For brain health, don’t get straight back in the saddle after a horse fall

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Neuropsychologist Stephanie Bajo has been tracking emergency visits to UVA Health and has found a higher rate of concussion among horse riders than even football players and athletes in other high-impact sports. Photo: Jackson Smith Photography

As a child growing up in the Chicago suburbs, Stephanie Bajo fell in love with competitive horse riding and its inherently rugged way of life.

“The equestrian community is pretty tough,” she said. “We’re getting up in the dark and cold and crushing ice in buckets because our horse’s drinking water has frozen. Serious riders are pretty stubborn and if they get injured, they just grin and bear it.

“Horse riding makes people extremely resilient, but it also puts them at risk when they experience a concussion and say, ‘I’m fine,’ and want to keep riding,” she told the University of Virginia news outlet, UVAToday.

Bajo knows this mindset firsthand: “Now looking back,” she said, “there were probably two or three times where I had fallen and definitely had some confusion or seeing stars and developed some sort of headache. I got back on and kept riding. In a lesson with a riding instructor, I remember I was told to get back on.”

Today, as a neuropsychologist with UVA Health, a University of Virginia academic medical center in Charlottesville, Bajo knows well that this deeply ingrained attitude in the riding community needs to change. She shares with parents and coaches that it is important to take concussion symptoms seriously, but to also realize that the vast majority of people will recover in a matter of days or weeks – and without lingering brain damage.

“When I talk to equestrian groups, I tell them, ‘Do not have your students get back on until they’ve been assessed for concussion symptoms and their symptoms have cleared up.’ It would be very detrimental to fall again before recovering. And what is the detriment of ending the ride that day?”

As a longtime rider, Bajo said she understands that falls will always be a part of riding. Riders are taught how to roll to avoid injury. And sometimes it is important to get back in the saddle quickly in order to work through the challenges and help the rider gain confidence rather than fear.

Not all falls will result in a concussion, Bajo said, but it’s important to know too that a concussion can occur after a high-impact fall even when a rider does not hit their head. A helmet, she added, won’t protect a rider from concussion, but can help prevent a skull fracture.

Stephanie Bajo is a University of Virginia assistant professor of psychiatry and neurobehavioral sciences. Photo: Supplied

Riding immediately after a concussion, Bajo said, means your balance is going to be off and you’re not going to be able to process information as effectively, putting you at a greater risk for a second injury and prolonging your recovery. “No one, especially horse riders, want to be out of their normal routine for longer than they have to be.”

Adolescents can take anywhere from a few to 30 days before their concussion symptoms clear up and they can safely return to their sport. Collegiate athletes tend to recover in seven to 10 days, Bajo noted.

As a mild brain injury, concussions can typically be assessed by a primary care provider. If someone’s symptoms are getting worse – like confusion, dizziness or an extreme headache – it’s important to seek medical care right away to rule out a more serious injury like a brain bleed or swelling.

Bajo has been tracking emergency visits to the medical center and has found a higher rate of concussions among horse riders than even football players and athletes in other high-impact sports. While she knows horse riding and other high-impact sports can temporarily injure the brain and its processing, she’s also aware that the benefits far outweigh the risks.

“While it’s understandable to have concerns when your child wants to participate in a high-impact sport, there’s also a detriment that can occur by not allowing your child to have the support and community that sports allow and bring to people,” she said. It’s very rare, she added, that she ever needs to advise an athlete to stop playing altogether because they’ve experienced eight or nine concussions, which can have a compounding effect and lead to lasting damage.

As a neuropsychology expert, Bajo sees patients who are still having symptoms four to six months after a concussion or other brain injury. Her job is to determine what other factors might be delaying recovery and causing memory or processing problems.

“With concussion, we expect people to improve back to their baseline functioning and not to have lifelong disturbances to their brain functioning,” Bajo said. When people don’t improve in a normal window of time, it can be due to reasons not related to the brain injury, such as stress, anxiety or by following outdated medical advice. Being sedentary and cooped up in a dark room for many days will only prolong recovery from a concussion, Bajo advised.

Instead, the new recommended standards indicate a person should begin an active recovery after rest for 48 hours, and start with walking fast enough to get your heart rate up or riding a stationary bike as long as symptoms are improving.

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