Even in the Equestrian World, Helmets Do Not Prevent Concussions…But They Are Not Even Designed to Try

A recent study, published in Sports Medicine – Open in May 2019, retrospectively found that 70% (139/189) of reported equestrian fall accidents (seemingly focused on horse racing and jockeys’ injuries specifically) resulted in a head injury – 91% of which were concussions. Other head injuries included: skull fractures (4%); diffuse axonal injury (3.6%); subdural hematoma (1%); and cerebral edema (0.7%).

The Study

216 helmets were collected via a damaged helmet return scheme in the UK and USA. Of the 216, 189 accident report forms were provided by the rider or their doctor. These reports were not standardized and the details provided varied. In saying that, associated injuries from the fall were recorded. These helmets also were visually examined to identify damage (or lack thereof) as well as disassembled to inspect any internal damage; all of the helmets were certified.

More to the Story

Little has changed with helmet testing over the last 30 years despite an increased understanding of impact biomechanics

Out of the 139 helmets that also had a report of head injury, 75 (54%) of the helmets showed damage whereas 64 helmets (46%) showed no damage. In fact, the more stringent the certification (i.e. – the stiffer the helmet), the more likely the helmet was to show no damage.

On the one hand, helmets that are very stiff will very likely help protect against skull fracture, more serious brain injury, and death. On the other hand, the researchers of this study suggest that stiffer helmets may be less effective for lower-severity impacts. They argue that this is specifically the case because equestrian helmet certification tests currently do not test helmets under the conditions that falls in equestrian sport occur.

There is a tendency for equestrian falls to occur on softer, uneven surfaces which will ultimately create oblique hits with rotational acceleration and current tests focus on linear acceleration (1-3). In fact, little has changed with helmet testing over the last 30 years despite an increased understanding of impact biomechanics (4).

Finally, the researchers suggest that if helmet testing were to consider these components and helmets were designed with these factors in mind, equestrian helmets may be better suited at reducing incidences of concussion/head injury in low-severity impacts.

Further Considerations Need to Be Made Prior to These Claims

The researchers of this study strongly state that new helmets need to be created by examining detailed accident reconstruction, clinical outcome data, and the needs of helmet users

Yet, in concussion literature, it is widely stated that helmets do not prevent concussion but rather, protect the head against more serious injury. Certainly, ensuring that helmets are designed with the sport in mind is important as is ensuring that helmets are diffusing as much energy from the impact as possible so that they are most effective at preventing these more serious brain or structural injuries. The fact that the researchers of this study strongly state that new helmets need to be created by examining detailed accident reconstruction, clinical outcome data, and the needs of helmet users in a collaborative environment with engineers, clinicians, riders, and equestrian regulatory authorities is reasonable. Certainly, these conditions are vital to achieve this goal of creating a safer equestrian helmet. It may be unreasonable however, given that there is no threshold force to sustain a concussion and that concussion is not prevented in other sports with helmets, to suggest that improving helmets in this way will reduce incidences of concussion.

How to Move Forward

Equestrian sports are incredibly high risk with higher reported rates of concussion and mild traumatic brain injury (mTBI) than American football or boxing

In saying that, equestrian sports are incredibly high risk with higher reported rates of concussion and mild traumatic brain injury (mTBI) than American football or boxing and it is important to start exploring ways to reduce incidences of concussion (5-12). Perhaps exploring the circumstances in which head injuries are arising may lead to changes to the sport/environment/rules/etc. that will help reduce concussion.

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.

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