Because of Covid there is no visiting, so nobody is coming in with [the casualty], they come in on their own,” she said. “And if their level of consciousness is low, they can’t tell me what’s happened. I need a baseline and a degree of suspicion, so when I or the radiologist is peering at your scans, if we know what happened, we have a really good idea of what we are looking for and it may change how we manage you.”

Horse & Hound magazine, out every Thursday, is packed with all the latest news and reports, as well as interviews, specials, nostalgia, vet and training advice. Find how you can enjoy the magazine delivered to your door every week, plus options to upgrade to access our H&H Plus online service which brings you breaking news as it happens as well as other benefits.

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

While riding hats that comply to accepted standards are already rigorously tested, with some manufacturers going above and beyond the required standards to ensure their products give the best protection possible, new research has suggested ‘there is an urgent need to assess the protective capacity of equestrian helmets under real-world conditions’. H&H finds out more...

There is an “urgent need” to assess the protective capacity of equestrian helmets under more types of real-world conditions, a study involving racing and eventing falls has found.

The study involved researchers from the University College Dublin and the University of Ottawa, as well as British Eventing’s (BE) national safety officer Jonathan Clissold, the British Horseracing Authority’s chief medical officer Jerry Hill and the Irish Horseracing Regulatory Board’s former senior medical officer Adrian McGoldrick.

It was published in the peer-reviewed Journal of Science and Medicine in Sport in March 2020.

The purpose was to examine biomechanics of real equestrian accidents and develop associated thresholds for when concussions happen.

While much previous understanding of sporting concussions is based on research in other sports, this looked specifically at rider falls and also the surfaces competitors are likely to fall on — turf and sand — and the forces, speeds and angles associated with falling from a horse.

Riding hats from reputable brands that comply to accepted standards are already rigorously tested in recreated scenarios in which riders might find themselves. These can vary slightly depending on which standard they comply with, but include situations such as a blow from a horse’s foot, the crushing force from a falling horse and landing on different types of object, such as a pole.

Many manufacturers also go above and beyond the required testing standards to ensure their products are giving the best protection possible.

This study is in no way saying helmets are not fit for purpose, rather that as knowledge of this area continues to grow through research and testing, assessing the level of protection helmets offer in real-world situations would be of additional benefit.

“This investigation found that concussive equestrian accidents occurred from oblique impacts to turf or sand with lower magnitude and longer duration impacts [than linear drop to a steel anvil testing, commonly used in helmet testing standards],” states the study.

“This suggests that current equestrian helmet standards may not adequately represent real-world concussive impact conditions and, consequently, there is an urgent need to assess the protective capacity of equestrian helmets under real-world conditions.”

Footage of 1,119 racing and cross-country falls in Britain and Ireland between August 2011 and May 2018 was collected. These included both falls that resulted in diagnosed concussions and those where riders did not have a head injury.

Of these +1,100 falls, 114 were concussive and of these, 25 met the exact criteria needed for the study. This included having a clear view of the fall, the rider’s head must have hit the ground and they cannot have had multiple impacts (for example, falls where a rider landed and then was kicked were excluded). The study also included 25 non-concussive falls.

These 50 falls, which included both men and women, were then reconstructed.

“From the accident reconstructions, it is apparent that current certification standards for equestrian helmets represent different loading conditions than those associated with real-world concussion,” concluded the researchers.

“It is unknown how equestrian helmets perform for oblique impacts to a compliant surface and, therefore, there is a need to assess the protective capacity of equestrian helmets under these impact loading conditions.”

Mr Clissold told H&H BE was “lucky enough” to work with Dr Michio Clark, one of the study’s authors, on this “very detailed and thorough project”.

“We hope the findings will lead to further development of equestrian helmets to help reduce the risk of riders’ being concussed in falls,” he added.

A spokesman for Charles Owen, which provided helmets for the research, told H&H studies like this are “important to support the whole equestrian industry in taking small steps towards improved safety for all riders”.

“The research from this paper, and others like it, are used as reference material for industry-standard committees, like ASTM [American Society for Testing and Materials — one of the safety standards riding helmets can comply to],” he said.

“Those standards dictate the kind of tests each equestrian helmet must go through to be sold in various markets around the world. So in essence, research papers and studies conducted today help form safety standards for rider’s helmets for the future.”

The spokesman added Dr Clark has spent time at Charles Owen and has been involved in other published papers “vital” in shaping equestrian helmet standards.

“We are actively using them in the helmet committees and working groups that address changes and improvements for the future,” added the spokesman.

“Having a wider audience in the general public rather than just academics and the industry will also help to push changes.

“This paper and others that look at oblique impacts are making the noise necessary for change and new test methodology in the standards is being written.

“The helmet industry is taking notice and looking to create helmets that mitigate rotational falls.”

A spokesman for helmet manufacturer Champion Safety added the company has been investigating the relationship between rotational acceleration and concussion for many years, recently introducing the MIPS (multi-directional impact protection system) brain protection system to several ranges of its helmets. The MIPS system is also available in some riding hats from other manufacturers.

“MIPS works by allowing a small movement of the helmet on the head which redirects rotational forces away from the skull in the event of a fall and in doing so helps mitigate against brain injury,” he told H&H.

“As the industry’s understanding of the relationship between horse rider falls and concussion increases, we hope to see more test labs having the capability to measure these forces and this will hopefully mean we can start to include performance criteria for this type of injury into our global standards.”

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Following recent discussions about the benefits of gumshields for riders, H&H canvassed opinions from governing bodies’ chief medical advisers, a dentist and mouthguard specialist, plus riders from across the disciplines...

Debate over the use of gumshields in equestrian sport has resurfaced following a call from a high-profile jockey and discussion at the International Eventing Forum.

The 20-time Grade One-winning jockey Paddy Brennan called for “every jump jockey to be wearing” a gumshield, adding that his “saved his head” in a fall at Leicester last month.

While talking about the best way to fall at the International Eventing Forum at Hartpury (3 February), orthopaedic surgeon Michael Eames said wearing a gumshield can help dissipate the energy in your jaw and neck, reducing the risk of a head injury.

Although there is no conclusive evidence gumshields reduce a person’s risk of concussion, some who wear them are convinced of the benefits, and they can certainly help prevent dental injuries, which are painful, inconvenient and expensive.

 Cheltenham Gold Cup-winning amateur Sam Waley-Cohen offers cost-price mouthguards to jockeys through his business, Portman Dental Care.“At the moment, we can’t categorically say to jockeys if they wear a gumshield and fall, they’ll have less chance of concussion,” said the British Horseracing Authority’s (BHA) chief medical adviser Dr Jerry Hill.

“I encourage jockeys to wear gumshields, especially ones that are custom-made, and as long as they’re properly fitted, there isn’t any issue with them.

“We’re in the process of commissioning a new medical records system, which will allow us to gather much more useful data and we’ll be able to do more analysis. That will give us sport-specific data for racing and then we can give sensible advice.”

H&H has been contacted by dozens of riders across the disciplines — particularly racing, polo, team chasing and eventing — who opt to wear gumshields for a variety of reasons. All opted for a properly fitted type, over the “boil and bite” version, at a cost of roughly £50 to £100, depending on the level of protection. Some said they barely notice wearing them, while others found they took a bit of getting used to.

Abigail Lewis told H&H she is a convert after cracking teeth in a pointing fall last season.

“It was the most painful thing I’ve ever done,” she said, adding that she wears it for both tooth protection and concussion prevention. “I don’t even realise I’ve got it in — it was £120 compared to £800 for [the work I’ve had done].”

Aurora Eastwood told H&H she wears a gumshield “every time” she plays polo, for both teeth protection and to mitigate against concussion, and believes they should be compulsory in all fast equine sports.

Amateur eventer Alysen Miller, who has a background in racing, told H&H she looked into it extensively and said the research she found between mouthguards, concussion and even spinal damage prevention “didn’t seem entirely baseless”.

“An absence of evidence doesn’t mean an evidence of absence,” she said, adding it is the piece of equipment she notices “the least”. “It does seem a very small tweak you can make to your kit, even if it is a very small chance [that it will help].”

Former jockey Alice Mills told H&H wearing one for racing was a natural progression from hockey and rugby.

“I didn’t see any reason not to carry on wearing it for team chasing,” she added.

Billy Aprahamian, amateur jockey and assistant trainer to Nicky Henderson, told H&H: “It is becoming more and more common now compared to five years ago in point-to-pointing and is much more common in jump racing, where a lot of the jockeys are wearing them — anything to protect themselves.”

Anthony Lovat, dentist and founder of pioneering mouthguard company OPRO, told H&H the company does not collect data on which sports its customers take part in, so could not say if it has had an increase in demand from racing or equestrian sports.

“What I can say is on the whole, the use of mouthguards is certainly on the rise globally,” he said, adding that people are becoming more aware of dental injuries and how to prevent these.

He added that impression-fitted mouthguards offer greater protection because they result in a better fit and the thickness is greater than that of the boil and bite. This is because the process and machines used to create them are stronger than a human hand or bite can achieve.

“That’s not to say all boil and bite mouthguards are bad, but the ultimate is the custom fit,” he added.

The company is also working with Sports & Wellbeing Analytics on their latest mouthguard, which features built-in technology that monitors head impact data.

Mouthguards work by absorbing energy, meaning the force the wearer experiences is dissipated over a longer period of time, reducing or eliminating dental injuries.

One rider told H&H she looked into them after suffering a nasty fall while not wearing one, but was advised against it by her treatment team owing to the forces riders can experience in a fall and the question as to whether that could result in greater damage.

Dr Lovat added in the 20-plus years of Opro, he has never known a mouthguard to cause harm.

The British Equestrian Federation’s chief medical officer Pippa Bennett told H&H that looking at the research available, there is no conclusive evidence a mouthguard protects the wearer from concussion.

“Custom-made mouthguards will help protect your teeth — will it lower your risk of concussion? Possibly, but it’s not proven,” she said.

She added that much research is ongoing into factors surrounding concussion, including neck strength, gender and the lasting impacts of head injuries.

Dr Bennett encouraged people to be aware of concussion symptoms and that these can sometimes first become apparent hours later.

She is also working on a system within the World Class programme, whereby riders would have an initial assessment after a fall, followed up by further assessments at various intervals, such as three, 24, 48 and 72 hours.

“We want to be absolutely sure we are not putting anyone back on a horse when they really shouldn’t be riding,” she said.

“We are also working on graduated return advice. At the moment, there is the initial 21-day stand-down time [from competition], but nobody really tells riders what to do at home.”

There is growing evidence in how improved neck strength can help prevent concussion, as this can help control the rapid acceleration and deceleration in a fall. Concussion is not always caused by direct blows to the head, but the brain hitting the inside of the skull, with research showing a stronger neck can help reduce the amount of energy transferred to the brain during an impact.

The Injured Jockeys Fund has shared videos of neck-strengthening exercises for riders, to help mitigate their risk.

An ongoing project at Imperial College London, funded by the Racing Foundation, is also looking at an in-ear device, which monitors the wearer’s heart rate, electrical activity of the heart and brain, blood oxygen levels and respiratory rate, as well as containing an accelerometer.

It is being trialled within the NHS at present and the BHA is looking at potentially testing it to measure the above statistics after a fall.

The ultimate aim is for jockeys to wear these while racing, but it is not at that stage yet.

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Both current and former riders who’ve been concussed after a fall are sought for a study into the long-term effects of concussion in equestrians.

Volunteers should be aged 51 or older and have experienced one or more concussions during their riding career.

The three-year study, carried out by Dr Michael Turner of The International Concussion and Head Injury Research Foundation (ICHIRF), aims to find out if suffering a concussion alters brain health in later life, which could lead to early onset dementia or depression.

“We want to see if falling off your horse causes harm in the long term,” said Dr Turner.

Former Grand National winner Bob Champion, who is now 70, has just undertaken the screening process. During his race-riding career he had about a dozen serious concussions. After one he was banned for riding for six months on medical grounds.

“Currently, we don’t know how concussion might affect the brain as we age, and because of my concussions, I do worry about my future brain health, and what life may look like in years to come,” he said.

“This research is important for horseracing, as it’s the first of its kind, and the results should provide a deeper understanding of concussion and its long-term effect on the brain,” he added.

Screening takes place over a day at the Institute of Sport, Exercise and Health, at the University College, London.

“To date we have screened well over half the people we need to, and we are now making a final call to former jockeys and competitive riders, over the age of 50,” said Dr Turner.

Female riders are particularly urged to take part as the study is the only one looking at women in this age group.

All travel expenses for the day are covered by the ICHIRF. To find out more and register to take part visit: www.ichirf.org

Continued below…

Calls for riders to donate their brains ‘when they’ve finished with them’

The International Concussion and Head Injury Research Foundation is exploring whether repeated head trauma leads to neurological problems later in

Would you know if someone was suffering from concussion after a fall?

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In the research process tests compare a group of athletes who have suffered one concussion with a similar group who have never had concussion.

“There are a lot of horsey people who’ve had numerous falls in their youth leading perfectly normal lives in their later years,” said Dr Turner. “We need the science to back this up.”

The results of the research are expected to be published by the end of next year.

For all the latest news analysis, competition reports, interviews, features and much more, don’t miss Horse & Hound magazine, on sale every Thursday.

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A pin-prick concussion blood test could be on the market as soon as 2019.

Researchers at the University of Geneva (UNIGE), in collaboration with hospitals in Barcelona, Madrid and Seville, have developed a small device that can diagnose mild brain trauma from a single drop of blood.

The research involved identifying biomarkers in the blood that increase when a person has experienced a brain trauma.

“Our idea was to find a way to do a quick exam that would allow, during a boxing match or football for example, to say if the athlete can return to the field or if his condition requires hospitalisation,” said Jean-Charles Sanchez, a professor at UNIGE’s department of internal medicine of specialties and the centre for biomarkers.

“[This is] the opposite of a CT scan, [which is] a test that lasts a long time and cannot be done anywhere.”

The nature of this new test means that unlike a CT scan, it is small enough to be taken anywhere and can be done quickly.

When someone sustains a brain injury, damaged cells release proteins, which increases the amount of these present in their blood.

The researchers isolated four molecules that indicated the presence of a slight traumatic brain injury.

Professor Sanchez’s team has now developed a rapid diagnostic test, called TBIcheck, which is inspired by pregnancy tests.

By placing a single drop of blood on the stick, a patient will know in 10 minutes if they are likely to have sustained a mild trauma.

“If a band appears, the injured [person] must go for a CT scan, if there is nothing, he can return home safely,” he added.

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The results were published in the journal Plos One, and there are plans to market the device next year with the start-up company ABCDx.

“We are preparing an even better TBIcheck, which will send home 50% of patients, but which requires an increase in the sensitivity of the [part of the device] that receives the blood,” added Professor Sanchez.

The company’s ultimate goal is to market biomarkers that can also diagnose stroke and aneurysms.

Research into biomarkers with the potential for developing a pitch-side test has been ongoing for several years and could have real benefits for riders. The risk nature of the sport means equestrians are at particular risk of head injuries. There are already very good cognitive tests used to help diagnose concussion, but these are not totally foolproof.

Recent research has shown the dangers of receiving a repeat injury while still recovering from a previous brain trauma and rules in many equestrian disciplines are designed to protect riders from this. A rapid test that can be done while at a competition could help give medics and riders a faster diagnosis and less time on the sidelines for those who are uninjured, while those who are receive the necessary treatment.

For all the latest news analysis, competition reports, interviews, features and much more, don’t miss Horse & Hound magazine, on sale every Thursday

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Riders are invited to donate their brains to help form a greater understanding the long-term effects of concussion in sport.

The International Concussion and Head Injury Research Foundation (ICHIRF), led by Dr Michael Turner, is exploring whether repeated head trauma leads to neurological problems later in life (news, 28 January, 2016).

The project involves in-depth screening of jockeys, riders and other athletes who have had concussion, comparing their results to control subjects.

Dr Turner told H&H the next stage is to look at whether concussion can lead to the neurodegenerative disease, chronic traumatic encephalopathy (CTE).

CTE can only be diagnosed after death, when the brain can be examined for evidence. This is where the brain donation scheme comes into play.

“It sounds very gory but when you talk to friends, most are organ donors and have already come to the conclusion that they are happy to give up their organs to somebody else to save their life,” he said.

“We don’t need the brain to be active. We’re happy to wait until you’ve finished with it.”

Dr Turner explained that those donating their brains must be involved in the screening process, although those who are screened as part of the concussion project do not have to sign up to donate their brains.

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ICHIRF is looking for controls and those who have been concussed for brain donations, as well as more people, preferably aged over 50 to sign up for the screening process, which is free for participants.

The brain donation scheme is organised alongside the Queen’s Square Brain Bank at the UCL Institute of Neurology. Each brain examination will cost £5,000 and ICHIRF is looking for more sponsors of scheme.

For more information visit www.concussioninsport.org

For further information about the brain donation scheme and the ICHIRF project, including comments from Richard Pitman and Bob Champion, don’t miss this week’s H&H magazine, out on Thursday (31 May)

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

Riders who fall while taking part in British Eventing (BE) competitions will be eliminated in most cases under a tightening-up of the organisation’s safety rules.

From this season, any rider who falls during the dressage or having passed through the start in the showjumping or cross-country phases will not allowed to continue.

BE implemented the rule after “continued monitoring” of concussion research, and head injury assessment guidelines, and consultation with BE’s medical officers, officials and event organisers.

The change also took into account feedback from stakeholders, and is on the advice of BE chief medical officer Judith Johnson.

“Post-fall assessment of riders may require a thorough physical, mental competence and neurological assessment,” Ms Johnson said.

“This is a time-consuming process, and may need to be repeated after a period of time in order to make a clinical decision whether that rider is fit to compete again that day.

“We have a duty of care to our members which, in the light of recent guidelines on concussion management, has led to this rule change.”

H&H reported on BE’s rule changes for 2018 late last year, which originally said that if a rider falls during the showjumping, the bell will be rung and the clock stopped while they remount and the jump is rebuilt. It added that six seconds will be added to the competitor’s time and the 45-second rule (elimination for failing to jump the next obstacle within 45 seconds) will not apply.

The rule also stated that riders falling on the cross-country course must be checked by a paramedic or doctor before they may remount and continue.

But BE national safety officer Jonathan Clissold said: “Whilst every effort has been made to enable a rider to continue after a fall in a safe manner, BE and event organisers have worked incredibly hard to provide standards of safety and medical provision for all BE events that are as high as possible and this rule change is essential to ensure that rider safety is maintained.

“The new rule will also bring BE in line with FEI rules regarding the fall of a competitor which have been imposed by them since 2008.”

The rule is also in line with British Showjumping competitions, in which any rider who falls is eliminated.

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Key points:

Riders who fall during their dressage test or anywhere on course in the showjumping or cross-country phases will be eliminated and unable to continue.

Riders who fall in the warm-up of any phase or before passing through the start of the showjumping or cross-country must be checked by a doctor before continuing.

Multiple-horse riders who fall off must undergo a fit to ride assessment carried out by the event doctor before being allowed to ride subsequent horses.

A competitor who falls at any stage of the competition must be checked by the event doctor before continuing or leaving site. It is the responsibility of the competitor to ensure compliance with these rules.

A copy of the updated rule changes will be published on the BE website in the near future.

For all the latest news analysis, competition reports, interviews, features and much more, don’t miss Horse & Hound magazine, on sale every Thursday.

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

The dangers of continuing to ride with concussion have been highlighted in a short film.

Leading experts in concussion and jockey health, as well as top jockeys Liam Tredwell and Martin Dwyer, spoke of the “collective responsibility” those in the industry have when it comes to head injuries.

The film was produced by the Jockey Education and Training Scheme (JETS) and focuses on some of the myths surrounding concussion and why it is so important for riders to take it seriously.

“I really don’t think jockeys are aware enough about concussion,” said 2009 Grand National winner Liam.

“If I had been educated and known that I could take myself out for a fortnight, or the period everyone advised, that could have been that.

“But lo and behold I kept battling on along the road of ‘I’ve got to be seen to be head down, grafting and riding’ and I was out for nearly six months.”

Derby-winning jockey Martin added: “Nine times out of 10 you think you’re fine, you don’t realise you’re actually suffering with something. I think that’s probably one of the biggest problems.”

British Horseracing Authority’s chief medical adviser Dr Jerry Hill warned some concussions can have delayed onset, meaning it takes time for the symptoms to start after a fall.

“If you ride with symptoms of concussion before it is resolved, it’s like you are riding when you’ve been drinking,” said Dr Hill.

He added this means performance will be poor, there is increased risk of sustaining another injury and it is “not very impressive” to a rider’s owners and trainers.

Emma Edwards, senior physiotherapist at the Injured Jockeys Fund, spoke of the cumulative effect repeat concussions can have and both the common and less recognised symptoms.

“A lot of jockeys don’t realise you don’t have to hit your head to have a concussion – it’s the rotation of the brain within the skull that causes the concussion rather than necessarily the bang on the head,” she said.

She added common signs are headache, nausea and vomiting, sensitivity to bright lights and noise, while less common symptoms can include feelings of anxiety or panic, difficulty sleeping, difficulty coping with a lot of people in the room, slower in processing and answering questions.

Dr Michael Turner, medical director at the International Concission & Head Injury Research Foundation added that racing has the “highest rate” of concussion compared to any other sport.

“You can get concussion from any impact that goes through your body and gives your brain a shaking,” he said.

“Racing is an all or nothing sport, once you’re up there you’re at risk and the problem with concussion is it slows you down, your instinct and your ability to keep out of trouble.”

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He stressed the importance of seeking medical advice, adding that the condition affects everybody differently and a person can have different symptoms from one concussion to the next.

“Jockeys fall off on the gallops and that [also] needs to be taken seriously, because youngsters are not going to come forward and say ‘I’ve got a splitting headache and double vision’,” he said.

“The trainers and people in the yard have to be really, really careful about that because they have a duty of care.”

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

This weekend (16-17 September 2017) is the eighth annual International Helmet Awareness Day, and to mark the occasion we take a look at a few things that you may not know about concussion

1. The average amount of traumatic brain injury-related deaths in equestrian sport is more than seven times that of traumatic brain injury-related deaths in contact sports — that’s an average of 60 deaths in equestrian sports each year.

2. According to the Centre for Disease Control, a concussion is a type of traumatic brain injury (TBI) caused by a bump, blow or jolt to the head, which causes the brain or head to move back and forth rapidly. When that happens, inside your head your brain will bounce or twist around, damaging the brain cells, thus creating chemical changes in the brain.

3. Concussions cannot be captured on any imaging because there are no abnormalities, says Dr Lola Chambless, a neurosurgeon at Vanderbilt University in Nashville, Tennessee, and long time event rider. The symptoms are purely a clinical diagnosis — you will not see anything on a CT scan or MRI.

4. Symptoms of a concussion can include appearing dazed or confused, headache, nausea or vomiting, balance problems or dizziness and feeling groggy or sluggish. However, not all concussions are obvious so if you are at all concerned you should seek professional medical advice.

5. Because most falls can happen when you’re not at a sanctioned equestrian event, most concussions can go undiagnosed. “Things like that happen all the time, and most people generally are not going to seek medical attention unless they are very symptomatic,” says Dr Chambless.

6. Dr Chambless has worked with the National Football League in America, which has produced a concussion protocol to be used along the sidelines at the games to help diagnose players with concussion. And while the protocol’s questions are football-specific, they can be modified for any sport. She strongly encourages trainers, instructors and riders to all learn to ask these questions any time a fellow rider has come off their horse. The series of questions are fairly simple to essentially test immediate and short-term memory of the person in question. Questions may include: Where are we riding today? What colour is your saddle pad? Where did you last compete your horse? What’s your horse’s name? If she/he cannot answer one of these questions, it is recommended to have medical professional see them to make a further diagnosis.

7. And it’s the aftercare for concussions that are just as important. Someone who has suffered from a previous concussion should try to avoid taking any unnecessary risks with training, but most importantly prevent secondary injury. Secondary injury is when a rider returns to the saddle before they’ve fully recovered from a concussion, putting them at a much greater risk for long-term or permanent issues from a concussion.

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8. While approved helmets do reduce the chance of a lethal head injury and can save your life, they do not prevent concussions.

9. Helmets are designed to limit the types of forces that cause skull fractures and intracranial hemorrhage, which are things that are going to kill you or leave you with neurologic problems. Unfortunately, they are not designed to affect the forces that generally we believe can cause a concussion. “Unfortunately, there is no safety gear out there currently that really reduces your chances of concussion from a fall of six feet, which is basically what you’re assuming you’re going to fall from in most equestrian injuries,” says Dr Chambless. “We can’t prevent people from falling off, but we can make it a lesser risk by wearing a helmet and riding in safe situations.”

To celebrate International Helmet Awareness Day, Riders4helmets has teamed up with leading manufacturers to offer special discounts on safety headgear. Find out more at riders4helmets.com

For all the latest news and reports don’t miss Horse & Hound magazine, out every Thursday

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Equestrians across Britain, from those who ride for pleasure to leading competitors, are being asked to take part in a survey to aid research into the effects of concussion.

Professor Huw Williams, associate professor of clinical neuropsychology at the University of Exeter, is seeking Horse & Hound readers who have had one or more falls in which they have hit their head, whether or not they suffered concussion as a result.

“We will be looking to assess what happened during the accident, whether or not they sustained concussion, what the rider noticed about their condition following the incident and what their aftercare was like,”  said Prof Williams, who is currently conducting research on recurrent concussion in rugby players.

“We will also seek to discover the time scale between a rider’s bouts of concussion and whether or not they are still suffering from symptoms.”

The rider concussion survey will start with an online questionnaire that will go live at the end of this year.

Once the data has been collated, Prof Williams and his team will share the findings with Horse & Hound readers.

It is hoped that the project will assist riders in obtaining earlier assessments and appropriate aftercare and support, as well as signposting when they need to get help from their GP or another medical professional.

“Another aspect is resilience,” added Prof Williams. “We want to look at what has helped riders to recover from concussion.

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“Some recover particularly well from head trauma, which indicates that they are somehow protected, and we want to know why this is.”

Some respondents may be given the opportunity to assist with other research into acquired brain injury.

In 2006 Prof Williams undertook a study on neuropsychological dysfunction following repeat concussions in jockeys.

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Repeat tests and active rehabilitation are among the new concussion protocols to be introduced by the British Horseracing Authority (BHA).

The enhancements to the BHA’s rules will come into force on 1 August.

The aim is to ensure riders are better protected and prevented from riding while they have a concussive injury.

Dr Jerry Hill, the BHA’s chief medical adviser, said it is “essential” that a sport should not be complacent about the management of such a serious issue as concussion.

“For some time British racing has been recognised as pioneers when it comes to concussion management, as you would expect from a sport which carries an above average risk of concussion injury,” he said.

“It is my intention that in British racing we provide our jockey athletes with the appropriate guidance, treatment and care.

“This is why I am personally putting a renewed focus on the support these athletes receive in injury management as well as wellbeing, nutrition and mental health.”

This follows a review of the existing concussion management protocols led by Dr Hill, in consultation with relevant stakeholders such as the Professional Jockeys Association.

The updated protocols include an extension of the course-side screening test to ensure all riders involved in a fall are assessed with symptom scores, balance and short and long-term memory tests — previously only memory was tested.

Doctors will also be allowed to test riders involved in heavy falls a second time, around 25-30 minutes after the initial test, even if the rider passed the initial screening. This is to help detect late-onset concussions.

As well as this, the BHA is involving other members of racecourse teams to encourage potentially concussed jockeys to attend testing and retesting with the on-site medics.

Further research and development of an active rehabilitation programme and enhancing baseline testing are also part of the updates.

The Injured Jockeys Fund’s almoners will be included in the baseline testing process to help make it more convenient for riders.

“The enhancements to our concussion management protocols will help reduce the risk of jockeys continuing to ride while suffering from a concussion,” added Dr Hill.

“It will also aid their safe return to riding following a concussion injury.”

Related articles:

• Concussion: are women more at risk? *H&H VIP*
• FEI to help develop protocol for dealing with sporting concussion
• ‘From denial to panic’: long-term effects of concussion explored

More improvements planned for the “near future” include a rewrite of head injury guidelines given to jockeys plus enhancements to the helmet bounty system.

The BHA is also working on an education programme for anyone working within racing on how to diagnose concussion and the risks of riding with a head injury.

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A protocol for how to deal with a concussed athlete is the aim of an international concussion conference taking place later this year.

The FEI is joining a number of other top international sports organisations — including World Rugby, the International Olympic Committee and FIFA — at the Fifth International Consensus Conference on Concussion in Sport.

It will feature a summary of new evidence-based research before experts attempt to come up with a protocol document for the care of injured athletes.

Research — covering all aspects of concussion from definition, management, investigations, treatment, return-to-play protocol and prevention — will be discussed.

Abstracts are still being accepted for the event in Berlin on 27-28 October.

An expert panel, including FEI medical committee member Allen Sills, will review the findings.

They will then work together to create the protocol for physicians and healthcare professionals involved in the care of injured athletes at recreational, elite or professional level.

The conference, which was first held in 2001, has become a leading forum for concussion awareness and prevention.

It led to the publication of the first Sport Concussion Assessment Tool (SCAT) in 2005, which is still used by sports leagues and federations.

The last conference was held in Zurich in 2012, when members further developed and adjusted SCAT to better fit requirements for both pro-athletes and children.

A pocket concussion recognition tool — a leaflet listing the key symptoms, “red flags” and what action to take — has also been created for parents and coaches to help recognise the condition.

Related articles:

• Genetics could influence concussion recovery time
• ‘from denial to panic’: long-term effects of concussion explored
• Simple reading test could help detect concussion

Why is this relevant?

Concussion is the most common type of all head injuries and there has been a flurry of research into the condition.

A conference focusing specifically on concussion in women was also held in the US earlier this year.

H&H has reported on a number of recent scientific findings, from advances in testing to whether women are more at risk and an extensive research project into whether repeated head trauma can lead to neurological problems later in life.

See Horse & Hound, out Thursday, 21 April, for more information.

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Riders who have suffered concussion may be more at risk of suicide, according to a recent study.

Research carried out in Canada found that concussion patients were three times more likely to commit suicide than those who have never been concussed.

In addition, weekend concussions were associated with a one third further increased risk of suicide, compared to those that were concussed on a weekday.

The research, carried out over a 20-year period, involved 235,110 adults who had been concussed from Ontario, Canada.

“We were surprised that the association between concussions and suicide was not confined to professional athletes or military veterans and, instead, extended to regular adults engaged in everyday activities in the community,” lead researcher Dr Donald Redelmeier told H&H.

“The main implication of our research is to emphasize the importance of prevention. When a concussion occurs, you should get lots of rest, return to activities slowly, avoid a second concussion and seek medical care for long-term follow-up. Health care cannot provide miracles but can stop a bad situation from becoming worse.”

Dr Redelmeier said weekend concussion could present a higher risk of suicide due to “feelings of self-blame if the activity was self-initiated.”

Meanwhile, an extensive research project has been launched in the UK, exploring whether repeated head trauma can lead to neurological problems later in life (news, 28 January).

The research, conducted by the International Concussion and Head Injury Research Foundation (ICHIRF), centres on jockeys.

“It’s a very interesting study and is one part of the picture,” lead researcher and ICHIRF medical director Dr Michael Turner said of the Canadian research.

“The inference from North America is that suicide if very common in the concussion group, but we don’t see that in the concussed population outside North America.

Related articles:

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“When you take sportsmen as a group, they have a much lower risk of suicide than the general population, which is one of the areas we will be exploring.”

The researchers involved in the Canadian study now plan to carry out ongoing research to explore ways to help patients to recover more fully from concussion.

Their paper was published in the Canadian Medical Association Journal on 8 February.

Ref: H&H 18/02/2016

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A test that could help detect the severity of a concussion is a step closer after researchers found a specific protein present in patients with a certain type of head injury.

Scientists have discovered that some “mild” concussions can cause cognitive impairment that lasts for several months or longer.

Researchers at the University of Pennsylvania and the University of Glasgow have found a biomarker that is present in concussions with this brain damage.

They have narrowed it down to a specific protein, which rises in the blood following this type of concussion.

Scientists hope this could be used to diagnose specific brain injuries and predict cognitive impairment in patients.

“We’re starting to believe that ‘mild traumatic brain injury’ is an oxymoron,” said author Dr Douglas Smith. “For some people there’s nothing mild about it.”

A concussion test similar to the standard blood test used to detect cardiac damage from a heart attack may be available in the future.

“The brain protein specifically indicates the presence of nerve fibre damage that we call diffuse axonal injury,” said Dr Smith.

“Our findings confirm that even relatively mild, concussion-type brain impacts can cause permanent damage of this kind.”

Dr Jerry Hill, chief medical advisor at the British Horseracing Authority (BHA), said the development of biomarkers as pitchside or near-patient tests has been the subject of research from groups around the world.

“If these chemicals could be measured on breath or finger-prick blood tests that gave instant results and were accurate, reliable and cost-effective, then such tests have the potential to revolutionise the management of concussion,” he told H&H.

“Research is ongoing and the BHA will monitor developments to assess when and if such testing can be incorporated into our current protocols.

“Racing has, for many years, been recognised as being ahead of the curve when it comes to concussion management, however we cannot be complacent.”

He added that the BHA is currently reviewing its concussion protocols.

The BHA rules currently require all professional jockeys to undergo yearly baseline neuropsychological screening.

Related articles:

• Concussion: are women more at risk? *H&H VIP*
• Simple reading test could help detect concussion
• ‘From denial to panic’: long-term effects of concussion explored

Following a concussion diagnosis, a rider is immediately stood down for a minimum of six days.

They then undergo one or more repeat neuropsychological tests that are compared to their baseline, an assessment by a separate consultant neurologist and, in some cases, a brain scan.

Only when the results of these tests return to normal is the jockey allowed to return to race-riding.

Ref: H&H 18 February, 2016

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An extensive research project into concussion will explore whether repeated head trauma can lead to neurological problems later in life.

The research, conducted by the International Concussion and Head Injury Research Foundation (ICHIRF), centres on jockeys, both amateur and professional.

The long-term project, launched on 21 January, aims to discover whether retired sportsmen and women have increased incidence, or suffer an earlier onset, of neuro-degenerative disorders such as Parkinson’s disease, Alzheimer’s disease and chronic traumatic encephalopathy.

“Through impartial, objective analysis of a significant pool of data, we will seek to establish whether there is any correlation between repeated concussion and long-term damage to the brain,” ICHIRF medical director and lead researcher Dr Michael Turner told H&H.

“We’re not so interested in what happens when you hit the ground, but how you’re coping 20, 30 and 40 years after the concussion.”

The study will be inclusive of all sports where concussion is a recognised risk, but as horseracing has the highest recorded rates of concussion, the initial screening process will be on more than 200 retired jockeys living in the UK, Ireland and France.

Former champion National Hunt jockey Richard Dunwoody is one of the first volunteers for the study.

“As professional jockeys, with a fall every 14 rides on average, it was accepted that we would suffer concussion, but we gave little thought as to what the long-term effects of repetitive head injuries would be,” he told H&H. “Jockeys will find it very useful and I imagine a lot will sign up.”

Fellow former champion jockeys AP McCoy, Peter Scudamore, John Francome and Stan Mellor will be joining Richard in the screening. They will undergo MRI scanning, blood tests and full behavioural analysis as part of the project.

The research will then expand to include riders from other equestrian disciplines, as well as members of the public who have never been concussed.

“The temptation is just to have lots of jump jockeys, but that skews your data if you only look at one group,” said Dr Turner.

“Members of the public are crucial to our success as we need a cohort of people of similar age, gender and weight to compare to the group who have been concussed.”

Concussion in women

As well as exploring the long-term effects of concussion, researchers hope the study will reveal an insight into the differences in concussion between men and women.

Last year (news, 17 September 2015), research carried out by the University of Michigan found that women reported, on average, one-and-a-half times more symptoms of concussion than men.

“The point-to-point demographic is 50/50 men to women riders,” Dr Turner said.

“When you separate men and women you see there’s quite a difference — men fall more often than women. But women sustain concussion four times more often than men.

“We need women riders to take part in the research as we are really interested to find out why that is.”

The study will cost £2m in total for the jockeys and controls to be screened. Funding support for the project has come from a range of sources, including Horse & Hound’s charity of the year the Injured Jockeys Fund (IJF), Godolphin and the National Football League in the USA, as well as private backers.

The ICHIRF hopes to have more than 20,000 people signing up to participate in the research in its first year. The study is set to continue for more than 10 years and preliminary results are expected in three years.

“As we go along the knowledge base will increase,” said Dr Turner. “We will hopefully see that there is a genetic marker for the problem [degenerative disorders that can be brought on by concussion], so you can see if you have a high risk. It’s not about banning anything, but giving people a clear understanding of what the long-term risk is.”

Take part in the research

To participate in the study, volunteers should indicate an interest by completing a registration form at www.concussioninsport.org

Once this has been logged, the individual will be offered the opportunity to complete an online questionnaire on an annual basis.

From all the volunteers who complete the online questionnaire, a number will be invited to attend a detailed screening in London — the same screening that is being carried out on the jockeys.

The cost of screening will be covered by ICHIRF and the project will continue to monitor the progress of all participants —questionnaire only and screened individuals — over subsequent years.

‘People have gone from denial to panic’

Former jockey Brough Scott, chairman of the IJF and an ICHIRF director, has been tested as part of the research. He told H&H the study was “essential”.

“People have gone from denial to panic [regarding the effects of concussion],” he said. “What we don’t have is any proper, peer-reviewed research on a lot of people who have been concussed.

“Jockeys are going to get concussed so we need to know what happens. You need to know the

risks so you can make a decision — you can’t pretend you can eliminate the risks.”

H&H is supporting the IJF as it’s charity of the year 2016. To find out more and make donation click here.

Ref: H&H 29/01/2016

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A simple reading test could help establish whether a rider has concussion, according to researchers.

A timed vision test — known as the King- Devick Test — involves athletes with a suspected head injury reading numbers as quickly as they can off a series of three cards, while being timed with a stopwatch.

This is then compared to their result from a pre-season baseline test.

It took concussed athletes an average of 4.8 seconds longer than their baseline score to complete the test, whereas non-concussed athletes improved by an average of 1.9 seconds.

The study, which was published on 10 September in the journal Concussion, was carried out by researchers at the NYU Langone Medical Center in America.

“There is no diagnostic substitute for a medical professional when it comes to evaluating an athlete for concussion, but physicians are not always on the sidelines when an injury might occur,” said senior study author Prof Laura Balcher.

Researchers reviewed 15 studies where a rapid number-naming test had been used.

In total, the study involved 1,419 athletes from sports including hockey, football, boxing, lacrosse and rugby, of which 112 had sustained a concussion.

The test detected 96 out of the 112 concussions, which were then confirmed by clinical diagnosis.

Co-author Dr Steven Galetta said that when used as part of a “battery of tests” assessing cognition and balance, the vision test can “raise a flag” for those athletes that need to see a medical professional.

This is one of several recent studies that have thrown up questions about how concussion is measured (news, 17 September).

According to Sport England, 15.5m people aged 16 years and over play sport weekly — including 279,300 riders.

“This research is very interesting and could benefit riders to ensure that anyone with concussion is identified and provided with the correct medical treatment,” said Sarah Phillips from the British Horse Society.

“It will be interesting to see how the practical application of this procedure can be adapted for equestrian sport.”

Ref: H&H 5 November, 2015

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Women are likely to experience greater symptoms of concussion than men, according to a recent study.

Research carried out by the University of Michigan found that concussion does not have different effects on men than on women. However, it did find that women experienced concussion symptoms more severely than men at preseason testing.

This is particularly relevant to equestrianism because women currently represent 74% of the riding population, according to the British Equestrian Trade Association (BETA).

The study was presented at a sports concussion conference in Denver on 24-26 July, which was hosted by the American Academy of Neurology.

Researchers tested 148 college athletes from 11 different sports at the university. Of these, 45% were women, 51% played contact sport and 24% had experienced a concussion.

Women reported, on average, one-and-a-half times more symptoms and scored three points higher on severity than men.

On clinical reaction time, women were 19 milliseconds slower to react than men.

On tasks assessing processing speed, attention and working memory speed, women scored on average 7% below men.

“The difference in performance between genders should be of great interest to athletes, coaches, athletic trainers and doctors who utilise baseline assessments to aide recovery protocols,” said study author Kathryn O’Connor of the University of Michigan and a member of the American Academy of Neurology.

Making progress

Steps are being made to see if wearable devices could help detect head trauma in sports where athletes are at a high risk.

Last season, Saracen Rugby Club trialled a device called the xPatch, which measures blows to the head.

The information is transmitted via a secure database to an app on authorised mobile devices, such as a smartphone.

This means trainers and medical staff can see real-time information about injuries sustained during competition.

A mouth guard aimed at detecting concussion is also currently in development at the University of Florida.

The aim is to create something that could measure the strength of a blow to the head, which in turn would give doctors early warnings about head injuries.

According to researchers at University College Dublin, the chance of jockeys in Ireland, France and Britain sustaining a concussion in a fall is 15%.

Dr Jerry Hill, the British Horseracing Authority’s (BHA) chief medical adviser, said force detectors and gum shields are interesting developments, but unlike in other sports where the injury may not be apparent, in equestrianism it is.

“If you fall off a horse, whether you hit your head or not, concussion must be considered,” he told H&H.

“In the future it would be very useful to have a blood, urine or breath test to detect chemicals released during brain injury, which would give an objective measure of the presence and severity of concussion.

“These are under development but are still some way off. Refining skull cap design to help dissipate impact forces is another area of ongoing research.”

Racing was the first non-team sport in the world to operate a standardised concussion management programme.

Rules require all professional jockeys to undergo yearly baseline neuropsychological screening in regional centres before receiving a licence.

If a jockey is diagnosed with concussion at a meeting, they are immediately stood down for at least six days.

Following this, they undergo more tests, which are compared to their baseline, a separate neurologist assesses the rider, and they may also have a brain scan.

Only when the results of these assessments have come back normal is the jockey allowed to return to race-riding.

“Our approach to concussion aims to prevent jockeys with reduced cognitive [brain] function riding and putting themselves, horses and colleagues at risk of injury,” Dr Hill added.

“This is akin to not letting someone who has been drinking alcohol drive before they have completely sobered up.

“Prevention of long-term health issues is another target, but we do not yet have the data to give a definitive answer on this.”

How is it dealt with?

Protocol varies across the different equestrian governing bodies.

British Eventing (BE) has a compulsory 21-day ban for all riders who suffer a concussion at one of its events.

This rule was introduced last year.

Previously, riders could be given a seven-day suspension if symptoms resolved within 15 minutes.

But there are exceptions to the current rules, which can allow riders to return after seven or 10 days — subject to medical assessment or a pre-season “baseline test”.

“We are kept informed of developments around concussion by our chief medical officers on a regular basis, and of course alter rules accordingly,” BE’s national safety advisor Jonathan Clissold told H&H.

The British Showjumping (BS) and British Dressage (BD) rules are less clear.

The BS rulebook states that “any rider under a medical suspension may not compete in another equestrian discipline without the permission of the appropriate governing body”.

Medical suspensions are not directly referred to in the BD or BS rulebooks.

Heightened risk

David Davies is a neurosurgery research registrar to the National Institute of Health Research (NIHR) specialising in traumatic brain injury, and also provides medical cover at equestrian events.

He said that once an individual has a concussion, the risk of another injury may be increased by up to seven times.

“The key to safe concussion management is to rest until the symptoms have completely resolved and then start a gradual return to training,” he said.

If symptoms return, more physical and mental rest should be taken.

“In riding there is no doubt that wearing a helmet is essential and has prevented many serious injuries,” he added.

However, the evidence to support concussion guidelines in sport is surprisingly sparse. “Research is increasing and with luck in the near future more robust protocols will be formed.”

Leading by example

The University of Birmingham and the NIHR Surgical Reconstruction and Microbiology Centre are currently running a leading European study into recurrent concussive injury in sport.

Mr Davies said he is “concerned” by some top riders’ attitudes towards wearing helmets at major events, such as when the helmet is removed for the lap of honour.

“In our opinion no professional or role model rider should be seen on horseback without protective head gear at a competition,” he told H&H.

Charity Headway — the brain injury association, which works to improve life after brain injury — welcomed the studies.

Supporters of the charity include top jockey Hayley Turner, who suffered a serious head injury during a fall on Newmarket’s gallops in 2009.

Charity spokesman Luke Griggs said it is positive that the public is becoming more aware of the consequences of head injuries.

“There are numerous trials taking place for products that can help identify the impact and potential damage caused by a blow to the head, but far more research and work is needed before they can be relied upon as accurate diagnostic tools,” Mr Griggs told H&H.

“Concussion is an evolving injury that can be notoriously difficult to diagnose.

“It is therefore vital people seek medical attention after a blow to the head and do not take any chances.”

Ref: Horse & Hound; 17 September 2015

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All concussed eventing competitors will be suspended for 21 days under a new rule set by British Eventing (BE).

This is in response to recommendations from the Zurich Convention on Concussion in Sport (November 2012), The Jockey Club procedure for jockeys and BE’s evolving understanding of concussion in athletes.

Every concussed rider must now be assessed by a medical practitioner (doctor or consultant) as fit to ride, including after the mandatory 21 days’ suspension. Previously, if the symptoms of concussions resolved within 15min, the suspension was just 7 days.

But there are exceptions allowing riders to return after 7 or 10 days — subject to medical assessment or a pre-season “baseline test”.

Dr Peter Whitehead, chairman of the FEI medical committee and chief medical officer at the British Equestrian Federation (BEF), said the changes reflect latest research.

“Previous rules followed an old understanding of concussion and graded the concussions by length of time of amnesia and loss of consciousness,” he said. “We now feel that concussion is serious whatever the symptoms.

“Anyone suffering from concussion should cease competition to prevent repetition of the injury and be followed up until all symptoms have resolved.”

Exceptions to the 21-day rule

A “graduated return to play” (GRTP) is permitted in many sports by day 7, subject to daily assessment. BE’s rulebook now permits riders to resume competition after 10 days, if approved by a medical practitioner.

BE chief medical officer Dr Judith Johnson said: “Most event riders do not have access to sports physicians on a daily basis to allow this in a safe, progressive manner.

“By changing our rule to day 10 allows a supervised GRTP and reassessment with a margin of safety. We are following evidence that 80-90% of athletes have recovered [by day 10].”

There is also a revision aimed at professional riders allowing them to compete after 7 days, like jockeys. They have to pay for an annual “baseline test” — a pre-season computerised assessment of cognitive functioning — which can be compared post concussion. If they fail to meet their baseline, they must retest 10-14 days later.

Key signs that you may be concussed

➤ Loss of consciousness or responsiveness

➤ Seizure or convulsion

➤ Balance and co-ordination problems

➤ Headache or neck pain

➤ Drowsiness

➤ Memory loss

➤ Dizziness, nausea or vomiting

➤ Confusion and feeling “like in a fog”

➤ More emotional than usual — “not feeling right”

➤ Blurred vision or light sensitivity

Dr Whitehead recommends that riders, trainers and officials download the concussion recognition tool. Visit http://bjsm.bmj.com/content/47/5/267.full.pdf

This article was first published in Horse & Hound magazine (6 March 2014)

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Edwina Tops-Alexander is recovering after a fall from her horse Cevo Socrates in the 1.45m CSI***** class on Saturday (26 May) at Wiesbaden in Germany.

In was initially thought that the Australian showjumper had broken her wrist but a hospital check-up showed just a mild concussion and she was kept in hospital overnight.

It meant that Edwina, who is the current Global Champions Tour ranking leader could not ride in Wiesbaden’s GCT grand prix on Saturday.

“She’s fine, but is suffering from minor concussion,” said her husband, GCT boss Jan Tops.

On her website, Edwina said she hoped to be back in the saddle soon. “I am an Aussie, I never give up,” she added.

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An accident at a show in which a rider was kicked in the head has highlighted the lack of rules surrounding head injuries in showjumping and dressage.

On 2 July showjumper Charlotte Arnold, from Co Durham, was taking part in a competition at Waterford Equestrian, when she was kicked and taken to hospital.

But there was no rule to say she should not compete after such an injury and the next day she went on to win a class.

Charlotte told H&H she was putting studs on the back shoes of her horse Gibside Queen Bee when a horsefly landed on the mare and she lashed out.

“She walloped me full on the head,” said Charlotte. “I went flying — I turned three somersaults in the air.”

She was assessed in hospital and had six staples to her head. The next day she competed in the last Scope qualifier of The Blue Riband Classic and won.

Though she chose to compete, she thinks there should be stricter rules.

“I squeezed my hat over the bandage and felt OK,” she said. “I wasn’t concussed, but if you are, I think you should be stood down.”

Unlike racing and eventing, where post-concussion suspension is mandatory, a spokesman for BS said there were no rules regarding head injuries and it was up to the rider’s discretion.

H&H columnist Graham Fletcher said: “We’re turning into a country of wusses, so I applaud her carrying on. But with concussion there should be a rule — it’s very serious.”

British Dressage also has no formal rules regarding concussion.

On 9 July 16-year-old Emma Littlewood was kicked in a fall during a BYRDS competition at Keysoe and taken to hospital, only to compete the next day.

She said she was “determined” to continue as she “didn’t want to let the team down”.

Dr Suzannah Hoult from the Medical Equestrian Association said it depends how serious the injury is but added: “I feel the bodies should look at rules regarding assessment of riders after a head injury and hand out a suspension as appropriate.”

This news story was first published in the current issue of Horse & Hound (14 July, 2011)

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now