Thrown, Kicked or Knocked Down: Concussion Questions for Ocala Providers Who Treat Horse People
Riders, grooms and farm workers in Marion County tend to get back on after a fall and come to you for the neck or the back. What equestrian concussion research shows, and the intake questions that bring a hidden head injury to light.
Who this is for: Written for chiropractors, primary care and urgent care physicians, orthopedists and physical therapists in Ocala, Gainesville and Marion County who see riders, grooms and farm workers.
Picture a 38-year-old exercise rider who comes to your Ocala office for low-back pain. Two weeks ago a young horse spooked and dropped her against the rail. She was wearing a helmet, got back on, and finished the morning's sets. Only when you ask does she mention that she keeps losing her train of thought on the phone and that the barn lights bother her in the early morning.
Marion County carries the official title Horse Capital of the World, and the county reports more horses than anywhere else in the country. The riders, grooms, trainers, farriers and farm hands who work with those horses eventually walk into chiropractic, primary care, urgent care and orthopedic offices in Ocala, Belleview, Dunnellon, Williston and Gainesville. This article is educational and is not medical advice.
Key takeaways
- In a 2023 study, 210 experienced equestrians reported 728 concussions, about 3.5 per person.
- Riders were wearing a helmet 85% of the time when a concussion happened (Glace et al., 2023).
- Only 12% of 1,486 equestrians surveyed knew a helmet cannot prevent concussion (Theadom et al., 2020).
- Riders often present for the neck or back. A few targeted questions can bring a head injury to light.
What equestrian research shows
A 2023 study in the Journal of Science and Medicine in Sport surveyed 210 experienced equestrians, almost all women, who together reported 728 concussions, about 3.5 per person (Glace et al.). The concussion rate while riding was 0.19 per 1,000 hours, which the authors noted was higher than rates reported for football or rugby training. Riders were wearing a helmet at the time of injury 85% of the time. Most respondents also said they would keep working with horses while injured.
A larger 2020 survey of 1,486 adult equestrians found that knowledge of common concussion symptoms was high, above 80% for most items. Yet only 12% understood that a helmet cannot prevent a concussion, and 46% reported reusing a helmet after a hit to the head (Theadom et al.).
Helmets remain essential, and Glace's team suggested they reduce concussions severe enough to need urgent medical care. The point for a treating provider is narrower: a helmet, and an undamaged one, does not rule out a concussion.
A helmet, even an undamaged one, does not rule out a concussion.
Why these patients slip through
Horse people are a tough, practical group. Horses need to be fed, worked and shipped whether or not the rider feels right, and for many, income depends on being back in the saddle the next morning. A few patterns make a head injury easy to miss:
- The chief complaint is musculoskeletal. The patient books for the neck, shoulder or lower back and never connects fogginess or headaches to the fall.
- Mechanisms vary. Besides falls, there are kicks, a horse throwing its head into the handler's face, and being knocked down or pinned in a stall or trailer. The CDC notes that a hit to the body that moves the head quickly can also cause a concussion.
- Repeat injuries are common. A patient who has had several concussions over years of riding may describe today's symptoms as "normal for me."
- Balance and dizziness complaints get attributed to the back, the neck or plain fatigue.
A short intake checklist
When a patient mentions a fall, kick or knock-down, a few extra questions take minutes:
- How did it happen: height and speed of the fall, how they landed, whether the head or helmet struck the ground, a rail or the horse.
- Right afterward: did they feel dazed, confused or slowed, or lose any memory of the event? Under the 2023 American Congress of Rehabilitation Medicine criteria, loss of consciousness is not required for a mild TBI.
- The helmet: was it damaged, and has it been replaced?
- Since then: headaches, dizziness or balance changes, light or noise sensitivity, sleep changes, trouble concentrating, irritability.
- History: how many prior concussions, and how long recovery took.
- Work demands: riding young or difficult horses, operating equipment, hauling trailers.
MedlinePlus advises that people with concussion symptoms avoid activities that raise the risk of another head injury, including sports, operating machines and physical labor, until a provider clears them. For a working rider, that conversation matters.
Where testing fits
When you decide testing makes sense, Braintree's mobile team performs concussion and TBI testing at your own office in Ocala, Gainesville and across North Central Florida, with scheduling coordinated through you. Results are delivered as physician-reviewed diagnostic reports. A neurologist receives the report before the patient's neuro evaluation and interprets it. You then receive a copy to inform advanced brain imaging and treatment recommendations. The same process applies to your crash patients.
For related reading, see youth and high school sports concussions in Gainesville and Ocala and concussion after a work injury. Learn more about concussion and TBI testing, see mobile testing in North Central Florida, check the North Central Florida Crash Map, or send a referral. Patients can read what to expect.
Frequently asked questions
Can a rider get a concussion while wearing a helmet?
Yes. In a 2023 survey of 210 equestrians, riders were helmeted 85% of the time when a concussion occurred. Helmets help protect against serious head injury, but they do not prevent every concussion.
Can a horse kick or head-butt cause a concussion?
Yes. The CDC describes concussion as a brain injury from a bump, blow or jolt to the head, or a hit to the body that moves the head quickly. A kick, a horse throwing its head, or being knocked down can all do that.
Should a rider with concussion symptoms keep riding?
MedlinePlus advises avoiding activities that raise the risk of another head injury, such as sports, operating machines and physical labor, while symptoms last and until a provider says it is safe.
Does a concussion require losing consciousness?
No. Under the 2023 American Congress of Rehabilitation Medicine criteria, loss of consciousness is one possible sign of a mild TBI, but it is not required.
Can Braintree test patients at my Ocala office?
Yes. When you decide testing makes sense, Braintree's mobile team tests at your office. Our reports go to a neurologist for interpretation ahead of the neuro evaluation, and you then receive a copy. Scheduling is coordinated with you.
Sources
- Glace BW et al. Incidence of concussions and helmet use in equestrians. J Sci Med Sport. 2023;26(2):93-97
- Theadom A et al. Concussion knowledge, attitudes and behaviour in equestrian athletes. J Sci Med Sport. 2020;23(11):1055-1061
- CDC: About mild TBI and concussion
- Silverberg ND et al. The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury. Arch Phys Med Rehabil. 2023;104(8):1343-1355
- MedlinePlus (U.S. National Library of Medicine): Concussion in adults, discharge
- Marion County, Florida: Horse Capital of the World
- Florida Department of Health: Florida trauma centers
Photo credits: Horse farm, Ocala, Florida, by Excel23, CC BY-SA 4.0, via Wikimedia Commons. Gypsy Gold Farm, Ocala, by AaronBarlow, CC BY-SA 4.0, via Wikimedia Commons.
This article is educational and is not medical or legal advice. If this is a medical emergency, call 911.
