Saddle up safely guidelines for return to horse-related activities after concussion
Authors: Camargo Fernanda C , Han Dong (Dan) Y , Erlandson Erika E , Camargo Fernanda C , Stowe Jill C , Gombeski William , Mattacola Carl G 
Published: November 2017

ObjectiveThe objective of this proposed guideline is to adapt the Zurich Graduated Return to Play protocol into an equestrian “return to riding” protocol.DesignSaddle Up Safely (SUS) is a coalition of over 40 medical, public health, educational, and equine organisations from the US and Canada led by the Uvniversity of Kentucky’s UK HealthCare and the Agriculture Equine Programs. The objectives of this coalition are to raise awareness and understanding of rider/handler safety, reduce the number and severity of horse-related injuries and encourage injured riders to return to the sport safely. In 2015, the SUS Auxiliary, which consists of physicians, nurses, research and outreach personnel, and industry leaders adopted and modified the Zurich Concussion Guidelines to create the first “return to horse-related activities” guidelines. These guidelines include 6 stages of rehabilitation (Light Aerobic, Equine-specific exercise, Light Riding, Return to Full Riding – No Competition, Return to competition), along with appropriate riders’ exercise, objectives, and examples for each stage. The purpose of this development was to provide sport-specific guidelines for equestrians recovering from a concussion and their care providers.ConclusionsThis is the first return to activity guideline developed for equestrians. This protocol is easily adopted by equestrians recovering from a concussion and should be made available to health care providers worldwide. The protocol is currently available in English; however, it can be translated into French, Spanish, Russian and Arabic to comply with procedures of the Fédération Equestre Internationale (FEI).Appendix (the following table will be added to the poster abstract should this submission be accepted).(Table 1) Returning to horse-related activities after concussion: level of activity/exercise recommended by rehabilitation stageAbstract 110 Table 1Rehabilitation StageRider’s exercise at this stageObjective of this stageExamplesNo activityNone until symptoms have resolvedRecoveryLight aerobicLight cardio training with no resistance trainingIncrease heart rateGrooming, feedingEquine-specific exerciseExercises with no potential head impactAdd movement, strength, and balanceGround work, barn work, cleaning stalls, cardio, and balance exercises off horseLight ridingMore complex exercises and resistance trainingExercise, coordination, balance, and cognitionRiding for short periods of time at the walk wearing helmet and on a safe horse. Concentration on strength and balance exercises, e.g., carrying hay balesReturn to full riding – no competitionAll exercises in a careful, controlled mannerRestore confidence and assess functional skillsRiding with a helmet in all gaits on a reliable horse, in a familiar environment with familiar equipmentReturn to competitionNormalReleased to full sport with a helmet on all horses in all venuesNote: If you experience problems, always return to a previous level.Competing interestsNone.