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UVa neuropsychologist: Getting right back on after a fall may not be best idea for riders
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UVa neuropsychologist: Getting right back on after a fall may not be best idea for riders

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Stephanie Bajo

Stephanie Bajo, a University of Virginia neuropsychologist and dedicated equestrian, seen here riding her mare Tika, said those who fall off their horses, bikes or motorcycles should reconsider the idea of getting right back on and instead allow time for physical assessment and recovery.

Getting back in the saddle after an unscheduled dismount and potential noggin clocking is not necessarily the best advice, despite the old adage exhorting you to do so.

In fact, a University of Virginia neuropsychologist and dedicated equestrian says it may be best to take an hour, a day or even a week off to check for symptoms of a concussion and assure recovery.

“The culture in riding has always been to just get back on,” said Stephanie Bajo, of the UVa Health System’s Department of Psychiatry and Neurobehavioral Sciences. “But when people get concussed, they shouldn’t get right back on the horse or the bike or go back in the game. If you get reinjured while you’re still recovering, it tends to prolong recovery.”

Bajo and her Oldenburg-thoroughbred mare Tika compete in eventing, the triathlon of the equestrian world that includes cross-country racing, stadium jumping and dressage. A long-time rider, Bajo said that she, too, has fallen prey to immediately remounting.

“There were a couple of times where I clocked myself and got right back on when I probably shouldn’t have,” she admitted.

She is not alone. Bajo has been tracking emergency visits to the UVa Medical Center and has found a higher rate of concussions among horse riders than among athletes in high-impact sports.

The joy of riding — be it horse, bicycle or motorcycle — and competition is its own reward, Bajo says. She said people involved in those activities tend to shake off mishaps and get back at it. Sometimes that’s good.

“It can be scary when you fall, and getting back on and facing it right away is often good psychologically for the rider because you don’t get a mental block and develop fear,” Bajo said. “It’s been a part of the equestrian culture because horses react to our emotional status and tension. But sometimes it’s best to wait.”

Those times can be hard to recognize, especially for the fallen who may be shaken and stirred to continue. That’s where bystanders, observers and friends come in, Bajo said.

“If you’re a football player, you know it’s not the best thing to go back out and play if you get your bell rung. There are also protocols to follow if you play in a league or for schools,” she said. “But if you’re on a bicycle or a motorcycle or at the barn or on a trail ride, you don’t have those protocols.”

If you see a fall and know someone hit their head on the way down, discourage them from immediately getting back in the saddle, Bajo said. Also discourage them if they didn’t hit their head but feel dizzy, disoriented or a bit off.

“One of the common symptoms of a mild concussion is confusion. They may not lose consciousness, but they’re not quite with it,” Bajo said. “Sometimes you can tell they’re hurt because they’re a bit confused or appear glazed over and not really able to focus on questions.”

That, Bajo said, is known as an altered mental state.

“If someone falls but doesn’t hit their head and doesn’t exhibit symptoms, they’re probably at lower risk of an injury and they’re OK to get back on,” she said. “If they hit their head, or are just looking not quite right, that would be the time to take the day off. It may just be that the fall disoriented them, but even if they say they’re feeling OK, it’s still probably a good idea to take the day off and come back the next day.”

If it’s a hard fall, it may be best to rest even if there was no head strike.

“You don’t have to hit your head to get a concussion. You can get concussed if you fall and just your torso hits,” Bajo said. “The impact of the forces that stop you also stop your body, but your brain keeps going and stops when it hits the wall of the skull.”

Helmets are important to wear to help prevent traumatic brain injuries such as skull fractures. They also can absorb some impacts that would otherwise shake the brain, but a concussion can occur even with a helmet.

Plus, each fall is different, Bajo said. Very similar falls can have very different outcomes at different times. On one day, a fall will not cause an injury. A month later, the same fall results in a concussion. That makes reviewing symptoms such as headaches, ringing in the ears, drowsiness, blurry vision, nausea or vomiting more important.

Unfortunately, Bajo said some symptoms are less than specific. A fall can be disorienting. Stress and muscle strain during the fall can cause headaches. Most people feel fatigue after the excitement of a fall.

“They’re sort of non-specific symptoms, but if they’re all occurring at the same time and appear to be tied to one particular event, that’s a clue. If someone’s confused, if they had even brief loss of consciousness, they don’t get right back on the horse,” Bajo said.

“Even if they begin to feel more cognitively normal, they may be a bit off because they got knocked around. That places them at risk for another fall right after they had one,” she said. “It becomes more important for the bystander to say to the rider, you can’t get back on. Take the day off and reassess the next day or the next couple of days.”

If the rider hit their head and has symptoms, they should contact their doctor and stay off until the doctor gives an OK. If there are severe symptoms, a trip to the emergency room is in order.

If the rider hit their head and has no symptoms, wait a day, Bajo said. If no symptoms develop, they are likely uninjured and can throw a leg over the next day.

“Horse riders are pretty gritty people. They love to be around big animals and tend to be resilient. They love what they’re doing, and when anything gets in the way of riding or being with their animal, people are resistant to that. That’s understandable,” Bajo said.

“But there are micro- neurobiological changes that occur when your brain gets rattled around, and there is some healing that has to occur. That takes a little time,” she said. “A little time off now means more time in the saddle later.”

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