Helmet Head: Head Injuries, Concussions and Riding Helmets

Pick any given date on the calendar and guaranteed there is a made-up occasion to celebrate. National Dog Day, Cupcake Day, Do a Grouch a Favour Day (it’s on February 16th, which is probably a result of Valentine’s Day fallout), even Be a Dork Day. But one that stands out as having a worthy reason for existing is International Helmet Awareness Day. One would think wearing a helmet when riding a horse would be a no-brainer, pun intended, but many riders still choose not to wear one. For some they just never have, others find helmets too hot and heavy, or say they cause headaches, while others think they’re just plain ugly and prefer a cowboy hat or the wind blowing through their hair like they’re on the cover of a romance novel.

International Helmet Awareness Day was created by riders4helmets, a grassroots organization born out of a desire “to educate equestrians on the benefits of wearing a properly fitted and secured, certified helmet.” On its website, the group uses American stats from 2007 that found “78,279 people visited the emergency room as a result of horse riding related injuries. Head injuries comprised about 15 per cent, or 11,759 of these visits.” Three years after these stats were compiled, at least one of those riders nearly lost everything.

It was March 3, 2010 and U.S. Olympic veteran Courtney King Dye was schooling a “very well-behaved six-year-old” when her life was altered forever in seconds. “We were cantering down the long side and he tripped over his own feet and fell,” she explained via email. “My head slammed into the ground. He did nothing naughty.”

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It was an accident that reverberated throughout the dressage community. This was no amateur athlete; King Dye was a Certified Dressage Coach who had represented the U.S. in World Cup events as well as the Olympics. The fall resulted in a Traumatic Brain Injury (TBI). Four weeks in a coma were followed by three months in an in-patient rehabilitation program learning to walk and talk all over again. As she recovered – she is now on the U.S. Para-Olympic Team – riders from all arenas of equestrian sports took notice.

Daisy Kosa, now 30, who owns and operates MJM Riding School Inc, in Hamilton, Ontario as well as Daisy Meadows Equestrian was one of them. “After I turned 18, I pretty much stopped wearing a helmet,” she said, pointing out that when she came of age in the sport many of her mentors didn’t wear them. “Wearing helmets was simply not the norm for dressage riders at the time. I wore a helmet when I jumped, as that was the norm in the jumper ring, but when flatting I rarely wore one.”

After King Dye’s accident the culture of the sport changed. “Now I manage a riding school and teach, and always wear a helmet. I try to make sure to exemplify safe horsemanship at all times to set a good example for my students.”

Indeed, there was a wave throughout the high-performance level of dressage that saw many eschewing traditional top hats for safety helmets. Yet, there are holdouts that refuse to give up the top hat. “I think [top hats] should be banned,” said King Dye, who was a catalyst and is an avid supporter of riders4helmets. “The top level show ring is the most important place to showcase the importance of a helmet. It’s what people watch, it’s what they want to mimic. How better to get the every-day-rider to wear a helmet?”

Of course, it’s not only dressage riders who opt out of safety when riding. Jean Milligan, has been the barn manager at Camelot Farms in Richmond Hill, Ontario for 10 years, prior to working extensively at Thoroughbred racetracks. Personally, she’s competed in the hunter and dressage rings, but also in western pleasure. “On other people’s horses I always wear a helmet, always have,” she said. But when it comes to competing her off-the-track-Thoroughbred, Kemp, in western pleasure, the cowboy culture takes over. “It was always a cowboy hat, that was the trend, unless you’re a youth.” She concedes it does defy logic, adding, “You’re just as liable to fall off a western saddle, and western horses are just as prone to spook.”

Milligan explained that in western pleasure classes you are allowed to wear a safety helmet and are supposed to be judged equally if you choose to, but that from what she’s seen western riders predominately choose making a fashion statement. “It’s always been long, low and slow in the western performance,” she explained. “Riders get a false sense of security because you’re not moving at speed. It’s supposed to be long, low and slow, and with the bigger tack you feel more secure.”

Milligan also pointed out that many riders who enter under saddle hunter classes in the Quarter Horse world still ride in the hunt caps with only an elastic strap under the chin. “It says right on the box, ‘for apparel use only.’” Since she and her horse have reached a certain age, and the fact she’s riding a lot of other people’s horses these days, wearing a helmet has become a good habit for Milligan. “I feel safer wearing it.”

Ralph Fitzgerald has been a farrier for 24 years in the Calgary, Alberta area. While he works on sport horses in multiple disciplines in his job, as a horseman, Fitzgerald competes in team roping. When asked about cowboy culture and helmets, he admitted that it’s not part of the vibe of his sport, or rodeo in general. “I’ve gotten bucked off and come off horses, but [not wearing a helmet] is just a western way of doing things. At the big rodeos it’s mandatory to wear a cowboy hat, even in the bucking horses. Those guys get thrashed and hammered and they never wear one. Bull riders just started introducing helmets into the sport. It’s more common. But none of the saddle broncs or bareback riders wear them.”

The reason for this distinction may lie in the type of injuries more often sustained in riding western performance athletes. Fitzgerald cited facial injuries as being more commonplace than concussions. “You see the odd guy come off, but not many, and if they do, you probably see more broken ribs than head issues,” said Fitzgerald. “You’re not jumping high. When you fall most guys brace themselves and their elbows break their ribs.” He said that the livestock riders wear flak jackets (safety vests), as their biggest concern is being stepped on, whereas the bareback riders wear neck braces. “Historically, you look at how many football players and hockey players deal with concussions, and you don’t see that in old cowboys, they take a lot of abuse, but you never hear about a professional rodeo cowboy with concussion syndrome.” However, he points out that when his children, aged three and six, ride they wear helmets. “Whether it’s cultural or historic or the image of the cowboy who just wants to be tough, that’s just the way it is. You never see trainers wear a helmet either. You look at the speed at how fast a western horse can go, but it’s something you don’t even think about.”

For recreational riders or trail riders, wearing helmets can also seem like an afterthought, but one that can have dire consequences. This past June tragedy struck Rebecca Fentum-Jones, a 22-year-old woman from the Winnipeg area when a horse she was riding stumbled while crossing a road and she fell off and hit her head on the pavement. She wasn’t wearing a helmet and was placed on life support in a coma. According to the CBC, by mid-August she was speaking in a whisper and using a walker to get around. “She usually would wear a helmet, but this time, for whatever reason, she didn’t feel it was necessary,” Fentum-Jones’ boyfriend, Richie Rodgers told CBC News. “It’s something you do a thousand times – it doesn’t seem like a big deal – but all it really takes is just that one instance like this one where a bunch of things went wrong at the same time.”

And you don’t have to be riding to sustain an injury. “Equestrian sports and caring for horses in general (in the barn, vet practices) has a high risk for concussion, head and body trauma (given the velocity of a fall, risk of a horse landing or striking the body, striking the ground, an animal head-butting an individual during grooming etc.),” said Dr. Shannon Bauman, of Concussion North, a sport medicine clinic in Barrie, Ontario. “Yet it is not given the [same] attention as hockey, football, and other contact sports when it comes to concussion prevention, media, recognizing injury and developing a plan for post injury care and return to sport.”

Parachute, a national Canadian charity founded in 2012, promotes researched, evidence-based and expert-advised resources and tools that can help to prevent serious harm or death from preventable injuries. On their website, the statistics are sobering; annually in Canada predictable and preventable injuries result in 16,000 deaths per year and 3.5 million visits to the emergency room. While there are no stats on Canadian equestrian sport related injuries, suffice to say riding ranks up there.

Dr. Bauman, who is on Parachute’s Expert Advisory Committee on Concussion, said she has cared for several horse related/equestrian patients – one who had an associated skull fracture, others who did not suffer a fractured skull, but had significant issues with persistent symptoms: headaches, vestibular (dizziness), whiplash, visual and cognitive effects for months after injury related to trauma. “I think the importance of creating awareness that equestrian and the care of horses can be a mechanism for concussion/TBI, and the importance of a detailed medical assessment after injury to rule out brain bleed, skull fracture and other neurologic and body related co-existing injuries needs to be emphasized,” she explained. “The post injury care of concussion [especially specific to returning to riding] requires a very experienced team with concussion and vestibular and proprioception/balance/spatial awareness, and neck stabilization skills to ensure a safe return to this sport.”

It’s worth noting that helmets can’t prevent all head injuries. Dr. Bauman also pointed out that there is not a concussion-proof helmet. “There has not been a clinical correlation with helmets and proving this statement that a helmet can prevent a concussion. A concussion can come from landing on your tailbone [butt], back, shoulder – not just the head. It can be a whiplash mechanism or a force delivered to the head from another body part.”

Canadian show jumping star Ainsley Vince has suffered three concussions in her career. The most recent occurring in 2015, where, like in the case of King Dye, the horse fell down and she went down with it. She was in a coma for three days, in a wheelchair and a walker before her own grit enabled her to make a full recovery. Vince always wore a helmet, but it wasn’t enough to prevent injury, which reaffirms the fact that riding horses can be a dangerous sport no matter the precautions.

Admitted King Dye, “It’s impossible to know if [my injuries] would have been prevented. Judging by the severity of the damage, the doctors think I would have still sustained a brain injury, but I’m sure the result would have been less devastating.”

Carla Bahr, of Bahr Saddlery, has been selling helmets since 1981. She remembers when the shop was making leather harnesses and riveting them into hunt caps. Personally, Bahr can’t imagine not wearing a helmet. She compares it to driving without a seatbelt. “To me, I get into a car, if I take my seatbelt off, I hyperventilate because I don’t feel safe. If I were still riding I’d feel the same about a helmet.”

Bahr said that for the novice rider, many of whom are children and juniors shopping with their parents for a helmet, safety is the number one priority. But for more experienced and older riders, the choice is often what brand they’ve always worn and how it looks. “The fact that people are purchasing for aesthetics concerns me less now than say, 10 years ago when they could wear an unapproved one,” she said. “Now the helmets we sell all meet or exceed the safety standard so there’s more liberty.”

So, how safe are today’s helmets? David Anderson, owner of Phoenix Performance, the company that makes Tipperary helmets, explained that helmets are tested by a third party – the Safety Equipment Institute (SEI). The SEI is the watchdog that oversees all the testing using certain laboratories in the U.S. that are accredited to the current American Society for Testing and Materials (ASTM), the international standards organization that develops and publishes voluntary technical standards for products and services.

Anderson said that every five years the standard has to be revisited and revalidated, if there’s any member of the board that wants to make changes or present changes it has to brought forward at that time and voted upon by the committee and it must be a persuasive change. According to Anderson, the next round will look at performing a rotational test. “In layman’s terms, currently the testing is for straight angles, a single straight impact. But most often the actual rider hits the ground or surface at an angle so the head rolls and moves within the helmet. That’s what we’re trying to establish – a proper test apparatus for a rotational type test.”

Why has it taken so long for the horse sports to catch up to other sports in terms of head injury prevention? “The equestrian industry hasn’t had new technology in decades; every single helmet has the same technology,” said Anderson. The reason for this is the lack of funding that other sports have to invest in research and development. But that is about to change. “Now the NHL and NFL [are] the dominant sports with head injuries and concussions. There’s millions being poured into new technology and we will be able to piggyback onto this research. So the next few years will be exciting and we will be able to hang our hat on new technology.”

“It’s challenging to put a figure on just how many Canadians suffer from brain injuries,” said Dr. Louis Hugo Francescutti, one of the country’s leading medical experts and educators on injury prevention. “They don’t all present for care, especially the milder it is. The trouble with a brain injury is that you don’t appear to be injured, [but] it is a leading cause of death.”

Back on Track Canada, makers of the first equestrian helmet to utilize multi-directional impact protection system (MIPS) technology, along with Spruce Meadows, other equestrian sports leaders and the emergency medicine community recently announced the creation of a national consortium committed to increasing concussion awareness in the Canadian equine community. The scheduled date for this is in January 2019, and Dr. Francescutti will serve as the keynote speaker.

According to a press release issued by Equestrian Canada, symposium workshop leaders, speakers and panelists are being drawn from a roster of recognized experts in the equine world. The one-day event is designed to equip participants with resources they can take back to their respective horse-riding communities and put into daily use. “We want to provide a toolbox of resources to all Canadian equine organizations, so they can better deal with the critical issue of rider health and wellness,” said Dr. Blaine Bugg, president of the Canadian Pro Rodeo Sports Medicine Team.

“Equestrian Canada is delighted to have been asked to be a part of the continuing conversation surrounding concussion awareness. Although there have been strides made, there is still a lot of work to be done to help athletes and their support teams, in all sports, be armed with the information they need. EC would like to thank the consortium’s founding members for making this Symposium possible,” said Jon Garner, Director of Sport with Equestrian Canada.

The take away from all this? Know the risks, and that wearing a helmet can reduce them. “I’m certainly no one to criticize other people for not wearing a helmet, as I didn’t wear one for 20-odd years. My hope is only that others can learn from my mistake,” King Dye said. “If it doesn’t impact a person that an Olympian who was riding a horse who did nothing naughty – he simply tripped and fell – sustained a completely devastating and life-altering injury, nothing I could say would influence them.”