The Helmet Question LYNN VAN WOUDENBERGH/ARND VAN BRONKHORST PHOTOGRAPHY LYNN

30 EQUUS 495 December 2018 ew topics spark as pas- Every rider sionate a debate among falls sooner horsepeople as the need for riding helmets. or later, and The question of this one piece whether to wear protec- DUSTY PERIN Ftive headgear is deeply personal, and of equipment it cuts to the heart of how we identify may make the ourselves as equestrians. Many of us--- especially those of us born in the 1980s difference or earlier---grew up admiring horsemen and -women who wore either Western between hats or velvet hunt caps. Our heroes walking did not wear protective headgear, and neither did we. (In fact, apart from away versus jockeys and polo players, almost no a lifetime of one did in those days.) But what if we could set aside all of disability. the emotional history and take a fresh look at head protection, just as we consider new research into saddle fit, feeding, veterinary care and just about every other aspect of horsemanship? By Dee McVicker Whether you choose to wear a helmet when you ride on your own is ultimately your decision, but from one rider to another, please make sure your opinions are fully informed. When you understand exactly how concussions injure the tissues of our brains and how protective helmets may limit the damage---and when you consider the research that shows how increased use of helmets can mitigate or prevent brain injuries---you might just want to make sure that you’re wearing protec- tive headgear every time you mount up.

December 2018 EQUUS 495 31 the brain can shift more and there’s WHAT TRAUMA twisting and tearing of fibers,” says DOES TO THE BRAIN Julian Bailes, MD, chairman of the Traumatic brain injuries (TBIs) are Department of Neurosurgery and defined by the Centers for Disease co-director of NorthShore University Control as jolts, blows or penetrating HealthSystem’s Neurological injuries to the head that alter the vic- Institute in Chicago. tim’s mental state. Although most of The severity of TBIs can be us understand that a sudden blow ranked on different official can cause a concussion, it’s impor- medical scoring systems, such tant to know that you don’t need as the Glasgow Coma Scale or the FREDERICK CHEHU /ARND BRONKHORST PHOTOGRAPHY to strike your head to sustain a Abbreviated Injury Scale, but gener- dangerous brain injury: Simply ally concussions can be described whipping your head hard can as mild, moderate or severe. To some cause the brain---which floats in degree, all TBIs can change the way a a layer of cerebrospinal fluid--- person thinks, feels and acts; they can to slam into the interior of the also affect language and cause sleep skull, and both a blow and a jolt disturbances. can stretch, tear and/or bruise People who sustain mild TBIs may the neural tissue. lose consciousness for a few minutes, The direction of force mat- or they may remain awake but sim- ters, too. Blows and sudden jerks ply be confused or “dazed” following tend to cause linear forces, in an injury. They may experience which the brain moves in a memory loss that persists for straight line inside the skull. up to a day. Other symptoms However, some injuries to the common following milder head cause rotational forces TBIs include fatigue, head- within the brain. “Rotatory aches, dizziness, blurred movement is probably vision, nausea or vomiting, more dangerous because loss of balance, increased DUSTY PERIN

Blows and sudden jerks tend to cause linear forces, in which the brain moves in a straight line inside the skull. However, some injuries to the head cause rotational forces within the brain. WIKIPEDIA

32 EQUUS 495 December 2018 irritability or other emotional distur- of unconsciousness is a sign of much People who survive moderate and bances, sensitivity to bright lights or more serious injury. “If a person is severe TBIs are likely to require exten- loud noises, ringing in the ears, and knocked unconscious, it usually sive rehabilitation. Long-term depression. Sometimes these signs can means their brain experienced enough effects are common and may include: be subtle and easy to miss, and they strain to disrupt transmission path- • physical changes, such as chronic may persist for weeks or in some cases ways. A loss of consciousness typically pain, seizures, loss of bowel or bladder symptoms may last for a year or more. means the head impact was more se- control, and sleep disorders Although recovery from mild TBIs vere than when the symptoms are a • cognitive changes, DUSTY PERIN

is usually uneventful, it can take a headache and dizziness,” says including difficulties with memory minimum of six weeks for the neural biomechanical engineer Stephanie and concentration tissues to fully heal. During that time, Bonin, PhD, PE, of MEA Forensic • speech and language impair- damage from an additional blow to the Engineers & Scientists in Laguna ments, such as slurring, and dif- head would be cumulative: A second Hills, California. ficulties with reading, writing and TBI might cause serious long-term These patients almost always comprehension complications or prove fatal, even if need to be hospitalized, possibly in • sensory issues, such as lost or di- neither blow alone would have been intensive care. Blows to the head hard minished taste or smell, blurred vision life-threatening. (For that reason, physi- enough to cause serious TBIs may or blindness, or ringing in the ears cians suggest not riding or participat- also be complicated by issues such as • emotional changes, such as ag- ing in other high-risk sports until the skull fractures, hemorrhage or subdu- gression, irritability, lack of motivation brain has had time to heal.) ral hematoma (the pooling of blood or depression. More moderate to severe TBIs cause between the brain and the skull), Over the long term, TBI---even a unconsciousness for 30 minutes or all of which can place pressure on mild one---may leave a person at an longer, ranging up to coma, and when the brain and cause seizures, increased risk for developing epilepsy, awake, these patients may experience breathing difficulties and other life- Parkinson’s disease, Alzheimer’s dis- extensive memory loss. The period threatening conditions. ease and other neurological disorders.

EQUUS 495 33 December 2018 SPECIAL RISKS proof helmet because the brain is still those concussive forces, but it’s not floating inside your skull and has the going to protect you entirely,” says FOR RIDERS capability of moving or twisting,” Bailes Carl G. Mattacola, PhD, of the University The potential for more serious says. A helmet also won’t protect you of Kentucky. “Helmets may not be TBIs is greater for equestrians than against a broken neck or other serious able to protect against the torsion and for participants in other sports, says injuries to your body. the torque that take place at the time Bailes. Because of the height of the What a helmet can do is absorb of injury.” horse, a rider falls farther than other shock and reduce the force of a direct The bottom line is that having a athletes, and the force of the potential impact on your head, such as from a protective helmet on during a serious blow from a fall increases with the kick or a fall---and that may be enough fall may make the difference between a speed of the horse. to limit the severity of a TBI and prevent dizzying embarrassment you can walk Overall, counting all injuries, people complications such as skull fractures. away from, versus a coma followed by who ride horses are less likely to hurt “The purpose of a helmet is to life-long disability, if you survive at all. themselves than are people who partici- protect the skull from open-head According to the United States Pony pate in other sports, including football, injuries and protect against some of Clubs (USPC), head injuries among basketball and skiing; however, rider their members decreased almost 50 injuries are more likely to be severe percent after the organization mandated and require hospitalization, according Because of the height their members wear approved helmets. to data compiled by Sara Mastellar, of the horse, a rider Few other equestrian organizations col- PhD, of Ohio State ATI, in a paper falls farther than other lect enough data to draw conclusions published at iGrow.org. And, according athletes, and the force about how instituting rules for man- to numbers from the National Trauma of the potential blow dated helmet use has affected the rate Data Bank, between 2003 and 2012, from a fall increases of head injuries among their members. riders accounted for more than twice with speed. “The USPC data is the only data I am as many sports-related TBIs (45.2 aware of that has specifically tracked percent) than even football players (20.2 head injury incidence percent). before and However, it is important to after imple- understand that a rider who menta- falls while wearing a tion protective helmet can still sustain a concussion. “There is no concussion- DUSTY PERIN

34 EQUUS 495 December 2018 TIPS FOR • Look for labeling that helmet, it’s also a good shows the SEI certification idea to style your hair as 4 BUYING mark with the ASTM you will when you ride; number F-1163. This ponytails or other “updos” A NEW indicates that the helmet is may affect the fit. HELMET tested and certified for use • Make sure the jaw in horseback riding. strap can be securely • Try on different fastened so it touches the models and choose skin. It’s also a good idea one that fits your head to make sure you can comfortably—some open and close the clasp people’s heads are quickly and easily—it will rounder, and some be less tempting to ride are more oval. Most off with it dangling. helmets today come • Once the helmet is with adjustable fitting fitted and secured, make systems, but it’s best to sure it sits level from front start out with a helmet to back. Your eyebrows that is closer to your should move with the natural shape. (For helmet if you rock it front online shoppers, look for to back. Also check that it measuring instructions on cannot be shifted or rocked the manufacturer’s site.) out of position, either front When shopping for a new to back or side to side. ARND BRONKHORST of a helmet policy,” says Mastellar. However, she adds, “New York State did THE LATEST INNOVATION see a drop in horse-related deaths after the state Horse Council mandated hel- As ongoing research forces at work, too, as the reduce injuries in the field met use. Since most deaths were caused into brain injuries yields rider’s body continues its is still being evaluated, by head injuries, ‘deaths’ can serve as a information on how to momentum after the head and helmet manufacturers proxy statistic for ‘head injuries.’” prevent them, helmet strikes the surface. Recent are not yet required to Even without data, it seems safe to technology is continuing to advances into brain injury incorporate MIPS into their say that helmets have saved lives. We’ve develop, too. show that head rotation is current lines. all heard at least one story from some- One of the newer likely to cause or contribute However, Stephanie one who survived serious falls relatively innovations is MIPS to concussions. Bonin, PhD, PE, a member unscathed. “Helmets that are certified technology, which stands In helmets with of the ASTM headgear have to demonstrate a certain level of for multi-directional impact MIPS technology, the and helmet subcommittee, protection against simulated falls,” says protection system. As outer shell and foam expects to see a rotational Mastellar. “In my own experience, when they are designed today, liner are separated by a requirement in helmets I came off into the wall of an indoor riding helmets protect low-friction layer, which across most sports in the arena, my helmet was punctured by the head against linear allows the outer shell to next several years: “It’s a nail that was sticking out. That was acceleration—that is, rotate independently of pretty well accepted that damage that my head didn’t take.” a straight blow without the liner. The idea is that helmet certification testing twisting forces. But when the movement within the should include a rotational STRUCTURED FOR a rider hits the ground, helmet should reduce the test, and the equestrian PROTECTION the head motion is almost rotational forces on the helmet might be one of the never purely linear; rider’s head; the ability of first single-impact helmets In 1988, the American Society for instead, there are rotational the technology to actually to implement it.”

Testing and Materials (ASTM, now DUSTY PERIN december 2018 EQUUS 495 35 THE EVOLUTION OF HELMETS called ASTM International) published the first standard, titled “F1163, Specification for Protective Headgear Polo players show organizations Used in Horse Sports and Horseback began wearing hard have implemented Riding.” Within a year, the first helmets hats in the early 20th helmet rules for their bearing an “ASTM/SEI-certified” century, and they participants. Helmets label were on the market. Here’s became standard are compulsory for many what that means: equipment among disciplines governed • ASTM International publishes jockeys in the United by the United States very specific rules about the forces a States by the late Equestrian Federation, helmet must withstand. For example, 1950s. But the for example, and “any it must be able to absorb an impact push for protective exhibitor may wear and stop an object from penetrating headgear for use protective headgear ... the outer shell. It must stay on in the in other equestrian in any class or division event of a fall. It must perform equally sports didn’t start to without well in very low temperatures, very gain steam until the penalty from high temperatures and when saturated late 1970s. the judge.” with water. ASTM International does The National not conduct any tests; the organiza- Reining Horse tion simply publishes the rules helmet Association makers must follow. rules allow • SEI, the Safety Equipment participants to Institute, is a private, nonprofit orga- wear either a nization whose goal is to make sure “western hat manufacturers comply with the ASTM or a safety

THEARGOSYANTIQUES.COM standards. Helmet makers send sam- helmet,” and ple helmets to independent accredited the “use of labs for safety testing, which include FRANK SORGE/ARND BRONKHORST PHOTOGRAPHY The earliest ASTM/ an ASTM/ dropping them onto anvils---one flat, SEI-certified helmets, SEI-certified and one with a raised edge to simulate introduced about a decade helmet is mandatory in a horseshoe---at a velocity of 6.0 me- later, were heavy and hot, all Para-Reining classes.” ters per second. Helmets are placed and convincing people to The National Cutting Horse on a headform, and sensors inside the wear them was difficult. Association allows helmets headform measure the acceleration But over the years, “with advance approval of during impact testing as gravity (g) helmet manufacturers show management.” forces that would affect a rider’s head. introduced models that Today, riders have a Other procedures test the strength of were lighter, less bulky broad range of ASTM/SEI- the helmet straps. Then, the tests are and better ventilated. At certified helmets to choose repeated after the helmet is frozen to the same time, a growing from, with styles meant minus 20 degrees Fahrenheit (F), heat- number of equestrian like Denny Emerson, a to appeal to English and ed to 120 degrees F, and submerged in organizations—including prominent eventer, trainer Western riders, children water overnight. If in any test the forces the U.S. Pony Clubs as well and coach, more people and professionals, and just recorded by the sensors exceed 300 g, as groups such as the Girl began wearing ASTM/ about anyone in between. the minimum required to injure the Scouts of the USA—began SEI-certified helmets Protective helmets can even brain, the helmet fails. requiring members to wear voluntarily. be found with wide brims, to Equestrian helmets consist of a helmets at their own events. Within the last 10 mimic the look of traditional hard outer shell and an inner liner that With advocacy from people years, more and more Western hats.

ARND BRONKHORST includes a layer of polystyrene foam

36 EQUUS 495 December 2018 as well as a sturdy harness to hold riders still opt not to wear one. And, yes, the helmet in place during an impact. all adults get to make their own deci- In the event of a blow to the head, the sions about personal risks they are will- foam layer is compressed, which ab- ing to take. Sometimes, however, a close sorbs some of the force of the impact call or two can be pretty convincing. : before it reaches the skull. “I was one of those kids that was “The foam liner will crush and in- fearless,” says Gwen Kahler, who lives crease the period of time over which in Flagstaff, Arizona. “I grew up with the head accelerates,” says Bonin, who horses and didn’t think twice about specializes in the mechanics of helmet hopping on one and going. Helmets protection. “By increasing the acceler- weren’t even a thought. Then, when I ation time, the peak head acceleration got older, I was on a trail ride with my is reduced.” teenage daughter and my horse tripped The goal, of course, is to allow the and I fell sideways, backward and down helmet to take the brunt of the damage, the hill and hit the ground.” leaving your head relatively unscathed. Kahler was hospitalized with a But that also means that the helmet concussion after that incident, yet even can be in an accident only once: After then she still didn’t feel the need to an impact crushes the foam, it does not wear a helmet when riding. But she expand again. So even if the outer shell changed her mind a few years later, looks unscathed after a fall, the foam after her Tennessee Walking Horse underneath may be damaged, and the bolted and she was forced to cling to helmet will not provide adequate pro- his neck to stay on. “That was the most tection should you fall again. frightening ride of my life,” she says. Protective helmets are generally “After that, I said, ‘You know what? I designed for specific sports, based think I need a helmet.’” on the location and nature of the im- At the time of Kahler’s first concus- pacts the wearer is likely to sustain. sion, almost 20 years ago, brain injuries Bicyclists, for example, are more likely were not as well understood as they are to go forward over the handlebars in an today. Now we know that concussive accident, while horseback riders often symptoms can worsen with repeated fall backward or to the side, so helmets head injuries, and that the effects can designed for each sport are reinforced last a lifetime. Kahler suffered two in different areas. Also, bicyclists usu- more concussions unrelated to horse- ally strike their heads only once in an back riding, and with each one her accident, whereas horseback riders symptoms became more severe. Today, may sustain multiple blows from a col- loud noises, bright lights and even lapsed fence or a horse’s hooves in the smells can trigger “brain fog” and a same fall, so a strong retention system headache that she describes “as if a big is needed to keep the helmet in place hand is putting pressure on my head.” after the first blow. That’s why it’s im- portant to ride your horse in a helmet nyone---from rank amateurs to that is designed for that purpose world-class professionals---can ---riding your horse in a bicycle helmet Afall off of a horse. And even the is not a good idea. most reliable, bombproofed campaigner can trip, fall or spook. While an ASTM/ A VOICE OF SEI-certified helmet cannot prevent EXPERIENCE every injury, it can greatly reduce your Even knowing that helmets may risk of a serious concussion. And it reduce the risk of head injuries, many might just save your life. december 2018 EQUUS 495 37