The US Equestrian Federation has developed a Return to Sport Concussion Strategy for equestrians who have suffered from a concussion (or apparent concussion) to offer best practices for resuming riding and equestrian-related activities. Please note, these strategies are recommendations only and are not intended to provide or replace advice from a person’s own medical provider. Individual decisions regarding return of an injured person to practice and competition will depend on the specific facts and circumstances presenting to the person’s treating medical provider. 

The Return to Sport Concussion Strategy provides information for parents, guardians, trainers, friends and barn mates of anyone suffering from an apparent concussion to help with monitoring their health and behavior following a fall or accident. Often it is those people who know the equestrian the best that can detect differences in behavior that could be signs of a concussion. These strategies are based on the International Consensus Statement on Concussion in Sport and align with the United States Olympic and Paralympic Committee recommendations.
“Concussion is a potentially significant issue for all equestrians and The Return to Sport Concussion Strategy aims to ensure that anyone suffering from a concussion has the best possible outcome,” said Dr. Mark Hart, USEF Human and Equine Safety & Welfare Committee Chair.

It is essential to note that not all concussions are apparent at the time of injury. Early evaluation by an EMT or an emergency room evaluation with imaging scans may not detect a concussion, therefore, “it's important that people pay attention to the signs and symptoms of a concussion for 24 to 48 hours after an accident or fall,” Dr. Hart said. Additionally, “the extent of impact suffered does not always correlate with the potential severity of a concussion and how long the symptoms can persist. Anybody suspected of having a concussion should be treated as if they did have a concussion because of the potential health consequences of not doing so.”

“This equestrian-specific concussion strategy does not aim to replace any of their own medical providers’ recommendations, but rather provide our equestrians with additional information to get the most up to date concussion care,” Dr. Hart added. 

Here are the signs and symptoms of an apparent concussion that equestrians should look for in themselves or an injured person following an incident: 

Signs of Concussion (observable by others) 

• Changes in behavior, thinking, physical functioning 
• Slower processing speed, inability to complete tasks normally 
• Unable to remember directions/instructions as usual 
• Decreased balance and/or spatial awareness 

Symptoms of Concussion (reportable by injured athlete) 

• Headache 
• Dizziness 
• Mental clouding, confusion, feeling slowed down 
• Visual problems 
• Nausea, vomiting 
• Tiredness 
• Drowsiness, feeling “in a fog,” difficult to concentrate 
• Pressure in the head 
• Sensitivity to light or noise

The following more serious, “red flag” symptoms require immediate medical attention:

• Severe or worsening headache 
• Weakness or numbness in arms or legs 
• Nausea or vomiting 
• Slurred speech 
• Neck pain or tenderness 
• Loss (or partial loss) of vision or double vision 
• Drowsiness or inability to wake up
• Seizure activity or convulsions 
• Loss of consciousness or deteriorating awareness (going in and out of consciousness) 
• Increasing confusion 
• Increasing agitation, combative, or change in behavior
• Visible deformity of the skull or helmet

Call 911 immediately if there is a concern that an equestrian has suffered a more severe head injury or a spinal injury. 

Equestrian-Specific Return to Sport (RTS) Strategy 

Once a concussion has been diagnosed and treated, the equestrian   under guidance of their own medical provider   can refer to the Equestrian RTS strategy to ensure complete recovery prior to returning to competition.

Taking the time to fully recover “is quicker and safer than trying to battle through it and having setbacks from not following the proper kind of post-concussion care,” Dr. Hart said. He warned that some people begin to feel better after a concussion and go back to full activity too quickly, but then suffer from dizzy spells, headaches and poor concentration, and keep repeating the cycle for weeks. Dr. Hart said that more serious, long-term symptoms occur most often following multiple concussions over time. The sooner you have a second concussion following an initial concussion, the higher the risk of having a more serious and prolonged second head injury, he said.

USEF has developed an equestrian-specific, six-step RTS strategy that is recommended for anyone returning to equestrian sport – in the saddle, on the ground or driving – after a concussion. Each step should be separated by at least one to two days. Before Stage 3 (the integration of equestrian activities), the athlete should be free of concussion symptoms, including symptom-free integration of all prior cognitive activities, such as baseline school and work duties. If the athlete experiences new or recurring concussion symptoms, they should pause the progression, wait for symptoms to stop, then restart at the previous symptom-free stage a following day.

Stage 1: Initial Recovery

• Begins after apparent concussion
• No sporting activities
• Limit screen time
• Symptom limited physical and brain rest
   

Stage 2: Light physical activity (can begin two days after concussion event if no red flag symptoms or signs occurred)

• No strength training or high intensity activities
• Activities should be without risk of falling or hitting the head. No horse riding or driving related activities. Can include light activities such as walking, stationary bike, stretching exercises of 5-20 minutes duration
• Goal is to increase heart rate with light activity without increasing concussion symptoms
• Gradual reintroduction of work/school activities as tolerated
• Monitor for mild or brief exacerbation of symptoms associated with activity, with an increase of no more than 2 points, on a 0–10-point scale, when compared to the baseline value reported prior to the start of activity. If more than a mild >2/10 exacerbation of symptoms occurs, the athlete should stop and wait until
• the following day to resume activity
   

Stage 3: Unmounted equestrian discipline specific exercises 

• Activities should be without risk of falling or hitting the head which can include light to moderately intense aerobic and strength activities including brisk walking, light jogging, and swimming as tolerated
• Wear a helmet at all times when in contact with a horse for grooming or barn chores
   

Stage 4: Return to light equestrian discipline-specific riding or activities such as driving 

• Continue wearing a helmet at all times when in contact with a horse on the ground, when mounted on a horse or while seated in a cart
• Start with short duration (10-15 min) walking on horseback or in a driving cart on large circles or straight lines and gradually add in halt transitions and direction changes as tolerated. Consider riding or driving the horse on a lead line initially with a trainer and selecting a quiet, safe location such as an arena on a quiet horse
• No unsupervised riding or driving
• The athlete can incorporate posting trot or trot and jog transitions and add in smaller circles, patterns and direction changes, as tolerated 
• No jumping or obstacles
   

Stage 5: Full practice

• The equestrian can incrementally increase complexity and aerobic challenges of riding as tolerated adding canter transitions, ground poles, individual jumps and obstacles progressing in height gradually over the course of days to weeks as tolerated. Continue wearing a helmet at all times 
• All horse-specific activities should be under observation by appropriately trained personnel
• Increase equestrian specific demands to the level of the athlete and prior intensity and duration of equestrian-specific activities to determine if there are any persisting concussion signs or symptoms

 

Stage 6: Return to competitive equestrian specific discipline

• Goal of full participation in equestrian practice without restriction and without any concussion related symptoms prior to return to competition. Continue wearing a helmet at all times 

 

USEF Rules Regarding Concussions

The USEF recognizes that horse sports are unique, and there is a strong desire to get back to riding or competition when you think you have fully recovered. It is important to be mindful of your recovery as you return to mounted activity. Any equestrian suspected of suffering from a concussion at a USEF-licensed competition will not be able to compete again until they receive medical clearance. They must then have a Return to Competition Medical Release Form completed by their medical provider and submitted to USEF before returning to competition. Details of Rule GR848.6 Return to Competition can be found here.

The USEF Network has a Learning Center video on the signs and symptoms of concussions and overall helmet safety, which can be found here. It is recommended that a helmet is replaced after any significant impact as that compromises their protective ability after an accident even if they don’t appear damaged.

For more information, please visit the Concussion Safety section of the USEF website and review Concussion Recognition, Know the Signs and the Equestrian-Specific Return-to-Sport (RTS) Strategy.