University of Vermont AAHS
AMEA

August 1995, Vol. V, Number 3

Table of Contents

Cervical Fractures in Horseback Riding
Heat Illness
Horseback Riding-Related Traumatic Brain Injuries
NEISS Total Injured in Recreational Sports
NSC Accident Facts: 1994 Edition
Development of Competency Guidelines for Riding Instructors and Equestrian Coaches
Competency Guidelines: A Job for the 21st Century?


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Cervical Fractures in Horseback Riding

We horseback riders have become concerned this summer about broken necks from falls. The American Medical Equestrian Association has been concerned for some time about spinal injuries and ways they might be prevented. While there is a long way to go for prevention, there is an extensive neuro-surgical and orthopedic literature on spinal injuries in general. The information is in modern textbooks as well as in monographs, reviews, and original papers. The creation of regional spinal injury centers in recent decades has led to a marked decrease in deaths and decline in serious long-term sequelae from injuries to the spine, whatever the cause. It may be worthwhile to remind our readers of a few principles.

Hamilton and Tranmer reported 155 patients brought to the hospital in Alberta, Canada, in a recent 5-year period for neurological injuries related to riding horses (Journal of Trauma, 1993, 34(2): 227-232). This report included patients with potential injury to the nervous system, such as spinal fracture without prolonged neurological sequelae, One hundred twenty-one of the injuries involved the head. Only twenty injuries involved the spinal column or cord, and only about half of those affected the neck. Eight were injuries of both head and neck. Twenty-nine injuries came from kicks once the rider landed from a fall; four patients were crushed by the horse and two were dragged after falling. The director of a spinal injury center in Central New York region tells me that he has seen only one cervical fracture from a horse-riding injury in his many years there, though he has seen many thoracic and lumbosacral pelvic fractures from horses kicking and trampling people standing on the ground, and many more facial and soft tissue injuries from horses' feet and teeth.

What concerns us all is not how common neck injuries are, but how grave the consequences can be. Even physicians whose relatives have had major head injuries and permanent sequelae think that quadriplegia is often a worse fate than post-head injury syndrome. Despite the provisions society makes for the handicapped, permanent paraplegia is not a state in which we would like to see friends or relatives.

A fall from a horse can lead to many problems of the soft tissues of the neck: cuts of various types, hematomas and simple edema, strains and tears of ligaments, tendons and muscles, of the fibrous annulus that holds the spongy material of intervertebral disks in place. Fractures of the cervical spine are likely to be more serious problems. The likely problems differ depending on the location of injury. Major sites are fractures of the occipito-atlantal junction, fractures of the atlanta-axial complex, fractures of C-2 to C-3 or C-4, and fractures of the lower part of the cervical region. Damage to the cord at C-l, C-2, or C-3 can paralyze breathing.

Spinal injuries themselves can be classified into pure fractures, pure dislocations, and fracture-dislocations (Adams and Victor, Principles of Neurology, 5th ed. 1993 pp 1078- 1116). It is rare for a horse-rider's neck injury to be due to direct blow to the neck. A rider would have to fall onto a post or be kicked in the neck itself. The bulk of the neck injuries are due to rapid, forceful movements of the head relative to the trunk. There is usually vertical compression to the structures of the neck combined with a major degree of anterior flexion (a hyper-flexion injury) or posterior extension (a hyper-extension injury). With the latter the ligamentum flavum folds inward forcefully and damages the spinal cord even if there is no apparent damage to the bones themselves. Dislocations and fractures can lead to bone directly pressing an the cord- The most common levels of involvement are C-1, C-2 and C-4 through C-6.

In cross-section, the spinal cord is an oval structure with neuron cell-bodies largely in the center the "grey matter" and axones largely running up and down in the outer portion, the "white matter." he axones are laminated; in what appears to be an evolution of neuronal development that limits crossing and tangling of fibers, axones to and from the lowest parts of the cord, the coccygeal and sacral segments, tend to run nearest to the outer surface of the white matter. Axones to and from the lumbar region tend to be in the next ring in, then those from the thoracic segments, with those for the cervical segments lying nearest to the grey matter. This rule holds for all of the major sensory and motor pathways that neurologists and neurosurgeons usually examine. The major implication of the laminar arrangement is that a lesion in the neck that compresses the cord often produces a clinical picture confined to the legs. This can be seen with acute injuries, with chronic problems such as cervical spondylosis, and with microscopic damage from diseases like multiple sclerosis,

Trauma to the cord can compress, shear, and stretch axones, glia, and small blood vessels and often leads to bleeding in the central part of the cord. The break down of blood in a hemotoma increases local concentrations of potassium, calcium and of exciatory amnino acids, like glutamate. These damage neural tissues further. No doubt other biochemical mechanisms are also at work. For example, local fall in oxygen from a drop in the blood supply causes an increase in lactic acid production; lactic acid damages glial cells, especially the astrocytes which seem to "feed" neurones from the capillary bed. The rise in hydrogen ions gives further damage, and, when long-chain fatty acids such as arachnodonic break off damaged membranes, the fatty acids cause further damage. Local edema develops and increases a vicious cycle. In mild cases, the problems seem to reverse, at least so far as clinical function goes. In severe cases, the ultimate outcome can be a cyst filled with CSF in the center of the cord and loss of neural function of that area of the cord.

Spinal shock is a sudden loss of all functions of the spinal cord below the level of an injury It has been described best (and studied experimentally) largely with complete transections. While it is very rare for falls from horse-back to lead to a transection, there is usually an element of spinal shock, albeit transient, immediately after any injury to the spinal cord. In almost every case of injury to the cervical or thoracic cord, the major findings of spinal shock include a loss of reflexes below the segmental level of the injury. For example, the bulbocavernosus and the anal wink reflexes are lost, even though both are mediated solely within the spinal segments of the cord. The cause of spinal shock is not known; it appears to be more complicated than simply the loss of normal excitatory tone that the upper motor neurone system usually maintains in the spinal motor neurones.

With blunt injuries to the spinal cord such as contusions or hematomas after a fall, spinal shock may last only a few minutes or a few hours (Keenen and Benson in Browner, Jupiter, Levine & Trafton, 1992, Skeletal Trauma, Vol. 1, Saunders, Philadelphia, Chapter 23, pp 585-803). It is generally considered to have passed once the sacral reflexes such as the bulbocavernosus return. Once this happens, a careful neurological examination can give a great deal of information about the extent of the injury to the cord itself and about the prognosis for recovery. The less extensive the injury, the better the prognosis. Patients with an incomplete lesion--with some function below the level of the injury--are likely to improve. Patients with a complete deficit--no neurologic function below the lesion but intact bulbocavernosus and other sacral reflexes- -are not as likely to recover

The most common neurological syndromes from an incomplete injury of the cervical spinal cord are the central syndrome, the anterior syndrome, and the syndrome of root damage. In the central syndrome, the outermost long tracts are spared, but the central grey matter and some of the adjacent white matter is damaged. The arms are weak because of damage of the anterior horns of the grey matter. There is marked loss of perception of pin, of touch from cotton-wool and of hot and cold in the arms, shoulders, lower neck and upper-most truck, because these sensations are carried by sensory axones from peripheral nerves that come in the dorsal root and synapse in the dorsal horns of the grey matter. The next sensory axone for these senses crosses in the grey matter just in front of the spinal canal to the opposite side of the cord, and then goes up to the brain in the antero-lateral white matter. As the peripheral layers of white matter of the cervical cord are largely spared by a central lesion, sensory information can get to the brain from the lower trunk, the pelvis, and the legs; and the brain can send motor information to the regions of the body below the arms.

A central lesion in the cervical or thoracic cord will also interrupt autonomic function below the level of the lesion. Information from the hypothalamus descends in the mid- portion of the white matter centrally to laterally, to the lateral horn of the thoracic grey matter. Neurones in that horn convey signals out to the sympathetic chain. Parasympathetic information goes to (lateral to anterior) parasympathetic motor neurones in the grey matter in the sacral and cocygeal levels.

The anterior syndrome affects both the upper motor neurone pathways, the lateral and the venbal, giving spastic paralysis of muscles below the lesion. Often, there is damage to the lower motor neurones in the anterior horns of the grey matter at the level of the lesion, giving flaccid paralysis of the muscles of those segments. In the cervical cord, an anterior syndrom eventually will lead to flaccid weakness in the arms, with decreased or absent reflexes, and spastic weakness of the legs with hyperactive weakness.

The root syndrome comes from compression or avulsion of the posterior and/or anterior roots. The posterior roots convey sensory information into the cord from the corresponding dermatomes on the surface. The anterior roots largely convey motor information out to muscles that move the joints which lie underneath the same dermatomes. The picture from root damage in the neck is flaccid weakness of the muscles of the arms and/or sensory loss in the arms and shoulders.

There is a clinical rule that any head injury severe enough to cause more than a momentary loss of consciousness should be treated as if there is a fractured neck. The same rule holds true for any injury to the spine with neural deficits that persist at the time the EMT service arrives. The safety helmet must be left in place and only removed after a cross-table lateral X-ray has been performed and read in an emergency room. (Nowadays, after the proof from United States Pony Clubs statistics that the ASTM- SEI safety helmet works, we all ride in safety helmets all the time, don't we?) One person should hold the shoulders with either hand, cradling the head firmly so there is no motion of the head relative to the trunk while three to five other people lift the patient onto a spinal board. A firm cervical collar that can immobilize head and neck needs to be applied before the patient is moved by ambulance. The ER physicians will then evaluate the likelihood of damage to the cervical cord as well as the effects of trauma on other parts of the body

Many trauma centers recommend "pulse-dose" steroids (a gram of SoluMedrol i.v.) very soon after a spinal injury. These seem to decrease the secondary necrosis and edema and to improve prognosis greatly. Studies are still on-going as to any role substances that block endorphin receptors or substances that prevent damage from long-chain fatty acids.

While the spinal injury centers have made an enormous improvement, prevention would be ideal. Football players are trying "donuts" of protective material about the neck. Whether these, or any other device, would protect horse-riders from neck injuries is not yet known. Experts in spinal disease point out that people who are in poor physical condition or who are injured soon after drinking alcohol or taking street-drugs are much less able to protect themselves from head injuries, and much mere liable to broken necks in a fall, than are people who are in top physical shape. Don't ride to shape-up; shape-up to ride..

Pieter Kark; M.D., F.A.C.P.
Neurological Consultations
North Medical Center, Suite 4-J
S100 West Taft Road
Liverpool, NY 13088-4841

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Heat Illness

Despite exposure to a wide range of environmental temperatures the human body maintains a core temperature of 37 degrees C (98.6 degrees F) within a very narrow range of normal variation. The body tolerates hyperthermia poorly; tissue and organ injury became evident as tissue temperatures approach 42 degrees C (107.6 degrees F). Extreme body temperature disturbances result when (1) exposure to extreme environmental temperatures overload maximally functioning thermoregulatory processes, (2) endogenous heat production is greater than the body's capacity to dissipate heat, or (3) medical illness or drugs interfere with normal thermoregulation.

The cope temperature is most accurately defined as the temperature of the blood perfusing the hypothalamus. Although it may be higher than the rectal temperature, the rectal temperature is the closest approximation of the core temperature readily available to the clinician.

Hydration is the most important element in preventing heat illness. Water requirements are not reduced by any form of training or acclimatization. Water losses can reach 15 liters per day There is no advantage to carbohydrate/electrolyte beverages beyond their palatability which may encourage drinking.

Competing needs to maintain perfusion of exercising muscle, perfusion of skin for heat loss, and adequate blood pressure represent a major cardiovascular challenge to exercising heat-stressed riders. Failure to meet this challenge may result in collapse due to heat exhaustion, or heat stroke, the most severe manifestation of heat illness associated with life-threatening body temperature elevation. When an individual achieves a maximal heart rate during exercise yet heat storage continues to rise, further increases in cardiac output cannot occur and the body's hemodynamic response may be inadequate to maintain blood pressure and muscle perfusion in the context of the increased circulatory demands of thermoregulation. Volume depletion, which occurs during exercise as a result of sweat losses and fluid shifts into muscle, further exaggerates this progressive hemodynamic compromise. Volume depletion also impairs the ability to sweat.

Whether or not thermoregulatory failure is an obligatory antecedent of heat stroke in humans is not clear. A wide pulse pressure, suggesting vasodilation with decreased peripheral vascular resistance and copious sweating are frequently noted in victims of exertional heat stroke. On the basis of such clinical observation it is generally accepted that some cases of heat stroke may occur when the amount of heat produced during strenuous exercise exceeds the dissipation capacity of a normal functioning thermoregulatory system. Other patients exhibit clear evidence of thermoregulatory failure, manifested by the cessation of sweating noted in 25 to 50 percent of patients with exertional heat stroke. The magnitude of the risk to riders of an over-warm environment can be predicted by examination of air temperature, wind velocity, amount of radiant heat, and humidity. The most widely used heat index today is the wet bulb globe temperature (WBGT) which is calculated from information obtained with three different devices. The dry bulb temperature (DBT) is the air temperature taken from a thermometer placed in shade. The Wet bulb temperature (WBT) is taken by a thermometer whose bulb is in contact with a wet wick. When ambient humidity is low the WBT is substantially lower than the DBT, reflecting the effects of evaporation. As humidity increases, the WBT approaches the DBT.

The WBT's reliability decreases when radiant heat is substantial. The black globe temperature (BGT) is given by a thermometer whose bulb is in an air tight black globe exposed to the sun. Because the black globe absorbs radiant heat and may gain or lose heat to the surrounding air by convection and radiation, the BGT may be higher than the DBT or lower, as when clouds block the sun or wind velocity increases convective heat loss.

WBGT = WBT x 0.7 + DBT x 0.1 + BGT x 0.2 (out-doors) (98.1)

WBGT = WBT x 0.7 + BGT x 0.3 (indoors) (98.2)

The WBGT predicts the rate of rise of the rectal temperature in healthy acclimatized persons during exercise. It does not correlate with the rate of rise of rectal temperature in persons who exercise in heavy protective clothing. The WBGT has been adopted as a guide to the modification of exertional activity during stress by athletic organizations, the armed forces and industry. The goal of exercise modification guidelines is that a well acclimatized rider whose salt and fluid intake is adequate and while wearing light riding attire can perform the normal activity while maintaining a rectal temperature below 38 degrees C.

The performance of riding in a hot environment leads to physiologic changes that increase tolerance to exercise. During the first week of exposure, a significant decrease in the heart rate response to exercise and an increase in stroke volume occurs. During exercise, if unacclimatized, persons in good physical condition produce less metabolic heat for the level of work performed and exhibit both a lower pulse rate and smaller temperature increase than poorly conditioned, unacclimialized people. Achieving acclimatization at the maximum rate seems to require 2 hours of continuous exercise exposure per day. In a large case series, 70 percent of cases of exertional heat stroke occurred within 2 - 3 weeks after beginning exercise in the heat. Controlled physiologic studies demonstrate significant acclimatization effects in most healthy persons at 7 to 10 days.

Risk factors for heat stroke include sleep deprivation, obesity, poor physical conditioning, lack of acclimatization, dehydration, febrile illness, medications that impair the normal thermoregulatory response, and skin disorders that affect sweating. Heavy protective gear also confers a significant risk. A history of heat stroke has been regarded as a risk factor for repeated heat stroke.

Medical Illnesses that Predispose to Heat Stroke

Cardiac disease of any cause decreases the maximal cardiac output and impairs the capacity to increase cutaneous circulation. Diabetic or atherosclerotic vascular disease impairs vasodilation. Patients with disease of the central nervous system also exhibit inadequate thermoregulatory responses. Extensive cutaneous disorders, whether psoriasis, extensive scarring or burns, or even sunburn and heat rash, decrease the ability to sweat adequately and may alter vasodilation.

Prevention

Before any planning begins the medical director must be functioning as a full member of the staff. The physician has a role as an educator as the riders prepare for the activity in hot environments. The riders must know the steps they can take to minimize the risk of heat illness. They must understand the importance of hydration, nutrition and skin hygiene. They must be trained to recognize the signs of heat illness in other riders and the importance of care and concern for other equestrians. The staff must understand the critical importance of water to the riders so that they encourage drinking water in the activities. Planners must understand the detrimental effect of heat in their schedules by adding rest and hydration stops. Riders may not drink so they can avoid the need to urinate. Toilets must be as private and convenient as possible. Water should be as cool as possible.

Thirst is well known to be an inadequate measure of fluid needs. In order to avoid dehydration, riders must drink beyond their thirst, and be made aware of the need to (1) drink adequately, (2) rest periodically in a cool environment, (3) not ride when ill (4) avoid ethanol prior to and during the activity. Coaches, managers, supervisors and other participants should be aware of the meaning of early signs of neurologic impairment, such as irritability, confusion, or clumsiness. A ready means of cooling should be available at every site where heat injury might occur.

Clinical Manifestations of Heat Stroke

The single clinical finding that distinguishes heat stroke from other forms of heat-related illness is altered mental status caused by heat injury to the brain. Its manifestations range from mild confusion to psychosis, seizures, and coma. Mortality is correlated with the height of the temperature, the duration of temperature elevation, and the duration of coma longer than 3 hours. Although complete neurologic recovery is the rule in survivors of heat stroke, deficits may develop including cerebellar ataxia, paresis seizure disorder and cognitive dysfunction.

Most patients with exertional heat stroke have tachycardia, and approximately half have systolic blood pressure below 100 mg Hg. Two types of hemodynamic patterns are evident. A hyperdynamic state is most common, with vasodilation and a wide pulse pressure suggesting low peripheral resistance and a high cardiac output. Less often, patients with exertional heat stroke manifest a hypodynamic state with clinical evidence of low cardiac output, hypotension, and increased peripheral resistance. Significant volume depletion, heart failure, or increased pulmonary vascular resistance may be the cause.

Heat cramps are extremely painful muscle contractions that occur in well acclimatized, physically fit persons as a consequence of sodium depletion following intensive use of the involved muscle. Severe heat cramps are adequately treated by rest and oral administration of salt-containing fluids.

Management of Heat Stroke

The most critical steps in the management of heat stroke are recognition of the possibility of temperature elevation and immediate, on-site initiation of rapid cooling. Cooling must take precedence over all other resuscitation or diagnostic procedures. Immersion in cool or iced water with skin massage is the classic technique for cooling heat stroke patients. Ice water produces the most rapid rate of cooling. However ice water is uncomfortable. Shivering and agitation, which do increase heat production, may be effectively controlled by small doses of an intravenous benzodiazepine titrated to effect. While cooling is underway rectal temperature should be closely monitored, Active cooling should be discontinued when the rectal temperature reaches 39 degrees C.

Hypotension should be treated with volume resuscitation and careful monitoring of urine output. Volume depletion usually is not substantial, and the hypotension responds to cooling and moderate fluid administration.

Airway control is essential. Vomiting is common and endotracheal intubation should be used in any patient with a reduced level of consciousness. Supplemental oxygen should be provided when available. Patients are frequently agitated, combative or seizing. Diazepam is effective for control and can be administered intravenously, endotracheally or rectally. The sedated heat stroke patient should be intubated.

Information from Environmental and Occupational Medicine, Second Edition, William N. Rom, MD, MPH,
Little Brown and Company, 1992,
and Report 91-3 "Heat Illness, US Amry Research Institute of Environmental Medicine, provided by Carl S. Hudson, MD,
Bow 662 Borger, TX 79008.

Edited by Doris Bixby Hammett, MD.

Signs of Heat Illness

Piloerection on chest and arms
Dizziness
Chilling
Extreme Muscle Fatigue
Headache
Clumsiness and Unsteadiness
Nausea
Stumbling
Excessive Sweating
Apathy
Dry Skin (cession of sweating)
Gradual impairment of Consciousness
Sinus Tachycardia

From Squire DL, "Heat Illness: Fluid and Electrolyte Issues for Pediatric and Adolescent Athletics" Pediatr Clin North Am 1990; 37:1085-1109)

Drug that Interfere with Thermoregulation

Drugs that increase heat production:

Thyroid hormone
Amphetamines
Lysergic acid diethylanide

Drugs that decrease sweating:

Antihistamines
Anticholinergics
Phenothiazines
Benztropine mesylate
Cyclic antidepressants

Drugs that decrease thirst:

Haloperidol

Drugs that decrease hydration:

Diuretics
Alcohol

Drugs that decrease carcfiae contractility and alter cutaneous blood flow:

B-Adrenergic receptor blockers
Calciurn channel blockers

Drugs that limit cutaneous vasodilation

Drugs with u-adrenergic effects
phenylephrine
phenylpropanolamine
Amphetamines
Cocaine

Medical Operations

Facilities: air-conditioned trailer and open-air tent centrally located.

Experienced sports medicine physicians at facilities at all times Paramedical staff, coaches, and teammates watching for participants who might be displaying symptoms of heat-related illness. Presenting symptoms: dizziness, light-headedness, weakness, headache, mild disorientation, nausea, and syncope with some displaying muscle cramping and hyperventilation. Record keeping and follow-up

From: Elias, SR, Robert, WO, Thorson DC, "Team Sports in Hot Weather,": Physician Sportsmed, 1991; 19:67-78.

Key Points and Reminders

1. Successful prevention of heat casualties is more important than their treatment. 2. Your success in preventing heat illnesses will depend on your skill as an educator. 3. To influence the conduct of an activity or training, you must integrate yourself into the planning process. 4. Be alert to early signs of dehydration and heat illness. 5. Be sure there will be enough water when and where you need it. Never forego water planning. 6. The skin is a vital organ in the heat. Its care is more than just for comfort or aesthetics. 7- Use shade and early morning as much as possible. Shorten course, slow speeds, and lengthen check point time as indicated.

PREVENTION

EDUCATION

HYDRATION:

Eight ounces of cold water before activity and 8 to 12 ounces every 20-30 minutes during the activity should be enforced. After completion the riders must remember that it is not sufficient to drink only until thirst is quenched. Each pound of weight lost requires a pint of replacement oral fluid.

APPROPRIATE CLOTHING:

When exercising under conditions of high heat and humidity, clothing should be lightweight. As much skin as possible should be exposed to facilitate sweat evaporation. Periodically sweat-saturated garments should be replaced by dry ones.

CONDITIONING ACCLIMATIZATION:

After traveling to a warmer climate, initial workouts should be moderate in intensity and duration. A gradual increase in the time and intensity of physical exertion over 8 to 10 days will permit optimal acclimatization.

The U.S. Government Department of Commerce, National Weather Service, has between 250-300 first order stations across the nation from which the predicted dry bulb temperature and the dew point can be obtained. Tables are available for various temperatures of the dew point which give the humidity of the air. Other locations at which temperature predictions can be obtained are TV Weather channels, radio stations, airports and agricultural centers.

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Horseback Riding-Related Traumatic Brain Injuries

Horseback riding is a very popular recreational activity in the United States. An estimated 30 million people ride horses each year. In Oklahoma, that number is estimated to be 300,000. Risk: of injury is high in the sport of horse-back riding.-Horses have varying degrees of training and riders have different levels of skill and experience. An 1,100 pound animal which has a mind of its own acid a 150 pound rider communicating only through physical cues can sometimes be a dangerous combination.

One of the most serious injuries incurred by horseback riders is traumatic brain injury (TBI). It is the leading cause of death among horseback riding injuries. Of the 3106 hospitalized or fatal TBI's reported in Oklahoma in 1992, 109 were spoors-related. Horseback riding accounted for more TBI's in 1992 than baseball/softball (23) and football (14) combined. The 38 TBI's in this report include only persons "riding" and subsequently being thrown or falling. It does not include persons sustaining injuries while working around, standing near, or administering medical treatment to horses.

Fifty-five percent of the persons suffering a horseback riding-related TBI were female; 95% were white, and 5% Native American. Ages ranged from 3 to 53 years. 22 (58%) of injuries occurred among persons less than 25 years of age.

Two (5%) of the injuries were reported to be work related, and 1 (3%) additional injury occurred at a rodeo. None of the injured persons were known to be riding with another person on the same horse. Alcohol use was reported in 2 (5%) of the 38 injuries. Sixty- one percent of injuries occurred between March and July with a peak in May.

There were no TBI fatalities resulting from horseback riding in 1992. Hospital stays ranged from one day to 24 days; 21 (55%) of persons were hospitalized for one day. Loss of consciousness was experienced by 26 (68%) of the 38 injured persons. Two (5%) were discharged from the hospital with neurologic sequelae/dysfunction; one received inpatient rehabilitation. None of the injured were reported to be wearing a helmet while riding.

Prevention

Horseback riding can be an enjoyable and rewarding pastime- However it does require a certain amount of skill, coordination, and timing. Riders must practice safety around horses. The rate of serious injuries per number of riding hours is estimated to be higher for horseback riders than for motorcyclists and automobile racers. Riding in proper clothing such as heeled boots that fit the stirrup and using good equipment that has been maintained properly contribute to make the sport a safer one. Also, the use of alcohol can impair a rider as it does a driver of a motor vehicle. Slow response time may hinder a rider's ability to stay mounted.

The use of riding helmets can decrease the incidence of traumatic brain injuries. Few equestrians, however regularly wear protective head-gear, especially in Western riding activities, ranch work, and rodeo. Helmets required by the U. S. Pony Club have contributed to a 20% decrease in injuries in the past ten years at junior competitions and jumping events.

The American Academy of Pediatrics recommends the following measures to prevent/reduce horseback riding-related injuries:

Safety education programs for riders, parents, and instructors Matching the rider's skill to the horse's level of training Approved helmets for young riders

Sarah Lantis
Oklahoma University
Health Science Center

From INJURY UPDATE; August 26 1994, produced by the Injury Prevention Service, Oklahoma State Department of Health, 1000 NE 10th Street, Oklahoma City, Oklahoma 73117-1299

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NEISS Total Injured in Recreational Sports

The National Electronic Injury Surveillance System is a part of the US Consumer Product Safely Commission. NEISS records the number of injuries that go to Emergency Rooms at identified hospitals. From these figures, national estimates are projected. NEISS warns that these figures are estimates only. The total figures are low because persons with injuries not receiving treatment, treated at their private physician or free standing emergency clinics, or who died and were not transported to emergency rooms are not included. Sports in upper case letters are combined from several NEISS categories (equipment, professional, amateur).

NEISS: US Consumer Product Safety Commission, Room 625, 5401 Westbard Avenue, Washington, DC 20297

ALL AGES/ALL SPORTS 1993               Number Injured
  1. BASKETBALL                           761,171
  2. Bicycles/accessories                 604,066
  3. FOOTBALL                             409,280
  4. BASEBALL                             391,992
  5. SOCCER                               146,409
  6. SWIMMING                             118,641
  7. SKATING                              105,015
  8. VOLLEYBALL                            96,671
  9. Swings/Swing Sets                     94,286
 10. Monkey Bars Playground climbing       84,857
 11. Fishing                               75,959
 12. Track and Field                       69,095
 13. Horseback Riding                      68,517
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National Safety Council Sports Injuries
Accident Facts 1994 Edition

The table below shows estimates of injuries treated in hospital emergency rooms and participants associated with various sports. Difference between the two sources in methods, coverage, classification systems, and definition can affect comparison among sports. Because the frequency and duration of participation is not known, and because the number of participants various greatly, no inference should be made concerning the relative hazard of these sports or rank with respect to risk of injury. In particular it is not appropriate to calculate injury rates from these data.

SPORT                          PARTICIPANTS      INJURIES
Swimming                        63,100,000        122,697
Bicycle Riding                  54,600,000        649,536
Fishing                         47,600,000         82,436
Bawling                         42,500,000         24,361
Exercising with Equipment       39,400,000         95,179
Baseball/Softball               34,300,000        477,380
Billiards/Pool                  29,300,000          5,835
Basketball                      28,200,000        762,798
Roller Skating                  26,500,000        136,353
Golf                            24,000,000         37,556
Volleyball                      22,100,000        137,658
Tennis                          17,300,000         31,042
Football                        13,500,000        447,320
Soccer                          10,600,000        160,289
Table Tennis                     9,500,000          1,455
Horseback Riding                 8,500,000         73,484

National Sporting Goads Association (1992) figures include those who participate more than one time per year except for bicycle riding and swimming which include those who participate more than six times per year.

Figures from the National Safety Council
1121 Spring Lake Drive
Itasca, IL 60143-3201

EDITORIAL NOTE: When we use these figures (8,500,000), horseback riding is number sixteen in the number of participants. The horse community has developed other estimates of the number of participants which have been as many as 30,000,000 people riding a horse each year,

Using the figures of NEISS 1993, horseback riding is 13th in the number of hospital emergency room admissions from recreational activities. Although we are told above that it is not appropriate to use these figures to calculate risks, the table below does so for the interest of our readers.

SPORT                PARTICIPANTS  INJURIES  INJURY/
                                             PARTICIPANT
Football               13,500,000   447,320  0.033134
Basketball             28,200,000   762,798  0.027949
Soccer                 10,600,000   160,289  0.015121
Baseball/Softball      34,300,000   477,390  0.013917
Bicycle Riding         54,600,000   649,536  0.011896
Horseback Riding        8,500,000    73,484  0.008645
Volleyball             22,100,000   137,658  0.006228
Roller Skating         26,500,000   136,353  0.005145
Exercising w/ Equip    39,000,000    95,179  0.002415
Swimming               63,100,000   122,697  0.001944
Tennis                 17,300,000    31,042  0.001794
Fishing                47,600,000    82,436  0.001731
Golf                   24,000,000    37,556  0.001564
Bowling                42,500,000    24,361  0.000573
Billiards/Pool         29,300,000     5,835  0.000199
Table Tennis            9,500,000     1,455  0.000153

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

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The Development of Competency Guidelines for Riding Instructors and Equestrian Coaches

Within the United States, a great deal of disparity exists between the professional preparation of individuals providing instruction and coaching in equestrian sports as opposed to other sports. Although no research has been conducted in this area, a great deal of evidence suggests that riding instructors are involved with coaching equestrians for participation in competitive events. If riding instructors are involved with coaching, their current professional preparation may he inadequate.

Current riding instructor education and certification programs may not be providing adequate coverage of the academic aspects of coaching science. Riding instructor education and certification programs primarily emphasize the technical aspects of the sport, safety, and instructional techniques. In contrast programs designed for athletic coaches emphasize those aspects as well as human biomechanics, exercise physiology, sport psychology, motor learning, etc. However, it is important to note that within the United States, athletic coach education and certification programs do not have provisions for equestrian sports.

The development and implementation of competency guidelines for riding instructors and equestrian coaches would assist the equestrian sports industry in assuring that their professional preparation is adequate. The purpose of this study was to (a) develop competency guideline statements that indicate the knowledge and skills that riding instructors and/or equestrian coaches should possess or demonstrate, and (b) determine if significant differences exist regarding the importance of each statement for inclusion in competency guidelines for riding instructors and equestrian coaches.

Competency guideline statements were developed by the researcher and were seen to fall into five logical categories Administration, Equine performance, Equestrian Sport Techniques, Human Performance, and Pedagogy. The statements and two questionnaires were submitted to experts affiliated with 77 national equestrian-related organizations. The organizations were selected from the American Horse Council 1994 Horse Industry Directory, representing the areas of Sport, Show, Education, General Interest, and Health and Research. Representatives from 14 organizations responded.

Six competency guideline statements produced significant differences regarding their importance for inclusion in competency guidelines for riding instructors and equestrian coaches. These statements were in the Equine Performance, Equestrian Sport Techniques, and Human Performance categories. No significant differences were produced by statements in the Administration and Pedagogy categories.

Further analysis of the data revealed that all of the statements were considered to be important for inclusion in competency guidelines for equestrian coaches. However, nine statements were not considered to be important for inclusion in competency guidelines for riding instructors (representing all categories except Administration). The statements that were considered to be important for inclusion in competency guidelines for riding instructors were not only a subset of those for equestrian coaches, but were also generally considered to be less important. Statements that addressed the enhancement of safety and provision of instruction were considered to be more important for inclusion in competency guidelines far riding instructors than for equestrian coaches. Statements that addressed the enhancement of equine and equestrian performance for competitive purposes, were considered to be more important for inclusion in competency guidelines for equestrian coaches.

The results of this study suggest that although the distinctions between riding instructors and equestrian coaches are understood, in reality there is a tremendous cross-over between the two roles. In addition, respondents indicated that competency guidelines would be valuable to the equestrian sports industry and that a number of organizations may be interested in being involved with their development and/or endorsement.

Recommendations:

1. Determine the intended purpose of competency guidelines.

2. Identify national equestrian-related organizations that would be interested in the development of competency guidelines for riding instructors and equestrian coaches.

3. Plan additional research to determine the feasibility of one set of competency guidelines for riding instructors and equestrian coaches which would consist of several competency levels.

4. Examine the consequences of competency guidelines for riding instructors and equestrian coaches.

5. Develop and implement competency guidelines for the education and certification of riding instructors and equestrian coaches.

Johanna L. Harris
4721 Alston Chapel Road
Pittsboro, NC 27312.

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Competency Guidelines: A Job for the 2lst Century?

Johanna I. Harris is quite correct: there is "a great deal of disparity between the professional preparation of individuals providing instruction and coaching in equestrian sports, as opposed to other sports," And, there is a reason!

The equestrian sports, as we know them, only began to grow in the second half of the 20th Century. Previously, yes, our military riders took part in the Olympics, the wealthy civilian riders hunted, rode at the National Horse Show in New York or at Upperville, Virginia, handled their Saddlebreds and Walking Horses in the South and the ranchers in the West got the Cow Palace going. Even in the 1960s the American Horse Shows Association, the Masters of Foxhounds Association, the U.S. Pony Clubs, Inc., the U.S. Combined Training Association and the U.S. Equestrian Team, all had their annual meeting in the Plaza Hotel in New York City in the same week so everyone could go to every meeting. (I know! I was there!) The latter three organizations were just getting off the ground. At that point there were many fewer than 20,000 involved in the above areas - in a country of 350,000,000! The equestrian sports were not national sports. Colleges and universities were not teaching Equine Studies. In my own college, scholarship students were not allowed to ride (it was only for those with means!).

As the equestrian field grew particularly after WW II many untutored types who could ride a horse hopped an the bandwagon and hung out their shingles, "Riding Instruction." The so-called "slimy horse dealers" also saw a good thing coming and made lots of money selling inappropriate horses to unknowledgeable clients (this still happens). There lies the root of the problem.

In the United States we do not have a long history or knowledge of the equestrian arts (as in France, German, Scandinavia, Spain and Portugal). American are wont to think "We can do anything!" and they include riding a horse in that category! I call it "The American Instant Success Syndrome" and I see it every week. Many so-called riders have absolutely no concept of how to motivate a horse properly and are stuck in the kick, pull, tie-down mode. Unfortunately, their under-educated instructors have caused the problem. Here, I am not referring to the Olympic, Grand Prix or upper-level riders, but to the thousands of "everyday" riders who think they are doing wonderful things with their horses but, in reality, it could be called "horse abuse".

Fortunately, today, in the 90's, we have some excellent American instructors and coaches, and, fortunately, they are out teaching, doing clinics, making videos and in general, helping to raise the standards of knowledge in the field. Colleges and Universities are sponsoring Equine Studies curricula and, in the future, there may be enough call for a Coaching curriculum. Now, there are so many competitive aspects in the equestrian held, for the sake of safety for horse and rider it behooves the organizations to develop competency guidelines. It will not be an easy feat! It will be a goal in the 21st century.

Virginia Martin
340 South Route 94
Warwick, NY 10990

Virginia Martin is President and Chief Instructor at Borderland Farm, Inc. in Warwick, NY. a 250 acre horse farm and riding facility for the able-bodied and the disabled. She is a graduate of Skidmore College receiving her BS in Theatre, and post graduate education at NYU in Communications. She is a recipient of the NARHA "James Brady Award" the most prestigious award to a professional in the field of therapeutic riding. She was a NAHRA Board member for 6 years and is now on the Accreditation Committee. She is presently Executive Director of Equus Outreach, Inc. She has produced video programs including "Challenged Equestrians" which has been viewed around the world.

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