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

Objective The objective of this proposed guideline is to adapt the Zurich Graduated Return to Play protocol into an equestrian “return to riding” protocol. Design Saddle 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. Conclusions This 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 stage Abstract 110 Table 1 Rehabilitation Stage Rider’s exercise at this stage Objective of this stage Examples No activity None until symptoms have resolved Recovery Light aerobic Light cardio training with no resistance training Increase heart rate Grooming, feeding Equine-specific exercise Exercises with no potential head impact Add movement, strength, and balance Ground work, barn work, cleaning stalls, cardio, and balance exercises off horse Light riding More complex exercises and resistance training Exercise, coordination, balance, and cognition Riding 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 bales Return to full riding – no competition All exercises in a careful, controlled manner Restore confidence and assess functional skills Riding with a helmet in all gaits on a reliable horse, in a familiar environment with familiar equipment Return to competition Normal Released to full sport with a helmet on all horses in all venues Note: If you experience problems, always return to a previous level. Competing interests None.