University of Vermont AAHS
AMEA

August 1993, Vol. III, Number 3

Table of Contents

The Danger of Heat Injury
Conditioning for the Equestrian Athlete
Risk Factors of Head and Neck Injuries in Equestrian Activities
Why Not Ride Double with a Child on a Horse?
Equestrian Acidents in the United Kingdom
Jockey Injuries
AMEA Protective Vest Survey
Body Protectors


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The Danger of Heat Injury

The summer months and early fall can be dangerous times to both rider and horse to compete in equestrian events if one fails to be aware of the danger of beat injury. In hot humid weather, athletes are unable to, dissipate body heat effectively, with risk of developing a heat injury. Prevention is the key. For those who do not exercise regularly or are accustomed to competing in a cooler climate it is important to acclimatize yourself. Daily progressive work avoiding overexertion for a week will lead to acclimatization. Heat acclimatization results in the earlier onset of sweating and skin blood flow so the maximum temperature regulatory responses are achieved at lower body temperature. Athletes who are not heat acclimatized are at a disadvantage in initiating and attaining an adequate sweat rate and consequently attain higher core temperatures during exercise.

Athletes at risk for developing a heat injury include (a) those with a history of previous heat illness or peripheral vascular or sweating deficits; (b) unacclimatized athletes; (c) overweight individual; (d) overly eager athletes who always are at full go; (e) and those with any febrile illness or illness associated with diarrhea and vomiting.

The early season training program should be graduated over the first 7 to 10 days, and should be scheduled during cooler parts of the day. Decrease the training program on very hot or humid days. Adequate cold water should be freely available al all times. Athletes must drink often - at least 8 ounces every half hour of practice.

Electrolytes can be made up after practice by drinking a light electrolytes solution or through diet. Salt tablets and sugar solutions are detrimental while exercising. Weight should he checked daily. Loss of more than 3% body weight is excessive and indicates lack of adequate fluid replacement. Practice in lightweight clothes

The simplest guidelines are based on the Temperature/Humidity Index (THI). This is the sum of the Temperature (T) and Humidity (H) multiplied by 0.4 plus 15. THI-(T +-H) 0.4 +15. Below 65 degrees, there are no problems. The risk of heat injury rises as the THI increases, and past 85 degrees, the risks of injury are extreme. Thus with a temperature of 90 degrees and humidity of 80, the THI would be 83. A more precise method is with a sling psychrometer, which contains both a wet bulb and a dry bulb thermometer, the temperature difference between the two depends on the relative humidity.

Despite the best intentions, heat injuries will occur. There are: three categories of injury: heat cramps, heat exhaustion :and heat stroke. Heat cramps, the mildest stage, are marked by muscle twitching, cramps, and spasms in the arms, legs, and abdomen. Administration of an oral electrolyte solution and rest in a cool environment will usually lead to resolution. Medical evaluation is indicated if the athlete does riot respond. The athlete should stay out of the heat for 1 to 2 days and then reacclimatize himself.

Heat exhaustion usually results from inadequate water and/or salt replacement over several days. The athlete will have decreased urine output and progressive weight loss. Symptoms include fatigue, nausea, incoordination, restlessness, and abnormal sensations such as pricking or burning. The rectal temperature is less than 104 degrees F (40 degrees C). This injury requires medical attention with monitored fluid and electrolyte replacement.

Heat stroke is a medical emergency which can be fatal. The rectal temperature exceeds 106 degrees F (41 degrees C). The body's thermoregulatory mechanism fails. Sweating usually stops, but may be present. The athlete is disoriented and irrational with involuntary body movements. He may vomit or have bloody diarrhea. Seizures or unconsciousness may develop. Treatment consists of rapid cooling with ice solutions and emergency transport to a hospital.

The best treatment for heat injury is prevention. Re prudent when exercising in hot weather. Monitor the temperature and humidity. Drink fluids generously and frequently. Remember to let your horse drink; also!

Robert A. Stanton, MD, FACS
Orthopaedic Specialty Group
Reef Medical Building
325 Reef Road
Fairfield, CT 06430

FOLLOW THESE GUIDELINES:

60 degrees (15.6" C)
no precautions necessary

61-65 degrees (16.1-18.4 degrees C)
observe those athletes with heavy weight loss

66-70 degrees (18.-211 C)
administer water on the field; watch riders carefully

71-75 degrees (21.6-23.9 C)
lighter practice with rest periods every half hour

76 degrees
delay or postpone practice

Whenever the humidity is greater than 95%, practice should he held with extreme caution.

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Conditioning for the Equestrian Athlete

The U.S.C.T.A. rules state “In the interest of the horse, the fitness and competence of the rider shall be regarded as essential." The equestrian rider spends many hours each week assuring proper nutrition, exercise, training and excellent medical care is provided for his/her horse. However, most riders overlook these important areas for themselves. The equestrian athlete is no different from any other athlete. Strength, flexibility and cardiovascular conditioning is just as important for the success of the equestrian athlete as it is for the track, football, basketball, gymnast or any other athlete.

It has been studied and documented that the well-conditioned athlete is better able to handle the repeated stress of their sport. The well-conditioned athlete who sustains an injury will also recover more quickly and be better able to return to his/her sport.

When discussing conditioning with the equestrian athlete, the. program must often followed is “I ride into condition." Riding alone does not provide sufficient demands on the muscular and cardiovascular system to develop peak physical conditioning. Although this method seems to work for some, it will not give the rider the competitive edge and will often result in chronic injury. Having the necessary strength, endurance, and flexibility will enhance the rider's performance by allowing better control of the mount, decrease the stress and fatigue levels, and thereby reduce the risk of injury.

Common muscular injuries seen in equestrian athletes include injuries involving the back, shoulders, wrist and forearm, as well as the legs. These injuries occur due to muscle imbalance, fatigue, lack of strength and flexibility, repetitive stress and improper riding technique. Muscular injures can be eliminated through proper stretching, strength training end conditioning.

Cardiovascular conditioning is controlled by two variables: intensity and volume. Intensity is simply defined as the effort exerted and the volume is the time or distance trained. Cardiovascular training should be progressive, gradually increasing intensity, time and distance.

Good general conditioning should include at least three days per week of aerobic workouts. Cross training, or performing different activities is a great way to increase the fitness level and keep the workouts fun. Running, swimming, and biking can be alternated to obtain a high level of fitness. All exercises should start at a low intensity for a short duration and increase as the body adapts to the new demands. Always start a conditioning program with a good warm-up and flexibility program, and end with a cool down and more stretching.

An example of a progression for a running program would be:

 

Week Distance Time 1 1 mile 8 minutes 2 1 1/2 miles 12 minutes 3 2 miles 16 minutes 4 2 1/2 miles 20 minutes 5 3 miles 24 minutes

It may take more than 5 weeks to reach 3 miles. Each person will have a different starting level. It would be acceptable to stay at each distance 2 or 3 weeks. Once 3 miles is reached, the distance may be shortened again, but the time the exercise is performed should be decreased. When 3 miles is reached again, it should be done in less time than previously.

The same principle applies in hiking and swimming. Perform these activities at a comfortable intensity, increase duration, then increase intensity.

To know if you are stressing yourself enough in your workouts, your heart beat is a very good indicator. Your conditioning should be done in the range of your target heart rate. The maximum heart rate is found by subtracting your age from 220. 65% - 85% of the maximum heart rate is the range training should take place

 

Example

220 -40 years old 180 180 x.65 x.85 117 153

117-153 beats per minutes is where a 40 year old person should be training. A lower heart rate does not provide sufficient demands on the body to increase fitness and a higher heart rate may put undue stress on the body.

Besides aerobic conditioning, the equestrian rider needs to increase strength and flexibility. Many riders complain of back problems or various overuse injuries. Many of these problems stem from lack of strength and flexibility.

A good weight training program is essential for all athletes to reach their optimal performance. In riders, it is imperative to have strong legs, shoulders, trunk and arms. The best way to increase strength is to learn what muscles are vital to performance and work these muscles either on free weights or on weight machines. Low weight, high repetition lifting regimes, three times weekly will increase strength, muscular endurance, and decrease incidence of injuries. Good muscle balance is important. If the front of the legs are worked, the back of the legs must be worked as well. The specifies of weight workouts depend on the available equipment. Even without expensive equipment, gains can be made with simple free weights made from items around the house such as soup cans in an old purses. Rubber bands, tubing or even an old inner tube tire can be used for resistance and can increase strength in the various ranges of motion.

Since back problems seem to be particularly aggravating to a rider the abdominal muscles must be strong and the hamstrings must be very flexible. Sit-ups will help keep the abdominals strong. They should be performed with the knee bent and the head and shoulders rolling up slightly off the ground.

Flexibility is obtained by pre and post activity stretching. Each major muscle group or specific muscles should be put in a stretch for at least a count of five. The repetitions may be based on body part or the individual. For example, the hamstrings may need 10 repetitions to be adequately stretched while the shoulders (rotator cuff) may need 5 repetitions. Some individuals need more stretching than others. Previously injured body parts may need more attention. Flexibility should not be overlooked in the equestrian athlete. It is a very important part of overall performance enhancement.

If you want to start a conditioning program, but need guidance, there are several avenues to explore Most towns or cities have a health club or spa. Most of them have trained personnel that can help design a specific program. A sports medicine clinic will have an Athletic Trainer or Physical Therapist that can get you started on your way to fitness They can also help with any injuries or rehabilitation you’ll need. There are also many good magazines and books that can help you design your own program. Be leery of the quick fix programs. If they sound too good to be true, they usually are.

Conditioning, strength training, and flexibility are the best ways to decrease injuries while allowing you to perform to your optimal ability in your sport Once you get on a program, stick to it and you will see great results.

Fitness Test

There are two accepted fitness tests that can he performed to help determine the equestrian athlete’s level of condition. One is a 12 minute run and the other is a 1.5 miles run. The fitness levels are given below for both males and females. The first shows parameters for 13-18 year olds and the second shows parameters for 19-29 year olds.

 
                     (13-18 Year Olds) 

SCORE MALES TEST FEMALES Excellent 1.73 mi. + 12 min. run 1.27 mi. + 9:40 min - 1.5 mi. run 14:00 min -

Good 1.6-1.72 mi + 12 min. run 1.16-1.26 mi + 9:41-10:35 min. 1.5 mi run 14.01-15.25 min

Fair 1.47-1.59 mi + 12 min. run 1.06-1.16 mi. + 10:36-11:30 min 1.5 mi. run 15.25-17:00 min.

(19-29 Year Olds)

SCORE MALES TEST FEMALES Excellent 2.00 mi. + 12 min. run 1.65 mi. + 9:00 min - 1.5 mi. run 11 min -

Good 1.75-2.00 mi + 12 min. run 1.35-1.64 mi. + 9:01-10:29 min 1.5 mi. run 11.00-11:59 min

Fair 1.50-1.75 mi. + 12 min. run 1.15-1.34 mi. + 10:30-12:00 min. 1.5 mi. run 12.00-15:59 min

Albert H. Green, ATC
Head Athletic Trainer
Sue Stanley, ATC
Associate Athletic Trainer
University of Kentucky
E.I. Nutter Center
Lexington, KY 40506

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Risk Factors of Head and Neck Injuries in Equestrian Activities

INTRODUCTION

There is very little scientific data to define precisely risk factors and parameters associated with head and neck injuries in the equestrian world. Other organized sports such as football, have developed excellent registries for cataloging significant injuries and influencing factors. Unfortunately, these resources are much more fragmented in horseback riding.

Even at the advanced competitive levels, equestrian sports still represent a very heterogeneous group. The demands upon the participants and the associated levels of risk vary greatly and each group has its own governing body. The likelihood of potential exposure to injury (falling) ranges from rare in dressage to more likely in steeplechasing and anticipated in rodeo. The individual governing bodies each take significant steps towards emphasizing rider safety. They are now expanding this to share information among the organizations in an effort to learn from each other. Much of this is occurring through the medium of the American Medical Equestrian Association whose sole purpose is emphasizing safe: riding through injury prevention, education, rule changes and ongoing studies of protective equipment. As this networking evolves, greater appreciation of injury patterns and risks will be gained.

The impact of this cooperative effort among the governing bodies will still be somewhat limited due to the large numbers of participants who do not belong to any organization. These leisure or recreational participants make up the largest population of horseback riders. It is in this population that most of the injuries occur and, in fact. the risk of injury per exposure is probably higher than in the competitive arena.

For this large population of recreational equestrians, the greatest impact on injury prevention will probably occur through education. It is unlikely that regulation alone will significantly affect such a poorly defined group.

RISK FACTORS

The single most unique aspect that separates equestrian sports from other groups is that these are team sports comprised of individuals of different species. They are intimately dependent upon one another, both for success as well as safety. Both are also capable of making their own decisions, but the horse is usually the less predictable of the two. The horse also outweighs the human by between one and two thousand pounds. Depending on the sport, these animals may achieve speeds of 35 to 40 miles an hour with tile: rider's head being carried approximately nine feet off the ground.

'There is no such thing as a safe horse. Even a quiet animal may be spooked. In fact, placing undue confidence in a seemingly quiet horse may increase the risk of injury if you misinterpret this to mean that routine safety precautions are not necessary.

The risk of injury just from handling horses while unmounted is significant. In one physician's experience, (William Brooks, Lexington, KY) of 83 central nervous system injuries (cranial and spinal), 22 occurred unmounted (all cranial).

In this series of 83 patients, there were 72 cranial injuries and 11 spinal injuries. There were seven deaths. Of the 61 injuries that occurred mounted, only 22 were wearing helmets. All spinal injuries occurred from a fall. Of the 83, 23 were legally intoxicated with an ETOH Level greater than 0.1. Also of the 83, only 20 occurred during some form of organized competition. With regard to risk factors, this emphasizes that of a significant number of individuals who were mounted, most were not wearing helmets. Alcohol was a significant factor in over one-quarter of the injuries and less than one-quarter occurred during some form of organized competition.

BIOMECHANICS OF INJURY

Unmounted cranial injuries occur from a direct blow such as being kicked. a horse's hoof has been calculated to produce greater than one ton of force representing significant destructive power. Mounted cranial and spinal injuries result from the forces generated during a fall. These forces represent the summation of the speed of the animal and the height from which the fall occurs, both of which may be considerable. Added to this is the potential component of being trampled after falling.

Becker's Principle states the proportion of head injuries in a sport reflects the degree of head-forward-stance adopted. Although not unique to our sport, nowhere is this principle better illustrated than in the equestrian world.

In racing, the rider leans forward over the shoulders of the horse, and his head becomes the leading part of his body. As the rider falls, he tends to duck his head, curl and roll. This helps dissipate the energy of the impact and also makes the rider a smaller target for the hooves of other horses.

As a consequence, axial loading of the cervical spine is rarely a mechanism of injury. Most are pure flexion injuries and are more likely to be associated with significant neurological deficit. Extension injuries are less common, and when they occur tend to be more stable. Also relatively unique to equestrian sports is the flexion injury to the noracolumbar spine. The incidence of neurological deficit is significant and the injury usually occurs from landing in the seated position.

CONCLUSIONS

The equestrian world is a very heterogeneous bunch. With few exceptions, there is very little hard scientific data to define accurately the risks of head and neck injuries.

However, several glaring factors do stand out. One of these is the importance of protective head gear in all mounted situations and the need or caution even in unmounted encounters with horses. Another is the role of alcohol in a significant number of severe equestrian injuries.

Most injuries do not occur in the competitive arena, but occur in the leisure, recreational or “working” environment. This area is especially difficult to regulate and again emphasizes the importance of education as a part of injury prevention.

The scarcity of data emphasizes our need to generate data collection and structure scientific studies to provide better education and awareness in the equestrian community.

J.W. Thomas Byrd, MD, FACS
Baptist Medical Plaza II 2nd Floor
2021 Church Street
Nashville, TN 37200

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Why Not Ride Double with a Child on a Horse?

An alert, inquiring 15-year old asks why the American Medical Equestrian Association stated in its brochure, "When Can My Child Ride a Horse?, NO ADULT SHOULD RIDE DOUBLE WITH A CHILD.

The American Medical Equestrian Association members are primarily physicians and medical personnel. They are part of the scientific community whose thinking is along scientific lines. The AMEA seeks studies of horse activities and evaluates injury and morbidity figures in preparing recommendations. The AMEA recognizes the horse community has not had sufficient studies to give the information needed and recommends horse activities keep records of accidents and injuries and the factors involved. Until additional information is forthcoming, the AMEA uses the information available for its recommendations.

North Carolina has an excellent Medical Examiner system in which statistics on deaths in North Carolina are placed in a data base. This data base can find horse related deaths and give information about the person and the activity involved in the death.

North Carolina recorded 30 horse related deaths is the years 1980-1991 of which two deaths occurred in separate accidents when riding double, for a percentage of 7% of deaths occurring in persons riding double on a horse. When the factor of the number of persons riding horses and the number of hours these persons ride double, 7% of the total riding population nor 7% of riding time is spent riding double. Therefore, the AMEA concluded riding double had increased risk.

If this is true, then why could it be so?

Two persons riding on a horse's back disperse the weight of the riders in areas in which the horse is not accustomed to carry weight. This gives additional weight over the lumbar area. the weakest part of the horse's back and the most susceptible to pain for the horse.

When riding double, the second rider's legs hang down by the horse's flanks, an area which is naturally sensitive in which most horses are not accustomed to being touched.

Both the additional weight and the wider area of weight bearing changes the balance of the horse, subjecting the horse to increased chance of tripping and falling.

Additional weight increases fatigue in the horse. increasing the above chances of accidents.

Both riders may not move in the same motion nor at the same time which movements give confusing signals to the horse.

Some horses tolerate riding double: at a walk or slow trot, but many will buck when they are asked to lope, canter or gallop.

Most saddles are not made for riding double, which leaves one rider without the security of the saddle seat or stirrups.

Riding: double distracts both the rider and the horse.

Riding double increases the fatigue of the rider.

When riding double, the rider has less control by signals or by reins of the horse.

If riding double has increased risk, riding double with a child increases this risk:

The child would be the rider without stirrups or place in the saddle.

If the child rides behind the saddle, the child cannot see without leaning to the side increasing the chances of falling from the horse or decreasing the balance of the horse.

If the child rides behind the saddle, the- child has the responsibility of holding onto the adult rider in the saddle. This puts responsibility to prevent the fall on the strength and attention of the child.

If the child rides in front of the adult, this places him/her between the rider and the reins decreasing control of the horse and interferes with the attention to the horse by the adult rider.

If we can transfer the automobile studies of riders holding children to horseback riding, in an accident the child has increased risk of being injured than the adult holding the child.

Doris Bixby Hammett, MD
103 Surrey Road
Waynesville, NC 28786

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Equestrian Accidents in the United Kingdom

Michael R. Whitlock, FRCS

There has been little published work on riding injuries in the United Kingdom in the last three years although much is still being collated. The OPCS monitor of all deaths in England and Wales publish their figures annually and still states that equestrian pursuits are the most dangerous. In 1990 there were eighteen deaths, 16 being female. Eleven females were under 34 years of age with one being under the age of 14. Two were riding point to point which is essentially amateur National Hunt. Most of these deaths were related to head and neck injuries. In addition to these deaths there were two spectators killed, one at a race meeting and another at a hunt.

In an analysis of all deaths from leisure activities 1982-8, Avery noted that there were 98 deaths from horse riding and 128 from swimming. The most hazardous activity for children was horse riding with 19 deaths. An increase in leisure activities and thus deaths was predicted in the next few years. In order to reduce the incidence he suggested more: adequate training and supervision.

In 1993 there have been 4 deaths between April and June in event riding and one at a race meeting. This has led many people to question the design of the BS4472 helmet and also the type of fence. The table fence has also been the subject of an official inquiry although no conclusions have yet resulted. Many are questioning the technical design as being unforgiving if a rider makes a mistake and that the fences should be easier for novice riders.

Chin has undertaken a comparative study of some riding hats with the cycle helmet and came to the conclusion that many cycling hats provide better protection. His findings using a different test rig are essentially the same as those of Whitlock and Mills in 1989, although at the time no action was taken by British Standards to insist on better performance tests. Improving the protection offered by the helmet may be delayed by the introduction. of a European standard. Many feel this will lead a flood of inferior hats on the market and undermine the old British Standard. All riding disciplines insist an a British Standard apart from show jumpers who demand a chin strap only. There is still concern by users that the helmet is uncomfortable to wear for long periods which substantiates Condie’s finding in Seattle.

Silver undertook a pilot study at the spinal injuries unit at Stake Mandeville Hospital to determine the cause of the accident. In 70% of the 20 riders, the cause was directly related to the behavior of the horse. Inadequate supervision and training was also thought to be a contributing factor. The number of patients was considered to be insufficient to be statistically significant.

Stable injuries have been known to be a significant cause of equestrian injuries (8.4%) with approximately one half being under the age of 20. Most injuries were due to kicks (41%) with the crushing of a horse’s foot next common (19%). It is interesting that there were equal number of upper and lower limb injuries (35%) in the West Midlands survey of' 1986.

Certainly there were probably more crush injuries to the foot which were unrecorded as they would not have seen a doctor. Concern has been raised with the type of boot used and an initiative by the medical equestrian association has resulted in the manufacturers making a boot with a metal steel cap which conforms to industrial standards. Unfortunately the appearance is not as good as the traditional boot and consumer sales have been poor.

Alcohol has been suggested as a related cause for some accidents in the States but in England and Wales there is no evidence to suggest that alcohol plays .a significant part.

REFERENCES:

OPCS Monitor DH4/91/4, Silver ]R. Hazards of Horseriding as a popular sport. British Journal of Sports Medicine, 25(2);105-110), 1991 Avery IG. Do We Pay Too Dearly for Our Sport and Leisure Activities. Public Health, 104(6), 417-23, 1993. Condie C. Strategies of successful campaign to promote the use of equestrian helmets, Public Health Reports-Hyattsville 108(1) )121-6, 1993. Chin B Comparison between pedal cycle and horse riding helmet. A report for the Mark Davies Injured Riders Fund. Transport Research Laboratory. Crawthorne Berkshire.

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Jockey Injuries

Of the 52 jockeys who ride at Turf Paradise, 29 were asked to describe the injuries they have had in their careers. Only one had not suffered an injury. The following injuries were reported:

 

INJURY AREA NUMBER TOTAL FRACTURE 117 Upper Extremity 53 Clavical 13 Shoulder 12 Arm 2 Elbow 3 Wrist 8 Hand 1 Finger 7 Thumb 7 Trunk 30 Ribs 17 Neck 5 Back 7 Pelvis 1 Lower Extremity 22 Leg 7 Kneecap 2 Foot 1 Ankle 5 Toe 7 Head 12 Nose 8 Cheek 4 TORN LIGAMENTS 4 Knee 2 Ankle 2 ABDOMEN 7 Bruised Liver 1 Kidney 2 Rupt. Spleen 2 BRUISED Ribs 2 2 CONCUSSION 49 49 LACERATION Sutures 147 147

TOTAL 443 Jockeys Reporting 29 Ave. Injuries per Jockey 15

Mark Armijo
THE JOCKEY NEWS
June/July 1993
7183 Cascade Drive
Boise, ID 83704-0816

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AMEA Protective Vest Survey

'The AMEA recently completed a survey of riders pertaining to the: use protective vests. The purpose of this survey as with other evaluations of protective helmets was to assess the perception of riders as to their use of protective padding and solicit information regarding any lessening of injuries that might be attributed to the vest.

The pitfalls of such a survey are readily apparent. Such a survey relies entirely on the cooperation of the equestrian community and furthermore accepts the respondent’s interpretation of injury as a true and accurate report of a medically diagnosed injury. A fallen rider may well (and perhaps appropriately) believe his/her injury to be much more serious than perhaps a health-care professional; would diagnose. This important limitation notwithstanding the results of such a survey do indicate trends in not only injuries that may arise during equestrian sporting activity, but also provide some insight into the riding community's attempt to improve the safety of their sport.

The present survey was conducted in 1992 by requesting information for the readers of periodicals devoted to horseback riding. Thus, one obvious limitation of this survey is that not all riders were surveyed and only those who were willing to participate were included in the interpretation of the results. Whereas 2430 riders responded in the AMEA helmet questionnaire only 317 returned information adequate for study in this survey. Nevertheless, this small population provided sufficient to invoke additional consideration of the potential benefits of protective padding.

Of those that responded, only 15% consistently wore protective vests while riding. Most of these were individuals involved in jumping or combined training. The greatest number of riders were 25 years of age or under which is a younger group than responded to the helmet survey (45 years). Interestingly, of the .55% who did not wear protective padding, 28% stated that the vests were considered useless or interfered with their riding hence were not recommended or used. Most in this group considered the vests not to be "particularly useful." Even more interestingly, 33% of those who routinely wore vests had little faith that protective padding would prevent a serious injury. Indeed, many in this group believed these vests did not prevent the injury they sustained.

Although these data would tend to dismiss the potential usefulness of protective padding, a closer look at specific areas of injury provide a somewhat different conclusion. A total of 808 injuries were sustained by those who responded to this questionnaire. 61 occurred in those wearing vests. Thus, the overall injury occurrence was similar in the two groups 9% not wearing vests sustained some form of injury compared to 7% who faithfully wore vests. Comparison of specific injuries that might be lessened by protective padding including those involving the ribs, abdomen, spine/back, and pelvis/buttock. It may be hypothesized that if protective vests are to lessen the forces rendered to a falling rider, it would be most effective in those areas that are best covered. These areas include the chest, abdomen, pelvis, and spine.

When these specific areas are compared between the two groups it would appear that protective padding does afford some lessening of the injury rate. For example 27% of those not wearing vests sustained some injury to either the chest or ribs, only 14% of those wearing vests received injuries in this area. Although no difference was reported in those sustaining abdominal injuries (2% vs 2%), riders wearing vests seemed to have fewer pelvis/buttock as well as spinal/back (6% vs. 16% and 12 vs 31% respectively). No differences were noticed in those with neck injuries.

Although this survey would support the use of protective vests as beneficial in reducing the numbers of injuries that riders experience while riding, the data must be interpreted with a great deal of caution. The areas of injury, severity, subsequent medical requirements and no been not been adequately evaluated. Moreover, this study cannot he interpreted as medically or scientifically controlled because it relies entirely on respondents interpretation of their injury without appropriate documentation or confirmation. Nonetheless, the indications do call for more research on various protective padding products and certainly support the contention that these vests may he helpful in particular incidents involving equestrian sports.

In summary, the AMEA survey of protective padding, with its significant limitations notwithstanding, calls for more research into those forces that are brought to bear on a falling rider or one kicked by a horse in attempting to develop standards to which protective materials can be made and fashioned in flexible protective vests. Moreover, this study urges that all equestrian organizations keep accurate and well documented records of all injuries that may arise in their particular discipline in order more carefully to identify those injuries that are associated with a particular style of riding and hence evaluate the need and efficiency of protective vests.

William W. Brooks, MD
Neurosurgical Associates
1401 Harrodsburg Rd.
Suite B-485
Lexington, KY 40504

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Body Protectors

There has been increasing interest in the use of body protectors in England since the BETA standard was introduced a couple of years ago. 86,000 new garments have been sold. It is compulsory for all professional jockeys to wear a protector although they have not insisted on a specific standard. The other organizations tend to follow the lead of the Jockey Club, but not all the officials understand the type of injury sustained in their branch of riding may be different from jockeys.

All event riders have to wear a protector and there have been anecdotal reports where they have suggested it may have reduced the incidence of bruising. Most people in riding circles have accepted the garment will not prevent major spinal injury and it has been put on each garment.

Because of the different design for different work, the fitting of the protector on each person has given them some concern. retail shops will only stock a few garments and a rider is sometimes sold a protector which may, for instance, be suited for flat racing, but the rider wants to use it for eventing. There are plans to have seminars for the retailers so that they can appreciate the difference.

The committee has recently met to discuss the existing tests and to get the feedback from riding organizations and the riders themselves. The Jockey Club is attempting to make riders wear a protector for Level 5 this year, although in practice almost all National Hunt jockeys wear one to level 7.

Comfort is regarded by riders as a high priority and a relative new material is available which tends to old itself onto the skin. This also avoids the loss of mobility for which some garments have been criticized. There are no statistics as to the effectiveness of the garment and time will tell if riders continue to use them. There was one incident at a recent horse trial where the rider was wearing a body protector and died from chest injuries.

Now that the standard has been accepted there are going to be more tests undertaken and stricter control of the area of the body covered. Some riders want the shoulder covered, although this might restrict the movement for some. The idea of testing for falls and kicks is being explored as well as testing inside and outside the garment. A problem with the new material being used is that it is not rigid and some claim the rigidity is an essential part of protection.

The next year will see some major changes in the garments. It must be remembered that when the standard was first introduced no garment would pass level 5, but now some are passing a level 8 or 9. Progress may be slow, but at least there is some in the right direction.

Michael R. Whitlock, FRCS
Barnet General Hospital
Wellhouse Lane
Barnet, Hertfordshire
England

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