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  • What is the awareness of concussion in adult horse riders, and what are typical attitudes and behaviours?

    Concussion is classed as a mild form of traumatic brain injury (TBI) and can lead to significant and prolonged symptoms, even after a ‘mild’ injury. Equestrian sports, along with cycling and rugby are associated with high TBI risks1. Where awareness of concussion is low, there can be early return to sporting activity and poor management of the condition. This can affect recovery and increase the risk of further injury. Equestrian activities are associated with TBIs occurring while riding and when working around horses. While the use of riding helmets is required in competitive disciplines, many injuries occur during leisure riding activities.

    A study recently examined the knowledge of concussion and attitudes and behaviours towards concussion in New Zealand adult horse riders. The survey included questions about the use riding helmets. An online survey was completed by 1486 participants with a mean age of 39.1 (¬+ 15.4) years old. Most respondents identified as female (91.6%). Those completing the survey included coaches/trainers (n = 303; 20.4%), leisure (non-competitive) riders (n = 196; 13.2%), and competitive riders competing at local (n = 427; 28.7%), regional (n = 251; 26.9%) or national level (n = 441; 29.6%).

    More than 80% of respondents were aware of what concussion was, the symptoms of concussion and how to recognise it. Females demonstrated higher levels of concussion-related knowledge than males (t = -6.55, P < 0.001; 95% CI = -3.26 to -1.75). Awareness of guidelines relating to concussion was moderate (56%) and only 12% of survey respondents were aware that the use of riding helmets would not prevent concussion. Interestingly, 87% of participants recognised that a riding helmet should be replaced following a fall, although a large number reported the re-use of riding helmets following a head impact (46%). 10.3% of participants noted that they would return to riding sooner than medically recommended after a concussion incident. The majority reported wearing a helmet while riding, with 10% reporting choosing not to wear a helmet. Helmet wearing while working around horses on the ground ranged from very low to moderate (6-24%), based on the task undertaken – hoof picking, lunging, groundwork. One third (n = 527; 35.5%) reported being taught how to fall to reduce injury risk.

    The study results reveal that while there is a good level of knowledge regarding concussion, there are inconsistencies between attitudes and behaviour. There is also a lack of awareness of some concussion symptoms (such as disturbed sleep). This suggests that enhanced education about the symptoms and effects of concussion is warranted, including clear guidance on returning to activities. Additional information relating to the the use of riding helmets, and their replacement following falls is required, to further reduce rider injury risk.


    1. Theadom A, Starkey NJ, Dowell T, Hume PA, Kahan M, McPherson K, Feigin V; BIONIC Research Group. Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport. 2014 Nov;17(6):591-6. doi: 10.1016/j.jsams.2014.02.001. Epub 2014 Feb 9. PMID: 24602688.

    2. Theadom A, Reid D, Hardaker N, Lough J, Hume PA. Concussion knowledge, attitudes and behaviour in equestrian athletes. J Sci Med Sport. 2020 Nov;23(11):1055-1061. doi: 10.1016/j.jsams.2020.05.008

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