Abstract
Objective
The purpose of this study was to describe the types of equestrian-related musculoskeletal injuries and their management.
Methods
We retrospectively reviewed the charts of 19 patients who presented with injuries from equestrian activities at a chiropractic practice from December 2000 to December 2020. Deidentified data were extracted from the charts and summarized.
Results
Of the 19 patients, 42.3% presented with acute trauma, 38.5% had overuse injuries, and 19.2% had chronic injuries as a result of previous trauma. We found that 90% of overuse injuries and 18.2% of acute injuries led to chronic conditions that needed ongoing management.
Conclusion
From this sample of patients, there was a high percentage of overuse and chronic injuries for patients who participated in equestrian activities.
Key Indexing Terms: Athletic Injuries, Horses, Humans, Retrospective Studies
Introduction
Equestrian disciplines are popular recreational activities and competitive sports.1 The rate of injury associated with the sport2 has a 1-year prevalence of 26.6%.3 Equestrianism is associated with acute injuries, typically arising from blunt trauma,4, 5, 6 such as being thrown off or being kicked by a horse, which may require surgery.7 In addition, those participating in equestrian disciplines may experience overuse3,4 and chronic injuries,5 such as lower limb pain from riding for prolonged periods or low back pain from repetitive impact from the saddle and horse's gait. Such overuse injuries have been reported to account for approximately one-half of equestrian-related injuries.3 Additionally, conditions such as structural scoliosis may pose a risk factor for injuries as rider asymmetries can affect the kinematics of the horse's thoracolumbar spine, changing dynamic stability and the horse-rider interaction. Despite these rates of chronic injuries, the literature regarding horse riding has been mainly focused on trauma,6 with little focus on chronic and overuse injuries. Therefore, the objectives of this study were as follows: (1) to describe characteristics of injuries, (2) explore their relationship to horse-riding and related trauma, and (3) describe treatment consisting of musculoskeletal manipulative therapy and modalities for these injuries.
Methods
A retrospective chart review identified patients who reported injuries from equestrian activities who presented to a chiropractic practice in Southern California from December 2000 to December 2020. Patients who had injuries from equestrian activities were defined as individuals participating in sports that use horses as a main part of the sport, including the rider being on the horse's back or a horse-drawn vehicle. Patients with equestrian-related injuries were identified from the patient demographic information and initial intake form in the medical chart. Data extraction was performed by 1 of the authors (T.W.), the chiropractor who previously evaluated and treated the patients.
The following variables were included in the data abstraction sheet: age, sex, mechanism of injury, anatomic location of injury, management of conditions, and outcomes of injuries. Overuse injury was defined as an injury occurring in the absence of a single, identifiable traumatic cause.8 Equestrian-related chronic injury was defined as an injury that persisted for more than 3 months related to or exacerbated by riding.9 Equestrian-related acute injuries were defined as acute injuries (less than 3 months in duration) sustained while riding or insidious pain occurring with riding. Specifics of the injuries were identified on the intake form by the patient, and the history, which included injuries resulting from horse riding, was recorded by the chiropractor. Injuries were considered resolved or adequately managed if there was documentation at the time of follow-up visit that pain or dysfunction was resolved. Injuries were considered chronic if pain or dysfunction were documented on follow-up visits greater than 3 months from the time of injury.
Ethics
The study received institutional review board approval (#HNGUY001) through the Institutional Review Board, Human Subjects Protection, at the Southern California University of Health Science. The data extracted were deidentified. All personally identifiable information was removed.
Results
A total of 19 patient charts were identified and included in this review. There were a total 26 new diagnosis visits and a total of 127 treatment visits. The average age at the time of evaluation and treatment was 34.9 ± 20.1 years. Sixteen subjects were female patients. The average number of injured anatomic areas per diagnostic visit was 3.2 ± 1.8. The most commonly injured sites were the lumbosacral spine, followed by the thoracic spine, cervical spine, extremities, and head (Table 1). Structural scoliosis was noted in 52.9% of riders.
Table 1.
Sites of Injuries of 19 Patients
| Site of Injury | Number of Patients (%) |
|---|---|
| Lumbosacral spine | 16 (84.2) |
| Thoracic spine | 14 (73.7) |
| Cervical spine | 13 (68.4) |
| Extremity | 6 (31.6) |
| Head | 10 (52.6) |
Most patients received chiropractic manipulative therapy and supportive modalities such as ice, therapeutic ultrasound, cold laser therapy, kinesio taping, active rehabilitative, strengthening, and stretching exercises (Table 2). Over half (57.7%) of the visits were for chronic injuries as sequelae of prior trauma or overuse injuries. Visits for acute trauma accounted for 42.3% of visits. Ten percent of overuse injuries and 60% of chronic injuries were adequately managed or resolved without needing further chiropractic visits and management. The remainder of patients required ongoing management for their conditions and further chiropractic visits. Chronic conditions that needed ongoing management are listed in Table 3.
Table 2.
Interventions Used in 26 Treatment Courses
| Intervention | Number of Patients (%) |
|---|---|
| Chiropractic manipulation | 23 (88.5) |
| Exercise | 18 (69.2) |
| Modalities | 20 (76.9) |
| Orthotics and/or bracing | 7 (26.9) |
| Soft tissue manipulation | 4 (15.4) |
Table 3.
Injury Type for 26 Diagnostic Visits
| Injury Type | Number | Chronically Recurrent After Treatment |
|---|---|---|
| Overuse injuries | 10 | 9 |
| Chronic injuries as a sequelae of trauma (Thrown/fall off horse) | 5 | 2 |
| Acute trauma | 11 | 2 |
| Thrown or fell off horse | 7 | 1 |
| Horse fell on rider | 2 | 1 |
| Kicked by horse | 1 | 0 |
| Dragged by horse | 1 | 0 |
Discussion
Equestrian activities are popular for both recreational riding and competitive sports but have a high burden of injury.3,10 Our chart review showed similar findings to prior reports of overuse3,4 and chronic injuries.5 The majority of patients included in this study were women. A prior report of injuries in the Netherlands corroborates high rates of injuries in equestrianism, specifically in female individuals, accounting for 6% of all sports-related injuries, with the majority aged 18 to 34 years.11
Blunt traumas make up a large proportion of traumas.6,12,13 Our study showed that 18.8% of traumas resulted in chronic long-term dysfunction compared to 59% previously reported.5 In our patients who delayed seeking medical attention for their trauma until the development of chronic symptoms, some were treated with resolution of their injury, while others required ongoing treatment. Of our patients who sought immediate health care attention for their traumatic injuries, a vast majority had resolution of their injuries without further sequelae. This resolution may demonstrate improved outcomes with proper early health care intervention for traumatic injuries.
The lumbosacral spine was the most commonly affected anatomical area in our sample. This rate is consistent with reports of low back injuries in pediatric equestrians4 and much higher than prior reports of upper and lower back pain in Malaysian riders.10 Discrepancy between the literature and our study rates may be secondary to the health-seeking behavior of riders, with 60% of riders reporting that they do not seek medical attention post-injury.10
Our study finding of riders with structural scoliosis corroborated prior reports that equestrian riders have structural asymmetries14,15 that may be risk factors for injuries.4,14 Rider asymmetries may also affect the kinematics of the horse's thoracolumbar spine and change dynamic stability.16,17 Thus, the horse-rider interaction may play an important role in both rider and horse injuries that could possibly result in such asymmetries.18 In turn, horse asymmetry may lead to rider asymmetry.19 This complex interplay of horse-rider asymmetries suggests that clinical interventions may be needed to address both the rider and the horse.
Limitations
This was a retrospective study on a small sample; thus, these findings are preliminary. There is a potential for selection bias since the doctor who abstracted the data also had treated the patients. Another limitation of the study is the limited number of cases were from only 1 region. In addition, data from the study were limited to 1 practice in 1 discipline, which is not representative of patients with equestrian injuries in other, larger health care settings such as emergency departments or sports medicine clinics. Other data were not collected, such as what type of equestrian activity resulted in the activity, nor were data on the experience of the rider, type of protective riding equipment, or years of riding collected. These may have important implications for the findings and clinical applications.
Future Studies
Although the number of cases is small, the data presented are novel and can serve as baseline data to guide future larger-scale studies. Further prospective research with a larger number of participants across practice settings is recommended. The outpatient chiropractic setting may be ideal for addressing equestrian injuries as chiropractors are commonly sought health professionals by equestrian riders.20 However, due to the complex nature of some of these injuries, future studies on multidisciplinary collaboration with various neuromusculoskeletal specialties will be needed.
Conclusion
Our results indicate that equestrian injuries may stem from both trauma and overuse, which may potentially lead to chronic conditions. Patients with musculoskeletal complaints resulting from injuries resulting from equestrian activities seek care in chiropractic settings. The results suggest that early detection and management of equestrian injuries may guide proper diagnosis and intervention and may help to prevent chronicity. Although the number of cases is small, the data presented are novel and can serve as baseline data to guide future larger-scale studies.
Acknowledgments
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Contributorship Information
Concept development (provided idea for the research): T.W.
Design (planned the methods to generate the results): T.W.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): T.W., H.N.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): T.W.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): T.W., H.N., E.H.
Literature search (performed the literature search): T.W., H.N.
Writing (responsible for writing a substantive part of the manuscript): T.W., H.N., E.H.
Critical review (revised manuscript for intellectual content, this does not relate to spelling and grammar checking): T.W., H.N., E.H.
Practical Applications.
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Half of equestrian-related injuries were chronic and from overuse.
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Traumatic injuries may lead to chronic injuries.
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Early management of traumatic injuries may lead to better long-term outcomes.
Alt-text: Unlabelled box
References
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