Lack of concussion awareness and misdiagnosis contribute to delayed recovery in horse riders

Research has highlighted the need for “vastly improved” awareness of concussion in horse sport – as progress is being made in this area.

Mental health charity Riders Minds supported work on the effects of and recovery from concussion, and the level of understanding of the condition, carried out by researcher Amelia Collins.

A Riders Minds spokesperson said the interview study of female riders “highlighted the lack of education around both the symptoms and the severity of concussion as a brain injury and misdiagnosis from professionals, leading to delayed care and prolonged recovery time”.

“Findings show that prolonged concussion recovery is not only physical but psychological, social and identity-related,” the spokesperson said. “Many riders reported cognitive and emotional changes such as poor concentration, low mood and mental fatigue that were not initially recognised as concussion-related and were sometimes attributed to stress or anxiety, which delayed appropriate care.

“A lack of concussion awareness also meant many riders underestimated their symptoms and  continued riding or working through them, unknowingly prolonging recovery.”

One participant said she did not know she was concussed and pushed on – her recovery took two years and nine months. Others reported being dismissed or misdiagnosed, but also downplaying their own symptoms.

Concussion in horse sport: more action needed

“A key finding was that cognitive and emotional symptoms, including poor concentration, low mood and mental fatigue, were frequently not recognised as concussion-related,” the spokesperson said. “Riders reported that these symptoms were often initially attributed by medical professionals to stress, work pressures or anxiety, delaying appropriate concussion-specific care. This lack of early recognition contributed to confusion, frustration and prolonged recovery for many participants.”

The study found limited awareness meant many riders ignore warning symptoms, prolonging their recovery; physical issues such as numbness, pins and needles or fatigue were often not understood to be signs of a brain injury.

Ms Collins said: “Being both a coach and a rider, I’ve seen first-hand how often concussion symptoms are minimised. Many riders just focus on pushing through, unaware that this is a serious brain injury that can have long-lasting effects, and that recovery from concussion can be a hard process.

“I’m incredibly grateful to all the interview participants who generously shared their time and  insights; this research wouldn’t have been possible without them. Speaking to them was a  powerful experience for me and I hope this research helps raise awareness of concussion in  equestrian sport. Change starts with education and by sharing these stories, we can begin to turn  knowledge into action within the sport, supporting riders as they navigate their concussion recovery journeys.”

Riders Minds says the study shows the need for better awareness of concussion in horse sport, and recognition of symptoms, as well as education on prolonged recovery.

British Showjumping (BS) has brought in new concussion rules this year; any rider taken directly to hospital from a show or in whom medics, officials or organisers suspect a concussion will be suspended for 21 days to prevent competitors returning to competition during a time when suffering a second brain injury could have catastrophic effects.

BS will also alert other British Equestrian (BEF) member bodies, not of medical information but of suspension dates. To request the period be shortened, a rider must provide a hospital discharge sheet or doctor’s report clearing them to compete.

The dangers of a second head injury

“We’re not trying to spoil anyone’s fun but we need to help educate people – especially those responsible for young people in the sport – about the dangers of a second head injury in that time period,” BS CEO Iain Graham told H&H.

A British Dressage (BD) spokesperson told H&H BD follows the same protocols as BS, including reciprocal suspension arrangements with other BEF member bodies as “it is vitally important for the health and safety of all participants, both equine and human, that we follow the correct policies and procedures”.

Head of British Riding Clubs Rachael Hollely-Thompson told H&H anyone who experiences symptoms of suspected concussion, however brief, will be suspended for a minimum of 21 days.

“We ask that they are symptom-free for 14 days before the suspension comes to an end and that they have written confirmation from a registered medical practitioner,” she said. “It’s incredibly important that this rule is followed, across all disciplines, mitigating any risks so that the rider can go on to enjoy future events.”

The BEF confirmed it is researching a centralised system for co-ordinating suspensions across member body activities and directed H&H readers to its concussion hub, at which there is extensive guidance and advice.

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