Name: Instructor: Curse: Date: Horseback riding and head injuries Introduction Horseback riding or just horse riding is the skill of driving, riding, vaulting or steeple-chasing with horses. Since time immemorial, horse riding (also referred to as equestrianism) has been an important aspect of human culture. In the last centuries, it was done mostly for utilitarian purposes such as work, warfare and transportation. In the present, horse riding is most commonly for recreational activities. Many people who like riding horses do it either for fun or for competition purposes (Kate 24). About 30 million people in America ride horses every year. However, there are approximately 2500 cases of riders who are below the age of 25 years being admitted to hospitals every year due to cases of horse riding injuries (Michael 201). A good number of these injuries are those related to head and brain. The risk of injuries in horseback riding is significantly greater than in bicycle riding. They occur because some of the activities like jumping are very risky since horses can be as heavy as 1500 pounds, move as fast as 30 miles per hour, and can stand as tall as 3 meters. Most of these injuries result when the horse falls off, or the horse rider is thrown forward and lands on his/her head or striking their heads on a nearby object like poles. Some of the factors which may increase the chances of falling and causing injuries to the riders are like slippery footing, bareback riding or green horse, and the height from which the horse rider falls will determine how severe the injury will be. They sometimes result in very severe head injuries. People who survive after head injuries may suffer complete loss of some functions, severe or moderate disabilities and thus the need for intensive health-care after such injuries. The cost of medical care for the victims is substantial due to the adverse neurological problems and the many number of days in hospital. This research paper focuses on the investigation, analysis and discussion of some of the practices that cause head injuries in horse riding as well as the safety measures that can be taken to minimize or completely avoid such injuries. It also answers the question of why high rate of injuries associated with horseback-riding occur in warm months during the weekends in the afternoon hours and furthermore, why most of the injuries associated with horses but not horse-riding are among children. Literature survey A survey carried out in the regional spinal and head injury unit in Ontario shows that out of the 17400 cases of brain and head injuries that were admitted in five year period, 59 patients suffered head injuries due to horse riding. Most of the cases involved females. Out of the 59 head injuries, 56 were small injuries, 3 were severe and one died. Cases of skull fracture were observed in 10 patients, and at least 5 out of the 10 were wearing headgears during the impact. Scalp trauma was observed in 22 patients where most were occipital injuries. All the cases of major injuries had a fracture of the skull. A fifth of these patients sustained other minor injuries on other parts of the body. Most of the patients (90%) recovered well, 2 became moderately disabled while one became severely disabled. Another survey carried out at Oklahoma in 2011 showed that 52 000 deaths are associated with head injuries and this accounts for one quarter of all deaths resulting from injuries in the United States each year. Furthermore, about 75 000 people who survive after head injuries suffered complete loss of some functions, moderate disabilities and thus the need for increased health-care due to these injuries. Cases of brain trauma are mostly caused by motor vehicle accidents, assaults, falls, sports and other recreational activities (Kate 25). During 2011 in Oklahoma, most sports-related head injuries were caused by horse riding. A total of 9409 cases of brain trauma occurred during the year. 109 of them (1.2%) which included three deaths were related to horseback riding, 23 other cases of brain trauma were associated with horses although not horse riding. The number of injuries among males was 62 and females were 67. The horseback riders were between the ages of 4 years and 71 years. The cases of horseback injuries occurred most commonly in summer and spring (78% of all cases). 22% occurred in autumn and winter. Nearly a half (49%) of the brain injuries associated with horse riding occurred on Saturdays or Sundays. Out of the 93 cases of whose times of injury were known, 69% occurred between 11 a.m. and 8 p.m. Out of the 105 head injuries for which the mechanisms of injury were specified, 100 of them involved horseback riders striking their heads on a nearby object or on the ground after falling from the horseback. Four were kicked or were rolled on the ground by the horse after falling, and one striking his/her head on a pole while horse riding and falling to the ground. Among the 96 riders for whom details on the type of horse riding activity were known, most of them (86) were related to sporting activities, and the remaining 10 were related to work activities. Most of the riders (98%) who suffered from, horse riding accidents were admitted to hospitals and 2% of the cases resulted in deaths at scenes of accident. Out of the 109 survivors of head injuries associated with horse riding, 87 had at least one indication of severe brain injuries, 67 lost their consciousness, 49 suffered amnesia due to brain injuries, and 14 had persistent neurological problems(such as speech, vision or hearing) after being discharged from the hospital. Among the 23 cases of brain injuries which were associated with horses but not riding, 21 occurred due to direct kick at the head; one died, two needed cardiopulmonary resuscitation, 13 of these cases occurred among young people of age 10 years or below. Among the 19 persons whose places of injury were known, 15 occurred in farms.
Horseback riding poses a big risk of head injuries to most of the riders, majorly young women. This survey shows that wearing of the riding headgears does not completely protect the horse rider from skull injury, which mostly affects the occipital region. For the reported cases of deaths and severe injuries, most riders were not wearing protective headgears/helmets or were wearing poor quality headgears, or the headgear was dislodged from the head while falling from the back of the horse. The moderate injuries were mostly bruises, abrasions, cuts and fractures. In general, the injuries among children were more severe as compared to those among adults (Michael 56). Head injuries are usually much worse than broken bones and those who suffer from them do not recover completely (Michael 56).
The major reasons for hospitalization of horse riders are the head injuries and they make about 20 percent of all the horse riding injuries in the US. A research in 2010 by Center for Disease Control showed that head injuries comprise11 percent often total number of traumatic brain injuries in recreational horse riding activities from 2007 to 2009. Out of the 14,400 treated injuries related to horseback riding in 2009, 3,790 were severe cases and required hospitalization. Skull fractures and brain hemorrhages comprised most of the major injuries. A research conducted by EMSA indicated that head injuries comprise approximately 60 percent of death cases resulting from horseback riding accidents.
Analysis and discussion Some of the factors which may increase the chances of falling and causing injuries to the riders are like slippery footing, bareback riding or green horse, and the height from which the horse rider falls will determine how severe the injury will be. A horseback rider sits at the back of a horse at a height of nine feet or more from the ground, and falling from a height of just three feet can damage the brain permanently (Michael 36). Although only 1.2% of the brain injuries in Oklahoma during the year were related to horseback riding, the cost of medical care for the victims is significantly high due to the associated neurological problems and the number of days spent in hospital. Furthermore, head injuries relating to horse riding described in the survey probably underestimated the number of such injuries because some of them were neither hospitalized nor reported hence the data was unpublished. In Oklahoma, people who are not hospitalized are not captured by the health surveillance system. During 2010 and 2011, head injuries associated with horseback riding were nearly a half of those associated with bicycle riding. The severity of injuries in accident in horseback riding is significantly greater than those in bicycle riding. During 2010, the rate of injuries resulting from horse-riding and are severe to require emergency healthcare was approximately 18 per 10,000 riding hours whereas the rate of injuries associated with bicycle riding was 2 per 10,000 riding hours. The high rate of injuries associated with horseback-riding during warm months during the weekends in the afternoon hours was probably because many people ride during these times. The high number of injuries associated with horses but not horse riding among children occur because of their direct contacts with horses or were playing near a horse. Moreover, it is difficult to continuously supervise the children to ensure that they always wear protective equipment whenever they go near the horses. Young riders are generally more susceptible to injuries from horse riding due to their inadequate riding skills and little experience (Michael 49). Head injuries as well as other injuries that are associated with horseback riding can be minimized by wearing protective helmets or headgears that meet the ASTM standards to ensure that they are of good quality. Rules and regulations should be formulated to ensure the use of helmets in horse riding organizations and clubs. More efforts to avoid these problems should include an assessment of the quality and effectiveness of a headgear to be used during horse-riding activities, understanding the biomechanics of the injuries associated with horse riding, attending training programs in riding of horses, their safe grooming as well as how to carefully match the horses to the meet the skill levels of their riders. Countries like France and Great Britain require the horse-ride leaders to undergo training and pass exams in order to be licensed (Kate 55). In Northern California, horseback riders have grown more conscious with the safety issues in horseback riding. Although, serious head injuries can still occur when wearing helmets or headgears, studies have shown that the use of helmets or headgears reduces the severity of the head injuries. Helmets or headgears are important in horse riding sports which involve show-jumping in high dressage competitions; the horse riders usually wear ball hats which do not provide any protection. Although accidents are rare during competitive dressage, they can occur. Most dressage horse riders don’t wear helmets or head gears when practicing and some go for the competitions without them. A further study showed that the protective equipment decrease the chances of head injuries by approximately 50%. The type of horse riding done determines the safety. Injuries are less common in leisure riding as compared to amateur racing. Jumping increases the risk of injury by ten times(Michael 17).The two methods of horseback riding; the jockey style, where the rider takes the cross country position having his/her head facing forward and the rider is most likely to have head injuries in case of an accident. The second style is the classical style. This is a case where the rider holds his head high and she/he is most likely to fall on her/his buttocks. This poses less risk to head injuries as the rider is likely to fall in the buttocks. Jumping phases result in most head injuries than dressage phases. Horse riding without a helmet increases the risk of head injuries and jumping also increases it significantly. The best thing one would do to lower the chances of head injuries would be not to jump. This may be the reason why several western horse riders do not feel the necessity for wearing riding helmets or headgears. It is hard to jump onto the saddle and the ride is close to dressage style when he/she sits upright (Michael 76). It is safer for a person to do a flat riding when wearing a helmet than when wearing a ball cap. The horse riding head injuries are most frequent in persons under the age of 21 of years. The skull injuries or traumatic brain injuries can seem mild but may have long term effects (Kate 45).
Horse riding is a great activity for the whole body but if one does not take the necessary precautions, she/he can get serious head injuries when riding. Some of the tips a horse rider can follow in order to minimize or prevent head injuries as well as other riding-related injuries are as discussed below.
Majority of injuries related to horses (about 80%) occur while horse riding. Around 20% of the horse’s related injuries occur when handling the horses (such as feeding, shoeing, giving treatment, leading or grooming) as well as when doing unrelated activities like children playing near a horse. While riding, ne should not be too fast on sloppy or slippery terrains because there are high chances of the horse slipping and falling off and thereby causing severe head injuries to the rider. Like other animals, horses are also terrified when they see or hear anything unusual. At high speed, the horse would find it hard to make a sudden stop or turn in the case of a perceived danger. In such a situation, the horse is likely to fall as it tries to suddenly stop when an object unexpectedly falls in front of it during the ride. For example, when the rider in front loses his/her raincoat, hat or any other object tied carelessly on the saddle and falls off. Moreover, areas with barbed wires, trees or any other dangerous equipment should be approached cautiously and at low speeds. One should always be careful not to approach the horse so closely from behind whether it is known to be a kicker or not. Furthermore, people should be extra careful with horses which often kick and keep the children far from them. Some horse-riders tie red ribbons on the tails of the known kickers in order to warn guests and other riders about the danger of being close to such horses. Horse riding should be understood as a sporting activity and therefore, requires trim body and good muscles for the good results. A horseback rider who is too heavy cannot perform well because she/he puts a lot weight on the muscles. In case he/she falls off from the horse or thrown forward and lands on the head, severe head injuries are likely to occur because the weight puts a lot of stress on his/her skull .
Just like the taking off and landing of a plane, mounting as well as dismounting from a horse are potentially risky times. It requires the horseback rider to put her/his weight on one side of the horse thus throwing it off balance which may make it to react. With one of his/her feet out of the stirrup, he/she is susceptible to any movement made by the horse since at this time he/she has inadequate control of the horse. If there are any doubts about mounting or dismounting, someone should hold the horse as the rider mounts or dismounts. Alternatively, safe mounting block can be used to make mounting easier and safer. Whether a horse is known to be a kicker or not, one should always be cautious when around the horse’s hind legs because they are well adapted for kicking. The riders should be extra careful with horses which often kick and keep the children far from them. Some horse-riders tie red ribbons on the tails of the known kickers in order to warn guests and other riders about the danger of being close to such horses.
Just like taking off and landing of a plane, mounting as well as dismounting from a horse are potentially risky times. It requires the horseback rider to put her/his weight on one side of the horse thus throwing it off balance and may make it to react. With one of his/her feet out of the stirrup, he/she is susceptible to any movement made by the horse since at this time he/she has inadequate control of the horse. If there are any doubts about mounting or dismounting, someone should hold the horse as the rider mounts or dismounts. Alternatively, safe mounting block can be used to make mounting easier and safer. All horse riders should always wear horse riding helmets or headgears and they should ensure they meet the required quality standards. Poor quality ones may be prone to breakages and may contribute to the severity of the injury in case of a riding accident. Damaged head equipment can also cause injuries to the head during the riding activity even when the rider does not fall off. The rider’s clothing needs to be comfortable and should not be too loose. One should inspect the riding equipment before use to be sure that none of them is damaged. All the riding equipment should be secured properly to avoid damaging them. Inexperienced riders and children should always use safety stirrups which can break away if the horse rider falls from the horse. The novice horse riders should learn from the experienced riders or instructors and should always be supervised when they are riding. Moreover, amateur rides should take place on flat terrain, open or in monitored horse riding areas. Stunts and jumps require high level of horse riding skills and should not be attempted by anyone without close supervision by the instructors.
If the rider feels he/she is falling off the horse; she/he should try and roll away immediately he/she hits the ground. This would avoid the cases of the horse stepping on the rider’s head or any other part of the body and thereby causing injuries. Any horse rider should never ride on a horse when he/she is tired, on medication or has taken alcohol. Horse riders should always know that she/he is riding on an animal which also has its ways of reacting to the sounds, smells and sights the rider is experiencing. They should understand that horses would run away when they realize sudden movements or hear noises. The rider should therefore, stay alert to note anything that may disturb the horse. They should always be prepared to make fast and appropriate responses to such occurrences. When the horse rider is doing trail riding, she/he should always try as much as possible never to go off the rail and should never be tempted to. The riders should note and follow the warning signs. Anyone should never walk behind the horse as this threatens them. The best thing to do is to approach them at the shoulder. This does not threaten them.
In order to know what the horse feels, one should watch its head, more specifically its ears. How the horse moves its ears will tell about the horse’s reaction to its environment (other animals or people in its surrounding). The horse will always direct both or one of its ears to the source of sound. When the horse holds its ears on the sides, it tells that it is sedated, sick, or sleeping and when it faces its ears backwards, it indicates threat or anger. If one performs any activities like giving the horse medication, she/he should ensure that she/he keeps his/her head at a distance and also keep the hands open, the fingers flat and extended because the horse can bite or break the fingers.

Conclusion
Horseback riding is a great but risky sport. The large numbers of admissions in hospitals due to head injuries each year result from horseback riding. Women horse riders are most likely to be hospitalized with major head injuries. Research findings showed that this is because there are more women horse riders and the larger number of incidents of head injuries is probably proportional to the total number of female horse riders. The high rate of injuries associated with horseback-riding in warm months during the weekends in the afternoon hours was probably because many people ride during these times. The study showed that the high number of injuries associated with horses but not horse riding among children occur because of their direct contacts with horses. They occur due to children being kicked directly on the head by the horses. Moreover, it is difficult to continuously supervise the children to ensure that they always wear protective equipment when they go near the horses. The head injuries are due to being thrown against an obstruction and mostly occur at the when the horse jumps. They are more common in point to point than in social riding or flat racing. Most of the accidents that cause head injuries occur in cross country races which involve jumping over obstacles at high speeds. If a horse collides with an obstacle, either the horse or the rider falls off. Both of them can also fall. Most commonly, the horse rider is thrown forward and lands on the head and thereby causing damages on the head. Some cases involve horseback riders striking their heads on a nearby object like poles while at the back of a horse or striking their heads on the ground after falling from the horse. The other area where head injuries are common is in practice for jumping phases. Some of the factors which may increase the chances of falling and causing injuries to the riders are like slippery footing, bareback riding or green horse, and the height from which the horse rider falls will determine how severe the injury will be. Head injuries related to horseback riding can be reduced by observing the safety precaution for horseback riding. Head injuries as well as other injuries that are associated with horseback riding can be minimized by wearing protective headgears that meet the ASTM standards. Rules should be formulated to ensure the use of helmets in horse riding organizations and clubs. More efforts to avoid these problems should include an assessment of the quality and effectiveness of a headgear to be used during horse-riding activities, understanding the biomechanics of the injuries associated with horse riding, attending training programs in riding of horses, their safe grooming as well as how to carefully match the horses to the meet the skill levels of their riders.

Works Cited McGhee, Miller. Horseback riding and head injuries: Admissions to a regional head injury unit. Department of Surgical Neurology, University of Edinburgh Royal Infirmary, Ontario.2011. Print Michael, Smith. Horseback Riding: A Major Cause for Recreational Brain Trauma. Quebec. 2007. Print
Kate, Colder. Horseback riding in action. Ontario. 2011. Print.