In Practice: Managing Rider Injuries

By Niki Gay, MS, SCAT, ATC

The old adage is you aren’t a “real rider” until you’ve fallen off your horse. It is estimated that around 20 percent of equestrians will experience some type of injury each year: that makes a lot of “real riders!” If you and your horse do part company, it is important to know which injuries are probably minor, and which ones are to be taken more seriously. How do you know if you are okay, or if you need medical attention and are done riding for the day? Aside from falls, are there other injuries riders should look out for?

If You Fall

Falling off your horse can be scary. It can cause head, neck, back, and limb injuries. The first thing to do when you fall off is take a second and breathe. Take a moment to check yourself and see what hurts and how badly. If you can’t move without severe pain, have blood pouring from a wound, have a contorted limb of some kind, or have any numbness anywhere, then you should stay still and call for medical assistance. Don’t let anyone move you until 911 arrives. There is no shame in being cautious. 

Can you feel your limbs, wiggle your toes and fingers, breathe without pain? If you did not lose consciousness, your head isn’t pounding, blood isn’t pouring from anywhere, and no limbs are pointing in the wrong direction, you are probably safe to get yourself up slowly. Continue to monitor what hurts as you rise to your feet, and assess yourself from there. Traditionally riders were encouraged to remount and continue to ride after a fall on the theory that if you don’t get “back on the horse” you will be afraid to ride later. However, if anything hurts, and particularly if you have hit your head, you should be done riding for the day. This will give your body the chance to show you any more serious injuries you may have sustained. Not all injuries have instant symptoms. 

Head Injuries

Head injuries and concussions are a very real danger for riders. A 2019 study published in the journal Sports Medicine found that 70 percent of all reported equestrian fall accidents resulted in a head injury, 91 percent of which were concussions. 

A concussion is caused by a forceful motion of the head or other part of the body that results in the rapid movement of the brain within the skull.  Most concussions do not cause loss of consciousness, abbreviated as LOC. In fact, only 10 percent of concussions result in LOC. Concussion symptoms can be immediate, or may or take up to 48 hours to become obvious. This means that if someone had the “mechanism of injury” for a concussion (abbreviated in medical literature as MOI) they should monitor themselves (or if they are a child, have an adult monitor) for any symptoms for two days. 

Most concussions, managed appropriately, resolve in a few weeks, but concussion injuries can be more serious and even cause permanent disabilities. Returning to activity too soon may mean more severe symptoms, and even death. Second Impact Syndrome is a rare but typically fatal injury that can happen if an individual sustains another concussion before the first has healed completely.   

Signs and symptoms of a concussion can include a headache, a feeling of pressure in the head, dizziness, nausea, sensitivity to light or noise, feeling slowed down, having difficulty concentrating, feeling anxious, frustrated, and having difficulty sleeping.  If you have had the MOI for a concussion, it is recommended that you remove yourself from any type of physical activity for at least the remainder of the day. If you have even one symptom, you should assume you are suffering from a concussion and need to rest and follow up with your physician for further care.  

Some symptoms are considered red flags and require immediate attention and a call to 911.  These are repeated vomiting, convulsions or seizures, loss of consciousness, one pupil larger than the other, an inability to wake up, a headache that gets worse or is unbearable, slurred speech, weakness, decreased coordination, or behavior that is unusual for the injured person. It is always best to err on the side of caution and call 911. After all, you only have one head.

Bones and Joints

What if your head seems okay but you have a bone or joint that is very sore or swollen? If you don’t have full use of any of your joints, it is recommended that you end your ride and get your injury evaluated by a physician. You do not generally need to go directly to the emergency room unless your pain is severe or the bone or joint is obviously displaced. If it is simply swollen and tender, you can use the “Rest-Ice-Compression-Elevation” (RICE) method for immediate care and get to the local urgent care or call your doctor the next day if you are not better. Ice the injured area for 15-20 minutes every hour, apply a compression bandage to control swelling, and elevate the limb above your heart as much as possible.  Once you’ve seen a medical professional for proper evaluation, follow their guidance for returning to riding. Going back too early can cause further damage and keep you from getting back to what you enjoy. 

Too Much Sun

Heat injuries are also a risk for riders, especially in the Carolinas in the hotter months. Heat exhaustion symptoms include confusion, dizziness, fatigue, fainting, dark colored urine, headaches, muscle cramping, profuse sweating, nausea, and rapid heartbeat.  If you have any symptoms of heat exhaustion you need to be done riding for the day, go somewhere cool, rehydrate, and get some general nutrition.  

Heat stroke is much more severe than heat exhaustion and is a medical emergency.  A person suffering from heat stroke has a core body temperature of over 104 degrees Fahrenheit.  At this point, the body’s temperature control system fails.  Symptoms of heat stroke include a throbbing headache, a lack of sweating, muscle cramping, dizziness and light headedness, nausea and vomiting, rapid and shallow breaths, seizures, and unconsciousness.  Treatment requires calling 911 and immediate cooling: an ice bath is ideal. If this isn’t immediately possible, reach for the water hose and sit in front of a fan. Adding ice packs to the neck, groin, back and armpits can also help lower the body temperature. 

For heat injury, prevention is key.  Drink at least half your body weight in ounces every day –  a 140 pound person should drink at least 70 ounces, about nine cups. Make sure you are drinking before your ride, during your ride if you can, and definitely after you get off.  Follow a healthy, balanced diet. Plan to ride in the cooler parts of the day and make sure you are getting the proper amount of sleep because sleep deprivation can make you more susceptible to heat stress. Wear light-colored, lightweight clothing and wide brimmed hats when riding. Monitor your urine output: If your urine is darker than a light lemonade, you are dehydrated!  Heat illnesses are scary but completely preventable if you take care of yourself.

Niki Gay, MS, SCAT, ATC is a Certified Athletic Trainer based at Prisma Health Orthopedics in Columbia, SC.

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