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Guest Post by:
Michael J. Barr, PT, DPT, MSR
Sports Medicine Program Manager
MUSC Health Sports Medicine

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.5Rider falling from horse

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

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]:

8.      Paulick, Ray.  ‘Comeback Kid’ Stevens to Have Knee Surgery but Vows ‘I’m Not Finished’ [Internet]:

Local farrier Peter Drake has been shoeing horses at farms around South Carolina for nearly 40 years. He prides himself on taking care of horses’ feet and legs to keep them healthy. But, for the last eight or nine years his hips were deteriorating and the pain made it difficult for him to walk. Peter’s hips were in a locked position from a condition called osteoarthritis, the most common form of arthritis.

MUSC Health orthopaedic surgeon Dr. Jake Drew recommended a minimally invasive procedure to get Peter back to his active life with less discomfort.


Watch Peter’s story


Meet Dr. Drew.

Learn more about MUSC Health’s Hip and Knee replacement team.

May is American Stroke Month. Why is American Stroke Month important? Because every 40 seconds, someone in America has a stroke. Because stroke is the leading cause of severe, long-term disability.

A stroke—or brain attack—occurs when blood flow to the brain is disrupted either by a blood clot or burst blood vessel in the brain. Stroke is a serious medical emergency. When someone recognizes a stroke and acts fast, the patient has a greater chance of receiving life-saving treatment to reduce the risk of brain damage and disability.

Can you spot the signs of a stroke? It might make the difference between life and death or between a full recovery and permanent disability.

Think F.A.S.T.:

F - Face drooping: Does one side of the face droop or is it numb? Ask the person to smile.

A - Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

S - Speech difficulty: Is speech slurred, are they unable to speak or are they hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly?

T - Time to call 911: If the person shows any of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately.

At the MUSC Health Comprehensive Stroke Center, our stroke specialists have one of the fastest times in the country for treating stroke patients with clot-busting medication or necessary medical procedures.  With one of the nation's largest teams of top stroke and cerebrovascular specialists supported by a full range of leading-edge technology and facilities, our patients receive care available only at the most elite neuroscience medical centers in the country.

If you spot signs of a stroke, act F.A.S.T. and choose MUSC Health for the best stroke care in South Carolina.

Guest Post by:
Harris S. Slone, MD
Assistant Professor
Department of Orthopaedics
Medical University of South Carolina

Golf season is officially full swing.  With exciting Masters and TPC tournaments in the books, and remaining PGA majors upcoming, many of us will hit the links this spring as well.  There are over 27.8 million golfers in the US alone, and the average golfer plays around 37 rounds per year. Golfer at tee

Golf is generally considered a safe sport.  Surprisingly, the number of injuries in golf is higher than one might think.  A recent study of Australian amateur golfers demonstrated that about 16% incidence of injury per year.1 The vast majority of golf injuries are “overuse” injuries, which is no surprising given the non-contact nature of the sport.  Overuse injuries can be just as debilitating, and can require just a long of recovery as traumatic or acute injuries.  Additionally, golf is enjoyed my athletes of all ages and skill levels, and a larger proportion of participants are older compared to other sports.

Most injuries in golf involve the upper extremity (elbow, hand and wrist) or back.  These injuries are also related to the amount of golf played.  Studies show that golfers who play 3-4 or more rounds per week, or those who hit more than 200 golf balls per week are more likely to sustain an overuse injury. 1,2

If most golf injuries are overuse injuries, it makes sense that these injuries may be more amenable to prevention, when compared to traumatic injuries. Many golfers fail to sufficiently warm up before a round, despite evidence to suggest that warming up reduces the risk of injury.  Players who do not warm up are more than twice as likely to sustain an injury over the course of a year compared to players to regularly warm up for 10 minutes or more. 2

Don’t put the clubs away just yet! Here is the good news: over half of the golf related overuse injuries will resolve over the course of a month, and over 80% will improve over 6 months.   The health benefits of golf are many, especially when choosing to walk the course as opposed to riding in a golf cart.  Golfers who regularly walk the course are more likely to weigh less, have slimmer waists, lower “bad” cholesterol, and higher “good” cholesterol. 3 Now get out there and hit ‘em straight!

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  1. McHardy A, Pollard H, Luo K. One-Year Follow-up Study on Golf Injuries in Australian Amateur Golfers. American Journal of Sports Medicine. 2007;35(8):1354-1360. doi:10.1177/0363546507300188.
  2. Gosheger G, Liem D, Ludwig K, Greshake O, Winkelmann W. Injuries and Overuse Syndromes in Golf. American Journal of Sports Medicine. 2003;31(3):438-443.
  3. Parkkari J, Natri A, Kannus P, et al. A controlled trial of the health benefits of regular walking on a golf course. The American Journal of Medicine. 2000;109(2):102-108.

Guest Post by:
Kathleen Choate, ATC, CSCS, CEAS
Athletic Trainer
MUSC Sports Medicine

The weather is getting warmer, the days are getting longer, and the smell of fresh cut grass and barbecue is filling the air. This can only mean one thing, the beginning of another lacrosse season.  Lacrosse was started by the Native Americans centuries ago.2  Since then, there have been changes to the equipment used to increase safety such as helmets, mouth guards, shoulder pads, elbow pads, and gloves; however, injuries will always exist.  Some of the more common injuries sustained by lacrosse players involve the ankles, knees, and head.

A lateral ankle sprain is an injury almost every athlete suffers at some point.  The most common of ankle sprains involve injury to one or more of the ligaments on the outside (lateral) of the ankle.  Most athletes report rolling their ankle inwards and experiencing immediate pain over the lateral ankle.  Swelling and bruising may develop as well.  Initial management should include rest, ice, compression, and elevation (RICE).  In addition to RICE, recovery should involve improving strength, flexibility, and balance.  Most athletes with a mild ankle sprain are able to return to lacrosse within ten days of the injury.

Knee ligament sprains in lacrosse often include the anterior cruciate ligament (ACL), or the medial collateral ligament (MCL).  Injury to these ligaments can occur with or without contact.  With contact, the athlete is usually hit from the back or outside of the knee.  Injury without contact usually involves a cutting or twisting motion such as with roll dodges, face dodges, and split dodges where quick fast movements are made.   Athletes will usually notice sudden pain when the injury occurs and may also report a pop or difficulty walking.  Depending on the severity, swelling will occur within hours of the injury.  Immediate care for these injuries should include RICE.  With MCL and ACL injuries, the knee can quickly become very unstable.  While the length of time to return to play varies greatly depending on the severity of the injury, a full tear of the ACL usually means the end of the season for a lacrosse player.

Concussion should be considered the most serious of the common lacrosse injuries since it involves an injury to the brain.  In lacrosse, concussions are commonly suffered as a result of contact from another player, stick, or ball. Unlike more severe traumatic brain injuries, concussions cannot be confirmed with any imaging technologies.  They can be very easy to overlook, misdiagnose, and hide.  Mismanaging even the mildest of concussions can lead to long-term disability or death if there is a second trauma before the injury has completely resolved.  Concussion symptoms can include headache, “pressure in head,” neck pain, nausea/vomiting, dizziness, blurred vision, balance problems, sensitivity to light or noise, feeling slowed down, feeling “in a fog,” “don’t feel right”, difficulty concentrating, difficulty remembering, fatigue/low energy, confusion, drowsiness, trouble falling asleep, more emotional, irritability, sadness, and nervous/anxious.1  Other signs that may be observed include a loss of consciousness, loss of memory, confusion, or abnormal behavior.1  If there is even one mild and short lived concussion symptom after a hit to the head, this athlete should be immediately removed from play and evaluated by a healthcare professional that is well versed in the most recent evaluation and management criteria.  One common phrase used for concussion management is, “when in doubt, sit them out.”

With lacrosse quickly growing in popularity in the United States, safety always needs to be in the front of our minds.  It’s difficult for any lacrosse athlete who suffers an injury that results in lost playing time, but caring for them early and with the help of your Athletic Trainer or Physician will guarantee a return to the field as quickly and safely as possible. 

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1. SCAT3. Br J Sports Med. 2013;47(5):259.
2. Vennum Jr. T.  The History of Lacrosse. Accessed April 19, 2015.


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