Concussion - still a risk in equestrian sports

Safety awareness is steadily increasing within the equestrian world. This is a positive development! Much progress has been made, particularly in the field of riding helmets. Technology is constantly evolving, and today, wearing a helmet in the saddle is considered a matter of course. However, gaps in safety still remain—and riders are still being injured every week.

Riding will, by its nature, always involve a certain degree of danger: horses are very large animals, and it is impossible to completely predict what will happen or how they will act. This very problem with unpredictability will also affect any protective equipment. It is impossible to foresee every conceivable accident scenario and develop effective protection against all of them. But we can do our best.

Today, we understand how the powerful forces of an impact affect both the helmet and the brain, and we know how we can contribute to higher safety.

It’s about the helmet—but also about when you wear it!

When should you use a riding helmet?

The short answer: Always—as soon as you are around horses.

All activities involving close contact with horses are high-risk occupations. Statistics clearly show that everything—from the riding itself to the handling of the horses—carries a significant risk of accidents. Riding poses the greatest risk, as a fall from a horse can be from a significant height and involve high speeds. Consequently, these accidents generate the greatest forces.

However, accidents also occur in the stable, during loading, while leading the horse, or while grooming. On these occasions, it is common for people to lack the otherwise obvious and mandatory protection: the riding helmet.

The fact that an approved riding helmet is now seen as a natural and necessary part of the equipment has led to a real reduction in both head injuries and concussions among riders.

However, using a riding helmet consistently during all close contact with horses also reduces the risk of injury in situations where danger is not anticipated. Horses are simply so large, strong, and—to some extent—unpredictable, that the slightest lapse in communication can have serious consequences!

An Angled Impact Results in Rotation—and Shearing

An approved—tested and certified—riding helmet must be able to absorb the force of a hard blow to its exterior. The helmet’s protective core—often made of EPS (expanded polystyrene)—absorbs and dissipates the force before it reaches the head. Despite this, a rider can still suffer a concussion. How?

Firstly, the impact can be so severe that it exceeds the helmet's protective capacity. Secondly, the impact can strike at an angle, thereby generating rotational forces: that is, the head is jerked in a new direction. Rotational forces are a problem that many (approved) helmets are not built to handle.

The helmet dampens the force of a linear (straight) impact, but the head's rapid twisting, acceleration, and deceleration following an angled impact is something entirely different and distinct.

The Brain Twists

When the energy from an impact on the helmet leads to a sudden jerk of the head, kinetic energy is created: the skull moves faster than the brain tissue in an abrupt increase in speed, followed by a brutal decrease in speed.

Because the brain consists of soft tissue in several layers with different densities, it does not move as a solid unit inside the skull. Instead, the brain is subjected to shearing—a twisting deformation where different layers move at different speeds relative to one another.

When the brain twists in this manner, vital structures can be torn. The human body's built-in protection against the effects of rotational forces—the fluid surrounding the brain—is simply not enough to slow down the brain's movement quickly or effectively enough.

Mips® Safety System: Developed to Dampen Rotational Forces

Concussion is the clinical diagnosis given to a functional disturbance in the brain caused by trauma. A concussion can occur through several different mechanisms: through linear impacts, where the force causes the brain to hit the skull bone (both at the point of impact and on the opposite side as the brain "bounces" back), and through rotational forces that cause shearing.

One of the founders of Mips, neurosurgeon Hans von Holst, discovered that shearing caused very severe injuries even in cases where the patient was actually wearing a helmet.

Shearing leads to diffuse injuries across the entire brain, torn nerves and blood vessels, and a cascade of chemical and metabolic disturbances in the brain's cells.

A Swedish Invention

The realisation of both the correlation and the severity led to the development of a safety system specifically designed to compensate for rotational forces.

The invention consisted of a shell that could move in all directions independently of the helmet, thereby allowing the skull to move slightly with the motion after an angled impact. This "elasticity"—a range of motion of about 10–15 mm—was shown to be able to absorb some of the violent energy that could otherwise result in shearing of the brain.

The Mips safety system works by "imitating" the protective effect of the cerebrospinal fluid while simultaneously reinforcing it—by adding the mechanism as an extra, low-friction layer on the outside of the head.

Back on Track and Mips – A Success Story of Increased Safety

The brain—and its protective fluid buffer—is better at handling linear impacts that result in temporary compression or even a straight collision with the inside of the skull. Standard riding helmets are also designed to absorb these specific types of forces.

However, rotation is a very common mechanism during falls, and shearing is a central injury mechanism in concussions.

Back on Track was the first company to include the Mips safety system in its riding helmets as soon as the technology became available. This meant the safety system could be quickly commercialised and distributed—having a major positive effect on safety awareness in equestrian sports, followed by improved safety in other sports as well.

Read More About The "Brain Stairs" (Hjärntrappan)

The Swedish Equestrian Federation is making great efforts to increase awareness of concussions and how riders should handle their after-effects.

It is of the utmost importance that the brain is allowed to rest, that one takes it easy and recovers in several planned steps, and allows this process to take time.

Margaretha Rödén, the Federation Physician for the Swedish Equestrian Federation, has developed a six-step rehabilitation "staircase" that all riders should go through if they suspect they have suffered a concussion.