Poor fit a major reason why some riders don’t wear a helmet – study

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Study results reveal a need to increase rider awareness of head injuries and more education on helmet use, care and replacement.
Image by Robert Balog

Nearly half of surveyed horse riders who never wear a helmet say they would do so if it had a better fit.

The online survey, reported in the journal Concussion, garnered responses from 2598 riders through social media, with 1969 of them, or 75.8%, saying they always wore a helmet.

However, the remaining 629 riders said they only sometimes, seldom or never wore a helmet. Of these 629 riders, 306 said they would wear one if it provided a better fit.

Of those who did not always wear a helmet, their reasoning for sporadic use was that they did not want to (41.4%), they forgot (36.3%), the helmet was too hot (44.3%) or the helmet was generally uncomfortable.

Among these 629 riders, 57.4%, or 361, said they believed helmet use was unnecessary. A total of 15.6% said they would not wear a helmet more frequently under any circumstances.

Participants in the survey, organized by Ansley Grimes Stanfill and her fellow researchers at the University of Tennessee Health Science Center, were aged over 18 and rode at least once a month.

The frequency of helmet use was significantly associated with age and professional status for the sample.

Among the riding professionals who answered the survey, the percentage who always wore a helmet was slightly lower than the result for all participants, at 67.4% (254 of the 377 professionals).

In all, 2434 survey participants responded to questions on helmet ownership and care. Most owned a helmet that cost them $US50 to $US100, with 92.5% having owned their helmet for less than five years, and more than half planning to replace it within the recommended five-year time frame. Most stored their helmet either in a car or in a barn.

In total, 28.2% (686 of the 2434 respondents) reported having fallen in their current helmet, and only 4.8% followed the recommendations of most manufacturers to replace it after a fall.

Of the 2492 participants who answered the question “Have you ever received a head injury while riding?”, 53.2% said they had, while 6% said they were unsure. Of those who had received a head injury, more than two-thirds reported getting back on their horse immediately afterwards.

About 42% of those who were injured did not seek medical care.

For those who received medical care, 77% went to the emergency department but were not admitted, and 14% were hospitalized.

Most respondents felt comfortable in determining the signs and symptoms of concussion.

Discussing their findings, the study team noted that although a high rate of riding-related head injuries continues to occur, there remained a lack of information about how equestrians decide whether to use helmets, how they care for them, and how they identify and seek treatment for head injury if it occurs.

“This study addresses all of these concerns,” they said.

The results, they said, provide several opportunities for intervention for those that either could be persuaded or those that sometimes wore a helmet.

“Importantly, our results indicate that equestrians are overwhelmingly desirous of better fitting, more comfortable and better ventilated helmets. This was especially true for our leisure riders, as this demographic selected comfort above all other possible reasons for not always wearing a helmet.”

Although some more fashionable helmet models can cost up to $US600, many suitably certified helmets fall in the $US50 to $US100 range. Helmet cost was not found to be a major factor among those who opted not to wear them.

The result show that, to better protect equestrians, development and improvement of helmet quality and comfort may be necessary, the study team said.

“Our respondents that did not always wear a helmet indicated that the number one reason was comfort and fit, so improvement in these areas may increase helmet use.”

The authors noted that while advancements have occurred in helmet design, even the best technology does not work if they are not worn, are stored in improper conditions, or are not replaced after a potentially damaging blow.

“Our results indicate that equestrians need better education to know how to store, clean and replace helmets frequently.

“Those riders who do wear helmets on a regular basis to protect themselves but do not follow helmet care guidelines leave themselves more vulnerable to injury than they may perceive.”

Helmets, they said, should be stored at room temperature, out of direct sunlight and be properly cleaned on a regular basis to prevent helmet breakdown and ensure adequate protection.

Helmets that have been stored in direct sunlight, stored in hot temperatures, or left dirty with makeup, sweat and sunscreen, can experience a breakdown of the interior lining, potentially leading to ineffective protection in a fall.

“Furthermore, helmets should also be replaced following any fall, any blow to the head while wearing the helmet (e.g., contact with a tree branch on a trail ride) or if they are dropped.”

Most manufacturers’ websites recommend replacing helmets after five years of use even if a fall or blow has not occurred, as the materials degrade even under the best conditions.

“The majority of our respondents stored their helmets either in a car or in a barn, two locations where the helmet may be exposed to high temperatures, and therefore, be prone to breakdown.”

They said their results highlight a worrying issue in equestrian culture where there is an opportunity for intervention to increase safety.

“Many famous trainers have advocated for always getting back on the horse after a fall; this advice stems from the idea that riders should remount to avoid teaching horses to throw riders off to ‘get out of work’.

“While it is possible that horses may learn such behavior, the adage has become threaded into equestrian culture so deeply that unless injury is obvious (i.e., blood or displaced limbs), peer pressure to remount may supersede any concerns of a less obvious but still serious injury, such as concussion.

“Indeed, the invisibility of a head injury and peer pressure to perform are common risk factors that can lead to concussion under-reporting behaviors in many sports.”

Returning to activities too soon can worsen symptoms, raises the risk for long-term consequences, and can place riders at risk for further injury due to neurological changes that occur in concussion.

“Fortunately, the majority of our respondents correctly identified many of the more common concussion symptoms,” they said.

In conclusion, the researchers said while efforts have been made to promote helmet use, the results indicate that many equestrians are improperly caring for their helmets and may continue to ride after an injury is sustained.

The results, they said, will be used to develop equestrian-specific interventions to increase proper helmet use to reduce the number and severity of head injuries acquired during equestrian sports.

“The results from this study demonstrate a need for efforts to increase riders’ awareness of head injuries and highlight the need for increased education for equestrians on helmet use, care and replacement.”

The study team comprised Grimes Stanfill, Kayla Wynja, Xueyuan Cao, Drew Prescott, Sarah Shore, Brandon Baughman, Anthony Oddo and Jack Tsao.

Helmet use in equestrian athletes: opportunities for intervention. Ansley Grimes Stanfill , Kayla Wynja, Xueyuan Cao, Drew Prescott, Sarah Shore, Brandon Baughman, Anthony Oddo and Jack W Tsao. Concussion, Vol 6, No. 1, 14 Dec 2020, https://doi.org/10.2217/cnc-2020-0019

The study, published under a Creative Commons License, can be read here.

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