Helmets and injuries - some studies (LONG!)
 
 

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Helmets and injuries - some studies (LONG!)

This is a discussion on Helmets and injuries - some studies (LONG!) within the Horse Riding forums, part of the Riding Horses category
  • Is a horse riding helmet from 1991 still safe
  • Argunents against riding on a horses with a helment on

 
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    03-19-2011, 12:23 PM
  #1
Trained
Helmets and injuries - some studies (LONG!)

I wear a helmet when I ride. I'm in my 50s, wear bifocals, am a bit overweight and look like a dork because I'm an awkward rider. I'm not much worried about how I look, being cool or social acceptance. That said, lots of the helmet threads are kind of thin on facts. So below you'll find some stuff I found on the Internet about the risks of riding. I only found one study addressing how helmets impact safety and I underlined it.

Horseback Riding

While head injuries comprise about 18 percent of all horseback riding injuries, they are the number one reason for hospital admission. A 2007 study by the Centers for Disease Control and Prevention found that horseback riding resulted in 11.7 percent of all traumatic brain injuries in recreational sports from 2001 to 2005, the highest of any athletic activity. Of the estimated 14,446 horseback-related head injuries treated in 2009, 3,798 were serious enough to require hospitalization. There were an estimated 4,958 concussions and 97 skull fractures. Subdural hematomas and brain hemorrhages comprised many of the serious injuries. According to the Equestrian Medical Safety Association, head injuries account for an estimated 60 percent of deaths resulting from equestrian accidents.

There are factors that may increase the risk of falling, such as a green horse, slippery footing, or bareback riding, but it is the height from which the rider falls that most significantly impacts the severity of the injury. According to the Ontario Equestrian Federation, a rider sitting on a horse is elevated eight feet or more above the ground, and a fall from just two feet can cause permanent brain damage. Riders ages 10-14 are most likely to be involved in an accident with a horse.

While serious head injury can occur while wearing a helmet, the data very clearly shows that the severity of the head injury can be decreased through helmet wear. While helmets are required in equestrian sports that involve jumping, including eventing and show jumping, in high level dressage competitions, the riders generally wear top hats, which provide no protection. Accidents are less common in competitive dressage, but accidents can occur. While most dressage riders do not wear helmets even when practicing, they are allowed both during practice and competition.

AANS - Sports-Related Head Injury

Horse riding carries a high participant morbidity and mortality. Whereas a motor-cyclist can expect a serious incident at the rate of 1 per 7000 h, the horse-rider can expect a serious accident once in every 350 h, ie 20 times as dangerous as motor cycling.4 This depends on the type of riding. A Cambridge University study of 1000 riding accident hospital admissions has shown:5

* One injury for 100 h of leisure riding
* One injury for 5 h for amateur racing over jumps
* One injury for 1 h of cross-country eventing

Recent surveys have shown that 20% of injured riders attending hospital are admitted and approximately 60% of these have head injuries...

...The first paper from the Radcliffe Infirmary Accident Department, Oxford8 was a retrospective study of people who sustained injuries as a result of horse riding related accidents, who attended the Accident Department and were admitted to hospital. This was followed up by a comparison 20 years later by Chitnavis et al 9 who undertook a prospective study of attendance at the Accident Department in 1991. They found a reduction in total admissions of 46% because of a fall in head injuries most likely due to the use of riding helmets. Of 177 patients seen with 236 injuries, 42 (24%) were admitted to hospital. There were four spinal fractures....

...In an overall review of horse riding injuries,10 head injuries outnumbered spinal injuries at about 5 : 1 which would indicate that the force required to cause a head injury is rather less than that required to fracture the spine (Figure 1).

With regard to admission to spinal units for horse riding accidents, there are far more lumbar and thoracic injuries than cervical in contrast to all other sporting injuries (Table 12) which are almost entirely cervical injuries, indicating that there are different mechanisms involved.17 In all other sporting injuries where the head leads it is almost inevitable that the cervical spine, which is more vulnerable, will be fractured rather than the lumbar or thoracic spine. The only rugby injury in which the thoracic spine was involved was when a drunken rugby player fell downstairs after a game. This would be in keeping with the speculation that in horse riding accidents there are two methods of riding: either jockey style (cross country position) with the head forward, where the rider would be more likely to sustain a cervical injury accompanied inevitably by a head injury, and classical style where the head is held high and the rider would be likely to fall on to the buttocks.8

Jumping is the most dangerous horse riding activity.13,14,15,16,18 In Australia, injury rates were found to be especially high among event riders14 (Figure 2) and in the USA cross country schooling accounted for 22.5% of accidents at pony clubs.15 USCTA statistics16 show that most serious injuries occurred in a jumping phase (Figure 3). There were 12 back injuries in 1993 and seven in 1995, all occurring in cross country....

...The speed of falling is thought by many to be relevant to the likelihood of serious injury as slow falls are sometimes the worst in this respect. The proximity of other horses seems to be the major problem for jockeys as their tuck and roll technique seems to ameliorate quite a lot of injuries. Recent fatalities in eventing have nearly always been when the horse has fallen on the prone rider....

...Conclusion

Horse riding is a dangerous sport. There has been an increase in spinal cord injury admissions due to horse riding. Women riders are more likely to be admitted with serious injury but there are more women riding and the number of accidents to female riders is probably in proportion to the total number of women riders. Lumbar and thoracic fractures are much more common than cervical fractures, the likelihood being that this is due to fall on the buttocks or being thrown against obstructions. The injuries are more likely to occur in point to point and jumping than in flat racing or in social riding. Figures about hunting are not available and are pure speculation.

Spinal injuries resulting from horse riding accidents

The place where most accidents occurred was on cross country. Cross country involves jumping fixed obstacles at speed. If a hors hits one of these obstacles, either the rider or horse and rider will fall. The second most common area was either stadium or other unspecified. Warmup areas for the jumping phases were the next most likely place for an injury. It comes as no surprise the jumping phases accounted for 86% of the injuries. Dressage accounted for only 1% and the stable area and other accounted for 12%, again indicating the surprisingly large number of unmounted injuries.

American Medical Equestrian Associaton

Here is my interpretation, taken it FWIW:

Helmets reduce the risk of a head injury by roughly 50%. That is good enough for me. However, the type of riding done has far greater impact on safety. This comment "One injury for 100 h of leisure riding / One injury for 5 h for amateur racing over jumps / One injury for 1 h of cross-country eventing" would indicate that jumping raises the risk of injury at least ten fold.

It is echoed by this comment: "This would be in keeping with the speculation that in horse riding accidents there are two methods of riding: either jockey style (cross country position) with the head forward, where the rider would be more likely to sustain a cervical injury accompanied inevitably by a head injury, and classical style where the head is held high and the rider would be likely to fall on to the buttocks." and by this one:

"It comes as no surprise the jumping phases accounted for 86% of the injuries. Dressage accounted for only 1% and the stable area and other accounted for 12%, again indicating the surprisingly large number of unmounted injuries."

If riding without a helmet doubles the risk, but jumping increases it over 10-fold, then the single best thing you can do to reduce the risk of head injury is not jump. This may explain why many western riders don't feel a need for wearing helmets - the saddle is darn hard to jump in, and they ride closer to a dressage style seat (more upright, longer leg). Add in that most jumpers in these studies were probably wearing helmets already, and I don't see how one can avoid concluding that someone riding flats in a ball cap is safer than someone jumping with a helmet.

I'm not arguing against jumping. I think it is a great sport. I support steeplechases, and think eventing is arguably the pinnacle of the riding sports - although I'll never do it. With regrets, but I've concluded the mid-50s isn't the right time to take up jumping. Injuries just take too long to heal at my age.

I still wear a helmet and insist that my daughters wear them. I don't see much downside to wearing them.

Does anyone know of studies, however, showing that the riding activity doesn't outweigh the use of helmets in the risk of injury?
     
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    03-19-2011, 12:34 PM
  #2
Started
Yay... I'm glad I wear a helmet, and I'm glad I ride dressage.

Hopefully my dad doesn't see this though... he'd give me a hard time if he knew it'd been proven that horse riding is more dangerous than motorcycle riding. ^_^
     
    03-19-2011, 08:32 PM
  #3
Showing
Quote:
Originally Posted by bsms    
a rider sitting on a horse is elevated eight feet or more above the ground
Thats a very good point I never thought about. In MD fall from I believe 6 or 8 feet for the kid will automatically place him/her into the priority one (patient).
     
    03-21-2011, 05:04 PM
  #4
Started
BSMS, Nicely done.
I am convinced that some basic research by a reputable equine focused institution is needed to properly quantify the risks involved in horse riding.

We are not tackling the training of horse riders correctly. The process should start in the lecture room and safe practice must be acquired from the very beginning of the learning process in the same way as is appropriate for driving a vehicle.

Sadly I sense too often that with young women appearance is more important than safety. No riding hat can be as sexy as a head of long hair waving in the breeze.

In Britain nowadays the wearing of the riding hat is almost compulsory - by public opinion if not in law. But spinal protection is equally a must. Further work must be done to produce a back protector which is adequate for the task but flexible enough not to interfere with the posture of the rider. I'd like to see the wearing of back protectors as compulsory.

I am beginning to find it harder and harder to watch young novice riders learning to cope with spirited horses by trial and error rather than positive tuition. Sadly interference by me, an old man, is not usually appreciated by young people so I nowadays have a tendency to bite my tongue and say nothing.

I can't see much change in attitude coming about until the insurance companies get tough about claims for personal injury.
I'd also like to see us breeding horses for temperament instead of for performance.
But perhaps the most important requirement is for a horse riding safety code which is taught from the very beginning as part of basic rider training.

But nothing is going to improve until more riders start to preach 'safety'
     
    03-21-2011, 06:03 PM
  #5
Trained
I think - and I've seen studies that agree - that people base their behavior on perceived risk. There is some amount of risk they are willing to accept. How much varies between people and activity. They then are willing to accept risk, as they perceive it, up to that level. If it goes over that level, they modify their behavior to get it back under, either by changing the way they do something or by changing equipment.

The two biggest surprises to me from these studies were the overall risk of riding, and just how concentrated that risk is in jumping vs flats. Apparently, riding a horse for leisure on the flats is significantly more dangerous than riding motorcycles. That may well be accurate, too - I rode motorcycles for years without a single injury, but have had one injury in 2.5 years of riding that is still causing pain in my lower back 2 years later.

However, the risk of jumping is far, far higher than the risk when riding on the flat. Some of that makes sense. A rider going over a 3' or 4' jump isn't only higher off the ground, but has a rapidly changing vector and the powerful thrust of the horse too. But I also found this enlightening:

"This would be in keeping with the speculation that in horse riding accidents there are two methods of riding: either jockey style (cross country position) with the head forward, where the rider would be more likely to sustain a cervical injury accompanied inevitably by a head injury, and classical style where the head is held high and the rider would be likely to fall on to the buttocks."

I had not thought about it, but a forward position in an English saddle would make a fall forward onto the head more likely than a dressage or western riding position where you would most likely fall on your rear and injure your pelvis or lower back.

I think that goes a long way toward explaining why many western riders don't wear helmets. They can refuse to wear helmets and still keep their perceived risk, as based on the falls of others they know about, under their level of acceptable risk. The data indicates someone jumping while wearing a helmet is at far greater risk of neck/head injury - by perhaps a factor of 20-80 - than someone who doesn't wear a helmet while riding western. Add in that western saddles are deeper and have more to help you stay on when trouble starts, and the western rider correctly believes his risk is much lower than someone jumping who wears a helmet and back protector.

If going without a helmet makes your risk go up by 100%, but jumping makes it go up 5,000%, then a western or dressage rider can go without a helmet and still be far safer than anyone jumping.

This is very important when folks start talking laws or insurance. I'd be curious how many people would support a total ban on jumping by anyone under 19, or a requirement for all jumpers to wear body protectors as well as helmets.

I'm not a fan of laws banning risky behavior. However, how many little kids would you see jumping horses if their parents had to sign a waiver saying they knew the risk of serious injury or death was 20-80 times that of not jumping, and that they assumed the risk for their child's death? Or that they understood their insurance would not cover any injury that happened while jumping?

[Edited to remove pictures of small kids jumping - they were pulled from the Internet and that probably isn't right given the subject matter]
     
    03-21-2011, 06:20 PM
  #6
Yearling
I can see it now: The human race walking around in artificial exo-skeletons.
Posted via Mobile Device
     
    03-21-2011, 06:37 PM
  #7
Foal
I am glad that when I took my fall in a field, I was wearing an IRH helmet. I was 13 when it happened, but I don't remember a single thing about that day, or the following couple of months. I was brought to the hospital by ambulance. I'm lucky I was light enough for the EMTs to carry through the woods, or else I would've had to go by helicopter. From what I've been told, a tractor backfired, taking my horse by surprise. Keep in mind I had only been riding for about 2 years, was on a very spooky pony who had been known to act up in the field and he had virtually no neck to it was pretty easy to fall off of him. He went one way and I went another, right into a pile of wood chips. I got a severe concussion, my face was ripped apart and bleeding, my shoulder was out of the socket and I had bruised all the ribs on the right side of my body. This might be a bit of an exaggeration, but I might've died if I didnt wear that helmet. I'm surprised head injuries aren't more common in horse riding, I figured they would be..... hmm...
     
    03-21-2011, 07:14 PM
  #8
Trained
Quote:
Originally Posted by GreyRay    
I can see it now: The human race walking around in artificial exo-skeletons.
Posted via Mobile Device
We'd need extra padding between our bones too. The only major injury I've ever gotten from riding was from hitting my saddle wrong when I went from lope to a standstill. It jammed my back and twisted a vertebra in my neck.

I'm not going to lie, but I think it would take a significant fall for me to want to wear a helmet without requirement. Insurance now requires the wranglers at the summer camp I work at to wear them after one wrangler's horse spooked on gravel, slipped and flipped on her. She fractured her skull. (I'm also pretty sure she still doesn't wear a helmet.)

I mean, if I jumped, I would most likely wear one. Isn't it required anyway? I don't know anything about English rules or anything.

These facts are very interesting though. Riding isn't something you would think would be more dangerous than motorcycles, you know?
     
    03-21-2011, 07:58 PM
  #9
Green Broke
Wow, and I'm afraid of driving a car! But I ride every day the weather is acceptable. And I wouldn't be caught dead on a motorcycle. Can you say road rash!?

The only downside I have found to riding with a helmet is sunburn. I wish helmets came with a better brim. I know it would have to be something soft and floppy as to not cause neck injuries in a fall, but even a soft, floppy brim would be nice.

Sunburn is my number one reason NOT to wear a helmet on every ride. (I hate sunscreen because I feel like a greasy mess).

Stupid question, but in this quote, what does "h" refer to. Hours? Probably not, because then you could ride for one hour cross-country and expect to be injured!?? So what does the "h" stand for?

* One injury for 100 h of leisure riding
* One injury for 5 h for amateur racing over jumps
* One injury for 1 h of cross-country eventing
     
    03-21-2011, 08:09 PM
  #10
Started
BSMS
Newton's Laws of Gravity and Motion are at the centre of the problem. We have the equipment these days to measure the forces involved and if they were known and understood then maybe people would be able to visualize the potential impact of falling off a galloping horse and hitting the ground at 25 miles per hour. But I am no mathematician to illustrate the point.

Undeniably Western riding is safer because the rider sits deeper in the saddle which anyway offers a much more secure seat. In 36 years I have never fallen from a Western saddle, but I have fallen countless times from an English saddle.

I suggest reades of this thread read Melanie Reid's articles in the Saturday editions of The Times. She describes what it is like to be paralysed from the neck down after a fall from a horse. Life as she knew it is at an end - and
The life of her husband is irreversibly altered by the need to nurse and look after his wife, who cannot care for her self.

I am not suggesting we don't ride and compete - I am merely suggesting that we take more care to try to reduce the odds of suffering severe injury.
     

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