Injury Rehabilitation Underutilized by Equestrians, Researchers Say

You're a horse owner. You can effortlessly throw hay bales into the loft, halter break weanlings, pound fence posts, and handle a fractious stud--all before breakfast. You eschew wimpy "city folk" things like sunscreen, tetanus shots, and annual wellness exams. You fall off, you get back on. Yeah, you're tough. We get it.

But when it comes to rehabilitation from major horse-related injuries, researchers have one request: knock it off and listen to the nice doctors.

Doctors at Foothills Medical Centre in Calgary, Alberta, reviewed the records of patients over 16 years of age that were admitted to the Level 1 trauma center from 1995 to 2005. Of 7,941 trauma patients, 151 (2%) were injured while participating in an equestrian activity. Head, chest, and abdominal injuries were the most common in this group. A report on the injury portion of the study was released in 2007.

Now the researchers have shifted their focus to the long-term effects of major equestrian injuries by following up with 78 of the 141 surviving injured equestrians, 55% of whom had chronic physical difficulties following their accidents. Of these respondents, 38 (49%) underwent rehabilitation therapy in the course of their recoveries while admitted to the hospital.

The authors defined rehabilitation as "the act of restoring a patient to a condition of good health, such as the ability to work. For the severely injured equestrian population, this involves helping riders regain their physical independence and safety in everyday activities."

Researcher Jill Ball, BHScOT, explained, "The majority of riders unfortunately experience chronic physical difficulties after a major horse-related injury. Therefore, injuries may need some 'help' along the way to ensure maximum recovery."

A rehabilitation therapy team assists patients in regaining skills and abilities lost as a result of injury, along with aiming to prevent or minimize long-term disability. These therapy providers might include physiatrists (medical doctors specializing in physical medicine and rehabilitation), occupational therapists, physical therapists, and speech therapists, as well as various assistants.


"(Equestrians) often regarded injury as just part of the risk involved with being around horses, so they were less likely to ask for, or accept, help when it was offered."
-Dr. Jill Ball

Of the study respondents who underwent therapy, 46% underwent physical and 18% underwent occupational therapy. Victims most likely to undergo therapy were those who sustained severe injuries to an extremity (73% of those in therapy), had pelvic (80%) and spinal fractures (70%), and spinal cord trauma (100%).

Those who had sustained injuries from horseback riding (47% of the study population) prior to the current injuries were less likely to receive therapy.

"This is likely a result of riders sustaining previous injuries, perhaps not as severe, and recovering fully from them on their own," Ball explained. "This reinforced to riders the belief they could recover at their own pace, on their own time. However, the types of injuries sustained in the riding population that we contacted included major trauma. With these more severe injuries, chronic physical difficulties are more likely to result, and would therefore benefit from therapy early on in the recovery process.

"Our respondents often commented that they had been riding for years, they had been thrown or stepped on before, and that they just got back on their horses again," Ball said. "They often regarded injury as just part of the risk involved with being around horses, so they were less likely to ask for, or accept, help when it was offered."

In reviewing the data, the researchers communicated that the equestrian--particularly the Western-riding--culture of self-reliance necessitates a change in tactics for individuals working with these patients. They found that an emphasis on the benefits of rehabilitation therapy while the patient was hospitalized brought results--25% of patients willingly sought out further assistance as outpatients.

The researchers recommended that individuals treating equestrians with severe injuries emphasize the need for rehabilitation to reduce long-term impairment. They should also discuss potential functional deficits (such as balance deficits, upper extremity weakness, chronic pain, headaches, limited use of hands and arms, and psychosocial challenges) with the physicians treating these patients.

"Horseback riding is an inherently risky activity," Ball said. "However, it is also an incredibly rewarding, enjoyable activity that people will continue to enjoy. It is our hope that through sharing the experiences of injury and recovery, other riders may be able to prevent some accidents from happening. Or, if they do sustain a horse-related injury, they will utilize the rehabilitation services offered to them during their recovery to ensure they achieve their maximum recovery possible."

In short, following the doctor's--and rehab team's--orders really is the best way to get back in the saddle following a major horse-related injury.

The study, "Ten years of major equestrian injury: are we addressing functional outcomes?" was published in February in the Journal of Trauma Management & Outcomes. Authors included Jill Ball, BHScOT; Chad Ball, MD, MSc; Robert H. Mulloy, MD, FRCSC; Indraneel Datta, MD; and Andrew W. Kirkpatrick, MD, FRCSC, FACS. The study is available online.  

About the Author

Erin Ryder

Erin Ryder is a former news editor of The Horse: Your Guide To Equine Health Care.

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