“How many helmets have you had to replace?”
It’s a common, inside-baseball question among competitive equestrians. Because—let’s face it—most, if not all, of us have suffered falls and blows to the head at various points in our horse-riding careers.
Whether you were diagnosed with a concussion at the time of your accident or not, universally accepted safety protocols, including those recommended by US Equestrian, dictate that you should replace your helmet after a fall, kick, or other impact to the head.
And while we all know Samshields don’t grow on trees, it’s advice that’s supported by both research and good common sense.
According to the numbers, one-half of all riders will sustain one or more concussions during their careers, a rate that places the equestrian concussion risk higher than high-contact sports including rugby and football. (It’s okay, you can read that again.)
That’s a scary statistic, and a good reason to replace that helmet, to be sure. Here’s another unsettlingly fact: concussions protocols are not designed for the female majority in horse sport.
“Gender is critically overlooked when examining the issue of concussions in sports,” writes #WeRideTogether Program Manager, Annelise Ware, MHS, in her recent blog “Bridging the Concussion Gap.”
“Despite growing evidence that concussions impact women differently (and often more severely) than men, concussion protocols and recovery programs often don’t take these gender differences into account. This is because concussion research overall lacks female participants.”
That’s important, she continues, because concussions cannot be treated properly if they don’t incorporate gender-specific differences into recovery plans.
A ‘Minor’ Myth
Not-so-fun fact: Seven out of 10 sports-related concussions reported to emergency rooms are suffered by kids younger than 17. And while the “dust yourself off” mentality has always been present in youth sports, including (and especially) equestrian, there’s no such thing as a “minor” concussion. That’s one of several common misconceptions.
Another is that all concussions will result in a loss of consciousness, or even present the same way. Symptoms could include headaches and memory loss, head shaking, and nausea—but not always. Others might present with sensory disturbances, such as a loss of sound or smell.
And while it can be hard to find a rider that hasn’t suffered some kind of head trauma (including whiplash) in their career, horse sports, by and large, have been historically slow to come to the concussion-awareness table.
Dressage top hats, for example, weren’t officially replaced by helmets in FEI competition until 2021—nearly a decade after the five-star career-ending injury suffered by American Olympian Courtney King-Dye in 2010. King-Dye wasn’t wearing a helmet, and her injury was considered a watershed moment for many in the U.S. equestrian industry at the time. Western and more niche disciplines, like ski-joring, have been even slower to adopt helmets.
Over the last two decades, approved helmets have become a ubiquitous piece of equestrian equipment across all Olympic disciplines. That’s a good thing, because the impetus for wearing one has certainly held up.
While 60% of horse-related deaths are caused by head injuries, according to the Medical Examiner, helmets can reduce this possibility by 70% to 80%. What’s more, since ASTM/SEI approved helmets were mandated by USEF in the aughts, the American Medical Equestrian Association estimates they have reduced all riding-related head injuries by 30%, and severe head injuries by 50%.
That’s a positive development, given that we now understand much more about the risk that concussions, and especially multiple concussions, can present to long-term health. Less than three years ago, the National Institutes of Health (NIH) officially acknowledged that chronic traumatic encephalopathy (CTE) is caused by repetitive traumatic brain injuries.
This neurodegenerative disease can lead to behavior and mood problems and may progress into dementia. (Deceased New England Patriots tight end Aaron Hernandez is a prominent example). It’s also more prevalent than we thought. Two years ago, Boston University announced it had diagnosed nearly 92% of the former NFL brains in its study with CTE.
And while the data has yet to exist for a comparable study of equestrian athletes, there are other reasons to be concerned as a woman in this inherently high-risk sport.
Women Are From Venus
Not only is equestrian one of the few sports where men and women compete as equals, women make up about 80% of the total participants. When it comes to concussions, that’s significant—especially when you consider that the rate of concussions among all female athletes has tripled in the last two decades.
One reason for this jump is likely due to positive societal changes: more concussions are now being reported, and more women are participating in sports than ever before. Yet while public awareness has helped to move the needle forward, female athletes still lag behind when it comes to receiving the treatment and protection they need.
A primary reason is that women don’t suffer concussions the same way that their male counterparts do. On average, they take twice as long to recover as men, and also report experiencing more severe symptoms.
Part of this is physiological, writes Ware; women having thinner skulls and smaller neck muscles than men. But there are also less-obvious hormonal differences, with certain neuroprotective factors, such as progesterone, fluctuating throughout a women’s hormonal cycle.
That means if a female rider’s progesterone levels are low at the time she falls off a horse, it could impact her ability to recover from the resulting concussion.
Even in the best-case scenario, research has shown that women are typically at a greater disadvantage after concussions. They report negative mental health symptoms at a higher rate than men do; the same goes for things like verbal and visual memory, reaction time, and concentration problems.
Are there ways to help mitigate pre- and post-concussion protocols in order to better suit the needs of female athletes, including equestrians? Probably. But the problem starts with the science.
An Uneven Playing Field
More female athletes are participating in sports today than there were 50 years ago. Even still, the vast majority of physical concussion research, resources, and safety measures continue to focus on male-dominated sports such as football, hockey, and soccer.
A closer look at the research that guides decision-making for concussion protocols also raises red flags. In 2022, the British Journal of Sports Medicine found that of the 171 studies cited in three papers that guide clinical care on sport-related concussions, roughly 80% of the participants were male. In fact, as many as 40% of these studies had no female participants at all.
“When scientific studies don’t include female athletes, we are not able to adequately treat them since we are not taking biological differences into account,” writes Ware, in “Bridging the Concussion Gap.”
“Sporting organizations are using science to create policies and protocols to protect these athletes, but that science isn’t representative of the majority of their athletes.”
As a co-ed, concussion-risk sport dominated by women, equestrian and its governing bodies are well poised to change the status quo. Concussion safety protocols for things like replacing helmets and returning to sport are great cursory steps. But the work is far from over.
By advocating for concussion research, prevention, and recovery plans that take gender-specific differences into account, equestrian can and should lead the charge to make their sport safer for all riders.
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