Biomedical Research

DOI: 10.4066/biomedicalresearch.29-17-3785

Abstract

Equestrian sports are known as potentially dangerous sports that are vulnerable to damage to the spine and extremities. The aim of this study is to characterize the type and localization of injuries and evaluate their relationship with occupational experience. In-between 2015-2017, records of orthopedic injuries during horse riding in jockeys were retrospectively evaluated. Patients were divided into 2 subgroups according to their professional experience. Winners up to 100 races were classified as amateur (apranti jockey), more than 100 race winners were classified as experienced (jockey). Localizations of injury types were divided into bones and soft tissue, and their relationship between age and experience were statistically evaluated. Eighty-five patients were included in this study. The mean age was 24.6 (17-32). Thirty-nine patients were classified as amateur and 46 patients were classified as experienced. Thirtytwo of 85 patients were treated conservatively. Of the eighty-five patients, 53 were treated with surgical methods. There is no statistically significant difference between experience, type and localization of injuries (p>0.05). The results of this study makes us think that horse sports are open to serious injuries that require surgical treatment and always requires high levels of attention independent from experience.

Keywords

Equestrian sports, Experience, Injury, Jockey.

Introduction

Horse riding is world widely well recognized sports branch and has a high popularity. Injuries potentially occurring during horse riding have higher risks than injuries developed during motorbike riding [1]. Potentially dangerous position of rider on the horse may increase the risk of injury. The horse can also be effective at the mechanism of injury as well as the rider can. Although race horses are well trained, they may show unbalanced and irregular behaviour’s and this makes the rider open to injuries. Therefore, this sport has unpredictable risks.

Injuries seen in equestrian sports usually involve head and extremities and may require surgical treatment [2,3]. In the literature, injuries in those who are involved in professional sports are described in details, however data on injuries in those who are involved in riding are limited [2,4-7]. Although it is a sport branch with high risk, epidemiological studies on injury patterns are rare [4]. We believe that this sport has a learning curve and requires labor; therefore, we evaluated the incidence of orthopedic injuries seen in jockeys during the race as well as their relationship with experience.

Our study is relevant as it is the first study about this sport in our country as well as searching the relationship with experience. The aim of our study is to evaluate to investigate the relationship with professional experience by characterizing the diagnosis according to injury types.

Materials and Methods

Records of jockeys who applied to our hospital in-between 2015 and 2017 after injury caused by equestrian sport during horse race were retrospectively evaluated. Patients were divided into 2 groups according to their occupational experiences. Winners up to 100 races were classified as amateur (apranti jockey) and those who won more than 100 races were classified as experienced (jockey). Localizations of injuries were documented as upper extremity, lower extremity and spine. Types of injury were divided into bone and soft tissue. Relationships between professional experience, localization and types of injury were evaluated statistically.

Statistical analysis

Descriptive statistics are used to describe continuous variables. (Mean, standard deviation, minimum, median, maximum) Ki- Square (or Fisher Exact test at appropriate locations) was used to examine the relationship between categorical variables. Mann Whitney U test was used to compare two independent variables with no normal distribution. Comparisons of two independent variables with no normal distribution fit were made using the Kruskal Wallis test. Statistical significance level was determined as 0.05. Analyzes were performed using MedCalc Statistical Software version 12.7.7 (MedCalc Software bvba, Ostend, Belgium; http://www.medcalc.org; 2013).

Results

Eighty five patients with an average age of 24.6 (17-32) were included in the study. According to experience, there were 39 patients who were classified as amateur (winner<100 races) and 46 patients who were classified as experienced (winner>100 races). Thirty-two of the 85 patients were treated conservatively. Diagnosis of 2 patients in 32 was with nondisplaced fractures (metatarsal fracture and distal radius fracture). Thirty of 32 patients have soft tissue injuries. The diagnosis of these patients were 10 ankle sprain, 8 finger capsule tear, 4 wrist sprain, 2 shoulder sprain, 4 lumbar sprain and 2 knee ligamentous injury.

Of the 85 patients, 53 were treated by surgical methods. The diagnosis of patients were 6 clavicle fracture, 6 ankle fracture, 3 distal radius fracture, 4 humerus fracture, 7 metacarp fracture, 4 metatars fracture, 6 anterior cruciate ligament rupture, 10 shoulders dislocation with Bankart lesion, 1 navicular fracture, 1 hip fracture, 1 femur fracture, 2 vertebrae fracture, 1 ulna fracture, 1 radial head fracture. Extremity injuries are numerically more common than axial skeletal injuries (spine) (Table 1).

Table 1. The diagnosis of jockeys in this study.

There was no statistically significant difference between age, injury type and localization (p>0.05). The localization of injury did not have statistical significance in terms of injury type including bone and soft tissue. The average age of experienced jockeys is higher than that of the beginner jockeys, and this difference is statistically significant (p<0.05) (Table 2), but there was no statistical significance between occupational experience and injury type and localization (p>0.05) (Tables 3 and 4).

Table 2. Age and experience relationship. There is a statistically significant difference in terms of age according to experience. (Mann-Whitney U test p<0.05).

Table 3. Experience and type of injury relationship. There is no statistically significant difference between experience and type of injury (Chi-square test p>0.005).

Table 4. Localization and experience relationship. There is no statistically significant difference between localization types and experience (Fisher Exact test p>0.05).

Discussion

Injuries seen during riding may frequently require surgical treatment and they are mostly orthopedic injuries [2,4,8-10]. The need for more standardized and clearly defined approach has been suggested to establish the incidence of injury for this sport branch [2]. In the literature, the rate of injuries seen in riders are highly various and there is no consensus; the incidence of orthopedic injuries among all injuries was reported as 30% to 70% [2,3,11]. In our study, we evaluated specifically the orthopedic injuries and injuries of head and thorax does not include the patient group in our study. This approach may lead to obtain more clear data about the incidence of orthopedic injuries in riders. In addition, our study included not only trauma resulting from extremity and vertebral fractures, but also soft tissue injuries. In the literature, incidence of fracture due to trauma during horse riding was reported; however, data on the incidence of soft tissue injuries is limited [2]. In our study, history of trauma was fall of the horse in all riders and injury area was not statistically significant regarding bone and soft tissue; however, this could be related with the severity of trauma.

Minimum an extremity fracture was reported in more than 60% of professional jockeys during their career [4]. In our study, we detected fracture in 55 of 85 jockeys and surgery was done in 53 of them due to fracture. In the literature, about 50% of injuries include upper extremities, 20% include lower extremities and the incidence is lower for vertebral column, body and pelvis [2]. In our study, 47 (55.2%), 32 (37.6%) and 6 (7.05%) of 85 injuries involved upper extremity, lower extremity and vertebral column, respectively.

In the literature, a study reported a remarkable difference in injury model between professional jockeys and amateur riders. The difference of equipment utilized was suggested to play a role in injury model. In this study, questions to injured persons were retrospectively evaluated and not included specifically orthopedic injuries [12]. Other studies also reported higher trauma risk in less experienced riders [3,13,14]. Grossman et al. reported no correlation between rider experience and trauma [15]. In our study, no significant difference was detected between experience of jockey and risk of orthopedic trauma. Our study group didn’t also show any difference regarding the utilized equipment and this may indicates that we used more objective approach in evaluation of relationship between injury risk and experience. When considering injury rate of our study, upper extremity injuries were more predominant than other injury areas. This could be associated with the reflex of arm extension during fall to protect the body [3,15]. In our study, the most common diagnosis of upper extremity injury is shoulder dislocation and this may predict that the mechanism of upper extremity injury in horse riding is to fall with open hand position which was mentioned in the literature for shoulder dislocation [16].

Lower extremity injuries are second frequently seen injuries following upper extremity injuries [17]. In our study, this was reported as 37.6%. Among lower extremity injuries, 16 of 32 (50%) were at ankle. Six of them (37.5%) were fractures requiring surgery and 10 (62.5%) of them were soft tissue injuries. The reason of lower incidence of lower extremity injuries than upper extremity injuries can be explained by fall off pattern [2]. In our study, no pelvic trauma was reported. In the literature, there are studies indicating rate of pelvic trauma as zero. However there are other studies suggesting the rate between 3.7% and 17.5% [9,15,18,19].

Majority of vertebral fractures seen during riding usually involve at thoracolumbar area (T11-L2) and incidence is rare for mid thoracic area [20,21]. In our study, vertebral trauma rate was 7.05% (6 pts.), beyond upper and lower extremity trauma. Two of 6 vertebral injuries were vertebral fractures at T5 and L1 level and both were surgically treated. Four of 6 vertebral injuries were including soft tissue trauma.

Protecting equipment used during horse riding were considered to reduce trauma risk [11,12,22]. Hasler et al. suggested that wearing a protective vest during riding, could highly reduce the risk of injury [22]. Certain publications also recommend to wear upper extremity protecting equipment as standard [11,23]. In our country, the jockeys use protecting vest and head-guard during race, but they have no special protecting equipment for upper and lower extremities. The limitation of our study is lack of reporting the incidence for head and thorax traumas as we included specifically orthopedic injuries. Another limitation is the retrospective nature of the study as well as small sample size. Inclusion of only orthopedic injuries and monocentric nature of the study could lead to small sample size. We believe in that this first study on national jockey would offer an insight on future larger multi-central studies with greater sample size including all branches of horse riding.

Conclusion

Horse riding is open to all kind of injuries. Orthopedic injuries are frequently seen in this sport branch. Understanding the frequency and types of injuries may guide to protective measures to bring this sport to safer status. We consider that understanding the types of injuries can predict the injuries and can contribute to training process of jockeys. In addition, there is no reference articles on injuries related with this sport in Turkey and our study is the first in this respect.

Acknowledgement

None.

Conflicts of Interest

The authors have no conflicts of interest to declare.

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