Jockeys’ Guild Assembly: Diagnosis, Management Of Head Injury Still Challenging

by | 12.14.2016 | 11:55am
Dr. Dan Han addresses the Jockeys' Guild Assembly Dec. 13

The Jockeys' Guild held its 2016 Annual Assembly in Las Vegas Dec. 12-13 with a program focusing on a variety of health, safety, and welfare topics for riders. The following is a list of a few takeaways from the series of informational sessions:

  • Unsurprisingly, head injuries are a major source of concern among jockeys, and as I detailed a year ago, we're still learning about the mechanism and long-term impacts of them. Concussions account for about 8 to 15 percent of equestrian-related injuries, but mild to moderate ones can go undetected, especially if a rider underreports his or her symptoms. Researchers are working on a blood test to detect elevated chemical levels which could help doctors determine the severity of a concussion and how long the rider needs to sit out.

  • It sounds odd to those of us living in Central Kentucky, but your average emergency room doctor may or may not have a strong understanding of what can be involved in a serious fall from a horse, or what demands a rider experiences while galloping horses or riding in a race. That means that not only could doctors at the local hospital miss underlying injuries or damage after a fallen rider arrives at the ER, they also may not be equipped to provide a suitable timeline for when the rider can safely return to work.

    “You would think, if you go to the emergency room, they would know exactly what to expect in context of riding, in context of injuries from a fall from a horse and so on,” said Dr. Dan Han, chief of neuropsychology clinical services at University of Kentucky. “The vast majority of them do not.”

  • There is stark contrast from state to state in the medical services available to riders after a fall. Dr. Kelly Ryan of Medstar Sports Medicine in Baltimore provides on-site sports medicine services to riders at Pimlico. Ryan will assess riders after injuries on track (in the morning and afternoon), works with them to coordinate follow-up care, and also communicates with the stewards to help figure out when a rider is physically capable of safely returning to work. Her role for jockeys is similar to an in-house team physician in professional sports. Maryland is the exception to the rule, however; Kentucky is launching a new program with the University of Kentucky in 2017 to put certified athletic trainers on-site to help evaluate riders for concussion after race-day falls. Outside those locations, resources for fallen riders vary greatly and are far less comprehensive.

  • Experts still haven't found the ideal balance between resting enough after a concussion, and resting too much. Initial research into this is mixed but seems to suggest a slow return to some types of activity can help the brain heal after concussion. This also makes it complicated to establish timeframes for a return to work. For Pimlico riders, Ryan waits 48-72 hours after their fall, then administers cognition tests, puts the rider through 30 minutes of a cardio workout, a 30 minute simulated ride, and 30 minutes of jogging on a horse (all tests 24 hours apart) before clearing a concussed rider to race.
  • Unconsciousness is not a good indicator for whether someone has suffered a concussion. Presenters throughout the assembly emphasized this; If a rider has been knocked unconscious during a fall there is a strong chance they have sustained a concussion. Even if they haven't, there could still be one lurking.

  • A jockey also doesn't have to experience a direct blow to the head to get a concussion. Hall of Fame rider Ramon Dominguez recounted a fall which he said resulted in worse concussion symptoms than any other spill but did not involve an impact to his head. This fits with research Dr. Han has seen in football players, who have been known to report similar events as a result of tackles or body blows. It's important to note concussion is the result of the brain hitting the inside of the skull, not an impact to the skull's exterior.

  • We are learning more about the dangers of Second Impact Syndrome. Second Impact Syndrome occurs when a second concussion or other brain injury is experienced days or weeks after a concussion. In response to the repeated trauma, the brain can swell rapidly, resulting in coma or death, as well as a vicious return of previously-quelled concussion symptoms which may then persist for weeks or months. It's unknown exactly how much time must elapse between concussions to avoid Second Impact Syndrome.

  • Education may be an important vehicle for improving riders' lives. This is something Camilla Henderson, sports performance consultant in the UK, told me when I spoke to her for a piece I did on sports psychology earlier this year. Many riders who are struggling to keep their weight down with drastic measures like flipping, sweating, or substance use may be doing so in part because they don't know how to make calories work smartly for them. This causes a number of potential problems and stresses on the body. One of the most concerning: Sarah Jane Cullen, exercise physiologist and Gillie O'Loughlin, reported a lack of proper nutrition, particularly calcium, is thought to predispose jockeys to osteoporosis. Cullen noted a majority of jockeys' skeletons show signs of osteopenic state, which means bone density is reduced from average, but not low enough to qualify as osteoporosis. Osteopenic bones are at an increased risk for fracture, which is problematic for a group of athletes who already experience a large number of fractures.
  • Dehydration could play a role in increasing damage from neurologic trauma. As a result of weight reduction strategies, jockeys are often dehydrated, in some cases severely so. This impacts cognitive processes and all kind of body functions necessary to performance, but also puts their brains at risk. Dehydration could reduce the amount of cerebrospinal fluid surrounding the brain and spinal cord. It hasn't been proven conclusively yet, but medical experts say it's reasonable to expect a reduction in that fluid could leave the brain and spinal cord without as much protection against an impact.

  • Support for disabled jockeys is still a massive financial challenge. Permanently Disabled Jockeys Fund president Nancy LaSala noted the PDJF has been unable to increase its monthly stipend to grantees since its foundation in 2006. PDJF supports 60 disabled riders with stipends of $1,000 per month. LaSala noted founders had hoped to receive more capital support from the industry when they began the Fund in 2006, and while some tracks have been extremely supportive, others could be doing more.

In addition to the educational program, the Guild presented its annual awards at a luncheon held on Tuesday. The Jacky Martin Award for outstanding achievement by a Quarter Horse rider went to Esgar Ramirez; the Laffit Pincay , Jr. Award for outstanding achievement by a Thoroughbred rider went to Russell Baze. Horse Racing Radio Network's Mike Penna was honored with the Eddie Arcaro Award for exceptional commitment to jockeys, while retired rider Stacy Burton received the Courage Award. JockeyTalk 360 gave out three awards of its own to outstanding riders; Noberto Arroyo, Jr. was recognized with the JockeyTalk 360 Comeback Award for his return to racing in California this year; Flavien Prat received the JockeyTalk 360 Breakthrough Jockey Award, and Florent Geroux was recognized with the JockeyTalk 360 Turf Jockey Award.

Twitter Twitter
Paulick Report on Instagram