University of Vermont AAHS
AMEA

February 1993, Vol. III, Number 1

Table of Contents

Jockeys' Guild Leads the Way for Safety
United States Pony Clubs 1992 Accident Report
Pro Rodeo Programs: 1981-1990 Justin Injury Report
Editorial Comments: Rodeo
Low Back Pain During Horseback Riding


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Jockeys' Guild Leads the Way for Safety

More than a half century ago, three riders -- Eddie Arcaro, Johnny Longden and Sammy Renick -- cared enough about conditions they and other jockeys endured to pool their money to form an organization to ensure change. They kicked in $5,000 each to found the Jockeys' Guild.

Jockeys had long suffered inadequate facilities and were without basic and proper medical attention. The impetus, however, came one hot, humid July day at the old Jamaica (N. Y.) Racetrack. Renick still recalls what happened: "The horse I was riding in the last race stumbled badly leaving the starting gate and went down. I came off, flipped and hit the ground hard. I was in severe pain and needed quick medical attention."

But there was neither ambulance nor medical personnel on site.

It was the assistant starters who attended Renick. "They picked me up and carefully placed me on a long seat in the back of an old truck. They elevated my leg in an outward position and drove to the hospital -- a painful, 30 minute ride."

A few weeks later the Jockeys' Guild was formed and, in 1941, had successfully negotiated an insurance policy with Lloyds of London.

Ironically, the day the policy became effective, a young apprentice rider, Joe Giangaspro, was involved in a horrible spill when his mount clipped heels with the horse in front. Giangaspro lost his balance and fell in the path of horses wearing aluminum shoes that kicked and trampled him. He was killed.

Conditions for riders improved slowly, but it was not until neatly a decade and a half later the Jockeys' Guild began to see real change. Bert Thompson had become the organization's national manager and had turned his attention to safety standards. He was responsible in insuring an ambulance on the track at all times. And he insisted management set up first aid rooms.

One of Thompson's biggest accomplishments was working with an Inglewood, CA, inventor named Welsh and, with backing from John Alessio, President of Caliente Race Track in Tiajuana, Mexico, to create the Caliente Safety Helmet.

The November 1956 issue of the Jockey News (the Guild's magazine) reports that 10 leading riders at Belmont Park had tested the Caliente Safety Helmet during the races October 1 and that the National Board of Directors approved the helmet. The article further noted the helmet was in full production and the price was $27.50.

Safety rails are another focal point in the Guild's continuing efforts for greater track safety. Unfortunately, tract managements are slow to respond to the need for replacing PVC pipes with modern, safety rails. I cannot help but point to the contrast of two separate incidents. Before Del Mar installed its safety rail, a horse Guild Director Gary Stevens was riding fell into the PVC rail, shattering it. A piece of rail hit Stevens in the forehead, leaving a round indentation the exact diameter of the pipe. Compare that to what happened to another Guild Director, Dean Kutz, at Oaklawn Park when his mount flipped, throwing itself and its rider onto the safety rail, both bounced, but both walked away with only a few bruises.

Drug and alcohol-free riding is an another ongoing safety issue. I am very proud that, at its annual meeting in December, 1989, the Jockeys' Guild was the first industry organization to pass a resolution demanding jockeys be prohibited from racing if they are under the influence of drugs and/or alcohol.

Another safety issue that has recently come to the fore is the use of flak jackets. Director Jeff Lloyd, who nearly lost his life last fall when a horse left its hoof print embedded in the middle of his back, cites the case of a fellow rider who was wearing a flak jacket and escaped with minor bruising from a similar incident.

At the urging of Jockeys' Guild President Jerry Bailey who has been racing with one for the past year, the Jockeys' Guild unanimously adopted a resolution at its 1992 annual meeting endorsing the mandatory use of safety vests, aka flak jackets, by all riders at recognized race tracts in the United States.

We are very proud the continued pursuit of safety by the Jockeys' Guild is paying off. In 1992, for the first time in many years, there was not a single death of a jockey on the racetrack.

While our efforts for improved safety standards are directed toward professional jockeys at pari-mutuel racetracks, I feel they are applicable to everyone whoever climbs aboard a horse, be it for a canter across a pasture, a trail ride or to follow the hounds.

Helmets and flak jackets, particularly, should be compulsory: after all, lives depend upon them.

John Giovanni
National Manager
JOCKEYS' GUILD
250 West Main Street
Lexington, KY 40507

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United States Pony Clubs 1992 Accident Summary

The United States Pony Club has completed in its eleventh year of an ongoing study of accidents occurring in its activities. The emphasis of the study is to determine causes of accidents, and to suggest preventative changes in programs to decreased both numbers and severity. An accident by the study's definition is any INCIDENT of concern to the Pony Club member, instructor, leader, parent or District Commissioner. An accident form is completed by the DC whether or not an injury occurred. All accidents involving injury for which an insurance form was filed had an accident form completed. Individual interpretation still exists as to when the form should be filed, so it must be assumed many non-injury incidents are not reported.

1992 was a Pony Cub Festival year, held August 1-8 at Kentucky Horse Park in Lexington, Kentucky, attended by 4,092 Pony Clubbers and participants. The Festival presents a major logistics problem to the organizers as far as medical coverage is concerned. According to the report of Medical Coordinator Ann D. Quattrocchi, RN, a total of 58 medical personnel were involved in the nine days of Festival. She reports the good weather contributed to an extremely low incidence of heat stress. She also credits waiving the wearing of coats in warm-up areas with reducing heat injury, a rule change which was received favorably by the competitors. The medical team had many competitive suggestions for future competitions, including improved treatment consent and report forms. The team also felt the programs for the various activities needed to be printed in a uniform format so that information on competitors could be found more easily. Parents and chaperones need to be instructed to pay closer attention to announcements, since minimum response time to the medical tent was 45 minutes. It was also suggested the children should be taught what to expect if they should be involved in a medical emergency.

At festival, a total of 106 reports were filed over the 9 day period. 89 of these were related to registered Pony Club members; the others were family members, coaches, and observers. There were no injuries which prevented anyone from returning to the Horse Park to compete or observe. Of the 16 falls, 15 were horse-related, and one was from a bicycle. 4 went to the hospital, and all returned to ride. 4 injuries were the result of being kicked, one during the official picture-taking. 17 people required treatment for blisters or abrasions. Other treatment included blisters, 11, rashes, bug bites, bee sting, 5, ice packs, 21; abrasions, 10, sprains, 9; asthmatics, 3.

Of the 106 festival reports, 24 were entered as part of the 1992 study; 18 of these were riding related. The total festival reports are summarized above.

1992 USPC ACCIDENTS STUDY

The total accident reports entered was 112. 96 (85.7%) were incidents which resulted in injury. The ten year study reported 93.5% injuries, which probably reflects increased interest in reporting all incidents of concern by the DC's.

Of the injury accidents, the ten year study showed the head as most often injured (14.4%). The breakdown of that percentage, computed both before and after 1990 when the ASTM/SEI helmet was required by USPC rules, is significant. During 1982 to 1989 the percentage of head injuries was 24.2%. The figure in 1992 was 14.3%. In 1992, facial injuries also represented 14.3% of the injuries. All were superficial with two minor lacerations being the most concern.

The next most-reported injury site was the knee (13.3%). The worse of these, a fractured kneecap, occurred in a non-horse accident on competition grounds. Most were bruises or abrasions. The fourth most frequent (11 .2%) was the neck. None of these injuries were severe; most involved bruises. There were a few instances of stiff, sore necks following jumping falls where the rider landed on the head or neck. None required medical or hospital care.

Of the type of injuries, the most common was bruise/abrasion (48%) including both primary and secondary injuries. This is up from the 10 year average of 35.1%. Sprain or muscle-pull was 17.4%, up from 12.8%, the second most common. Next came closed fracture (16.3%) down from 23%; and fourth was dislocation/separation at 8.2%. This was a newcomer to the top five. Fifth was concussion/unconscious at 7.1%, down from the 10 year figures of 7.4%. Concussion was defined to include any momentary "seeing stars", confusion, or memory loss- Unfortunately three of the head injuries were severe, two jumping accidents and one non-horse related "on the grounds" unhelmeted accident. The most serious involved a face-down fall, where a fracture occurred at the back of the head.

There were also several reports of accidents where horses either kicked or stepped on the heads of fallen riders; these were among the "no injury" reports, as were reports of falls where a primary or secondary impact was taken by the helmet. The only complaint about helmet fit was one which moved on the head at impact but the rider was not injured.

Those reporting a pervious injury in a horse-related accident were 33.7%, up from 26.2%. As has been pointed out Dr. Doris Hammett in the past, consideration of past injuries is important as a possible indicator for a future accident.

The figure for hospitalization has changed upward to 11.4% in 1992 from 8.7% in 1990 1991. This number is still lower than the 1982-1989 figure of 14.7% and may reflect increased caution on the part of instructors, parents and officials. The percent of members with injuries requiring a physician visit also increased to 40.4%, from 33.7% in 1990- 1991. The 1982-1989 figures was 60.5%

The activity in which most accidents occurred was jumping (24.7%). The mounted meeting and riding cross country figures were tied for second at 21.5% each.

There were several accidents which implied a lack of attention, sometimes involving non- members or younger siblings. For example, a four year old playing in a driveway during a local board meeting fell and hit his head on a rock. Another, while the adults were involved in a business meeting, was jumping on foot over a horse course which was set up nearby, fell and broke an arm. One child was playing ball after a rating, went behind a horse and was kicked. Luckily the ball absorbed most of the impact! A child at a knowdown hurt an arm. During festival picture-taking a child was kicked; another was hurt during the parade of teams. a picnic table blew over spooking a horse which then ran over a small child spectator. At: a local competition, a child, unseen by the driver, tried to climb up onto the back of a moving truck, and received serious head and knee injuries.

All organizers, officials, parents, and Pony Clubbers must stay alert in all Pony Club activities to avoid injury to spectators who may not understand the power and unpredictability of horses. Our own members must be reminded never to take even the best-behaved horses for granted.

USPC members can be proud of their awareness of accident prevention and of their excellent safety record. USPC's District Commissioners are overworked and underpraised; their ongoing cooperation in providing the Safety Committee with vital information is greatly appreciated.

Dru Malavase
2270 County Road 39
RR2
Bloomfield, NY 14469

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Pro Rodeo Program: 1981-1990 Justin Injury Report

The Justin Sportsmedicine Program compiled statistical data at rodeos officially designated a Justin Sportsmedicine Program. For the purpose of this study an evaluation is considered any question/answer session with an athlete during a Justin Sportsmedicine Program that pertains to a specific injury. A treatment is considered any exercise where a therapeutic modality is used on or with an athlete. A major injury is defined as one that requires the transportation by qualified medical technicians to a treatment facility and/or the confinement in a treatment facility of approximately twelve (12) hours or longer. An injury report was submitted each time a modality was used in the treatment of a rodeo athletic injury.

During the 10 years ending in 1990 the Justin Sportsmedicine Program increased involvement in the PRCA from 10 (1.6%) of the 641 rodeos in 1981 to 40 (5.7%) of the 751 events in 1990. The number of performances that fell under the Justin Sportsmedicine program increased during that same time frame from 110 (5.6%) of 1,941 performances in 1981 to 273 (12.6%) of the 2,159 performances in 1990.

The events with the most injuries remained Bullriding, Bareback Bronc and Saddle Bronc riding in that order over the decade. Rodeo Clowns/Bullfighter were, as could be expected, the most frequently injured non-contestants (82.7%).

The most injured sites were constant during the 10 years period with the spine, knee, and shoulder ranking 1, 2, 3. However, concussion remained the most frequent major injury from 1981 to 1990. The concussion injury rate increased slightly from 1981-1985 (2.3%) to 1986-1990 (2.6%) while the injury rate for all other major injuries declined from 8.2% to 3.1%.

Donald M. Andrews
Program Director
Mobile Sports Medicine Systems, Inc.
411 N. Washington, Suite 2000
Dallas, TX 75246

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Editorial Comments: Rodeo

Prior to the onset of the Justin Sports Medicine Program, rodeo health care was somewhat analogous to the health care of the frontier West. In most saloon fights, as in most rodeos, the victorious would stand proudly at the end of their efforts and buy a round of drinks for the crowd assembled around. The losers, of course, would be transported home (usually in the back of a wagon) to nurse their wounds in the bunkhouse, hopefully to rise and function once more.

Over the past one hundred years, the sole advance I could discern in this scenario was the replacement of the wagon with a pickup truck as the means of conveyance for the injured.

Professional rodeo, prior to the Justin program, was one in which virtually no attention was paid to the health of the participants. The very most one could hope for in any rodeo would be the presence of an ambulance with a crew that had little if any training or interest in the specific types of injuries encountered in rodeo performances. Many rodeos that I witnessed in my childhood did not even have an ambulance in attendance.

The Professional Rodeo Cowboys Association had a long-standing lack of commitment to the improvement of health care believing this was the responsibility of the participants. When I proposed doing an injury study in 1982 the PRCA became extremely troubled, fearing my efforts might possibly result in higher health insurance premiums paid by the participants As of this date, I am unable to identify a safety committee as an inherent and functioning part of the Professional Rodeo Cowboys Association, or any other similar rodeo based organization.

Into this void has stepped a" bright light -- Justin Sports Medicine Program. The program itself is a mobile program more or less commandeered by Mr.- Don Andrews, an athletic trainer. The physical equipment is housed in a semi-trailer rig so it may be transported to as many rodeos as possible. Having toured this facility, I can attest to the fact that it is a "first-class" training installation any professional sports team would be proud to own. Don Andrews' diligent efforts over the past ten years have resulted in some major improvements in the recognition and treatment of injuries in professional rodeo competition.

In viewing the period from 1981 to 1990, arena fatalities did decrease; however, the maximum number in any year was six; therefore, this was not statistically significant. The number of professional rodeo permit holders increased during this time from 6,632 to 11,554 (an increase of 68%). The Justin Sports Medicine Program increased its participation from 3% to 6% of the licensed rodeos. However, the number of licensed rodeos increased by 13% during the same period.

Don Andrews was able to identify the various type of injuries and noted interesting trends among these. He noted a decrease in the number of participants who required treatment from 15% to 14% which, considering the numbers, was quite statistically significant. While elbow hyperextension injuries has been reported to be the most common injury in rodeo participants in high school and collegiate ranks, in the professional ranks, Mr. Andrews noted that knee injuries rated first with shoulder injuries second. There was no significant change in their frequency.

There was a marked decrease in lumber spine evaluations with an overall percentage decrease of 54% over this ten year period. A number of factors seem to be involved in this decrease. These seem to include the use of protective saddle pads beneath the bronc's saddles, the avoidance of aspirin and the use of Tylenol as its replacement among the participants (thus reducing bruising and hemorrhagic tendencies) and the utilization of lumbar sport braces which was felt by many participants to be advantageous.

During this time, abdominal injuries increased 293%. This was felt to be due to an increased awareness on the part of participants as to the likelihood of severe abdominal injuries. This was further heightened by the death of a World Champion Bull Rider due to abdominal injuries in the Cheyenne, Wyoming, Frontier Days Rodeo in 1990. Awareness of this event seemed to heighten the participants' desire to be examined for abdominal injuries following their occurrence.

Second only to abdominal injuries was the complaint of head and face injuries. This was also felt to be due to a heightened awareness, and also the fact the sports medicine program had the facilities available for immediate diagnosis and treatment. Participants who heretofore may have only put a poultice on a wound and hoped it would heal satisfactorily were more likely to have the wounds closed or dealt with expertly once medical care was on the premises. Numerous head injuries were noted for bull riders during that: time, and some of the riders have begun wearing protective helmets. These are now commercially available in western style hats and it is hoped their use will continue to increase in the forthcoming years.

Included in these diagnoses was an increase in concussion reports. Once again, the availability of qualified health care resulted in increased reporting of losses of consciousness. The definition of concussion in this program was "an alteration of consciousness which followed trauma but cleared within 60 minutes." Simply put: because Andrews was available in the performance arena, he was asked to look at riders who otherwise would simply have been allowed to awaken and would have pursued their activities without medical attention.

Through the Justin Sports Medicine Program we are obtaining a more accurate data base. Hopefully this will allow for remedial programs if, indeed, such are needed. The use of protective helmets and protective chest gear is already being noted with increasing frequency among rodeo participants and hopefully the AMEA can be instrumental in encouraging this in the future.

Sadly the Justin Sports Medicine Program can only be present at a small percentage of rodeo performances. This is such an outstanding program, however, it deserves the full support and encouragement of the AMEA. Mr. Justin's benevolence in the development of this program should be recognized and appreciated by all who labor in this area. Hopefully, efforts such as Mr. Justin's may be pursued in the future either by Justin Boot Company or other similar corporate entities, thus resulting in improved medical care being brought to rodeo participants.

James S. Warson, MD.
Front Range Center for Brain & Spine Surgery
1313 Riverside Avenue
Fort Collins, CO 80624

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Low Back Pain During Horseback Riding

Low back pain is a common complaint among many horseback riders regardless of their age, sex, or particular interest. Following is a brief review of the etiology of back pain particularly as it relates to horseback riding. It is not intended to be a complete review of all injuries and/or pathological conditions that may interfere with horseback riding but to acquaint the reader with common features of low back pain that may occur during horseback riding.

In order to appreciate fully those factors associated with low back pain it is important to understand the relationship between the lumbar vertebra, intervertebral disc, facet joint, supporting musculature, and particularly the lumbosacral junction. Although herniated intervertebral disc, fracture, and degenerative disc conditions may be aggravated by horseback riding, by far the most common problem relates to abnormalities within the lumbosacral function and the musculoligamentous attachments, including the sacroiliac joint. These anatomical arrangements can be influenced by proper positioning to lessen the occurrence of low back pain and will be reviewed.

The muscles most important for horseback riding include the strong erector muscles which attach to the lamina and facet joints of the vertebra, the flexor group of muscles in the abdomen and the strong iliopsoas. It is the relationship of the flexor and extensor groups in association with the iliopsoas that determines the angle of the lumbar spine with the pelvis through its sacroiliac junction. In non-pathological conditions this angle determines whether a rider is more or less prone to low back pain.

The lumbosacral angle and the interspinous line are vital to balanced riding and the avoidance of low back pain. In the normal erect position the lumbosacral angle is approximately 30 degrees. In this position the vertical forces are absorbed through the individual intervertebral disc, facet joint, and supporting musculature. The back is relatively flattened with the center of gravity in the mid-thoracic region over the vertebral body (T-9).

When the spine is hyperextended the lumbosacral angle becomes open and the axial pressure is distributed to the facet joint and sacroiliac joint in the posterior margin of the intervertebral disc. The center of gravity is posterior. This position tends to lessen the security of the rider and be associated with low back pain related to compression of the joints and posterior margin of the intervertebral disc.

When the spine is slightly flexed, the lumbosacral angle is closed and the axial pressure is in the anterior portion of the intervertebral disc. This tends to aggravate any bulge of the intervertebral disc thereby associated with pain in the back which will then radiate into either lower extremity. The center of gravity in this position tends to be more anterior thereby giving the rider a greater sense of security.

It is easy to identify those riders most prone to low back pain by looking at the position of their lumbar spine when they are seated in the saddle. For a balanced riding position, the back will appear to be flat. The axial pressure in this position is in the midline with the center of gravity in the thoracic region with the facets and intervertebral discs in a relative normal position. Alternatively, when the back is hollow it appears to be extended with the pressures being more posterior, the facets closed, and associated with low back pain. A rider who assumes a slouched position will be flexed in the lumbar spine with the pressure being more anterior as is the center of gravity. This tends to accentuate the presence of a bulging intervertebral disc and thereby attended with back and leg pain.

The normal balanced riding seat may be improved through a series of exercises designed to strengthen the inter-play between the flexor and extensor muscle group with particular attention toward the iliopsoas. These exercises include a knee to chest, partial situp, full sit up, and straight leg raising. A physical therapist or athletic trainer can review these with you in more detail.

Most individuals who complain of lower back pain while riding can be improved with a series of exercises with particular attention to proper riding position. The individuals who do not improve by these measures should be further evaluated for the presence of degenerative disc or herniated intertertebral disc. Those with degenerative disc disease may improve with the judicial use of non-steroidal anti-inflammatory medications, physical therapy, and proper attention to riding which would include raising the stirrups in order to flatten the back. Riders who are diagnosed with a herniated inervertebral disc should be evaluated prior to resumption of horseback riding.

In summary, knowledge of the functional anatomy of riding is important to understanding painful conditions of the lumbar spine. Many acute and some chronic complaints of low back pain may be lessened through changes and correction in riding position and strengthening or stretching exercises prior to riding. In my experience, the older, female riders are more susceptible to low back pain while riding which is mostly related to poor positioning and the presence of degenerative disc disease. Most of these resume their riding activities after physical therapy and occasional use of non-steroidal anti- inflammatory medications.

This review has touched on those features associated with the common complaints of low back pain while horseback riding. Further presentations will include those who have sustained spinal fracture or herniated intervertebral disc.

William H. Brooks, MD
Neurosurgical Associates
Lexington Neuroscience Center
152 West Zandale Drive
Lexington, KY 40503

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