Equestrian Events
Introduction
Data are sparse, but the risk of injury while riding or working with horses is higher than that in automobile racing, motorcycle riding, football, and skiing and is as the same as that in rugby.
Events
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Olympic: dressage, eventing, show jumping
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Paralympic: dressage
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Racing: flat racing, harness racing, point-to-point racing, steeplechase, thoroughbred horse racing
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Others: combined driving, endurance riding, horseball, reining, tent pegging, vaulting, trail riding, sorting, rodeo
Common Injuries and Medical Problems
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Chest trauma is the most common injury that is evaluated in hospitals.
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Head trauma and concussions are the second most common injuries evaluated in hospitals.
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Eventing witnessed 12 rider deaths in 18 months (2007–2008) and the highest rate of spinal injury.
Rodeo
Introduction
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Rodeo is a competitive sport with participants of all ages and at all competition levels.
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Athletes may compete in a single event or multiple events and may attend anywhere from one to four or five events in a single weekend.
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Most events are derived from skills needed to work cattle.
Epidemiology
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The composite injury rate for professionals is 2.3/100 competitor exposures and for high school competitors is 8.2/1,000 competitor exposures.
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The incidence of catastrophic injury is around 20/100,000, with a fatality rate of 7.29/100,000.
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The highest injury rates are found in roughstock events, with bull riding injury rates 2-fold greater than those in any other major event.
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When compared to the injury rates of all other contact sports, bull riding ranks as the most dangerous.
Events
Roughstock
An 8-second duration is required for a qualified ride; one arm holds on to the animal, while the other is free and is not allowed to contact the animal. The score is based on the performance of the athlete and animal.
Bull riding: The rider hangs onto a rope tied to a bull ( Fig. 100.1A ).
Figure 100.1
Roughstock events.
Saddle bronc: The rider seated in a saddle, holding onto a rope attached to a halter.
Bareback riding: The rider holds on to a rigging attached to a horse’s back ( Fig. 100.1B-C ).
Steer riding: The rider hangs onto a rope tied to the steer (usually an event for younger athletes prior to starting bull riding).
Timed Events
Quickest time wins.
Steer wrestling: While atop a galloping horse, the athlete slides his/her arms onto the neck of a steer and throws it to the ground.
Calf roping: While riding a horse, the athlete ropes a calf, dismounts, and ties three of the four legs together.
Team roping: The header ropes the head of a steer, while the heeler ropes the heels.
Barrel racing: The rider races around three barrels in a cloverleaf pattern.
Steer roping: Similar to calf roping, except with a steer
Goat tying: A youth event similar to calf roping
Breakaway roping: Similar to calf roping, but the calf is not thrown and tied
Pole bending: Riding a horse through six poles in a pre-established pattern
Cutting: The rider separates a single animal from a herd.
Coverage
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Some rodeos are well covered by medical staff and services, but many are not covered at all, or maybe only by an ambulance crew.
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May be difficult to arrange follow-up care as many rodeo athletes travel to multiple sites
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Rodeo athletes pay entrance fees to each rodeo; a withdrawal due to injury results in the loss of money.
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An athlete may request a medical release if unable to perform, but medical personnel cannot prevent an athlete from participating.
Common Injuries and Medical Problems
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Thoracic compression is the most common cause of catastrophic injury.
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Unknown if a rodeo protective vest reduces injury
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Soft tissue contusions, sprains, and strains—most frequently reported injuries
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The true incidence of concussions is unknown as athletes do not usually seek care.
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The head is the most commonly injured area across all ages.
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“Rodeo SCAT” modifies Maddock’s questions to the sport of rodeo.
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Bareback riders experience 46 × g of head acceleration, while bull riders experience 26 × g (football players experience 21–23 × g consistently and may sustain hits of 98–102 × g ).
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Unable to establish impact threshold for concussions regardless of sport; helmet use does appear to reduce incidence of both catastrophic injury and fatality
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Thumb amputations—combination of crush and avulsion mechanisms occurs in roping athletes, with high incidence of infection and failed replantation
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Pectoralis major/latissimus dorsi tendon ruptures—occurs in steer wrestling, and is managed by surgical fixation
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Femoral acetabular impingement—exacerbated in the roughstock riding position
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Methicillin-resistant Staphylococcus aureus (MRSA)—livestock are frequently colonized, and infections can be transmitted in both directions
Horseracing
Introduction
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Horseracing is an immensely popular global sport with television audiences of over 100 million for major events (Melbourne Cup, Kentucky Derby); annual attendance figures are over 5 million in Great Britain alone.
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It is a very exciting and physically demanding sport with high injury rates.
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Career-ending injuries and fatalities are not uncommon.
Epidemiology
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Horses weigh 1,000–1,200 lbs (450–550 kg) and travel at speeds of 20–40 mph (32–64 kph).
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Jockeys are seated approximately 6 ft (183 cm) above ground level.
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The jockey’s head is approximately 8.5 ft (260 cm) above the ground during flat racing (higher when jumping).
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Concussion rates in horseracing are the highest in the recorded literature.
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Flat jockeys fall every 250 rides (concussion rate, 17.1/1,000 participant hours).
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Jump jockeys fall every 16 rides (concussion rate, 25.0/1,000 participant hours).
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Amateur jockeys fall every 8 rides (concussion rate, 95.2/1,000 participant hours).
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In flat racing, 0.41% of rides result in a fall, and 40% of falls result in an injury.
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In jump racing, 6.1% of rides result in a fall, and 17% of falls result in an injury.
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Fatality rates are roughly 460–900/100 million rides. Comparable fatality rates/100 million participant days in other sports are: mountaineering, > 780; air sports, > 640; motor sport, 146; water sports, 67.5; rugby union, 15.7; soccer, 3.8.
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In addition to the trauma caused by falls, the horse can inflict injuries by biting, pulling, kicking, standing, or rolling on the jockey, as well as hitting the rider in the face with a sudden movement of the head.
General Principles
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Horseracing is broadly divided into flat racing and jump racing (sometimes referred to as National Hunt racing).
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Trotting is not included in this review but is very popular with fewer injuries.
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Jockeys can generally start race riding at 16 years of age and are usually referred to as “apprentice jockeys” at the beginning of their careers (usually the first 5 years).
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Jump jockeys retire around 40 years of age, but flat jockeys can continue past 50 years of age.
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Male and female jockeys compete on equal terms. The male:female jockey ratio tends to be closer to 50 : 50 in amateur racing and higher in professional racing.
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Flat racing generally takes place over a 12-month season, whereas jump racing tends to be limited to the winter months when the ground is softer.
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Flat jockey in Great Britain ride in an average of 600 races/year.
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Jump jockeys in Great Britain ride in an average of 300 races/year.
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Flat racing takes place over 0.625–2.75 miles (1–4.4 km).
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Jump racing takes place over 2–4.5 miles (3.2–7.2 km).
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The minimum riding weight varies considerably from country to country. In Great Britain, flat jockeys must weigh at least 112 lbs (51 kg) and jump jockeys must weigh 140 lbs (63.5 kg). This weight must be achieved by the jockey while wearing normal riding clothes, riding boots, and carrying a saddle.
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Jump racing requires horses to jump over either hurdles [3.5 feet high (101 cm)] or steeplechase fences [4.5 feet high (137 cm)].
Safety Equipment
Helmets
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Helmets are designed to attenuate energy on impact through deformation of the helmet, and in particular the inner lining, which is usually constructed from EPS (expanded polystyrene) foam. The prevention of skull fractures and catastrophic injury is the primary aim. To date, no helmet has been proven to prevent concussions, but research is ongoing to develop a tangential impact test with a view to reducing concussions.
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When designing a helmet, the criteria used are:
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Shock absorption
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Penetration of the shell
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Lateral deformation
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Load distribution
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Area of protection
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Retention system strength and effectiveness
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Field of vision
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Weight
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Current helmet standards:
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Helmet standards vary enormously from country to country, and riders wishing to compete outside the US must ensure that their helmets meet the required standards for participation.
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Helmets in the US are required to meet ASTM or SNELL standards. In some situations, other standards may also be acceptable (e.g., the European Standard EN or the Australasian Standard AS/NZ)
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US: ASTM F1163-13 /ASTM F1163-04a/EN 1384:2012/AS/NZ 3838:2006/SNELL E2001
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Safety Vests
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Safety vests are purely designed to reduce chest wall injuries (i.e., rib fractures) and are not capable of preventing spinal injuries. Lightweight vests (Level 1) are licensed for use during race riding only, while heavier vests (Levels 2 and 3) are required while riding out/barrier trials/breeze ups, etc.
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Current safety vest standards:
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As with helmets, safety vest standards vary enormously from country to country, and riders wishing to compete outside the US must ensure that their safety vests meet the required standard for participation. In the US, safety vests are required to meet an ASTM or SNELL standard. In some situations, other standards may also be acceptable (e.g., the European Standard EN or the Australasian Standard AS/NZ).
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US: ASTM F2681-08 /ASTM F1937-04 /EN13158:2000 or 2009/BETA 2009 or BETA 2000 Body Protector Standard
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Goggles
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There are currently no equestrian goggle standards, but high-impact plastic or polycarbonate lenses are recommended to reduce the risk of shattering and eye injury.
Racecourse Medical Cover
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Medical cover at racetracks varies across the globe.
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In almost all countries, a minimum of two ambulances follow the riders. In many countries it is standard to have two doctors at the track also. However in some countries, such as New Zealand and Japan, only paramedics work at the track.
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Diagnostic equipment at the track varies from the very basic to full X-ray scanning facilities in Japan.
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Where medical staff members are deployed, it is important to ensure that they have the appropriate training and qualifications for prehospital care, and that they have access to the necessary emergency equipment and supplies.
Racecourse Safety Arrangements
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Major changes have taken place over the last 10 years with the replacement of cement/steel running rails and railings with flexible plastic to reduce the risk of injury.
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Provision of access to the racing surface has improved with the creation of ambulance roads or the deployment of four wheel vehicles in situations where access is difficult.
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In jump racing, rules are in place to bypass fences if a rider or horse is injured and cannot be moved before the racing horses complete the circuit and return to the site of the accident.
Insurance
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Race riding is a high-risk sport, and insurance can be difficult to arrange. In countries where there is an active Jockeys Association, insurance is usually available for death and disability, career-ending injuries, and private medical care.
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All medical staff must have suitable medical malpractice insurance if they wish to provide medical support on a racecourse.
Race Track Surfaces
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Most racing in Europe takes place on turf during the summer. During the winter months, some racecourses provide an “all-weather” racing surface which is constructed from a mixture of artificial frost resistant materials.
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In the US and Australia, racing also takes place on dirt or cinder tracks.
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The injury rates on turf tracks are similar to those found on all-weather tracks.
Common Injuries and Medical Problems
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Soft tissue injuries: 75%–80%
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Fractures: 10%–18%
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Dislocations: 1%–4%
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Concussions: 8% in professional racing (18% in amateur racing)
Head and Neck
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Concussion
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Cervical spine fracture
Upper Limb
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Fractured clavicle
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Dislocated shoulder
Torso, Back, and Trunk
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Spinal injury
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Ruptured spleen
Hip, Pelvis
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Fractured pelvis
Lower Limb
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Fractured femur
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Fractured tibia and fibula
Career-Ending Injuries
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In Great Britain from 1991 to 2005, there were approximately 1,113,500 rides, 32,445 falls, and 555 injuries. Of these injuries, 45 (8.1%) were career ending (including four fatalities).
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Career-ending injury location distribution: 24.3% torso–pelvis, 22.1% upper limb, 20% head, 17.7% lower limb, 13.3% neck and spinal cord
Summary
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Horse racing is a very high risk activity, and jockeys should wear the highest standard of protective equipment when riding (helmets and safety vests).
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Injuries are common, and medical staff providing cover at racing events must be prepared to deal with fractures, dislocations, concussion, head injuries, and acute spinal trauma.
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All medical staff members must be suitably trained in prehospital care and have the appropriate equipment on site to manage the anticipated trauma. This should include a rapid method of transportation for critically injured jockeys (e.g., a fully equipped paramedic ambulance).
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