Epidemiology of Injury Due to Race-Day Jockey Falls in Professional Flat and Jump Horse Racing in Ireland, 2011-2015

Wearable technology may assist in reducing jockeys' injuries if integrated into their safety vests: a qualitative study

While the term "safety vests" has been used to capture these products to reduce the potential for harm in jockeys under the Personal Protective Equipment (PPE) umbrella, much of the research in this area has focused on factors typically echoing health, well-being, physiological and cognitive function, and performance of horse riders with very little work about examining how its design may reduce the severity of jockeys' injuries. Due to the recent advances in technology and wearable sensors, the author considered a qualitative study focusing on the analysis of a real-life example involving end and co-dependent users in the design development of jockeys' safety vests. This little article offers an overview of the most popular jockeys' injuries, why there is a need for better protection, and also describes how data were collected and present a summary of the key findings to encourage future research in this field, aiming to create a new prototype. High-impact sports may potentially create severe injuries or deaths to athletes: thus, there is a strong faith in the application of wearable sensor data and data science to also enhance jockeys' safety vest performance.

Return to Sport After Operative Fixation of Midshaft Clavicle Fractures in Professional Jockeys

OBJECTIVE

Clavicle fractures are the most commonly observed fracture sustained in professional horse racing. This study is the first to report on time lost from injury and functional recovery after surgical fixation of midshaft clavicle fractures in professional jockeys.

DESIGN

Retrospective cohort study.

SETTING

Professional Horse Racing Ireland; Patients (or Participants): Professional Jockeys in Ireland with midshaft clavicular fractures managed with Open Reduction Internal Fixation. Interventions (or Assessment of Risk Factors or Independent Variables): Operative fixation with Open Reduction Internal Fixation.

MAIN OUTCOME MEASURES

Assessment of postoperative Quick Disabilities of Arm Shoulder and Hand (QuickDASH) score and Patient Reported Outcome Measures assessing for associated complications and time to return to competition among professional athletes.

RESULTS

Between 07/06/2013 and 29/09/2022, 22 patients met the predetermined inclusion criteria. Ninety-five percent of patients returned to competition at their preinjury level, one patient failed to return to competition for reasons unrelated to his injury. The mean time for return to competition was 68.14 days postinjury. Few complications were reported, whereas functional recovery was excellent across the cohort, with an average QuickDASH score of 0.85 (0.0-2.3).

CONCLUSIONS

Plate fixation of midshaft clavicle fractures is effective and safe in the setting of professional horse racing. Ninety-five percent of patients can be expected to return within 14 weeks of injury. Patients returning at less than 7 weeks after injury had no adverse outcomes, suggesting a potential role for more aggressive rehabilitation postoperatively and ultimately, a quicker return to competition.

Sustainability and the Thoroughbred Breeding and Racing Industries: An Enhanced One Welfare Perspective

As society debates the use of animals in sport, entertainment, and leisure, there is an increasing focus on the welfare, social, and ecological impacts of such activities on the animals, human participants, people close to them, and the physical environment. This article introduces the "Enhanced One Welfare Framework" to reveal significant costs and benefits associated with Thoroughbred breeding and racing globally. In addition, relative to calls to ban horseracing and similar activities as part of sustainability approaches that focus chiefly on animals, the "Enhanced One Welfare Framework" is better positioned politically to guide discussions that renegotiate the conditions under which horses are used for sport and the impact racing has on humans and the planet. In 2020, the International Federation of Horseracing Authorities issued its minimum horse welfare standards based on the Five Domains model, positioning lifelong horse welfare as "fundamentally important to the viability and sustainability of the industry". In this article, we critique the One Welfare framework's historic lack of focus on sport and enhance it by including sport, leisure, and entertainment and framing it within the Five Domains model. We offer a novel extension of the Five Domains model beyond animal welfare to consider human welfare and the physical environmental impacts of the sport, leisure, and entertainment industries and propose innovations that may help thoroughbred breeding and racing assure a sustainable future.

Clinical and Blood Biomarker Trajectories after Concussion: New Insights from a Longitudinal Pilot Study of Professional Flat-Track Jockeys

There is a recognized need for objective tools for detecting and tracking clinical and neuropathological recovery after sports-related concussion (SRC). Although computerized neurocognitive testing has been shown to be sensitive to cognitive deficits after SRC, and some blood biomarkers have shown promise as indicators of axonal and glial damage, the potential utility of these measures in isolation and combination for assisting SRC diagnosis and tracking recovery is not well understood. To provide new insights, we conducted a prospective study of 64 male and female professional flat-track jockeys (49 non-SRC, 15 SRC), with each jockey undergoing symptom evaluation, cognitive testing using the CogSport battery, and serum biomarker quantification of glial fibrillary acidic protein (GFAP), tau, and neurofilament light (NfL) using a Simoa HD-X Analyzer. Measures were performed at baseline (i.e., pre-injury), and 2 and 7 days and 1 and 12 months after SRC. Symptoms were most pronounced at 2 days and had largely resolved by either 7 days or 1 month. CogSport testing at 2 days revealed cognitive impairments relative to both non-concussed peers and their own pre-injury baselines, with SRC classification utility found at 2 days, and to a slightly lesser extent, at 7 days. Relatively prolonged changes in serum NfL were observed, with elevated levels and classification utility persisting beyond the resolution of SRC symptoms and cognitive deficits. Finally, SRC classification performance throughout the 1st month after SRC was optimized through the combination of cognitive testing and serum biomarkers. Considered together, these findings provide further evidence for a role of computerized cognitive testing and fluid biomarkers of neuropathology as objective measures to assist in the identification of SRC and the monitoring of clinical and neuropathological recovery.

Consensus on a jockey's injury prevention framework for video analysis: a modified Delphi study

Professional horse racing is a high-risk and dangerous sport with a high incidence of falls and injuries. While falls in horse racing are considered somewhat inevitable and carry an inherent occupational risk, little is known about the actual mechanisms of jockey injuries. Establishing injury aetiology and mechanism is a fundamental step in informing the design and implementation of future injury prevention strategies. Despite the availability of horse racing video footage, the use of video analysis to examine injury mechanisms is an underused practice. Using an expert consensus-based approach, an industry expert steering committee was assembled to develop a framework for video analysis research in horse racing. The aim of the framework is to encourage and facilitate the use of video analysis in the sport and to ensure consistency and quality of future application. To achieve consensus, a systematic review and modified Delphi method study design was used. Responses of the steering committee to two open-ended questions regarding the risk factors of falls and injury were collated and combined with findings from a literature search strategy. Appropriate descriptors and definitions were then formulated that defined and described key features of a jockey fall in horse racing and grouped into six discrete phases of an inciting event. Each member of the steering committee then examined the framework of proposed descriptors and definitions and rated their level of agreement on the 5-point Likert scale. A consensus was achieved on a total of 73 horse racing-specific descriptors and 268 associated definitions. The framework outlined in this study provides a valuable starting point for further research and practice within this area, while the recommendations and implications documented aim to facilitate the practical application of video analysis in horse racing.

Physics-Informed Machine Learning Improves Detection of Head Impacts

In this work we present a new physics-informed machine learning model that can be used to analyze kinematic data from an instrumented mouthguard and detect impacts to the head. Monitoring player impacts is vitally important to understanding and protecting from injuries like concussion. Typically, to analyze this data, a combination of video analysis and sensor data is used to ascertain the recorded events are true impacts and not false positives. In fact, due to the nature of using wearable devices in sports, false positives vastly outnumber the true positives. Yet, manual video analysis is time-consuming. This imbalance leads traditional machine learning approaches to exhibit poor performance in both detecting true positives and preventing false negatives. Here, we show that by simulating head impacts numerically using a standard Finite Element head-neck model, a large dataset of synthetic impacts can be created to augment the gathered, verified, impact data from mouthguards. This combined physics-informed machine learning impact detector reported improved performance on test datasets compared to traditional impact detectors with negative predictive value and positive predictive values of 88 and 87% respectively. Consequently, this model reported the best results to date for an impact detection algorithm for American football, achieving an F₁ score of 0.95. In addition, this physics-informed machine learning impact detector was able to accurately detect true and false impacts from a test dataset at a rate of 90% and 100% relative to a purely manual video analysis workflow. Saving over 12 h of manual video analysis for a modest dataset, at an overall accuracy of 92%, these results indicate that this model could be used in place of, or alongside, traditional video analysis to allow for larger scale and more efficient impact detection in sports such as American Football.

Body Composition and Bone Health Status of Jockeys: Current Findings, Assessment Methods and Classification Criteria

Jockeys are unlike other weight-making athletes as the sport of horse racing requires strict weight management to meet the racing stipulations, protracted working hours and an extended racing season with limited downtime. Several studies have reported on the body composition and bone status of male and female professional and retired jockeys, yet the variety of assessment techniques, lack of standardised testing protocols and classification inconsistency make interpretation and comparison between studies problematic. This review aimed to appraise the existing body composition and bone health evidence in jockeys and evaluate the assessment methods and classification criteria used. Dual-energy X-ray absorptiometry (DXA) has been used most frequently in jockey research to assess body composition and bone status, while various generic skinfold equations have been used to predict body fat percentage. Evidence indicates flat jockeys are now taller and heavier than the data reported in earlier studies. Absolute fat mass has steadily increased in male jockeys in the last decade. The bone status of male jockeys remains a concern as constant low bone density (BMD) is evident in a large percentage of young and experienced professional jockeys. Due to limited studies and variations in assessment methods, further research is required to investigate bone turnover markers in male and female jockeys. A standardised testing protocol using internationally recognised assessment guidelines is critical for the accurate interpretation and evaluation of body composition and bone health measurements. Furthermore, establishing jockey-specific BMD and bone turnover reference ranges should be considered using existing and future data.

Physical activities of jockeys during a working week

Horse racing and training is a physically demanding sport. The aims of this study were to quantify the physical activities of jockeys during a working week and to investigate self-reported fall and injury incidence rates of jockeys at work. A daily workload diary examining workday and physical activities was emailed to all jockeys licensed to ride in a race in New Zealand in 2020. Sixty-three jockeys (25 apprentices, 33 professional and 5 amateur riders) began the diary, representing 38% of the licensed population of jockeys in New Zealand. Jockeys worked a median of 44 (interquartile range (IQR) 33-57) hours, 6-days per week. A median of 7 (IQR 6-9) horses were ridden per day, comprising 58% of work time, with 11 (IQR 7-15) hours per week spent at training pace. Elite jockeys (high performance in the premiership table) spent more time riding in races (1.1, IQR 0.7-1.2 hours per week) than non-elite jockeys (0.0, 0.0-0.4, P=0.01), with 29% (IQR 0-54%) of their weekly rides as race rides. Extra physical training was conducted by 72% of jockeys, which consisted mainly of low intensity exercise such as pleasure riding (56%) and walking (43%). Falls during morning exercise work were recorded by 87% of respondents, 40% of which had sustained an injury in the previous 12 months. Jockeys who participated in extra physical training had higher fall incidence rates per 1000 horses ridden in morning exercise work (3.5, 95% confidence interval (CI) 3.1-3.9, P=0.002) but lower fall incidence rate in race riding (2.1, 95% CI 1.5-2.8, P<0.001) than jockeys who did no extra training (2.5, 95% CI 2.0-3.0 and 5.9, 95% CI 3.8-9.0). Elite jockeys experience a level of specific race exercise which is lacking in the other jockeys.

Risk factors for jockey falls in Japanese Thoroughbred jump racing

Jockey safety is an important subject from a welfare perspective and public perception. This is the first retrospective case-control study that aims to identify risk factors associated with jockey falls (JF) in Thoroughbred jump races held by the Japan Racing Association (JRA). JF in 17,459 maiden-class race starts at eight racecourses from 2003 to 2017 were retrospectively reviewed. Data were extracted from a database and official accident reports maintained by the JRA. Thirteen possible risk factors were evaluated using multivariable logistic regression to identify those that were significantly associated with JF. A total of 724 JF were recorded, with an incidence rate of 41.5 falls per 1,000 starts (95% CI: 38.6-44.5). Final model included stable, horse age, year, season, course, horse sex, horse experience, and jockey experience. No two-way interactions were observed. Six risk factors were significantly associated with JF: Year (2003-2007 or 2008-2012 > 2013-2017; P = .0011), season (spring, autumn, or winter > summer; P = .0006), course type (dual direction > single direction; P < .0001), horse sex (female > male or gelding; P = .0003), horse experience (inexperienced horse > experienced horse; P < .0001) and jockey experience (apprentice jockey > experienced jockey; P = .0332) significantly affected the odds of JF. In agreement with overseas reports, our results suggest that the occurrence of JF is multifactorial and associated with jockey- and horse-related factors as well as environmental factors. To safeguard the welfare of jockeys, implementation of measures according to identified risk factors is recommended.

Risk Factors for Jockey Falls in Japanese Thoroughbred Flat Racing

Jockey safety is of paramount importance from welfare perspective and public perception. This retrospective case-control study aims to identify risk factors associated with jockey falls (JF) in flat races of Japan Racing Association (JRA). JF in 715,210 race starts by 74,328 horses at 10 racecourses from 2003 to 2017 were reviewed. Data were extracted from a database maintained by JRA and from official accident reports issued by race stewards. Seventeen possible risk factors were evaluated using multivariable logistic regression, to identify those significantly associated with JF. A total of 992 JF incidents were recorded, with an incidence rate of 1.39 falls per 1,000 starts (95% CI: 1.30-1.48). 6 risk factors were significantly associated with JF. Odds increased with horses that sustained catastrophic musculoskeletal injury (CMI) (OR: 203; CI: 169-241; P < 0.001). Increased odds were also associated with dirt track surfaces (OR: 1.99; CI: 1.74-2.29; P < 0.001), apprentice jockeys (OR: 1.43; CI: 1.21-1.68; P < 0.001), smaller track sizes (OR: 1.41; CI: 1.24-1.61; P < 0.001), larger fields (OR: 1.25; CI: 1.07-1.47; P = 0.005), and longer race distances (OR per 200 m: 1.05; CI: 1.01-1.09; P = 0.02). Since CMI was identified as a major contributing factor for JF, measures to minimize CMI may lead to improvement of jockey safety. The increased odds associated with apprentice jockeys may indicate the importance of jockey education and training. For jockey safety, proper staffing of medical professionals especially for races on dirt, smaller track, larger fields, and longer distances is recommended.

A Cross Sectional Survey of International Horse-Racing Authorities on Injury Data Collection and Reporting Practices For Professional Jockeys

Jockey injuries are common in professional horse-racing and can result in life-threatening or career-ending outcomes. Robust injury data are essential to understand the circumstances of injury occurrence and ultimately identify prevention opportunities. This study aimed to identify jockey injury surveillance practices of international horse-racing authorities (HRAs) and the specific data items collected and reported by each HRA. A cross-sectional survey of representatives (e.g. Chief Medical Officer) from international HRAs was conducted. An online and paper questionnaire was designed comprised of 32 questions. Questions considered the barriers and facilitators to data collection within each HRA, and where available, what data were collected and reported by HRAs. Representatives from 15 international racing jurisdictions were included, of which 12 reported collection of race day injuries or falls, using varied definitions of medical attention and time loss. Six HRAs did not have a definition for a jockey injury, and eight HRAs had no parameters for describing injury severity. Race day exposure was collected by two HRAs. Results were commonly presented by HRAs as the number of injuries (n = 9/15) or proportion of injured jockeys (n = 6/15). The lack of a designated role for collection, collation and reporting of data was the main barrier for injury surveillance. Twelve HRAs agreed that mandatory collection would be a strong facilitator to improving practice. Enhancement and standardization of international jockey injury surveillance is required to move forward with evidence informed prevention. Concurrent investigation of how reporting practices can be best supported within existing HRA structures is recommended.

Epidemiology of race day injury in young professional jockeys in Great Britain from 2007 to 2018: a retrospective cohort study

INTRODUCTION

There are limited injury data in professional horse racing, particularly by sex.

OBJECTIVES

To describe injury incidence, characteristics and falls in male and female, flat and jump jockeys in Great Britain.

DESIGN AND SETTING

Retrospective cohort study of professional jockeys in Britain.

PARTICIPANTS

245 jockeys licensed between 2007 and 2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was injury on a race day. Injury incidence (per 1000 rides; per 1000 falls) was derived. Incidence-rate ratios (IRR) were calculated to compare incidence between flat and jump racing, male and female jockeys, and male flat and male jump jockeys for: (i) injury incidence, (ii) fall incidence and (iii) injuries per fall.

RESULTS

234 British professional jockeys were included. Jockeys were on average 19.5±2.0 years old at licence date, 79.9% male and 58.1% flat. The time of follow-up (racing in the study) was 3.7 (SD=2.3) years. There were 278 injuries, occurring in-race (81.7%), in the stalls (10.8%) or parade ring (6.1%). After one injury was removed to preserve anonymity, 57.2% were soft tissue injuries, 25.3% fractures and 10.5% concussion. There were 1634 falls, with 92% in male jump racing. The injury incidence was higher in jump racing (5.1 vs 1.0/1000 jockey rides). The falls incidence was 1.8/1000 rides in flat and 46.2/1000 rides in jump racing (IRR 0.04, 95% CI 0.03 to 0.04). There were over five times higher injuries/1000 falls in flat than jump racing (IRR 5.56, 95% CI 4.05 to 7.53). Male flat jockeys fell less than female flat (IRR 0.57, 95% CI 0.35 to 0.97).

CONCLUSION

Most injuries occurred in-race and were soft tissue injuries. Jump jockeys fell more often than flat, and female flat jockeys fell more often than male flat. Flat jockeys injured more frequently when falling. No sex differences were seen for injuries per fall.

Review of physical fitness, physiological demands and performance characteristics of jockeys

This narrative review collates data from different equestrian disciplines, both amateur and professional, to describe the physiological demands, muscle activity and synchronicity of movement involved in jockeys riding in a race and to identify limitations within our current knowledge. A literature search was conducted in Web of Science, Google Scholar, PubMed and Scopus using search terms related to jockeys, equestrian riders and their physiological demands, muscle use, movement dynamics and experience. Abstracts, theses and non-peer reviewed articles were excluded from the analysis. Jockeys work at close to their physiological capacity during a race. The quasi-isometric maintenance of the jockey position requires muscular strength and endurance, specifically from the legs and the core, both to maintain their position and adapt to the movement of the horse. Synchronous movement between horse and rider requires a coordinated activation pattern of the rider’s core muscles, resulting in less work done by the horse to carry the rider, possibly leading to a competitive advantage in race riding. Reports of chronic fatigue in jockeys demonstrate poor quantification of workload and recovery. The lack of quantitative workload metrics for jockeys’ limits calculation of a threshold required to reach race riding competency and development of sport-specific training programmes. Until the sport-specific demands of race riding are quantified, the development of evidence-based sport specific and potentially performance enhancing jockey strength and conditioning programmes cannot be realised.

Mental health difficulties among professional jockeys: a narrative review

Introduction

Emerging academic literature and high-profile disclosures of mental health difficulties and mental illness from current and former professional jockeys suggest that further exploration of the mental health of jockeys is required. To date, a comprehensive review of jockeys’ mental health has yet to be conducted.

Objectives

To examine the existing literature related to jockeys’ mental health, including the prevalence of symptoms associated with mental health difficulties and help-seeking.

Design

A narrative review of the literature was conducted with articles screened from inception until January 2021.

Results

Sixteen studies were included in the narrative review. Studies covered a range of mental health difficulties which included mood (depression), anxiety, distress, disordered eating and substance misuse. Rates of help-seeking among jockeys were also explored. Results indicated that jockeys reported higher levels of depressive and anxiety symptoms compared with other elite athletes. Substance misuse, in particular adverse alcohol use, also appears greater among jockeys than other elite athletes. Distress symptoms appear comparable with other elite athletes. Risk factors for mental health difficulties included injury, perceived stress, athlete burnout, career dissatisfaction and the contemplation of retirement. Weight-making negatively impacts jockeys’ mood and attitudes towards eating, with lower competitive riding weights associated with more disordered eating attitudes. Moreover, help-seeking from mental health professionals appears low.

Conclusion

The review identifies a high prevalence of symptoms of mental health difficulties among professional jockeys. Applied recommendations and future research considerations are proposed throughout the review article.

Physical and Lifestyle Factors Influencing Bone Density in Jockeys: A Comprehensive Update of the Bone Density Status of Irish Jockeys

Compromised bone density in jockeys has previously been identified as an important health and safety concern in horseracing. Despite this, no update on the bone density status in Irish jockeys has been provided in the past decade. The study aimed to conduct a comprehensive update of the current bone density status in professional Irish jockeys and identify possible contributory physical and lifestyle factors. Eighty-five professional male jockeys (flat n = 39; national hunt (NH) n = 46) completed a dual-energy X-ray absorptiometry (DXA) scan for the assessment of body composition and bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN) and hip, 24-hour food recall, bone-specific physical activity questionnaire (BPAQ) and lifestyle questionnaire on weight making practices and injury history. Z-scores were interpreted to assess current bone density status. Correlation analysis was used to identify physical and lifestyle factors associated with bone mineral apparent density (BMAD). Results revealed a high prevalence of low BMD (Z-score < - 1.0) at the LS (44%), FN (15%) and hip (29%) in Irish jockeys. Analysis of jockeys physical characteristics found a positive relationship with the LS but not FN BMAD. Riding experience and timing of weight cut in NH and the practice of cutting weight in flat jockeys negatively influenced BMAD sites, while supplement use in flat jockeys displayed a positive effect on LS BMAD. Findings indicate the need for targeted individualised support strategies. Further investigation is required into jockey-specific intervention strategies that promote the development of optimal bone health in professional jockeys.

Injuries outside of horseracing: is it time to focus on injury prevention of jockeys outside of races?

Objectives: Falls and injuries are frequent in professional horseracing. However, professional jockeys spend a large part of their week in horse-related activities outside of racing such as schooling, exercise riding, and yard-related activities. The injury risk related to these activities remains largely unknown internationally. This study aimed to identify the injury prevalence and injury profile of flat and jump jockeys during non-racing activities. Methods: In total 45.6% and 38.5% of all licensed Irish professional flat and jump jockeys completed a cross-sectional self-recall questionnaire examining injuries that occurred outside of racing during 2018. Injury proportion, repeat incidence proportion, and descriptive statistics were calculated. Results: Fifteen percent of professional jockeys sustained an injury outside of a race, half of those injured receiving at least another injury in 2018 and 66.52 injuries per 1,000 falls were noted. Injuries frequently occurred to the upper limb (36.67%), with fractures common (32.00%). Most injuries occurred due to a fall (60.00%) and 77.27% occurred in the gallops. Half of injuries resulted in the jockey missing racing, with 31.00 ± 47.18 (4-180) days lost on average. Twenty-three percent of jockeys attended hospital and 16.67% required surgery due to injury. Interestingly, just under a third did not report their injury to anyone. Conclusion: Injuries to professional jockeys, whilst not as frequent outside of racing, tend to be serious and can affect jockeys financially and impact their availability to ride. Prioritizing injury prevention strategies to maximize availability of jockeys to race is important. Education on the importance of reporting all injuries regardless of where they occur is important to ensure their management and rehabilitation.

Update on the epidemiology of work-related traumatic brain injury: a systematic review and meta-analysis

BACKGROUND

Traumatic brain injury (TBI) is a public health concern that can occur in a range of contexts. Work-related TBI (wrTBI) is particularly concerning. Despite overall work-related injury claims decreasing, the proportion of claims that are wrTBI have increased, suggesting prevention and support of wrTBI requires ongoing attention.

OBJECTIVES

This review aimed to provide updated information on the burden and risk factors of wrTBI among the working adult population.

METHODS

Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a combination of TBI, work, and epidemiology text words and medical subject headings. Two reviewers independently assessed articles for inclusion. Meta-analyses were conducted to estimate prevalence and mortality of wrTBI and a narrative synthesis was conducted to provide additional context.

RESULTS

Pooled proportions meta-analyses estimate that 17.9% of TBIs were work-related and 6.3% of work-related injuries resulted in TBI, with 3.6% of wrTBI resulting in death. Populations of wrTBI were predominantly male (76.2%) and were 40.4 years of age, on average. The most commonly reported industries for wrTBI were education and training, healthcare and social assistance, construction, manufacturing, and transportation. Falls, being struck by an object or person, motor vehicle collisions, and assaults were the most commonly reported mechanisms of wrTBI.

CONCLUSIONS

A better understanding of the epidemiology of wrTBI can inform prevention and management strategies. This review highlights existing gaps, including a notable lack of sex or gender stratified data, to direct future investigation.

PROSPERO REGISTRATION NUMBER

CRD42020169642.

Medicine in the Sport of Horse Racing

Horseracing is among the most popular and increasingly lucrative industry sports in the nation. The average jockey must control a thoroughbred horse 10 times their weight that may act unpredictably whether at rest or full gallop resulting in falls, kicks, or even biting injuries. Despite the risks, jockeys do not have access to the same quality of medical care that is standard in similarly profitable sports organizations. Beyond the mental and physical demands of training and performance endured by any professional athlete, jockeys are confronted with health challenges unique to their sport. In this review of the literature, we aim to educate sports medicine physicians regarding the underlying causes of injuries, describe injury management, and make recommendations for appropriate preventive strategies. Overall, there is a void of literature, and so our authors offer expert opinion and encourage others to get involved in making this a safer sport.

Epidemiology of jockey falls and injuries in flat and jump races in Japan (2003-2017)

Jockey safety is of paramount importance from the standpoint of welfare and public perception. Thus, an understanding of the epidemiology and associated risk factors is necessary to implement measures to reduce the jockey falls (JFs) and jokey injuries (JIs). This descriptive epidemiological study investigated the occurrence of JFs and JIs in 715,210 and 25,183 rides in flat and jump races, respectively, from 2003 to 2017. In flat races, the incidence rates of JFs and JIs were 1.4 and 0.6 per 1,000 rides, respectively. In jump races, they were 44.4 and 18.1 per 1,000 rides, respectively. In flat races, 56.8% of JFs at corners resulted in JIs. In jump races, the major causes of JFs and JIs were lost balance and hampered by a fallen horse at an obstacle. Our findings provide a basis to design a future study analyzing risk factors for JFs.

Injuries among Maryland jockeys during thoroughbred racing: 2015-2019

Objectives

Our goal was to characterise jockey injuries at Maryland racetracks during thoroughbred racing activities over 4 years using medical records maintained by the sports medicine team.

Methods

Injury data were prospectively gathered by sports medicine physicians who were onsite for all thoroughbred racing activities in Maryland from 12 September 2015 to 5 May 2019 to evaluate and treat any injury to the jockeys. Descriptive statistics (frequencies, rates with corresponding 95% CIs and proportions) of injury types, body parts, mechanisms, severity and location on track were calculated.

Results

Over nearly 4 years of racing and 45 000 mounts, there were 204 injuries involving 184 incidents and 131 falls during those races. The vast majority of injuries (80%) was related to soft tissue, while 4% were concussions. Most injuries involved the lower extremity (31%) or upper extremity (26%) and typically resulted from a fall from the horse. Among all incidents, 79.3% (n=146) resulted in an injury, while 76.3% (n=100) of falls resulted in an injury. We identified a significant proportion of injuries (41%) in and around the starting gate. Over a quarter of incidents resulting in injury required further medical care in hospital or other medical facility, while surgery was required in 2.5% of injuries.

Conclusion

Access to a consistent group of sports medicine providers facilitated jockey injury reporting and tracking. The majority of jockey injuries is related to soft tissue and results from falls, while the starting gate area is associated with the greatest proportion of injuries.

Concussion History, Reporting Behaviors, Attitudes, and Knowledge in Jockeys

OBJECTIVE

To examine concussion history, knowledge, and attitudes among Irish professional and amateur jockeys.

DESIGN

Cross-sectional survey.

SETTING

Questionnaire was distributed through e-mails sent to all licensed jockeys, over social media and during professional and amateur race meetings.

PARTICIPANTS

An average of 23.6% (12%-44%) Irish professional and amateur jockeys (n = 119) holding a license in 2017.

MAIN OUTCOME MEASURES

Jockeys reported their previous concussion history, actions after their most recent concussion and responded to questions examining their knowledge and attitudes toward concussion.

RESULTS

Amateur (32.4%) and professional (19.6%) jockeys, who were never medically diagnosed over their career, suspected that they had sustained a concussion. Jockeys displayed good knowledge of concussion signs and symptoms; yet, one in 2 jockeys would continue to ride out the same day if they suspected they had a concussion. They were less likely if they had a race that day. Reasons for continuing to ride include not considering a concussion as serious (85.7%); risk of losing the ride (84.0%); not wanting to let anyone down (77.8%); and considered it a sign of weakness (74.1%). Risky behavior was more common after a suspected concussion than a medically diagnosed concussion.

CONCLUSIONS

Underreporting of concussions is proposed as a serious concern, and concussion understanding and attitudes can impact reporting. To address the issue of underreporting of concussions in Irish horseracing, there is a need to educate jockeys and the wider racing community on the importance of timely concussion assessments and access to appropriate management systems.

Trends of traumatic spinal injury-related hospitalizations in Australian children over a 10-year period: a nationwide population-based cohort study

BACKGROUND CONTEXT

Despite its potential to cause serious and life-long disability or death, population-based data on traumatic spinal injury in pediatric populations is scarce.

PURPOSE

To quantify and describe the incidence and cost of hospitalizations for traumatic spinal injury among Australian children, and to examine the trend over a 10-year period.

STUDY DESIGN

Population-based retrospective cohort study.

PATIENT SAMPLE

Children aged ≤16 years who were hospitalized for traumatic spinal injury in Australia during 1 July 2002 to 30 June 2012.

OUTCOME MEASURES

Age-standardized hospital admission rates.

METHODS

This study used linked hospitalization and mortality data. Age-standardized hospitalization rates were calculated with 95% confidence intervals (CIs). Negative binomial regression was used to examine change in temporal trends in hospitalization rates.

RESULTS

There were 4,360 hospitalizations for pediatric traumatic spinal injury during the 10-year study period. Males and older children were more frequently hospitalized, and falls and road trauma accounted for almost three-quarters of hospitalizations. The average overall annual hospitalization rate was 9.43 (95% CI: 9.15-9.72) per 100,000 population, with an annual percent change of 1.2% (95% CI: -0.1% to 2.4%). There was an increase in the annual hospitalization rate for spinal dislocations, sprains, and strains (3.0% [95% CI: 0.8%-5.3%]) and among female children (1.7% [95% CI: 0.0%-3.4%]). The estimated total hospital treatment costs were AUD$43 million over the 10-year study period, with an estimated mean cost per child of AUD$9,867.

CONCLUSIONS

Pediatric traumatic spinal injury is associated with significant morbidity and mortality. The burden of hospitalized pediatric traumatic spinal injury in Australia is rising, in particular spinal dislocations, sprains, and strains among female children. Targeted prevention strategies are needed to reduce the burden of pediatric traumatic spinal injury. It is recommended that a coordinated national strategy for preventing childhood traumatic spinal injury is developed and implemented in Australia.

Incidence and risk factors for race-day jockey falls over fourteen years

OBJECTIVES

To determine the incidence of, and risk factors for, race-day jockey falls occurring in Thoroughbred flat and jumps (hurdle and steeplechase) racing.

DESIGN

Retrospective cohort study.

METHODS

Incidence rates for race-day jockey falls over 14 racing seasons in New Zealand (n=421,596 race-day starts) were calculated per 1000 rides. Univariable and multivariable analyses of jockey, horse and race level risk factors were conducted with Poisson regression in a generalized linear mixed model.

RESULTS

Most races (97%, n=407,948 race starts) were flat racing with 10 races/race-day, whilst most jumps races were longer and had 2 races/race-day. The rate of jockey falls was higher in steeplechase racing (99.9/1000, 95% CI 92.2-108.4) than hurdle (53.2/1000, 95% CI 48.7-58.3) and flat racing (1.2/1000, 95% CI 1.1-1.3, p<0.001). Experienced athletes (both horse and jockey) had lower IRR. In flat racing, IRR increased linearly with the number of race-day rides by the jockey. In jumps races, IRR increased with a fall in a previous race (IRR 1.5/1000, 95% CI 1.3-1.7, p<0.001). A shorter jumps race distance reduced the IRR of a jockey fall.

CONCLUSIONS

Athlete experience was associated with risk of jockey falls. The linearity of race ride number with IRR and longer distance in jumps racing, indicated that cognitive or physiological fatigue may play a role in the risk of a race-day fall. This data highlights the role sport-specific conditioning programmes may have on reducing risk.

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.

A 9-Year Epidemiologic Study (2007-2015) on Race-Day Jockey Fall and Injury Incidence in Amateur Irish Horse Racing

CONTEXT

Point-to-point racing may place jockeys at risk of serious injuries due to the high incidence of falls as previously reported. Despite many advances in health and safety strategies, the incidence of falls and injuries in point-to-point racing has not been reported since 2006.

OBJECTIVES

To provide a longitudinal analysis of the fall and injury incidence in point-to-point horse racing jockeys in Ireland from 2007 to 2015 and compare these findings with the previous literature.

DESIGN

Descriptive epidemiologic study.

SETTING

All injuries that occurred due to a fall at every official point-to-point race meeting from 2007 to 2015 were recorded by a medical doctor using a standardized injury report form.

MAIN OUTCOME MEASURE(S)

Falls and injury rates and their 95% confidence intervals were calculated. Incidence rate ratios (IRRs), 95% confidence intervals and percentage change were compared between point-to-point and professional racing, between previous data and the current results, and from 2007 to 2015.

RESULTS

An average of 67.40 injuries/1000 falls and 9.08 injuries/1000 rides occurred in point-to-point racing, and this was reduced compared with the previous analysis. Amateur jockeys sustained an overall mean of 134.77 falls/1000 rides and the yearly means decreased over the 9 years of the study. Amateur jockeys sustained a higher fall rate than professional jockeys (flat: IRR = 35.47 [31.03, 40.54]; jump: IRR = 2.72 [2.63, 2.82]); however, their injuries/1000 falls rate was lower (flat: IRR = 0.19 [0.15, 0.24]; jump: IRR = 0.33 [0.30, 0.63]). Soft tissue injuries were predominant (43.09%), with 26.06 fractures and 9.98 concussions/1000 falls occurring.

CONCLUSIONS

Although injuries have been reduced since the previous analysis, more serious injuries such as fractures and concussions were more common in point-to-point racing than professional racing, possibly due to their higher fall risk. Thus, identifying strategies to reduce the fall risk in point-to-point racing should be a priority.

Weight loss practice, nutritional status, bone health, and injury history: A profile of professional jockeys in Korea

[Purpose]

The purpose of this study was to investigate the impact of weight loss practices on nutritional status, bone health, and injury history among Korean professional jockeys.

[Methods]

Forty-three male jockeys completed a questionnaire to assess their weight loss practices. Of these, 10 jockeys were selected for in-depth assessment of their nutritional status, bone health, and injury history.

[Results]

The questionnaires revealed that 81.4% of jockeys lost weight every week mainly by dieting and/or exercising. None of the jockeys consumed enough food during the weight loss period. Two jockeys were diagnosed with osteopenia and one was diagnosed with osteoporosis. Only history of fracture showed a significant correlation with low bone mineral density. All jockeys had more than one injury experience throughout their career. Fracture was the most common type of injury, occurring during practice and/or competition and caused mainly by difficulties in handling the horses.

[Conclusion]

Professional jockeys in Korea use extreme weight loss methods. Their repeated periods of poor nutritional intake may result in seriously low bone mineral density, which may aggravate injuries sustained during horse races. Implementation of balanced dietary programs and delivery of health education on weight management are urgently required.

Hospital-treated injuries from horse riding in Victoria, Australia: time to refocus on injury prevention?

BACKGROUND

The most recent report on hospital-treated horse-riding injuries in Victoria was published 20 years ago. Since then, injury countermeasures and new technology have aimed to make horse riding safer for participants. This study provides an update of horse-riding injuries that required hospital treatment in Victoria and examines changes in injury patterns compared with the earlier study.

METHODS

Horse-riding injuries that required hospital treatment (hospital admission (HA) or emergency department (ED) presentations) were extracted from routinely collected data from public and private hospitals in Victoria from 2002-2003 to 2015-2016. Injury incidence rates per 100 000 Victorian population per financial year and age-stratified and sex-stratified injury incidence rates are presented. Poisson regression was used to examine trends in injury rates over the study period.

RESULTS

ED presentation and HA rates were 31.1 and 6.6 per 100 000 person-years, increasing by 28.8% and 47.6% from 2002 to 2016, respectively. Female riders (47.3 ED and 10.1 HA per 100 000 person-years) and those aged between 10 and 14 years (87.8 ED and 15.7 HA per 100 000 person-years) had the highest incidence rates. Fractures (ED 29.4%; HA 56.5%) and head injuries (ED 15.4%; HA 18.9%) were the most common injuries. HA had a mean stay of 2.6±4.1 days, and the mean cost per HA was $A5096±8345.

CONCLUSION

Horse-riding injuries have remained similar in their pattern (eg, types of injuries) since last reported in Victoria. HA and ED incidence rates have increased over the last 14 years. Refocusing on injury prevention countermeasures is recommended along with a clear plan for implementation and evaluation of their effectiveness in reducing injury.