Banged your head lately?

Head injuries are often incurred in equestrian sports. It is good to see work being done to improve how these are managed when they happen.

It is good to see that both the New Zealand Pony Club Association and Equestrian Sports NZ are starting to tackle issue of the head injuries in our sport and this initiative is being well received in the equestrian community.

In 2013 Accident Compensation Commission (ACC) estimated there are at least 35,000 head injuries in New Zealand per year and  21% of these are sustained through sport, most frequently during rugby, cycling and equestrian activities. Those who follow rugby will know that stringent requirements mean players are taken back to the changing rooms for further assessment and stood down for some time after any head injury.

Horse riders are a tough lot, and for many years it has been part of our culture to try to get back on the horse as soon as we can after a fall. Perhaps this stems from all those tales of this being the best way of retaining our confidence, or educating the horse. There are many examples of parents encouraging, or even forcing their child to get back on should they make an unplanned dismount. There are also many examples of riders being particularly belligerent after a fall (one of the symptoms of concussion), insisting and being allowed to get back on and continue jumping when clearly they are not right.

Concussion doesn’t only occur when you have a hit to the head. You can incur a brain injury simply from the impact of landing, even if your head hasn’t come into contact with something solid.

Both short- and, more importantly, long-term effects of concussion are serious. Recent medical research is starting to link repeated head injuries with depression, memory loss, behavioural and personality changes, Parkinsonism, paranoia, poor insight and judgment, aggression, apathy, confusion and reduced concentration.

Warren James, the Chair of ESNZ’s Technical Committee summarised the recent meeting where this was discussed. The full report is on ESNZ’s website.

 At this meeting, Dr Phil White, medical officer for New Zealand Thoroughbred Racing, talked about how the racing industry is improving the way concussion and head injuries are managed. Working with racing stewards and jockeys, assessment tools have been established to help officials and first aid officers diagnose concussion onsite. Protocols have been drawn up to manage such concussions so the jockeys can continue their profession as soon as is safe and practical. The diagnosis method is simple and is considered accurate to a high enough degree that removal of an affected rider is justified. It looks as if the racing industry and ESNZ are going to continue working together on this.
The NZ Pony Club Association has scheduled time at its forthcoming conference for a discussion about how clubs can best manage concussion incidents. While there is a general regulation that states a rider must not compete or participate in mounted Pony Club events or activities for a minimum of 21 days following a concussion without a doctor’s written clearance, General Manager Samantha Jones confirmed that they would like to strengthen this and see improvements in how it is managed.
These initiatives have been well received by many riders, including those who have experienced the consequences of concussion first-hand. They include Carissa McCall who has had a very rough time of it lately. She has given us permission to use excerpts from her Facebook post here – she makes strong and powerful statements. We have condensed this somewhat, but good on Carissa for making this public.
Carissa McCall and Esteban MVNZ, competing at top level in show jumping (Image: Take the Moment)

“So happy to see ESNZ looking into concussion issues and how to diagnose to be able to stop riders competing with concussion! As many of you know, I had a bad head injury. We now think I actually did this much earlier than we’d thought. In fact, we believe it happened a whole month before I ended up in hospital. In that month, there were many times in relation to a jump that where I thought I was, and where I actually was, were completely different. I’m not the most accurate rider, but I know when I make a mistake. But I swore black and blue… and then to see a video after was even more confusing.

“What I didn’t realise then is that concussions aren’t always a huge head-knock. The go-stop of a fall can do it. Concussions can alter depth perception (I had no idea!!). Concussions can alter balance.

“My last fall, it was obvious after the fact, when people talked, I was clearly concussed. In fact, my last words before my fall were that I couldn’t remember the course. I then tried to do two strides less in a line from 1 to 2 than we had planned. I’m very, very lucky I didn’t hit my head harder that day.

“Because I then had five falls in a month, making it worse each time, it has taken a lot of time for recovery. I work with a neuro-physio every week, concentrating on eye movements, depth perception, focusing and balance. Next week I go to a behavioural optometrist to make sure we are on the right track, and may end up with glasses with a prism in one eye as they are not always working together.

“I still have days where I’m exhausted from not doing a lot. When I got the okay to ride, riding did this too. It was exhausting. I am not allowed to ride when I’m tired even now – five months down the track.

“At this point, though, riding is helping my recovery. Poles and small jumps are great for focusing with my eyes. My improvement has been huge since I’ve started back riding. But it will take a while again before I’m normal.

“My point of this post is, if the rule comes in that riders have to be checked after a fall, please don’t complain. This really is for our safety!! Rugby players all have to do the same now!!!

“I have had many major injuries over the years and this has been by far the hardest. I don’t even know how to explain how life-changing this has been. If I had been checked (I thought my headaches were from my back like they often are), I most likely would have only needed a few weeks’ stand-down and been completely fine! I’m lucky now I have great people I’m working with and I’ll be back better than ever. Hopefully with a better eye than I had – haha – got to be some bonus for all this eye training I’m doing.

And thank you ESNZ for taking this seriously.”

There have been many words of encouragement from other riders to Carissa, with hundreds of comments. Carissa was also quick to point out that what happened to her is absolutely no-one’s fault, not any show and not ESNZ. “In fact, if anyone’s fault, it’s my own for not realising. But that’s why I am so happy that this is coming into place, as I would have been made to get checked! More awareness means more people may realise too and watch out more for others if they don’t seem right.”

Riders responding to Carissa’s post are generally very much in favour of NZPCA and ESNZ taking a hard stance on checks after falls, mainly on the basis of the importance of educating parents and riders to understand it is better to stand down from riding for a few weeks than risk ongoing cumulative effects of repeated concussions. Friends and family are in the best position to notice that things are not right with riders after a fall. While raising awareness is important so that further preventative action can be taken, having a good policy and process in place will certainly be a step forward.

Philippa Howells, who works as a health and safety consultant, says she has been concerned about this issue for a while. “I have had many concussions throughout my riding career – one particular (48 hours delayed) one 10 years ago has had long-lasting effects. The work and research that people like Elizabeth Charleston have done, along with watching the movie Concussion, really has made me more aware of the effects it can have on us. I have seen many riders, and I’m guilty myself, push on as if all is okay – putting the chance to compete ahead of our own health. Concussion doesn’t have to be a ‘big’ bang to the head; in fact, it can be just a case of the brain having a shake. The sudden braking in a vehicle can even cause this.

“We all need to take responsibility here too, and if we have had a knock to the head, then don’t put the competition ahead of our own health – get checked out. There is always another show. Also, competing when we aren’t 100% fit is not fair to the event organisers and officials, especially if they have to ‘pick up the pieces’ after we have had ‘that fall’. With Health & Safety today, we all need to take responsibility – its everyone’s concern.”

Some important information is available from ACC on this link which is well worth reading.

We look forward to further developments in how head injuries and concussion are managed in our sport. Of course we can’t let the opportunity go by without reminding everyone (again) of the importance of wearing a helmet!