Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries

Multi-level spondylolysis at Egiin Gol: A case from Xiongnu period Mongolia

OBJECTIVE

This paper presents and discusses the aetiology of an extreme case of multi-level spondylolysis with unique presentation.

MATERIALS

The affected individual is an adult male from Xiongnu period (209 BCE to 93 CE) Egiin Gol, northern Mongolia.

METHODS

Analyses were limited to macroscopic and non-invasive methods.

RESULTS

Seven complete spondylolytic clefts were documented on four vertebrae between T12 and L4, with only one located on L4, where most cases of spondylolysis occur, and four defects had atypical morphology. Evidence of spondylolisthesis was also observed.

CONCLUSIONS

Congenital susceptibility to spondylolysis, combined with a physically demanding lifestyle, likely account for the condition's unusual manifestation.

SIGNIFICANCE

The significance of this case its severity (one of the most extreme documented from archaeological contexts) and unusual presentation (location of the clefts and their atypical morphology).

LIMITATIONS

Only a small sample (< 30) of Xiongnu period human remains were available for comparison.

SUGGESTIONS FOR FURTHER RESEARCH

Interpretations from this case study would benefit from a more extensive analysis of spondylolysis, biomechanical stress, and acute trauma on the nomadic pastoral populations of northern Mongolia, including those pre-dating and post-dating the Xiongnu.

Assessing Equine Behavioural Responses in Equine-Assisted Services: A Field Study Analysis

Equine-Assisted Services (EAS) offer significant benefits for individuals with intellectual and/or physical disabilities. However, ensuring the welfare of the horses involved remains a key ethical concern. The objective of this study was to assess the affective states of horses involved in EAS while also establishing behavioural thresholds for indicators of positive or negative affective states. A total of 98 horses were observed over a two-month period, accumulating data about horse behaviour and session characteristics from 830 EAS sessions. Horses participating in coaching programs averaged four sessions in two months; those involved in therapeutic riding averaged 31 sessions. Equine behaviour and field experts defined behavioural thresholds to assess welfare standards. Negative state behaviours were predominantly aligned within excellent or neutral thresholds, while positive state behaviours were observed from unacceptable to excellent. Principal Component Analysis (PCA) of the gathered behavioural data identified six affective states in coaching sessions and four in therapeutic riding, explaining 63% and 73% of the total variation, respectively. Among these states, "comfortable" was the most frequently observed. Multiple linear regression showed several significant variables, highlighting the importance of health, suitable horse selection, and proper management in promoting positive affective states in EAS.

'We just make do': the use, comfort and functionality of personal protective equipment in the UK mounted police

Police officers wear personal protective equipment (PPE) to reduce their risk of injury while on duty. Despite the unique policing activity of riding a horse, little is known about the PPE used by mounted officers. The aim of this research was to assess the use, comfort, and functionality of mounted police PPE. Twenty officers from three UK Mounted Sections were recruited. Semi-structured interviews and range of movement assessments were conducted. Interview data was analysed using reflexive thematic analysis. Three main themes were generated: Functional requirements, Issues, and Areas for improvement. Much of the PPE worn by mounted officers is not designed for the risks associated with horse riding. There was a sense that officers 'make do' with their current PPE provision, but increased protection from falls and mounted specific public order protection were identified as particular areas for improvement.

Lessons learnt from horse-related human fatalities: Accident analysis using HFACS-Equestrianism

Equestrianism has an opportunity to learn lessons relating to safer human-horse interactions from those who no longer have a voice, by drawing data from the investigation of horse-related human fatalities and participating in accident analysis. Many human-horse related injuries and fatalities are not examined in equestrianism for the purpose of developing safer future risk mitigation practice, often due to the philosophy that horse sport is simply dangerous. This study analysed data from the Australian National Coronial Information System (NCIS) relating to fatalities involving human-horse interaction that occurred between 2000 and 2020. A total of 50 human-horse related fatalities were identified from the NCIS database for analysis using a validated accident analysis framework. The aim of the study was to identify what we could learn and potentially do differently to prevent future fatalities. This was done through a detailed frequency analysis of the underlying causes identified from the coronial investigation using Human Factors Analysis and Classification System-Equestrianism (HFACS-Eq), an accident analysis model specifically designed for equestrianism. As to be expected, the analysis found that most fatalities involved falls 56 % (n = 28) resulting in blunt force trauma 96 % (n = 48), with the horse as causal factor 90 % (n = 45). Beyond these obvious findings, the HFACS-Eq analysis revealed additional findings that in turn can guide future health, safety, and welfare advances in equestrianism. The analysis presented in this paper highlights the environment, surroundings, or location in which the human-horse interact as a critical factor of accident causation. Also, the role of non-technical skills such as communication, effective supervision, and adequate leadership were highlighted as factors that could contribute to enhanced safety in this high-risk domain. The human-horse dyad in equestrianism is complex and unique when compared to other high-risk work and non-work activities. A better understanding of the risk factors involved in handling and riding horses, coupled with a model to help mitigate that risk will also set us on the path to a good life for horses because human safety and horse welfare are inextricably linked.

Examining the Psychological Measures and Feasibility of Recreational Trail Rides in Reducing Cravings for Addictive Substances among Veterans: A Replication Pilot Study

INTRODUCTION

Equine-assisted services have been gaining popularity as complementary therapies for a variety of populations with a diversity of diagnoses. Interventions using equines might benefit the military Veteran population through building therapeutic alliance as well as reducing symptoms. This pilot observational study is primarily aimed to investigate safety, feasibility, and acceptability of equine-assisted services for Veterans with substance abuse disorders. It is the second pilot observational study, the first being completed in 2022. Secondary outcomes included recording the impact of trail riding on psychological measures among Veterans at a large Veterans Administration medical center.

METHODS

The study included a total of 32 Veterans who participated in trail riding sessions from May 4, 2022 to August 31, 2022. The study utilized the Positive and Negative Affect Scale, Adult Hope Scale, and Craving Experience Questionnaire to assess changes in positive affect, negative affect, hope components, and substance craving.

RESULTS

The results indicated significant reductions in negative affect and substance craving after the first session, with positive effects observed in subsequent sessions. However, demographic and diagnostic variables did not predict significant changes in psychological instruments.

CONCLUSION

Overall, the study demonstrated that trail riding was a safe and feasible intervention and may have potential benefits for improving emotional well-being and reducing substance cravings among Veterans. It is recommended that future studies research mechanisms of action, as well as conduct more rigorous investigations, including controlled trials using larger sample sizes and longitudinal research, to best determine lasting effects of these types of complementary therapies.

Equestrian Sports Safety: An Update on Safety Equipment and Event Medical Coverage

ABSTRACT

Equestrian sports are associated with high rates of major injury compared to collision and powered two-wheel sports. Advancements in rider and horse safety equipment and the implementation of comprehensive emergency action planning standards may help mitigate injuries, particularly in regard to the Olympic disciplines of dressage, show jumping, and three-day eventing covered in this review. Personal safety equipment to consider includes helmets, safety and air vests, and horse tack including safety stirrups, acoustic dampeners, and breakaway reins. Equestrian event medical coverage requires emergency action planning, partnership with local emergency medical services, and cooperation of interprofessional teams. Safety coordinators and medical providers may be tasked with providing first aid to spectators in addition to stabilizing and triaging crush trauma, traumatic brain injuries or spinal injuries, or fractures in competitors. Stationary and mobile medical units, proper medical equipment, acute spine stabilization protocols, and communication systems are critical components of equestrian medical coverage.

Does Equestrian Helmet Type Affect Head Injury? A Study on Equestrian Helmet Use Among Collegiate Athletes

OBJECTIVES

To characterize helmet use, head injury risk, and to examine rider-related factors that influence these variables.

DESIGN

Cross-sectional study.

SETTING

The University of Alabama at Birmingham Equestrian Sports Medicine Collaborative.

PATIENTS OR PARTICIPANTS

In total, 357 equestrians competing at the collegiate level participated in this study.

INTERVENTIONS OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES

χ2 tests were used to evaluate potential associations between a rider's experience level, riding style, and use of helmet designed with MIPS with number of falls, past head injuries, and helmet use frequency.

MAIN OUTCOME MEASURES

Data regarding helmet use and equestrian-related injuries were collected. χ2 analysis was used to determine potential associations.

RESULTS

More than 50% of athletes reported falling off a horse during the course of 1 year. Head injuries occurred with high frequency. Concussion was the most frequently reported type. More than 50% of athletes with self-reported concussion denied receiving medical treatment. The risk of head injury was similar across helmet brands, and between helmets with Multi-Directional Impact Protection System (MIPS) and those without. Riders with the most experience were less likely to report sustaining a head injury than those with less experience. Contrary to current safety guidelines, 78% of equestrians said that they would not replace their helmet after every fall.

CONCLUSIONS

Collegiate equestrians have a high risk of fall-related traumatic head injury. Despite this risk, they report helmet use practices that are not in line with current recommendations regarding helmet replacement.  This suggests that many of the athletes are using protective equipment that does not adequately protect against head injury. Neither helmet brand nor liner type was associated with lower rate of head injury.

CNS and Thorax Injury and Associated Risks Factors in Equestrian Sports

CONTEXT

Equestrian sports continue to gain popularity in the United States and are associated with a high injury rate, especially involving the central nervous system and thorax. Due to this high rate of injury and the potential for long-term consequences associated with participation, an understanding of the unique risks of this sport is needed.

OBJECTIVE

To describe severe injury in equestrian sports and review the role that protective gear plays in injury mitigation.

DATA SOURCES

The PubMed Database was searched using the search terms "equestrian" and "horse" combined with "spinal cord injury," "head injury," "traumatic brain injury," "experience levels," and "demographics."

STUDY SELECTION

A total of 53 papers were selected based on their relevance of epidemiology, risk factors, and management of injuries sustained during equestrian activities. Case studies, randomized controlled trials, prospective studies, and retrospective studies were all included for further review.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

None.

RESULTS

Injuries to the thorax, including fractures, pneumothoraces, internal organ contusions, and crush injuries, have been cited in multiple national and international trauma registries as the most prevalent injury location in equestrians; however, head and neck injuries, high cervical spine fractures, and closed head injuries are reported to be associated with the highest rates of mortality. Helmets provide protection against skull fracture and traumatic brain injury. Vests were not associated with diminished rates of spinal cord injuries; however, they may provide protection to the thorax. Riding experience also plays a role in reducing the prevalence of injury.

CONCLUSION

Equestrian-related activities are associated with a high risk of injury despite protective measures. Protective gear can mitigate some injury risk but does not protect against spinal injury. Continued investigation into improving protective equipment, rider education, and preventative strategies to mitigate this risk is needed.

Horse Owners' Knowledge of Fundamental Care and their Perceptions on the Implementation of a Mandatory Certificate of Knowledge

The aims of this study were to first determine the extent of owners' fundamental knowledge of equine care, second, gain their opinions on the implementation of a mandatory certificate of knowledge and third, to investigate the association of certification on horse owner knowledge. An online survey comprising 23 questions (18 closed, 5 open) was distributed worldwide via snowball sampling, and completed by 1847 horse owners who were all ≥18 years old from 17 different countries. Almost all (96%, n = 1781) completed surveys were usable. Just over half (52%) of participants held a current equine knowledge certification, and 59% believed a mandatory certificate of knowledge should be necessary to buy, own, or sell a horse. Horse owners with an equine certificate of knowledge were more likely to be in favor of a mandatory certificate (Pearson's Chi-squared = 50.79, df = 1, p < 0.0001). The mean correctly answered knowledge questions was 68%, indicating that approximately 1/3 of horse owners lacked fundamental horse care knowledge. Further examination indicated that participating horse owners showed the least understanding in the behavioral interactions domain (ANOVA F(4, 24) = 4.98, p < 0.01), specifically in relation to pain recognition and learning theory terminology. Arguably, this deficit in knowledge and likely correct application increases the risk of owners using misinformed or inappropriate techniques to manage horse behavior and training, predisposing the horse to experiencing a sub-optimal quality of life. Overall no significant difference was found between the total correct scores of horse owners with or without a certificate (ANOVA F(1, 56) = 0.78, p > 0.05); however, a series of Chi-squared tests revealed that for the more complex questions, horse owners with a certificate scored better than those without (all p < 0.05). Further work is needed to develop an evidence-based assessment framework if mandatory certification of horse owners is to become an effective tool for improving horse welfare and quality of life.

Neurosurgical Injuries Associated with Recreational Horseback Riding: A 6-year Retrospective Analysis

INTRODUCTION

Horseback riding can cause severe brain and spinal injuries. This study aimed to identify the spectrum of neurosurgical injuries related to recreational horseback riding.

METHODS

A retrospective study was performed utilizing the University of Puerto Rico neurosurgery database to identify patients who were consulted to the neurosurgery service between 2018 and 2023 after a horse fall during recreational activities. The outcome upon discharge using the modified Rankin scale (mRS) was documented. Descriptive statistics were used to report frequency and median values.

RESULTS

The neurosurgery service evaluated and managed 112 patients with a horseback riding fall-related injury during 6 years. Ninety-eight (87.5%) patients were male. The patients' median age was 31.5 (IQR 22-40). There were 89 head injuries (79.5%), 19 spinal injuries (17%), and 4 combined head/spine injuries (3.5%). Forty percent of the patients were admitted to inpatient care with a median length of stay of 7 days (IQR 3-17). Twenty-four patients (21%) required surgery. Upon discharge, 86.6% of the patients had an mRS grade of 0-2, 3.6% had a grade of 3, 1.8% had a grade of 4, and 1.8% had a grade of 5. Seven patients (6%) died (mRS grade 6).

CONCLUSIONS

Most neurologic injuries involve isolated trauma to the head. Fifteen percent of the riders' falls were caused after the horse was impacted by a motor vehicle. Forty percent of the patients require admission and 21% undergo surgery. Ten percent of the patients had a poor mRS grade of 4- to 6 when discharged.

An Exploratory Study into the Backgrounds and Perspectives of Equine-Assisted Service Practitioners

Equine-Assisted Services (EASs) are commonplace in today's society, but vary widely in both theoretical and practical applications. Until now, practitioners' experiences and perspectives in relation to these services have received little attention. To address this, a purpose-designed online questionnaire was distributed to EAS practitioners, exploring issues relating to the nature of the service provided, practice patterns, practitioner education, perceived knowledge, challenges faced and the future direction of these services. An analysis revealed a significant association between practitioners' backgrounds and the nature of the service offered, as well as perceived knowledge. Median EAS training received to first practice was 20 days of block release over a year; however, nearly half of the sample (42.4%) reported less training than this. Equine-specific training was more limited, with 41.5% of practitioners having no horse-relevant qualifications. The most important challenges reported by practitioners involved client and equine welfare, financial sustainability and raising awareness of EAS. This research highlights the diverse nature of EAS and also raises important challenges and possible opportunities for development. Findings suggest that more progress is needed to professionalise and legitimise the area to support and help practitioners provide the best service for all concerned.

The Physiological Requirements of and Nutritional Recommendations for Equestrian Riders

Equestrian sport is under-researched within the sport science literature, creating a possible knowledge vacuum for athletes and support personnel wishing to train and perform in an evidence-based manner. This review aims to synthesise available evidence from equitation, sport, and veterinary sciences to describe the pertinent rider physiology of equestrian disciplines. Estimates of energy expenditure and the contribution of underpinning energy systems to equestrian performance are used to provide nutrition and hydration recommendations for competition and training in equestrian disciplines. Relative energy deficiency and disordered eating are also considered. The practical challenges of the equestrian environment, including competitive, personal, and professional factors, injury and concussion, and female participation, are discussed to better highlight novelty within equestrian disciplines compared to more commonly studied sports. The evidence and recommendations are supported by example scenarios, and future research directions are outlined.

The Triple-E Model: Advancing Equestrian Research with Perspectives from One Health

Equestrian sport has various welfare issues and educational needs. To address these complex interactions, we propose an integrated approach called the Triple-E Model, which focuses on the equine, equestrian, and environmental triad. A literature review of existing models suggests that complexities of these interactions are overlooked, despite the significant impact of equine industries on economics, healthcare, and animal welfare. This paper discusses current models and theories used to evaluate equine-equestrian-environmental interactions and introduces the Triple-E Model to foster multidisciplinary collaboration. Unlike the One Health triad, which focuses on disease emergence, transmission, and zoonosis, the Triple-E Model extends to non-infectious research, such as musculoskeletal injury. It promotes collaborative care and rehabilitation within the equestrian community by engaging multidisciplinary, multi-setting, and multi-sectoral teams. Given the nature of human-animal interaction and welfare considerations, this model fills the gap in understanding human-horse interactions. The paper highlights the limitations of existing models and explains how the Triple-E Model guides and encourages holistic team collaboration in the equestrian community.

The psychological responses of British amateur point-to-point jockeys to personal injury

Previous research has reported significant psychological consequences of injury on rehabilitation success, performance, and wellbeing in athletes, although little is known within horse-based sports. There is a high prevalence of injury reported in point-to-point (P2P) jockeys, but despite this, comparatively little research exists examining the psychological implications resulting from physical trauma within horseracing. The aim of this study was to investigate the psychological responses to personal injury in British amateur P2P jockeys. Five amateur P2P jockeys (two male, three female, x- age 25 years old) were interviewed about their experiences post an injury sustained during racing in the preceding 12 months. Interview questions explored their pre-injury career, the rehabilitation phase, pre-return to racing phase issues and coping strategies used by jockeys. Thematic analysis revealed three higher order themes: emotional responses, coping strategies, and factors affecting recovery. Subjects universally cited negative emotional responses following injury, including grief, a sense of loss, and frustration, and all experienced denial at the onset of injury. Typical coping strategies included strong support networks of family, friends and racing staff, and goal setting. Fear of reinjury was identified by all athletes, particularly on return to the saddle, and the attitudes towards injury management, such as denial, seen in this study may provide opportunities to develop targeted education campaigns for P2P jockeys on injury services. Targeted marketing for P2P jockeys on available injury support is recommended, such as seen for professional jockeys, as well as the creation of career development resources to offer alternative routes for P2P jockeys following injury.

Maxillofacial Horse Trauma: A 10-Year Retrospective Study at a UK Major Trauma Center

Introduction/Objecive

There are very few studies that have investigated equestrian-related maxillofacial injuries. A retrospective review was performed to investigate maxillofacial horse trauma at a Level 1 Trauma Centre at the Royal Stoke Hospital over the last 10 years between 2010 and 2020.

Study Design/Methods

Search of the hospital's major trauma database as well as ED records showed 51 patients who sustained maxillofacial injuries related to horses. Statistical analysis was performed using Chi Squared tests.

Results

41 patients were female and the remaining 10 were male. 43% of patients were female and aged 30 and under. Kicks from horses accounted for 64.4% of equine-related maxillofacial injuries. A total of 90 injuries were recorded. Hard tissue injuries which include all fractures accounted for 66.3% of injuries sustained. 70.5% patients sustained isolated maxillofacial trauma. There was an association between patients sustaining non-isolated maxillofacial trauma and hard tissue maxillofacial injuries (P = 0.04). 65.6% of injuries were managed operatively. Patients aged 30 and under were more likely to be managed operatively (P = 0.03).

Conclusion

Equestrian related maxillofacial trauma represents a proportion of trauma workload. The safety aspect of horse riding should be considered and education in safe riding and the use of appropriate safety equipment is vital.

Analysis of Injuries in Competitive Equestrian Events

OBJECTIVE

Current equestrian sport-related acute injury research is sparse. The goal of this study is to explore equestrian injury types stratified by population and equestrian discipline.

DESIGN

Injury reports from the US Equestrian Federation (USEF) were compiled from 2015 through 2019, and the prevalence of different injury types within the main equestrian disciplines was calculated.

SETTING

Retrospective cohort study from USEF accident report data.

PARTICIPANTS

Athletes competing at USEF sanctioned equestrian events.

INDEPENDENT VARIABLES

Equestrian participant's age group, sex, and equestrian event type are the independent variables.

MAIN OUTCOME MEASURES

Frequency of types of injuries in equestrian events stratified by equestrian discipline, age (junior vs senior), and sex.

RESULTS

Three thousand four hundred thirty equestrian athletes injured from 441 816 total athlete exposures during 2015 to 2019 were analyzed showing an injury rate between 0.06% and 1.18% for each discipline with an overall injury rate of 780 per 100 000 athlete exposures. Hunter-jumper and 3-day eventing had the highest injury rates. Head injuries and bone injuries were the most common types. No clinically significant differences in injury rates were observed between males and females or junior and senior equestrian athletes.

CONCLUSIONS

Equestrian sports have an overall injury rate of 780 per 100 000 athlete exposures in the certified competition setting. Hunter-jumper and 3-day eventing have an increased injury rate compared with nonjumping disciplines. These data should help equestrian event clinicians to anticipate the types of injuries and help outpatient clinicians make preparticipation medical eligibility and assist in counseling for equestrian sports.

Injury patterns of equine-related trauma: A fifteen-year review of hospital admissions to a level 1 trauma center

OBJECTIVE

Little information exists about horse-related injury admissions to Level 1 trauma centers in the Western United States. This study describes injury patterns in this population, to reveal potential areas for injury prevention initiatives.

METHODS

A retrospective database review of 512 non-fatal equine-related injuries over a 15-year period was conducted, using a Level 1 hospital trauma registry. To determine patterns of injury, patients injured by riding or being near a horse were classified according to age, sex, helmet use, abbreviated injury score, anatomical region injured, and length of stay.

RESULTS

Equine-related injury was more frequent among females than males, the anatomical region most at risk among adults was the lower extremity (including pelvis), and among children and youth, the head. 75% of head-injured patients were not wearing a helmet at the time of injury and those with the most severe head injuries were least likely to be wearing a helmet.

CONCLUSION

Preventable equine-related injuries occur across all ages, are more frequent among females, and affect all regions of the body. Despite head-injury risks associated with horse activities, helmet use was not common among most of the injured. Decreasing the risk of these injuries requires use of appropriate protective equipment and enhanced education campaigns aimed at those in the horse industry and the general public.

Injuries and Overuse Injuries in Show Jumping—A Retrospective Epidemiological Cross-Sectional Study of Show Jumpers in Germany

This retrospective cross-sectional epidemiological study deals with sport-specific injury patterns in show jumping. A total of 363 show jumpers of all levels (S) answered a retrospective questionnaire about injuries and overuse damages which occurred in the course of their careers. Demographic data and information on injuries in various body regions were collected. In addition to descriptive analysis, significance tests were performed. For better statistical comparability with other sports, exposure time was extrapolated with total career duration and weekly training hours, and injuries per 1000 jumping hours were calculated. The study included 251 (69%) women and 112 (31%) men, who were on average 26.9 ± 10.9 years old. The injury rate for the entire collective was 3.7 per 1000 h of exposure. The most frequently affected body region was the head (31%). Overuse complaints play a subordinate role and mainly affect the upper extremities (65%). The riders of the professional lower performance levels are less likely to injure themselves per 1000 h than riders of the higher performance levels. Riders who often or always wore a helmet suffered significantly fewer head injuries (p = 0.008) and had a significantly lower total injury duration than riders who did not wear a helmet (p = 0.006). Similarly, the study showed that riders who often or always wore a safety vest suffered significantly fewer spinal injuries (p = 0.017) and had significantly fewer injuries per 1000 riding hours (p = 0.031) than riders who did not wear a safety vest. Based on the present results, there should be an extension of the general helmet requirement and a requirement to wear safety vests in show jumping in general.

Epidemiological Study of Equestrian Trauma in Geneva

BACKGROUND

Horse-related activities are increasingly popular among young people but are frequently associated with severe injuries requiring hospital treatment. There are few data on the incidence of equestrian injuries, especially in child populations, or on means of prevention. Thus, this study's purpose was to highlight the epidemiological data on specific injuries due to equestrianism and serve as the groundwork for future studies on the prevention of equestrian accidents.

METHODS

A retrospective study collected data on all children younger than 16 years old who attended our regional emergency department after involvement in an equestrian accident. The study covered the periods from 1990 to 2003 and 2011 to 2018. Twenty-two years of data on trauma circumstances, injury patterns (mechanism, anatomic site, and severity), treatment protocols, and hospital lengths of stay were analyzed.

RESULTS

This study confirmed that more young females participating in equestrian sports attended our emergency department than males. The leading cause of equestrian injury was falling from a horse (80.2%). Orthopaedic injuries represented around 60% of all reported lesions, far ahead of head injuries (30%). More than half of the injured children required hospitalization for inpatient medical care, and almost 50% of these underwent a surgical procedure, especially for upper extremity fractures (72% of all fractures). One patient died due to severe cerebral injury.

CONCLUSIONS

Horse riding injuries occur more frequently and are more serious than in many other sporting activities. There is an urgent need to reassess preventive measures to reduce the incidence and severity of equestrian injuries.

LEVEL OF EVIDENCE

Level IV.

Occupational vs. non-occupational equestrians: Differences in demographics and injury patterns

INTRODUCTION

Nineteen million people participate in horseback riding activities in the US, and the horse industry employs more than 460,000 full-time workers. Emergency department data suggest young female amateurs and male professionals are most at risk of death from horse-related injuries. However, there has been no investigation into factors that may increase severe injury and mortality risk in these populations. This study investigates demographics and injury pattern differences between occupational and non-occupational horse-related injuries in the US.

METHODS

The 2017 American College of Surgeons National Trauma Databank (ACS NTDB) was analyzed for horse-related injury using ICD 10 codes. Demographics, injury data, protective device use, and hospital procedures were analyzed. Occupational versus non-occupational injuries based on incident location (farm, sports, recreational, residential) were compared using ANOVA or Pearson's Chi-squared test.

RESULTS

Of 3911 incidents, the most common injury mechanism was falling from the horse, but occupational and non-occupational farm injuries showed higher incidence of being struck by a horse. One-third required surgery. Upper extremity injuries were most common. Occupational injuries more often affected upper extremities of working age, minority males with commercial insurance. Non-occupational injuries most often affected heads of women at the extremes of age. Helmet use was higher in occupational, non-occupational sports, and non-occupational recreation injuries, and severe head injury incidence was decreased in these groups. Complications and discharge dispositions were not different across groups.

CONCLUSIONS

In the largest trauma center study to date, we have shown equine-related trauma to be common and affect a predictable demographic that may permit injury prevention initiatives. Helmets may reduce severe head injury, but the efficacy of protective clothing remains to be validated.

The Effect of Stirrup Length on Impact Attenuation and Its Association With Muscle Strength

ABSTRACT

Keener, MM, Critchley, ML, Layer, JS, Johnson, EC, Barrett, SF, and Dai, B. The effect of stirrup length on impact attenuation and its association with muscle strength. J Strength Cond Res 35(11): 3056-3062, 2021-Horseback-riders have a high prevalence of low back injuries, which may be related to the repetitive low back impacts experienced in riding. The purposes of this study were to quantify the effect of 3 stirrup lengths and 2 riding styles on the peak acceleration experienced by the rider and the association between the peak acceleration and the rider's different elements of muscle strength. Thirteen female riders performed a sitting or rising trot at each of the 3 stirrup lengths (2-point length, mid-seat length, or dressage length), while the acceleration of the tibia, sacrum, seventh cervical vertebra (C7), and head were collected. Subjects completed a push-up, a vertical jump, and 4 core exercises to assess upper-body strength, lower-body strength, and core endurance, respectively. Peak acceleration of the sacrum, C7, and head were generally lower in the standing phase of the rising trot compared with the sitting phase of either the sitting or rising trot, particularly at the shortest stirrup length. Peak acceleration of the sacrum, C7, and head decreased as the stirrup length was shortened in the standing phase of the rising trot. Canonical correlations showed nonsignificant correlations between strength measurements and peak acceleration. Riding with more weight supported through the legs with a short stirrup length may decrease low back impacts and their associated injury risk. Technique training is likely needed to encourage riders to use lower-body and core strength for impact attenuation.

Fall, Crush, Kick: Mechanisms and Outcomes in a Cohort of Equine-Related Injuries

INTRODUCTION

The potential for significant traumatic injury to individuals who interact with horses remains high due to animal size, forces applied, and unpredictability. Despite an estimated 30 million riders in the United States annually, few recent publications have addressed this patient population.

OBJECTIVES

This study describes characteristics of patients injured in interactions with horses, focusing on mechanism of injury and use of protective equipment.

METHODS

We queried our institution's trauma registry for all patients admitted for equine-related injuries (ERI) between January 1, 2013 and December 31, 2017. We categorized by specific mechanism of injury (fall, crush, kick, fall + crush, and fall + kick) and presence or absence of protective devices.

RESULTS

We discovered 143 patients admitted for injuries in equine-related accidents. Patients averaged 49.2 years old, and 62.2% were female. Crush injuries resulted in a high rate of rib fractures. Riders who were kicked had an increased chance of solid organ and facial injuries and falls most commonly led to rib fractures and extremity trauma. Despite lack of documentation on most subjects, protective devices were associated with less severe injuries in those with data (n = 36).

CONCLUSIONS

In this relatively large series of patients with ERI, we found mechanism differences within injury groups. Providers should more carefully document specific circumstances of ERIs. All individuals working with or around horses should exercise prudence and consider using protective equipment.

Hearing hoofbeats? Think head and neck trauma: a 10-year NTDB analysis of equestrian-related trauma in the USA

Objective

There is a paucity of evidence about traumatic injuries and their sequelae sustained due to equestrian injuries nationally.

Methods

Retrospective study analyzing National Trauma Data Bank data from 2007 to 2016. Variables collected included age, sex, race, payer status, Injury Severity Score (ISS), hospital length of stay, Glasgow Coma Scale, systolic blood pressure (SBP) at presentation, discharge disposition, and mortality. Patient data were analyzed by anatomic region.

Results

The most frequent type of injury was in the thorax, but head and neck injuries produced the highest mortality. Increased ISS and an SBP of less than 90 mm Hg were also significant predictors of mortality.

Conclusions

The risk of hospital admission from equestrian injuries is higher than football, motor vehicle racing, and skiing. Preventive measures and campaigns should be instituted to highlight safety practices and the use of personal protective equipment while on horseback either for sports, leisure, or work.

Level of evidence

Level IV. Retrospective study.

Exploring the Severity of Craniomaxillofacial Injuries From Horseback Riding

PURPOSE

The purpose of our study is to assess the severity of craniomaxillofacial injuries from horseback-riding accidents.

MATERIALS AND METHODS

This is a 20-year retrospective cross-sectional study of the National Electronic Injury Surveillance System. Injuries from the activity of horseback-riding were included if they occurred in the craniomaxillofacial complex. Study predictors were derived from both patient and injury characteristics. The study outcome was the presence or absence (probability) of hospital admission from the emergency department. A multiple logistic regression model was created to model the odds of admission using all significant univariate predictors.

RESULTS

The final sample consisted of 6730 patients. The decrease in horseback riding injuries from 2000 to 2019 was significant (P = 0.042).The mean age of the sample was 27.80 years (range: 2-91 years). Gender-wise, females composed the majority of injured horseback riders (71.9%). Over two-thirds of the sample consisted of White patients (68.1%). Over three-fourths of the injuries occurred in the head (80.9%), rendering it the most frequently injured region of the craniomaxillofacial complex. The most common primary diagnoses were internal organ injury (40.2%). On univariate analysis, the admission rates were significantly associated with gender (P < 0.01), age group (P < 0.01), body part injured (P < 0.01), diagnosis (P < 0.01), location of injury (P < 0.01) and mechanism of injury (P < 0.05). Relative to young adults, children (odds ratio [OR], 1.579; 95% OR confidence interval [CI] [1.31, 1.91]; P < 0.01), adults (OR, 1.857; 95% OR CI [1.55, 2.22]; P < 0.01), and seniors (OR, 3.738; 95% OR CI [2.73, 5.12]; P < 0.01) were each independently associated with an increased odds of admission. Relative to the mouth, the head had 4.8 odds of admission (P < 0.01) and the face had 2.5 odds of admission (P < 0.01). Relative to contusions/abrasion, concussions (OR, 3.542; 95% OR CI [2.28, 5.49]; P < 0.01) and internal organ injuries (OR, 9.020; 95% OR CI [5.90, 13.79]; P < 0.01), lacerations (OR, 1.946; 95% OR CI [1.17, 3.24]; P < 0.05), and fractures (OR, 32.068; 95% OR CI [20.53, 50.09]; P < 0.01) were each independently associated with increased odds of admission relative to contusions. Direct trauma from a horse (OR, 1.422; 95% OR CI [1.06, 1.91]; P < 0.05) was associated with independently increased odds of admission relative to other injuries. Injuries that took place in a farm (OR, 1.617; 95% OR CI [1.25, 2.09]; P < 0.01) and a street (OR, 2.735; 95% OR CI [1.83, 4.09]; P < 0.01) were each independently associated with increased odds of admission. Finally, relative to females, males (OR, 1.374; 95% OR CI [1.20, 1.57]; P < 0.01) were independently associated with increased odds of admission.

CONCLUSIONS

Many variables contribute to the chance of hospital admission from horseback riding. Fractures seem to be the leading risk factor for hospital admission, therefore, future study may look into how to reduce the incidence of fractures through the employment of more protective equipment than helmets for horseback riders.

Craniofacial Fractures in Equine-Related Injuries: What Should a Maxillofacial Surgeon Expect?

ABSTRACT

Patients with equine-related injuries (ERI) have high rates of hospitalization and often require surgical treatment. This study aimed to clarify the injury profiles of patients sustaining ERI-related craniofacial fractures and their relationship with other severe head and neck injuries.This retrospective study included all patients with craniofacial fractures admitted to a tertiary trauma center during 2013 to 2018. Out of 3256 patients, a total of 39 patients were included in the study (1.2%). Demographic and clinically relevant variables were reported and statistically evaluated.Males represented only 7.7% of the study population. Isolated facial fractures were over-represented in this study population at 84.6% whereas only 7.7% of patients sustained isolated cranial fractures and 7.7% of patients sustained combined craniofacial fractures, respectively. Surgical intervention for craniofacial fractures was required in 48.7% of patients. In total, 17.9% of patients sustained severe head and neck injuries. Periods of unconsciousness and/or post-traumatic amnesia were seen in 41% of patients. Helmet use could only be confirmed in 17.9% of patients.As trauma mechanisms behind ERI are often multifactorial and patients are at a high risk of sustaining associated injuries, attentive examination, and exclusion of serious life-threatening injuries through a multi-disciplinary approach is imperative for this specific patient population.

Pelvic and acetabular trauma in amateur equestrian enthusiasts - A retrospective review

INTRODUCTION

Horse riding related accidents can present with devastating pelvic and acetabular fractures. This study examines the nature, management and treatment outcomes of severe pelvic and acetabular trauma in amateur horse riders presenting to a national tertiary referral centre. We also aim to define certain at-risk groups.

METHODS

This was a retrospective descriptive cohort of all patients who were referred to the National Centre for Pelvic and Acetabular trauma resulting from horse riding accidents. All patients who were referred to the National Centre for Pelvic and Acetabular Trauma between January 2018 and July 2020 were included. Professional horse riders were excluded. Clinical and treatment outcome measures were stratified to four different mechanisms of injury: fall from horse (FFH), horse crush (HC), Horse Kick (HK) and Saddle Injury (SI).

RESULTS

There were 31 equestrian related injuries referred to our centre between January 2018 and July 2020. One patient was a professional jockey and was thus excluded from the study. Eighteen were female and the mean age at referral was 37 years old. The majority of these were pelvic ring injuries (73%). Fifty per cent of patients required surgical intervention and the majority of these were male.

CONCLUSION

Horse riding is a potentially dangerous recreational pursuit with significant risk of devastating injury. Pelvic and acetabular fractures secondary to horse riding are frequently associated with other injuries and the need operative intervention is common in this group. Young women and older men are higher risk groups.

Equine Responses to Acceleration and Deceleration Cues May Reflect Their Exposure to Multiple Riders

Simple Summary

Successful horse training depends on riders giving clear and consistent cues. When cues are inconsistent, the horse may become confused, frustrated, or unresponsive. It is likely that each rider or horse trainer differs in the way they deliver training cues because humans vary in their weight, height, riding style, handedness, experience, and skill level. This study explored relationships between the number of people to ride or handle a horse and the horse’s response to training cues. Data describing 1819 horses and ponies were obtained from the Equine Behavior Assessment and Research Questionnaire (E-BARQ), an online global survey of horse owners and caregivers. The number of riders or handlers showed a significant relationship with two behavioural indices. Specifically, as the number of riders or handlers increased, horses were more difficult to accelerate and less difficult to decelerate compared to horses with fewer riders or handlers. This could indicate that an increase in rider or handler numbers is associated with those horses becoming relatively more unresponsive to leg and whip cues than to rein cues.

Abstract

It is logical to assume that horses with multiple riders encounter variation in application of training cues. When training cues are inconsistent, we expect to see a decrease in trained responses or an increase in conflict behaviours. This study investigated the relationship between the number of people that regularly ride or handle a horse and the horse’s response to operant cues. Data on 1819 equids were obtained from the Equine Behavior Assessment and Research Questionnaire (E-BARQ), an online global survey of horse owners and caregivers. Three mutually independent indices (acceleration, deceleration, and responsiveness) were derived from a parallel analysis of E-BARQ items related to acceleration and deceleration cues. These indices were then subjected to multivariable modelling against a range of dependent variables including horse and human demographics, horse management, and the number of riders or handlers. The number of riders or handlers was a significant predictor for two out of three indices. As the number of riders or handlers increased, horses were more difficult to accelerate (regression coefficient = 0.0148 ± 0.0071; p = 0.0366) and less difficult to decelerate (regression coefficient = −0.017 ± 0.008; p = 0.030) than those with fewer riders or handlers. These findings suggest that horses’ responses to rein tension cues are more persistent than their responses to leg pressure or whip cues. Alternatively, horses with these responses may be actively selected for multiple rider roles. Longitudinal studies of this sort should reveal how the number of riders or handlers affects horse behaviour and could lead to safer and more humane equestrian practices.

Equestrian Road Safety in the United Kingdom: Factors Associated with Collisions and Horse Fatalities

Over 60% of UK horse riders report having experienced a road-related near-miss or accident. The aim of this study was to describe horse-related road incidents (n = 4107) reported to the British Horse Society (2010-2020) and to identify factors associated with higher odds of collisions with another vehicle and horse fatalities using multivariable logistic regression modelling. Drivers passed the horse too closely in 84.2% of incidents while road rage and speeding were reported in 40.3% and 40.1% of incidents, respectively. Close passing distance alone (odds ratio [OR] 18.3, 95% confidence interval [CI] 6.5, 51.6) or in combination with speeding (OR 4.4, CI 1.7, 11.7) was associated with higher collision odds compared to speeding alone. Speeding was, however, associated with higher horse fatality odds (OR 2.3, CI 1.2, 4.6). Wearing high visibility clothing reduced odds of collision (OR 0.2, CI 0.1, 0.4). A fatal injury to a horse was almost 12 times as likely to result in severe to fatal rider/handler injury. Loose horses contribute significantly to road-related horse fatalities. Driver behaviour of how to pass horses safely on UK roads needs further improvement and will help reduce the risk of collisions and horse and human fatalities.

Effects of horse riding simulator on sitting motor function in children with spastic cerebral palsy

BACKGROUND

Horse riding simulator (HRS) is an electronic horse, working under the principles of hippotherapy. It is one of the advanced therapeutic methods to improve postural control and balance in sitting, which could be recommended in the rehabilitation of cerebral palsy if real horses are unavailable.

OBJECTIVE

To investigate the therapeutic effects of HRS on sitting motor function in children with spastic diplegia and evaluate the changes in sitting motor function at different periods of time (4, 8 and 12 weeks).

METHODS

This study is a randomized controlled trial conducted over a period of 12 weeks. Thirty children with spastic diplegia age between 2 and 4 years with Gross Motor Function Classification System (GMFCS) Level I-III were included and divided into two groups. The control group received the conventional physiotherapy while the experimental group received HRS along with conventional physiotherapy. Sitting motor function was assessed by Gross Motor Function Measure (GMFM)-88 (sitting dimension B) at baseline, 4, 8 and 12 weeks. Pre- and post-intervention scores were measured and analysed.

RESULTS

The baseline characteristics were similar in both groups before the intervention with p > .01. The observed mean value of GMFM in both groups improved over a period of 12 weeks. The results denote that the sitting motor function gradually improved over a period of time in both groups and the experimental group showed significant improvement (p < .01) than the control group in all the weeks.

CONCLUSION

The study results confirmed that gradual improvement in sitting motor function was observed in both groups. Children exposed to HRS show better improvement than the children in the control group. It was concluded that HRS is effective in improving the sitting motor function in children with spastic diplegia and the continuous provision of HRS in longer duration provide more benefits than the shorter duration.

Retrospective analysis of 15 years of horse-related maxillofacial fracture data at a major German trauma center

Purpose

The purpose of this study was to estimate the effect of the mechanism of trauma (fall versus kick), rider demographics, equestrian experience, protective equipment, and whether or not a horse was shod on the anatomic site of a horse-related maxillofacial fracture, operating time, postoperative complication rate, and length of hospital stay.

Methods

We retrospectively reviewed the medical records of patients treated for horse-related maxillofacial fractures at a single institution in Germany between January 2000 and March 2015. We used linear and logistic regression to test the above-mentioned variables for statistical correlations.

Results

During the study period, we treated 138 horse-related facial fractures in 71 patients. The mean patient age was 34.5 years, and 80.3% of the injuries occurred in women. Most of the maxillofacial fractures were the result of a horse kick (71.8%) when unmounted and the majority occurred in more experienced riders (70.4%). There was a significant association of wearing of protective equipment with a shorter hospital stay and lower risk of postoperative complications.

Conclusion

More education is needed in the equestrian community regarding the use of protective equipment when unmounted. Safety helmets should be redesigned to include a faceguard and be worn at all times.

Equestrian Trauma: Injury Patterns Vary among Age Groups

Patients with equestrian injuries were identified in the trauma registry from 2004 to 2007. We a priori divided patients into three groups: 0 to 18 years, 19 to 49 years, and 50 years old or older. There were 284 patients identified with equestrian-related trauma. Injury Severity Score for the three major age categories 0 to 18 years, 19 to 49 years, and 50 years or older, were 3.47, 5.09, and 6.27, respectively. The most common body region injured among all patients was the head (26.1%). The most common injuries by age group were: 0 to 18 years, upper extremity fractures; 19 to 49 year olds, concussions; and 50 years or older, rib fractures. Significant differences were observed among the three age groups in terms of percent of patients with rib fractures: percent of patients with rib fractures was 2, 8, and 22 per cent in age groups 0 to 18, 19 to 49, and 50 years or older, respectively. We found different patterns of injuries associated with equestrian accidents by age. Head injuries were commonly seen among participants in equestrian activities and helmet use should be promoted to minimize the severity of closed head injuries. Injury patterns also seem to vary among the various age groups that ride horses. This information could be used to better target injury prevention efforts among these patients.

Equestrian Injury is Costly, Disabling, and Frequently Preventable: The Imperative for Improved Safety Awareness

Horse-related injury can be severe and disabling. We investigated the causes, severity, and costs of equestrian injury with the goal of injury prevention. A retrospective review of horse-related injuries from 2001 to 2008 identified 231 patients with a mean age of 38 years and a mean Injury Severity Score of 11 (range, 1 to 45). Mean length of stay was 5.5 days. Fifty-nine patients (25%) required 84 surgeries. Helmet use was 20 per cent and of the 172 patients not wearing a helmet while mounted, 38 per cent received potentially preventable head injuries. There were three deaths of which two were the result of intracranial hemorrhage in riders not wearing a helmet. Mean hospital charge was $29,800 for a total of $6.9 million. Ninety-one patients completed a survey regarding causation and disability. Thirty-four per cent reported wearing a helmet at the time of injury. Forty per cent reported that poor environmental factors contributed, 30 per cent reported poor horse and rider pairing, and 9 per cent reported equipment failure. Fifty-nine per cent reported long-term disabilities. Compared with the general population, respondents had diminution in their ability to perform usual daily activities associated with physical problems, diminution in social function, and higher bodily pain. We conclude that equestrian injury is costly, disabling, and frequently preventable.

Perceived Benefits for Mental and Physical Health and Barriers to Horseback Riding Participation. The Analysis among Professional and Amateur Athletes

The aim of this study was to investigate perceived benefits for mental and physical health and barriers to horseback riding participation among professional and amateur athletes by gender. The empirical study of 2651 professional and amateur horseback riders was conducted during the last edition of Cavaliada competitions (held in Poznan in December 2019)—one of the biggest and most important horseback riding events in Europe. A diagnostic survey method was used in the study. In the questionnaire a division of benefits and barriers according to the EBBS (Exercise Benefits/Barriers Scale) was used. The results are presented by means of frequency distributions for individual items. The verification of hypotheses about the differences between the analyzed groups was conducted using the U-Mann Whitney test with a correction of tied ranks. For the compared groups the mean rank values were calculated. Research results showed that respondents rated the positive impact of equestrianism on mental health higher than on physical health. Among the barriers, the most frequently mentioned aspects were not related to the internal motivation of the respondents, but to external factors—money, time and distance of sports facilities. Men rated the social and psychological benefits higher, while women rated the positive impact of equestrianism on physicality. Professionals rated more highly a number of aspects related to positive effects on the body, while amateurs claimed that were more often not supported by loved ones. This is important research from the point of view of horseback riding promotion. Understanding the horseback riding benefits and barriers are needed, as such knowledge can be used to encourage horseback riding. Perceived benefits and barriers to horseback riding have so far been rarely studied by researchers.

An Evidence Basis for Future Equestrian Helmet Lateral Crush Certification Tests

The aim of this study is to determine what loads are likely to be applied to the head in the event of a horse falling onto it and to determine by how much a typical equestrian helmet reduces these loads. An instrumented headform was designed and built to measure applied dynamic loads from a falling horse. Two differently weighted equine cadavers were then dropped repeatedly from a height of 1 m (theoretical impact velocity of 4.43 m/s) onto both the un-helmeted and helmeted instrumented headforms to collect primary force–time history data. The highest mean peak loads applied to the headform by the lighter horse were measured at the bony sacral impact location (15.57 kN ± 1.11 SD). The lowest mean peak loads were measured at the relatively fleshier right hind quarter (7.91 kN ± 1.84 SD). For the heavier horse, highest mean peak loads applied to the headform were measured at the same bony sacral impact location (16.02 kN ± 0.83 SD), whilst lowest mean peak loads were measured at the more compliant left hind quarter (10.47 kN ± 1.08 SD). When compared with the un-helmeted mean values, a reduction of 29.7% was recorded for the sacral impact location and a reduction of 43.3% for the lumbosacral junction location for helmeted tests. Notably, all measured loads were within or exceeded the range of published data for the fracture of the adult lateral skull bone. Current helmet certification tests are not biofidelic and inadequately represent the loading conditions of real-world “lateral crush” accidents sustained in equestrian sports. This work presents the first ever evidence basis upon which any future changes to a certification standards test method might be established, thereby ensuring that such a test would be both useful, biofidelic, and could ensure the desired safety outcome.

Head and Spinal Injuries in Equestrian Sports: Update on Epidemiology, Clinical Outcomes, and Injury Prevention

Equestrian sports represent a variety of activities involving a horse and rider. Due to the unpredictable nature of horses, their height, and potential high speeds involved, equestrian athletes are at risk of head and spinal injuries. This review describes the epidemiology, injury mechanisms, and risk factors for equestrian sports-related head and spinal injuries. Traumatic brain injuries, including concussions, are more common than spinal injuries. Both injury types are most commonly related to a rider fall from a horse. Spinal injuries are less common but are associated with potentially significant neurological morbidity when spinal cord injury occurs. An improved understanding of preventable injury mechanisms, increased certified helmet use, improved helmet technologies, and educational outreach may help to address the risk of head and spinal injuries in equestrian sports.

Retrospective analysis of equestrian-related injuries presenting to a level 1 trauma center

OBJECTIVE

Report the incidence, pattern, and severity of equestrian-related injuries presenting to a rural level 1 trauma center and detail the total radiation dose, imaging, and hospital charges related to those injuries.

METHODS

An IRB-approved retrospective review of patients presenting to our facility following equine-related trauma was conducted. Demographics, mechanism of injury, types and number of imaging exams, approximate radiation dose administered, imaging findings, Injury Severity Score (ISS), rate/length of hospitalization, and approximate cost of care were recorded.

RESULTS

A total of 222 patients (161 F:61 M; mean age 38.5 years (range 4-79)) presented to our emergency department following horse-related injury. Mechanisms of injury included the following: fall (n = 186), kick (n = 18), stepped on (n = 9), and other (n = 9). Body part injured included extremity (26.1%), torso (26.6%), spine (25.7%), and head/neck (18.5%). Longer hospital admission, higher expenditure, increased CT/MR imaging, higher ISS, and radiation dose were noted in older patients and those injured by a fall or kick. Head injuries were more frequent following a horse kick (p = 0.006). Spinal and torso injuries were more common in patients older than 54 years (p = < 0.001) and those with falls (p < 0.04). Extremity injuries were more common in older patients (p < 0.001).

CONCLUSION

Patient age greater than 54 years and mechanism of injury are strong predictors of the ISS, injury localization, healthcare expenditure, and mean hospital stay. With the exception of obvious minor wounds, full trauma work-ups (CT chest/abdomen/pelvis and cervical spine) are encouraged for equestrian-related injuries in older patients and those injured by a fall.

Nonfatal horse-related injuries treated in emergency departments in the United States, 1990-2017

BACKGROUND

Horse-related injuries can cause severe morbidity and mortality. The objective of this study is to investigate the epidemiological features of horse-related injuries treated in emergency departments (EDs) in the United States.

METHODS

A retrospective analysis of horse-related injuries from 1990 through 2017 was conducted utilizing the National Electronic Injury Surveillance System (NEISS). Cases were identified using the NEISS code 1239 (Horseback Riding: Activity, Apparel, or Equipment). Analyses performed included calculation of national injury estimates, relative risks (RRs) with 95% confidence intervals (CIs), and linear regression.

RESULTS

From 1990 through 2017, an estimated 1,836,536 (95% CI: 1,494,788-2,178,284) individuals presented to United States EDs with horse-related injuries. The annual injury rate decreased by 30.8% from 1990 to 1996, increased by 33.0% from 1996 to 2000, and then decreased by 46.0% from 2000 to 2017. Among older adults >60 years of age, the annual injury rate increased by 139.6% during the study period. The number of concussion and closed head injury diagnoses increased by 337.2% from 1990 to 2009. The most common mounted mechanism of injury was a fall or being thrown (73.9%), while the most common unmounted mechanism was being kicked (42.1%). Mounted injuries were more likely to lead to hospitalization than unmounted injuries (RR, 2.10, 95% CI: 1.59-2.77).

CONCLUSIONS

Despite the recent decline in horse-related injuries, these injuries are still common. Clinicians should be aware of the spectrum of ED presentations of horse-related injuries. Prevention efforts focused on older adults and concussions and closed head injuries warrant special attention.

A preliminary study investigating functional movement screen test scores in female collegiate age horse-riders

The functional movement screen (FMS) is an easily administered and non-invasive tool to identify areas of weakness and asymmetry during specific exercises. FMS is a common method of athlete screening in many sports and is used to ascertain injury risk, but has to be used within an equestrian population. The aim of this study was to establish FMS scores for female collegiate age (18-26 years) riders, to inform a normative data set of FMS scores in horse riders in the future. Thirteen female collegiate horse riders (mean ± standard deviation (sd); age 21.5±1.4 years, height 167.2±5.76 cm, mass 60.69±5.3 kg) and 13 female collegiate non-riders (mean ± sd; age 22.5±2.1 years, height 166.5±5.7 cm, mass 61.5±4.9 kg) were assessed based on their performance on a 7-point FMS (deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability and rotary stability). The mean composite FMS scores (± sd) for the rider group was 14.15±1.9 and for the non-riders was 13.15±1.77. There was no statistically significant difference in median FMS composite scores between the rider and non-rider groups (Mann-Whitney U test, z=-1.249, P=0.223). However, 46% of riders and 69% of non-riders scored ≤14, indicating that a non-rider is 1.5 times (odds ratio) more likely to be at increased risk of injury compared to riders. Collegiate female riders scored higher than the non-rider population, but lower than seen in other sports suggesting some riders may be at risk of injury. Riders’ FMS scores demonstrated asymmetric movement patterns potentially limiting left lateral movement. Asymmetry has a potential impact on equestrian performance, limiting riders’ ability to apply the correct cues to the horse. The findings of such screening could inform the development of axillary training programmes to correct asymmetry pattern and target injury prevention.

Do riders who wear an air jacket in equestrian eventing have reduced injury risk in falls? A retrospective data analysis

OBJECTIVES

To investigate the association between air jacket usage and rider injury severity in equestrian eventing competition falls world-wide.

DESIGN

Retrospective data analysis.

METHODS

An analysis was conducted on Fédération Equestre Internationale data for 1819 riders who fell wearing an air jacket and 1486 riders who fell while not wearing an air jacket from 2015 to 2017. Injury data were categorised as either 'no/slight injury' or 'serious/fatal injury'. A chi-square test determined whether an association was present between injury severity category and air jacket usage and binary logistic regression determined the effect size of this association.

RESULTS

As a result of falls, 3203 riders sustained no/slight injuries and 102 sustained serious/fatal injuries. While 55.0% of riders who fell were wearing an air jacket, they represented 67.6% of the serious/fatal injury outcomes. Air jacket usage was significantly associated with serious/fatal injuries in falls (X² = 6.76; p = 0.009). Riders wearing an air jacket had 1.7 times (95%CI 1.14-2.64) increased odds of sustaining a serious or fatal injury in a fall compared to riders not wearing an air jacket.

CONCLUSIONS

Riders wearing an air jacket were over represented in the percentage of serious or fatal injuries in falls compared to riders who only wore a standard body protector. Further research is needed to understand the reason(s) for this finding. It is recommended that additional data on injury outcomes, rider characteristics and the biomechanics of falls be examined in future analyses, and that air jacket and body protector characteristics be further investigated.

Do equestrian helmets prevent concussion? A retrospective analysis of head injuries and helmet damage from real-world equestrian accidents

OBJECTIVES

To collect and analyse helmets from real-world equestrian accidents. To record reported head injuries associated with those accidents. To compare damage to helmets certified to different standards and the injuries associated with them.

METHODS

Two hundred sixteen equestrian helmets were collected in total. One hundred seventy-six helmets from amateur jockeys were collected via accident helmet return schemes in the UK and USA, while 40 helmets from professional jockeys were collected by The Irish Turf Club. All helmet damage was measured, and associated head injury was recorded.

RESULTS

Eighty-eight percent (189) of equestrian fall accidents returned an injury report of which 70% (139) reported a head injury. Fifty-four percent (75) of head injury cases had associated helmet damage while 46% had no helmet damage. Reported head injuries consisted of 91% (126) concussion, 4% (6) skull fractures, 1 (0.7%) subdural hematoma, 1 (0.7%) cerebral edema and 5 (3.6%) diffuse axonal injury (DAI). It is also shown that helmets certified to the most severe standard are overrepresented in this undamaged group (p <0.001).

CONCLUSIONS

It is clear that despite jockeys wearing a helmet, large proportions of concussion injuries still occur in the event of a jockey sustaining a fall. However, the data suggest it is likely that helmets reduce the severity of head injury as the occurrence of skull fracture is low. The proportion of undamaged helmets with an associated head injury suggests that many helmets may be too stiff relative to the surface they are impacting to reduce the risk of traumatic brain injury (TBI). It may be possible to improve helmet designs and certification tests to reduce the risk of head injury in low-severity impacts.

Injury Patterns of Equine-Related Trauma

Introduction:

Equestrian sports are popular in the United Kingdom (UK), with approximately 2.7 million people of all ages participating in equine-related sports in 2015. These sports are not without risk; the position of the mounted rider puts them at risk of injuries sustained by fall from a height, compounded by movement at speed. The aim of this study was to characterise demographics and injury patterns of equine-related trauma presentations at a major trauma centre in the UK.

Methods:

From a trauma admissions database and electronic search of radiology requests including keywords “equine”, “equestrian”, “horse”, and “pony” with cross-referencing from ICD-10 coding, 144 patients were identified to have presented to an adult major trauma centre with equine-related injuries from falls while mounted over a 3-year period.

Results:

Females accounted for 86% of patients (n = 123). The most common presenting age group was age 20-29, but most injuries occurred with patients of ages 50-59. Spinal injuries accounted for 41% (n = 69) of all injuries and occurred in a similar proportion in all age groups. Upper limb injuries accounted for 100% of injuries in those aged 0-9. 39% (n = 56) of patients required operative management for their injuries.

Conclusion:

We have been able to identify which body zones of injury are more at-risk in equine-related sports following falls from mounted riders, and recognize how certain injury patterns may be more prevalent in particular age groups. Spinal injuries have been demonstrated to be a new leading zone of injury, possibly due to stricter legislation from government and industry leading to the relative reduction of head injuries. Reducing the number and severity of these injuries will not only improve patient outcomes but reduce the burden on the healthcare system.

Effects of body protection vests and experience levels in prevention of equestrian injuries

Objectives

To investigate the risk reduction and benefit of wearing body protection/safety vests in equestrian sports.

Methods

A comparison of equestrians wearing body protective vests and those not wearing vests was performed using incident report data of 718 participants in the United States Pony Clubs during 2011-2017. Data obtained included age, gender, certification level of member, type of activity, description of incident, description of injuries, what protective equipment was worn and other possible contributing factors.

Results

While wearing body protective vests when riding on the flat or for show jumping was not correlated with a decrease in injuries, wearing vests for cross country was correlated with decrease in reported injuries (p=0.036) and showed a trend towards a lower incident severity level (p=0.062). Wearing body protection during cross country reduced the relative risk of injury by 56%. While the volume of incidents varied with a rider's experience level, the number of serious injuries did not appear to correlate with lesser equestrian experience.

Conclusions

While equestrian sports are considered to have a certain degree of risk associated with them, there are ways to make them safer. Wearing safety equipment, such as helmets and body protection, and obtaining education and experience can lessen the chance of incurring serious injuries.

Assessing the risk for major injuries in equestrian sports

Background/aim

Horse riding is a popular sport, which bears the risk of serious injuries. This study aims to assess whether individual factors influence the risk to sustain major injuries.

Methods

Retrospective data were collected from all equine-related accidents at a German Level I Trauma Centre between 2004 and 2014. Logistic regression was used to identify the risk factors for major injures.

Results

770 patients were included (87.9% females). Falling off the horse (67.7%) and being kicked by the horse (16.5%) were the two main injury mechanisms. Men and individuals of higher age showed higher odds for all tested parameters of serious injury. Patients falling off a horse had higher odds for being treated as inpatients, whereas patients who were kicked had higher odds for a surgical therapy (OR 1.7) and intensive care unit/intermediate care unit (ICU/IMC) treatment (OR 1.2). The head was the body region most often injured (32.6%) and operated (32.9%). Patients with head injuries had the highest odds for being hospitalised (OR 6.13). Head or trunk injuries lead to the highest odds for an ICU/IMC treatment (head: OR 4.37; trunk: OR 2.47). Upper and lower limb injuries showed the highest odds for a surgical therapy (upper limb: OR 2.61; lower limb: OR 1.7).

Conclusion

Risk prevention programmes should include older individuals and males as target groups. Thus a rethinking of the overall risk assessment is necessary. Not only horseback riding itself, but also handling a horse bears a relevant risk for major injuries. Serious head injures remain frequent, serious and an important issue to be handled in equestrians sports.

A preliminary study to investigate the prevalence of pain in international event riders during competition, in the United Kingdom

The aim of the study was to investigate the prevalence of riders at the international levels in eventing, competing with pain, the location of their pain, factors affecting their pain and whether they perceived this pain to have an effect on their performance. 331 questionnaires were completed by international event riders (FEI CCI*, CCI**, CIC***) at the Hartpury International Horse Trials, UK, to establish the prevalence of riders competing with pain. 96% of international event riders competed while experiencing pain, 76% of riders stated that this pain was in the neck, upper back or shoulders. All female riders reported pain, giving a significant correlation between gender and pain (X=-0.479, P=0.006). 55% of riders felt their pain affected their riding performance, giving an odds ratio of 1.14, compared to those riders who felt their pain did not effect their performance. Pain was perceived to influence performance by affecting fatigue, their concentration, and anxiety levels. 96% of riders reporting pain used medication to alleviate their symptoms. This high incidence of international event riders who compete with pain, particularly back pain, could be problematic given the longevity of a rider’s career, which can span over four decades and could potentially increase the risk of a serious or fatal fall in the cross-country phase. This research reports rider’s perceptions and self-reported pain and management options, which may affect the data. Further research is needed to establish the causes of back pain and appropriate management strategies.