Guild Aims for Uniform Medical Oversight

The Jockeys' Guild is reaching out to medical professionals at tracks throughout the country to try to improve on-track care of riders, with particular attention paid to concussions and head injuries.

"In Kentucky, we're trying to start with a grass-roots effort that will allow for better care overall," said Dr. Carl Mattacola of the University of Kentucky College of Health Sciences. "Because racing is fragmented, care is different from state to state and track to track."

Speaking on a panel discussing medical issues Dec. 12 at the Jockeys' Guild Assembly at the MGM Grand in Las Vegas, Mattacola said there isn't always a dedicated person thinking about all of the on-track care issues needed for riders. The effort is being made to bring more consistency in these matters to try to bring standards up to other professional sports.

"We want to develop relationships with medical professionals throughout the country who work with tracks to bring some consistency to the standards," Mattacola said.

Mattacola said a concussion protocol study in Kentucky was able to collect baseline testing from 30 different riders this fall and will aim to have more riders complete such testing in the spring. He said progress is also being made in other states on baseline testing, which aims to determine athletes' cognitive levels and physical balance abilities at a healthy state to allow for comparison after a head injury occurs to determine if a concussion has taken place.

Panel moderator Dr. Dan Han, chief of neuropsychology clinical services at the University of Kentucky, reminded a room that didn't need much reminding, that equine related sports have the highest rate of bodily injury, brain injury, and death. Despite those risks, the panel said riders in general do not have the medical and training oversight enjoyed by most college and professional team sports.

An exception to that has been Maryland, where the Maryland Thorouhbred Horsemen's Association and Maryland Jockey Club have funded Medstar Sports Medicine to provide care for horsemen, ranging from backstretch workers to jockeys. Kelly Ryan, one of five physicians participating in the program, said riders need to be in good physical condition because it's not just their good health on the line.

She noted that, in the case of a possible concussion, symptoms include blurred vision and compromised depth perception, which she noted could be very dangerous on the track where horses could clip heels.

"You'd not only be putting yourself at risk, but every other rider on the track as well," Ryan said of the risks of returning too soon from concussion.

After a spill, Ryan conducts concussion protocol by joining the paramedics with the rider on the scene.

"It's a lot better to have a physician there to say this patient needs to go to a trauma center, a regular hospital, or can just stay here," Ryan said. "If it's a neurological injury, I'd get the chopper in and send the rider to a trauma center. But if it's not a major injury, you don't want that treatment for just a bump on the head."

Ryan typically is witness to the spill when it happens and will later review video of the spill. She'll then evaluate the rider and craft a treatment protocol. Several panel members noted that a major goal is avoiding a second concussion after an initial concussion has been sustained—noting that can be a catastrophic situation.

Ryan said when an evaluation of a head injury is made on race day, she understands the desire for the injured rider to get back out and compete, but caution is needed.

"If there is any doubt in your mind that you may have a concussion, it is to your benefit that I will hold you out," Ryan said. "If we look at it and there are no signs of concussion, I will return you to riding, but if there are any signs of concussion or concerns, I will hold you.

"You may have the favored horse coming up in the ninth race that day, but I can tell you it's not worth the potentially years of problems you're at risk at."

Ryan later added that the force of falling off a horse at a high rate of speed also puts riders at risk of head injuries beyond concussion. She said CT Scans are needed to evaluate such injuries.

Dr. Hallie Zwibel, director of sports medicine at the New York Institute of Technology, updated some emerging technologies that will help doctors determine if a concussion has occurred. He said new types of MRIs may be able to pick up concussions and that blood tests may prove especially useful over the next five to 10 years because it's been found that certain chemicals in the blood are released following concussions.

He said currently jockeys need the baseline concussion testing, on-site assessments, and more buy-in from tracks and state regulatory bodies to put these initiatives in place.