Injury Prevention Strategies in Equestrian Activities 3

THE SMART EQUESTRIAN

1 Table of Contents

Smart Equestrian...... 3

Injury Prevention Strategies in Equestrian Activities...... 3

Use Your Equipment and Wear it Right!...... 3 Helmets...... 3 Vests...... 4 Riding Boots...... 4 Gloves...... 4

Responsible Action by All Involved Prevent Serious Injuries...... 4 Riders...... 5 Riders on the Ground...... 5 Parents...... 5 Pony Rides...... 6 Coach/Trainer...... 7 Camps, Riding schools and Equine Organizations...... 7

Equestrian Specific Injuries...... 7 An Overview of Equestrian Related Injuries...... 8 Mechanisms of Injuries...... 8 The three W’s of Equestrian Injuries – Who, Where and When?...... 8 Who gets Horse Related Injuries?...... 8 Where do the Injuries Happen?...... 8 When do Horse Related Injuries Occur?...... 9 General First Aid...... 9

Concussion in Equestrian Activities: It Happens!...... 10

Organizations that Developed this Program...... 14

Smart Equestrian

2 Smart Equestrian is an injury prevention program designed for young riders, coaches, trainers and parents. This program consists of a DVD, education booklet, and safety card, provided in both English and French. With the help of the Smart Equestrian Committee, organizations and partners such as the ThinkFirst Foundation of Canada, the Ontario Camping Association, Canadian Pony Club, Community Association for Riding for the Disabled (CARD), Running Fox, and the Woodbine Entertainment Group, this information guide has been created to enhance knowledge about the importance of injury prevention in equestrian activities. To learn more about ThinkFirst Canada and how to order additional copies of this program, please refer to section on “Organizations that Developed this Program.”

Injury Prevention Strategies in Equestrian Activities

Horseback riding is a very popular sport and recreational activity in many countries. It is a sport involving all ages and both genders. Injuries do happen in equestrian sports, and so creating a fun and safe riding environment is key! There are many steps that riders, parents, coaches, trainers and health personnel can take to help reduce the risk of injury in equestrian activities.

Use Your Equipment and Wear it Right! Wearing the appropriate equipment while riding is essential for injury prevention. Not only is it important to wear the proper equipment, but to make sure that the equipment fits and is in good condition!

Helmets  Before trying on a helmet, check the label to make sure that it has been ASTM/SEI approved. (There is no CSA Standard yet).  Helmets vary in size, shape and style from manufacturer to manufacturer.  Each helmet should have a safety harness bolted to it, and a strap that comes under the jaw fastened by a buckle or snap.  Helmets with adjustable features at the back of the neck should be checked for a snug fit each time the helmet is used.  Helmets should fit snugly against the back of your head.  Some helmets have vents which allow air to flow through and keep a rider’s head cool.  Helmets may have detachable lining and fitting pads, and visors so you can wear them with a custom colored cover.  Old helmets or helmets which do not meet current safety accreditation standards should be destroyed.  Although helmets may not be mandatory where you are riding, we strongly recommend that riders of all ages should wear helmets while riding, walking and working around horses.

3  ASTM/SEI-approved helmets are compulsory for juniors while mounted anywhere on the grounds of any Equine Canada-sanctioned competition or at any facility offering riding instruction to children under the age of 18 years.

To learn how to properly fit a helmet, check out the helmet fitting guide on the back of the concussion card that is included with this program.

Vests  Body protectors are designed to reduce trauma from blunt impacts and falls.  They can help to provide some protection to the trunk by reducing the severity of soft tissue injuries and rib fractures.  The Safety Equipment Institute (SEI) has approved a new certification for equestrian protective vests.

Riding Boots  Always ride in a boot with a heel - this will stop your foot from slipping through the stirrup.  Breakaway or flexible stirrups can prevent the foot from being caught in the iron. They should be considered for small children, beginners or for riders wearing heavier winter riding boots. It is important that the boot fit the stirrup. There must be a minimum of 1 cm of space between the boot and the stirrup iron on each side of the boot.

Gloves  Be sure to wear gloves designed for riding - gloves ensure a secure grip of the reins, offer protection from chafing and warmth in cold weather.

To find more information regarding the purchase and fit of proper equipment, go to the following websites:

. http://www.charlesown.co.uk . http://www.delmarhelmets.com . http://www.louisgarneau.com . http://www.troxelhelmets.com/flash.html . http://www.phoenixperformance.com . http://www.caballosaddlery.com Responsible Action by All Involved Prevent Serious Injuries A safe and positive learning environment which helps riders make appropriate decisions can only be achieved through the continued efforts of coaches, trainers, organizations and parents. Get educated! A smart equestrian is not born, but trained. The more you know, the less likely you are to get injured. Riders  Have knowledge of how your horse behaves - be aware of the horse’s movements and find a safe way to approach the horse.  Be sure your horse is sound.

4  Make sure that you are physically and mentally fit - to participate safely, you must be well rested and focused.  Always make sure that you are wearing the appropriate equipment and that your gear fits properly - never ride without your helmet and riding boots (heeled and smooth soled).  You may also want to consider wearing protective a vest. Gloves are useful. Keep focused on the horse at all times.  Make sure that your horse is properly equipped for the ride - check all tack and equipment before the ride.  Learn how to fall properly - hugging your arms into your body may help reduce injuries.  If you are a beginner, get riding lessons - riding lessons help to promote safe practices. Lessons are of continuing benefit to accomplished riders.  Never ride alone. Make sure someone knows where you will be riding and the time that you will be returning. That way, they will know where and when to start looking for you if you do not return at the time you specified.

Riders on the Ground Be safety conscious when you are on the ground working around horses. Approximately 20% of horse related injuries occur when the rider is on the ground. Keep focused on the job at hand. Remember that horses can move quickly and are unpredictable.  The following safety tips should be considered:

 Use a lead shank whenever you are  Never wear open toed shoes. leading a horse.  Horses should always be tied for  Do not kneel beside your horse. grooming and tacking. Remain on your feet.

Parents  Educate yourself about equestrian safety - this will help you to recognize how injuries occur, and how you can help prevent them!  Always make sure that your child is wearing the appropriate equipment, that the equipment fits properly and is in good condition.  Choose a horse that is suitable for your child - an experienced or trained horse person should assist with this process.  To find the right instructor for your child or yourself, visit prospective stables. Arrange to view a lesson or take an introductory lesson. Ask for references. Ideally you should choose an instructor with experience and interest in teaching students.  To find a coach, attend a show and see the coach in action. Make sure that the teaching or coaching style meets your expectations.  ThinkFirst Canada recommends that children under the age of five should not ride without the direct supervision of a responsible and knowledgeable adult. Direct supervision is defined as one on one. The adult must have complete control of the animal at all times.

5  As well as the desire to ride, the child must have sufficient muscle strength and balance to hold the proper position in the saddle. The child must also be able to understand and follow directions.  Unless you are certain your child meets these prerequisites, wait before planning that first ride. Horses and ponies are not machines. Unexpected behaviour can and does happen. No adult should ride double with an infant or child.

Pony Rides  Parents should realize that there are risks involved when young, inexperienced children ride, even if it is only at the walk. Be aware of the following:

 Ponies should never be tied  Attendants should be trained and focused on together. the pony and rider.  An ASTM/SEI approved, properly  Weather, noise and surrounding activities are fitted helmet must be worn (refer to factors which could contribute to a mishap. In helmet checklist). the case of inclement weather or extreme noise, do not put your child on a pony ride. Horses are very unpredictable in such circumstances.  Saddle “seat-belts” should not be  Only an experienced handler should lead the used. pony. This will allow the handler to make sure your child does not want to get off suddenly, and that he or she is following the safety rules.

 If you are new to the sport, and would like to be referred to a safe and reliable coach, a good option is to contact:

. Equine Canada 2685, Queensview Dr., Suite 100 Ottawa, ON K2B 8K2

Telephone: (613) 248-3433 Fax: (613) 248-3484 Toll Free: 1-866-282-8395

Coach/Trainer  Keep current with changes and trends that affect the equestrian community. Your interests and those of your clientele depend on it. Information technology now allows widespread

6 distribution of knowledge. Regardless of your history in the equine industry, professional re-evaluation and continuing education have become the reality for dedicated practitioners in all walks of life.  Have a good knowledge of horses, and always select an animal appropriate to the rider’s size and ability level.  Make sure that parents choose a horse that is suitable for their child.  Never let a rider on a horse unless he/she is wearing the appropriate equipment and that the equipment fits properly and is in good condition.  Make sure that the horse is wearing the right equipment - equipment that does not fit the horse properly may also cause injury to the rider.  Always supervise the child or adult while riding. Ensure that visitors and people who are unfamiliar with horses are supervised at all times on the premises.  Be a role model and set a good example - ride safely yourself and maintain high standards of stable management. Set realistic goals for your clients and conduct business in an ethical manner.  Maintain a calm, quiet atmosphere in the stable. All equipment should be put away after use. A clean, uncluttered barn is a safe barn.  Acquire a First Aid Certificate and maintain accreditation.

Camps, Riding schools and Equine Organizations  There should be a written policy outlining safety procedures.  The rules and regulations of the policy should be strictly enforced. It is recommended that a Safety Committee be established for this purpose.  Riders and parents must respect the rules implemented by the organizations.  A record of all injuries should be kept. This should be reviewed periodically by the committee to determine activities or areas which may need attention.  Safety should be the first consideration in the planning of any activity or event.  The policy should be regularly reviewed by riders and parents, and should recommend that all riders regularly review this program.

Equestrian Specific Injuries

Horseback riding is a very popular sport that has elements of risk. Research suggests that the risk of suffering a fatal injury while horseback riding is higher than it is for most sports such as football, hockey, or even baseball. Regardless of whether the rider is participating in dressage, show jumping or western riding, all riders are at risk of suffering horse-related injuries. Even the most experienced and knowledgeable individual, who is wearing the proper equipment, is not immune to injury.

An Overview of Equestrian Related Injuries Head injuries are considered to be the most common and serious form of catastrophic injury and cause of death suffered by horseback riders. Head injuries can range from concussions or

7 blood clots inside the head (to learn more about concussions, signs and symptoms, diagnosis and treatment, see the concussion card provided with this booklet). In terms of safety equipment, if the rider is wearing the appropriate protective head gear, the chance of suffering an injury such as a skull fracture is reduced. Although not as common, spinal injuries can occur, which are just as serious as head injuries. Some research has shown that the occurrence of a head injury can often be associated with spinal injury. Serious consequences associated with spinal injuries include fractures and dislocations, which can ultimately result in paraplegia or quadriplegia. Less serious injuries can include the following:

. Cuts . Sprains . Dislocations . Bruises . Scrapes . Strains . Bites . Fractures

Injuries such as these can occur to various parts of the body including: the upper and lower extremities, head or neck, the gastrointestinal or respiratory tract. Steps should be taken to prevent all injuries. To learn how to prevent injuries, look at the “Responsible Action by All Involved Prevent Serious Injuries” section.

Mechanisms of Injuries Most injuries occur when the rider falls, followed by the rider being trampled, or being dragged by the horse because his/her foot is caught in the stirrup. Other common causes of injury include:

. Being stepped on, kicked, or bitten by a horse . Having a horse fall on top of the rider . Getting caught between the horse and an object . Being struck by lightning . Getting hit by an obstacle while riding

The three W’s of Equestrian Injuries – Who, Where and When?

Who gets Horse Related Injuries? Horse related injuries can happen to anyone. However, children and adolescent groups are most likely to be injured while riding a horse. In Canada, children between the ages of 10 - 14 years suffer the most equestrian-related injuries. In terms of gender, injuries happen mostly to females due to their greater participation in equestrian activities.

Where do the Injuries Happen? People ride for many reasons, whether it be for recreation, to compete at a competitive level, for exercise, to help relax and/or to have fun. Riders need to remember that an injury can happen anywhere, even on your own property, a place that seems safe and secure. Most equestrian facilities are concerned with safety, but it should be remembered that horses, like people, are sensitive to their surroundings.

When do Horse Related Injuries Occur?

8 Horse related injuries happen mostly during summer, mainly during the months of June to August, followed by the fall months of September to November. Equine injuries occur mainly on the weekend, and during the afternoon, between the hours of 4 pm to 8 pm. Injuries also frequently occur between noon and 4 pm.

General First Aid

Observe and Assess the Situation . When an injury has occurred, always observe and assess the situation before taking action, or calling an ambulance. Assess the injured person’s airway, breathing and circulation as outlined below. . After recognizing that an emergency has occurred, take charge of the situation by following the appropriate steps:

1. Get Assistance . In the case of an emergency, such as a broken neck, one person cannot do everything. If others are around, ask for help.

2. Review the Area of Injury . Approach the injured person when it is safe to do so. . You may need the help of others to warn approaching traffic, keep away loose animals, or any other hazards. . Take actions that are safe! Always keep in mind the safety of the injured person, and the rescuers.

3. Call for Help: . After the injured person has been approached, and the seriousness of the injury has been established, call 9-1-1. Be sure to tell the dispatcher the correct number of injured people. . The person who calls 9-1-1 should be prepared to answer the following questions about the injured person: (a) What happened? – Always be specific (e.g. a rider was thrown from the horse) (b) What is the injured person’s complaint? – The resulting pain or injury is the complaint or problem (c) Is the injured person awake? (d) How is the injured person’s airway? (e) How is the injured person breathing? (f) Is the injured person bleeding and can it be controlled? (g) What is the injured person’s approximate age? (h) What is the injured person’s location? – Always be specific . The dispatcher will give the caller pre-arrival instructions that should be written down or remembered. Someone from the dispatch center will be sending help. If the location is difficult to find or access may be blocked, send a volunteer to guide the ambulance personnel to your location.

9 . The Lifesaving Society and Red Cross in their swim programs instruct candidates to always allow the dispatcher to hang up first - this helps prevent an anxious first aider missing important information.

4. A, B, C’s of First Aid: . While waiting for help to arrive, always check the A, B, C’s of the injured person. Do this with care, as there is a possibility that the injured person could have suffered a spinal injury. Do not move the neck. . A-Airway – Make sure that the airway is open and clear. If it is obstructed, use the chin- lift method to clear the tongue away from the airway, or if there are fluids filling the mouth, carefully roll the injured person onto his/her side while keeping the spine aligned. . B-Breathing – Make sure the injured person is breathing. If breathing has stopped, artificial respiration may be required. . C-Circulation – Make sure that the injured person has a pulse and is not bleeding profusely. Bleeding can be controlled by applying pressure and/or elevating the limbs (only if elevating the limbs can be performed without affecting spinal alignment). . Provide Basic First Aid as necessary.

Concussion in Equestrian Activities: It Happens!

A concussion is a type of brain injury that can happen in any sport, including horseback riding. A concussion can be caused either by a direct blow to the head, face, neck or elsewhere on the body, where an ‘impulsive” force is transmitted to the head. Falling off of a horse, getting kicked in the head by a horse or hitting your head on an object while riding, such as a tree branch, may cause a concussion or other head injury.

It is very important for riders, parents, coaches and trainers, to have a good understanding of what a concussion is, how concussions happen, and the signs and symptoms that can result from getting a concussion. It is also important to know when it is safe to return to riding after a concussion, and how concussions can be prevented.

Included in this program is a concussion/equestrian helmet checklist card. The concussion card provides the information that you need to know about concussions. Wearing a properly fitted protective helmet, is one way that the risk of concussion or other head injury can be reduced. Look to the reverse side of the concussion card on how to properly fit an equestrian helmet.

This section below provides detailed information for riders, parents, coaches and trainers on how to respond to a concussion, the steps that should be taken which will help determine when the rider is ready to ride again, as well as some advice for dealing with concussions.

10 1. Initial Response If there is a loss of consciousness, initiate an Emergency Action Plan, and call an ambulance. Assume a possible neck injury. Remember, all equestrian athletes should consult a physician after a concussion. Parents, coaches, trainers, and the injured athlete should not attempt to treat a concussion without a physician’s involvement.

In the event of a concussion: o Remove the rider from a risky area such as the competitive arena or a busy trail, if there is no indication of a spinal injury. A spinal injury would be suspected if there is difficulty breathing, or moving the arms or legs, or loss of sensation. o Do not leave the rider alone; monitor signs and symptoms. o Do not administer medication. o Inform the coach, trainer, parent or guardian about the injury. o The rider should be evaluated by a medical doctor. o The rider must not return to riding that day, even in the absence of symptoms or signs.

2. Return to Riding Guidelines* The return to riding process is gradual, and begins after a doctor has given the rider clearance to begin to return to activity. If any symptoms or signs return during this process, the rider must be re-evaluated by a physician. The rider must not return to riding if any symptoms or signs persist. Remember, symptoms may return later that day, or the next, not necessarily while riding or exercising.

Step 1:  No activity, only complete rest. Proceed to Step 2 only when symptoms and signs are gone.

Step 2:  Light aerobic exercise such as walking, stationary cycling, pool running or other light activity.  Monitor for symptoms and signs.  No resistance training or strength training at this time. When able to carry out light aerobic exercises for 45-60 min. without symptoms/signs, progress to Step 3.  It is O.K. at this time to work with your horse around the barn, but no riding.

Step 3:  Riding specific activities (e.g. pleasure/recreational riding walk, jogging, trotting and cantering) only. No hunting or jumping activities.  When able to pleasure ride for several days in a row without symptoms/signs, progress to Step 4. Step 4:  Riding specific training (e.g. pleasure/recreational riding walk, jogging, trotting, cantering, galloping).

11  Low training or hunting type jumps can be attempted, but no high jumping that involves fast speeds, impact of landing, and potential falls.  Physical training to include light resistance training, progressing to heavier weights, and eventually sport specific jump drills and dynamic activities.

Step 5:  Full non-competitive riding (including hunting and jumping), without any symptoms or signs evident to yourself or your riding coach.

Step 6:  Return to full competition riding.

These Guidelines were adapted from the Vienna Conference Return to Play Protocol and documents developed as part of the ThinkFirst Concussion Education and Awareness Program (www.thinkfirst.ca). These Guidelines are offered as suggestions, and are subject to some flexibility depending on age of the rider, etc. Individuals will progress through Steps 1-6 at different rates. Respect the symptoms and signs your body sends you, and speak to your physician if you have any concerns.

Note: Riders should proceed through Return to Riding Steps only when they do not experience symptoms or signs. If symptoms or signs return, the rider should go back to the previous step and be re-evaluated by a physician. Although the Return to Riding protocol of six steps emphasizes physical exertion, as a means of control, a number of athletes have recognized mental stress as a cause of increasing their symptoms following concussion. Such activities as school studies, playing a musical instrument, performing computer work or playing video games may increase their symptoms such as headaches. Therefore, it is recommended that these activities be limited if the post-concussion symptoms and signs are not gradually settling. Never return to riding or training for riding if symptoms persist because another concussion before full recovery from the last concussion may cause permanent deficits such as memory loss.

3. Advice to Parents, Coaches and Trainers 1. Instruct your rider on the importance of recognizing concussion and the serious potential risk of brain injury, if training and competition are resumed before all the symptoms have resolved.

2. Have knowledge of the rider/athlete’s past activities (e.g. the number of previous concussions, the degree of symptoms experienced, and the time required for recovery). If the rider easily becomes symptomatic with minimal jarring of the head, the rider should be advised to discontinue the activities that are producing the symptoms. Always remember to include concussions that have occurred in other sports as well as riding. Most athletes engage in a number of sports which have risk of concussions such as hockey, football, rugby, soccer, lacrosse etc.

12 3. Encourage prevention of cerebral concussion by insisting on the use of safety standards approved helmets (e.g. CSA, ASTM, SEI, SNELL, CE), strengthened neck muscles, and where appropriate, the potential use of mouthguards.

4. If concerned or confused by advice being offered to your child or athlete, seek advice from specialized doctors who have expertise in concussion management.

5. Where the rider’s discipline involves high risk activities, e.g. hunting, jumping, eventing etc., some concussion management specialists have recommended a further "wait time", using the formula of doubling the time it took the concussed athlete to go from Step 1 to Step 5 before undertaking high risk competition.

With this stepwise progression, the athlete should continue to proceed to the next level if asymptomatic at a current level. If any post-concussion symptoms occur, the patient should drop back to the previous asymptomatic level, and try to progress again after 24 hours.

References Available upon request.

Organizations that Developed this Program

13 ThinkFirst Canada ThinkFirst Canada is a national, voluntary, non-profit organization with over 20 chapters across Canada, dedicated to preventing injuries in young Canadians, especially brain and spinal cord injuries. The organization is endorsed by Canada’s neurosurgeons, neurologists, and nurses who treat people who have had a brain or spinal cord injury. ThinkFirst provides school-based injury prevention programs for kids, conducts research on the causes of injury and the effectiveness of our programs, and are developing a hospital-based program for teens. The two free, bilingual school-based programs are TD ThinkFirst for Kids, which is a program for elementary students, and ThinkFirst-Party Later, which is a program for teens. ThinkFirst plays a major role in the prevention of sports and recreational related injuries through its ThinkFirst- SportSmart programs which include:  A Little Respect: ThinkFirst! - a skiing and snowboarding injury prevention program, available in DVD and VHS format, targeted to ages 6 – 12 years.  Concussion Education and Awareness - a program designed to enhance knowledge and awareness about concussion for the health care, athletic and general communities.  Dive Right - a diving prevention video for elementary school students.  Smart Equestrian - a 10 minute injury prevention program educating riders of all ages about equestrian safety.  Smart Hockey: More Safety, More Fun! - a one hour video educating aspiring hockey players about serious head and spinal injuries and safety in ice hockey.  Smart Soccer - a soccer injury prevention program in the form of a booklet, for ages 6 – 14 years.  Sudden Impact - a diving prevention program for secondary school students.

Smart Equestrian Committee This program has been possible through the efforts of the

14 ThinkFirst-SportSmart Smart Equestrian Committee

Program Sponsor

Committee Member Position Organization Crowe, Val Administrator Canadian Pony Club Fine, Janet Representative Hollows Camp, Ontario Camping Association Friesen, Janet Past President American Medical Equestrian Association Guthrie, Muffie Director Jump Canada Hamilton, Mark Neurosurgeon Alberta Children’s Hospital, Calgary Hawley, Sandy Professional Thoroughbred Jockey Woodbine Entertainment Hunt, Brian Neurosurgeon ThinkFirst Vancouver Lamaze, Eric Professional Rider/National Hero/ Jump Canada Member of Canadian Equestrian Team LaPierre, Isabelle Professional Rider Jump Canada Rogers, Stacie Associate Producer Woodbine Entertainment Smith, Debbie Owner Running Fox Tator, Charles Neurosurgeon, President ThinkFirst Canada Webster, Sandy Executive Director The Community Association for Riding for the Disabled (CARD) Chair Krembil, Stacey Nurse, Director The Krembil Family Foundation Staff Russell, Jim Executive Director ThinkFirst Canada Provvidenza, Christine Research and Program Manager ThinkFirst Canada Alstructural Inc. CIBC Krembil Family Foundation Ontario Ministry of Tourism and Recreation Pheonix Performance Products Inc.

Educational Booklet Development Janet Fine, Christine Provvidenza and Charles Tator

We are pleased to extend permission to utilise our injury prevention material from our resources or website. All information should be used in its original format and should acknowledge ThinkFirst Canada. Source credits must include our name and website address www.thinkfirst.ca for further reference. If possible, our logo should also be included on the material. If you require our logo, please do not hesitate to contact us at 1-800-335-6076 or [email protected]. We request a copy of your materials for our records. We thank you for helping us convey our injury prevention message.

How to Order Additional Copies of “Smart Equestrian” and Other ThinkFirst Programs

Free copies of this program will be distributed by each of the participating organizations who have provided sponsorship.

• Additional copies of this Program can be ordered directly from ThinkFirst Canada. You may place your orders in the following ways:

 Phone: 416-603-5331  Email: [email protected]  Toll Free: 1-800-335-6076  Website: www.thinkfirst.ca  Fax: 416-603-7795

• A charge of $ 20.00 will be applied to cover the costs of shipping and handling. Payment may be made by cheque or Visa. Please make cheques payable to the ThinkFirst Foundation of Canada. • We welcome your comments regarding the DVD/ VHS, booklet and safety brochure, along with any suggestions for improvement. • As ThinkFirst Canada is a non-profit organization, donations would be greatly appreciated and can be sent directly to:

ThinkFirst Canada Med-West Medical Centre, Suite 2-227 750 Dundas Street West Toronto, ON M6J 3S3 • A receipt for income tax purposes will be provided for donations greater than $ 10.00.

Developed by ThinkFirst Foundation of Canada 750 Dundas Street West, Suite 2-227 Toronto, ON M6J 3S3 Phone: 1-800-335-6076 E-mail: [email protected] Website: www.thinkfirst.ca