Concussion

Head injury is a particular risk for horse riders. They may fall, be thrown to the ground and kicked. Wearing a protective helmet is strongly recommended, a legal requirement for children under 14 years old on roads and mandatory for riders under competition rules for most equestrian sports. As with all protective wear helmets reduce the risk of injury but cannot remove it entirely.

Concussion is a condition in which the brain’s function is impaired after impact without any structural changes that show up on the type of head scans that are currently routine. The full medical definition for concussion is more detailed and has been reviewed and modified in recent years. It’s important to diagnose concussion so that in simple terms the individual can be protected from themselves until they have recovered. Such protection involves avoiding further head injury – so not riding again - rest and avoidance of activity in which they may put themselves and others at some risk (for example driving a car or making important decisions). It may have been under-diagnosed in the past.

Concussion's effects are usually temporary lasting hours or days; though sometimes weeks or longer. It is not always associated with initial loss of consciousness. It may occur even without a direct blow to the head. If the body suffers a severe impact then some of the force will be transmitted to the brain.

In recent years doctors expert in brain injury have become more concerned about the potential for lasting or cumulative injury to the brain from repeated concussion. It is strongly recommended that a concussed person should minimise the risk of further blows to the head until they have recovered fully. This is why riders are suspended from competition.

The signs and symptoms of concussion can be quite
subtle. These are outlined in a statement issued by an international panel of experts in 2008 as:
(a) symptoms: somatic (e.g. headache), cognitive (e.g. feeling
like in a fog) and/or emotional symptoms (e.g. lability)
(b) physical signs (e.g. loss of consciousness, amnesia)
(c) behavioral changes (e.g. irritablity)
(d) cognitive impairment (e.g. slowed reaction times)
(e) sleep disturbance (e.g. drowsiness).
Any one of these can indicate concussion.

Many sports have adopted testing procedures for concussion as a result including football and rugby. All coaches in these sports are guided about recognising concussion and suspending competitors suffering from its effects. Riders competing under rules in sports such as eventing, racing and pony club activities will be checked after falls for concussion.

Most falls occur away from competitions and it is important for any rider who suffers a blow to the head to be aware of the possibility of concussion and to seek advice from a doctor if they feel unwell.

Severe head injuries do not always cause an immediate loss of consciousness. In some cases bleeding inside the skull or swelling of the brain builds up pressure after the initial injury. This is why any deterioration in symptoms or signs after someone experiences a blow to their head should prompt urgent medical assessment. At equestrian competitions the medical team will provide ‘head injury instructions’. These include a list of symptoms that should prompt urgent medical review (go to Emergency department or call 999). The same applies to riders who have experienced a severe blow to the head in any circumstances. If in doubt, go to the Emergency Department.

•     unconsciousness, or lack of full consciousness (for example, problems keeping eyes open)
•     any confusion (not knowing where you are, getting things muddled up)
•     any drowsiness (feeling sleepy) that goes on for longer than 1 hour when you would normally be wide awake
•     any problems understanding or speaking
•     any loss of balance or problems walking
•     any weakness in one or both arms or legs
•     any problems with your eyesight
•     very painful headache that won’t go away
•     any vomiting – getting sick
•     any fits (collapsing or passing out suddenly)
•     clear fluid coming out of your ear or nose
•     bleeding from one or both ears
•     new deafness in one or both ears