One win … two wins … could there be a Triple Crown? From May to June, six of the most exciting words we hear are “and down the stretch they go” as millions of people around the world eagerly watch to see which horse crosses the finish line first. American Pharoah has run into the hearts of millions and is trending online, as we again await the possibility of a Triple Crown winner. The Triple Crown is arguably the hardest feat to obtain in modern sports; the last time occurring in 1978 when Affirmed won the three historic races. We so often hear about the horses and their amazing power, who can weigh up to 1400 lb., with the capability of 40 mph running speeds and kicking with up to 1 ton of force6. When I’ll Have Another pulled out of the Belmont after winning the Kentucky Derby and Preakness in 2012 due to a lower leg injury, it was all over the sporting news. But how often do we hear about some of the smallest athletes; the jockeys? Who was the jockey on Affirmed in 1978? (Steve Cauthen). Who is the jockey riding American Pharoah? (Victor Espinoza).
Professional race jockeys usually weigh between 108 and 118 lbs., and they have to control a horse that is basically one big mound of muscle weighing 1200 lbs. When we hear about a traumatic injury occurring to a jockey, it’s usually due to being thrown from the horse, or the horse tripping and falling on top of the jockey. However horseback riding is not just about the professionals; the US Center of Disease Control reports over 30 million people ride horses every year in the Unites States2, and according to the National Electronic Injury Surveillance Survey (NEISS) in 2009 an estimated 78,500 people were treated in emergency rooms for equestrian related injuries.7
Equestrian activities are popular in the US and include a variety of forms such as racing, dressage, cross-country, jumping/show competitions, polo, and trail riding. Studies have shown that ~39% of all equestrian related injuries occur in patients under the age of 19 and in contrast to many other contact sports, the majority of these athletes are female.1 When mounted, a rider’s head sits approximately 9 feet off the ground; distortion and fractures of the upper extremities are the most common injuries that occur, followed by head injuries including concussion, mainly due to falls or being thrown from the animal.5
What we do not typically hear a lot about are the repetitive injuries that occur in equestrian related activities. Riding is an activity that requires prolonged muscular activation with constant changes to one proprioception in order to generate the stability needed to stay on the horse and control the mammoth animal. In the low-country, riding is a very popular activity. I’ve seen a number of both pediatric and adult riders for repetitive or overuse injuries including shoulder instability, low back pain from the constant jarring and bouncing movements, hip and SI joint dysfunction from the prolonged squeezing of the horse with their legs, as well as general knee pain and even degenerative knee issues from the repetitive impact and stress on the joint.
The jockey Gary Stevens is being labeled the “Comeback Kid”; after retiring in 1999 and 2005 due to right knee issues, he came out of retirement again in 2013, but unfortunately the agony of bone-on-bone in his right knee caused him to undergo a total knee replacement in July of 2014. Prior to the surgery Stevens said, “It’s six months for a normal, typical sort of surgery and a typical person, but I am not typical … they are not really use to seeing this type of person come in for knee replacement.”8 Stevens was back in the saddle a mere 91 days after surgery and jockeyed Firing Line to a second place finish at the Kentucky Derby.
Core strengthening and stabilization exercises, lower extremity flexibility training, and rotator cuff/peri-scapular musculature strengthening and stability exercises should all be incorporated into the regular injury prevention workout of anyone participating in equestrian activities. The American Academy of Orthopaedic Surgeons has also published a list of injury prevention tips, some of which include: 7
· All riders should always wear horseback riding helmets that meet ASTM and SEI standards.
· Wear properly-fitted, sturdy leather boots with a minimal heel.
· Be sure the saddle and stirrups are appropriate to your size and are properly adjusted.
· Children and novice riders should consider safety stirrups that break away if a rider fall off the horse
· If you feel yourself falling from a horse, try to roll to the side (away from the horse) when you hit the round.
* For the full list of tips for the AAOS go to http://orthoinfo.aaos.org/topic.cfm?topic=A00058
On June 6, 2015, all eyes will be on American Pharoah with hopes of seeing the first Triple Crown in 37 years, but don’t forget about the 5’2”, 112 lb. Victor Espinoza who will be risking his body to control the power and speed of the thoroughbred. Please remember, if you are an avid rider or novice, preventative safety equipment and an injury prevention training program is essential to reduce the odds of you being one of the 79,000 equestrian related emergency room visits.
1. Havlik, Heather. Equestrian Sport-Related Injuries: A Review of Current Literature. Current Sports Medicine Reports, American College of Sports Medicine: 299-302.
2. Center for Disease Control and Prevention [Internet]: http://www.cdc/gov/niosh/updates/upd-04-30-09.html
3. Lee KH, Steenberg LJ. Equine-related facial fractures. International Journal of Oral Maxillofacial Surgery. 2008; 37: 999-1002.
4. Pedulla, Tom. Thrill of the Chase Keeps Gary Stevens Coming Back. The New York Times. May 12, 2015.
5. Zoetsch S, Saxena AK. Equine-Related Injuries in Pediatric and Adolescent Age – Analysis and Outcomes in a Level 1 Pediatric Trauma Center in Austria. Pediatric Emergency Care. 2013; 29 (9): 1053-1054.
6. Kriss TC, Martich V. Equine-Related Neurosurgical Trauma: A Prospective Series of 30 Patients. The Journam of Trauma: Injury, Infection, and Critical Care. 1997; 43(1): 97-99.
7. Horseback Riding Injury Prevention. Ortho Info – American Academy of Orthopaedic Surgeons [Internet]: http://orthoinfo.aaos.org/topic.cfm?topic=A00058
8. Paulick, Ray. ‘Comeback Kid’ Stevens to Have Knee Surgery but Vows ‘I’m Not Finished’ [Internet]: http://www.paulickreport.com