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Ohio State University Extension


Recognizing Concussion or TBI in Horseback Riders

Agriculture and Natural Resources
Sara L. Mastellar, PhD, Equine Faculty, Ohio State ATI
Karen Bennet-Wimbush, PhD, Associate Professor – Technology Coordinator, Horse Production & Management, Ohio State ATI

Equestrian head injuries are often more severe and require more treatment than other types of horse-related injuries. Some symptoms can be immediate while others can be present days, weeks, or even later after the incident. It is important to take measures to protect against these injuries. Photo of four different helmets.

Recognizing Concussions or Mild Traumatic Brain Injury (TBI)

A first step toward getting help for riders who have had an accident or fall is being aware that concussions and other head injuries can occur. A loss of consciousness does not always accompany concussions. 

According to the Center for Disease Control, the following are symptoms of TBI:

  • Difficulty thinking clearly
  • Feeling slowed down
  • Difficulty concentrating
  • Difficulty remembering new information
  • Headache
  • Fuzzy or blurry vision
  • Nausea or vomiting (early on)
  • Dizziness
  • Sensitivity to noise or light
  • Balance problems
  • Feeling tired, having no energy
  • Irritability
  • Sadness
  • More emotional
  • Nervousness or anxiety
  • Sleeping more or less than usual
  • Trouble falling asleep

The United States Equestrian Federation (USEF) has created a poster listing key symptoms. The poster is linked here:

Training is available for coaches and youth event volunteers to learn more about identifying concussions or TBI in a rider who has fallen. The training has been jointly developed by the Centers for Disease Control (CDC), National Football League (NFL), and United States Pony Club (USPC). The training is linked here: 

Long-Term Effects of Concussions and/or Repetitive Head Injuries

Participants in several equestrian sports, such as racing and rodeo, are at a high risk of suffering from repetitive head injuries. This risk is not limited to only those activities. Multiple concussions have been associated with impaired baseline scores on verbal memory, reaction time, and migraine-cognitive fatigue symptoms more than eight days following a concussive event (Covassin, Moran, & Wilhelmy, 2013). Additionally, an increase in sleep disturbances associated with repetitive concussions has been reported in the literature (Oyegbile, Dougherty, Tanveer, Zecavati, & Delascobera, 2020; Gossilin et al., 2009). Sleep disturbances have been shown to predict concussive symptom duration (Oyegbile et al., 2020). The time it takes to recover from concussive symptoms is important to horsemen to minimize the risk of additional head injuries during what could be a vulnerable period. Clinically, cognitive-migraine-fatigue symptoms used as part of the Post Concussive Symptoms Scale (PCSS) have been shown to be good indicators of prolonged concussive symptom duration. Current research indicates multiple long-term effects of even mild, repetitive head injuries; thus, it is imperative that both professional and recreational riders work to prevent concussive injuries to the head. 

Head Injury Statistics for Equestrians

Head injuries are the most common cause of fatality in horse-related injuries (Meredith, Ekman, & Brolin, 2018). Of all sports in the United States, equestrian sports are the most common cause of sports-related traumatic brain injury (TBI) in adults (Winkler et al., 2016). Concussions are the most common type of TBI and can occur due to a fall from a person’s own two feet. The typical rider’s head is about 9 feet above the ground and the added height and/or speed of a horse can increase the impact of a fall. Injuries to the brain, including concussion, comprise 9%-15% of equestrian sport injuries (Zuckerman et al., 2015). Additionally, concussions are the third most common type of injury for professional rodeo athletes after knee and shoulder injuries (Butterwick, Hagel, Nelson, LeFave, & Meeuwisse, 2002). For more information regarding equestrian injury statistics refer to the Ohioline fact sheet “Equestrian Injury Statistics.”


Butterwick, D. J., Hagel, B., Nelson, D. S., LeFave, M. R., & Meeuwisse, W. H. (2002). Epidemiologic analysis of injury in five years of Canadian professional rodeo. American Journal of Sports Medicine, 30(2), 193-198.

Broshek, D. K. (2001). Concussion diagnosis and management. American Medical Equestrian Association, 12(4), 1-4. 

CDC. (2019). Symptoms of traumatic brain injury (TBI). Centers for Disease Control and Prevention,

Christey, G. L., Nelson, D. E., Rivara, F. P., Smith, S. M., & Condie, C. (1994). Horseback riding injuries among children and young adults. Journal of Family Practice, 39(2), 148-153. 

Covassin, T., R. Moran, K. Wilhelmy. (2013). Concussion symptoms and neurocognitive performance of high school and college athletes who incur multiple concussions. The American Journal of Sports Medicine, 41(12):2885-2889.

Gosselin, N., Lassonde, M., Petit, D., Leclerc, S., Mongrain, V., Collie, A., & Montplaisir, J. (2009). Sleep following sport-related concussions, Sleep Medicine, 10:35-46.

Havlik, H. S. (2010). Equestrian sport-related injuries: A review of current literature. Current Sports Medicine Reports, 9(5), 299-302.

Jagodzinski, T., & DeMuri, G. P. (2005). Horse-related injuries in children: A review. Wisconsin Medical Journal, 104(2), 50-54. 

Meredith, L., Ekman, R., & Brolin, K. (2018). Epidemiology of equestrian accidents: A literature review. Internet Journal of Allied Health Sciences and Practice, 17(1), 9. 

Oyegbile, T.O., Dougherty, A., Tanveer, S., Zecavati, N., & Delascobera, B.E. (2020). High sleep disturbance and longer concussive duration in repeat concussion. Behavorial Sleep Medicine, 18(2):241-248.

Sufrinko, A. M., Machetti, G. F., Cohen, P. E., Elbin, R. J., R. Valentina, & A. P. Kontos. (2017). Using acute performance on a comprehensive neurocognitive, vestibular, and ocular motor assessment battery to predict recovery duration after sport-related concussions, The American Journal of Sports Medicine, Vol. 45(5):1187-1194.

Williams, F., & Ashby, K. (1995). Horse related injuries. Hazard: Victorian Injury Surveillance System, 23(93), ISSN-1320-0593. 

Winkler, E. A., Yue, J. K., Burke, J. F., Chan, A. K., Dhall, S. S., Berger, M. S., & Tarapore, P. E. (2016). Adult sports-related traumatic brain injury in United States trauma centers. Neurosurgical Focus, 40(4), E4.

Zuckerman, S. L., Morgan, C. D., Burks, S., Forbes, J. A., Chambless, L. B., Solomon, G. S., & Sills, A. K. (2015). Functional and structural traumatic brain injury in equestrian sports: A review of the literature. World Neurosurgery, 83(6), 1098-1113.

Note: This article was originally peer reviewed and published through SDSU Extension (iGrow) in 2017. It was updated for an Ohio audience in 2020.

Originally posted Dec 23, 2020.