UK researcher working to prevent concussions in jockeys

It’s the fifth race on a beautiful, sunny day at Keeneland Race Course in Lexington and the jockeys are on their mounts up in the gates. The bell rings and the horses spring forward, looking for the perfect spot from which to make their charge. At the second turn, the No. 8 horse stumbles and recovers, but its jockey tumbles to the dirt. He sits for a few seconds, dazed, but then leaps to his feet and scrambles to safety.

Injuries are frequent among jockeys. During a recent interview, one jockey listed a jaw-dropping succession of injuries: two broken collarbones, a fractured wrist, broken ribs, a fractured spine and several occasions when he “got his bell rung.” These athletes get back to their jobs as quickly as possible – and potentially before they’re completely healed. That’s because, unlike other professional sports which offer guaranteed contracts to their players, horse racing operates on a “pay-to-play” model:  jockeys don’t get paid unless they’re riding.

Concussion dangers

While broken bones are nearly impossible to miss, concussions are a subtle but potentially more dangerous injury. Concussions – a brain injury caused by whiplash or other blow to the head – are notoriously difficult to diagnose, and symptoms are transient but can last several days or even weeks.

Repeated concussions have a cumulative effect. A recent study in JAMA, the Journal of the American Medical Association, determined that 110 of 111 autopsied brains donated to science by former NFL players showed evidence of chronic traumatic encephalopathy, a degenerative brain disease caused by repeated blows to the head and believed to be responsible for later cognitive impairment, depression and/or aggression. At this time there is no data to document the incidence of CTE among jockeys, although anecdotal evidence exists; for example, the effects of Gwen Jocson’s repeated concussions forced her retirement from racing in 1999.

During the healing process after a concussion, victims can experience headaches, memory loss, balance issues, sleep disturbances and/or disorientation. According to UK College of Health Sciences researcher Carl Mattacola, PhD, ATC, that’s a dangerous state to be in if you’re trying to pilot a 1,000-pound horse around a track at 30 miles per hour. That’s why he’s developed a clinical and research interest in helping jockeys.

Developing a safety protocol

Historically, Mattacola says, attention for the jockeys has been secondary to the equine athlete. But as the awareness of the dangers of concussion has risen, all corners of the racing industry – the tracks, the horse owners, and the jockeys themselves – have come together to assess the situation and lay the groundwork for a new model. And that process has its origins in Kentucky, born of a partnership between the Jockeys’ Guild, the Jockey Club, and the UK College of Health Sciences, among others. This is the second year of a pilot project to gather baseline cognitive data on every jockey racing in Kentucky. Mattacola spearheads the project, and starting with Keeneland’s Fall Meet this month, baseline cognitive and neuromuscular testing was mandatory for every mount.

Mattacola explains that most major professional sports – the NFL, the NHL, FIFA – have concussion protocols that guide decisions about when a player is healthy enough to return to play, but it’s difficult to copy their model exactly because each state – and sometimes each individual track – operates under different set of rules, so return to ride protocols aren’t consistent.

“Our group wants to create change in how we manage and assess concussions in horse racing, so we’re beginning local and we hope to use that data to develop a protocol that can be transferred to other states,” he says.

To illustrate how the data he’s collecting would be useful, Mattacola uses blood pressure as a metaphor.

“If we know what your blood pressure is this year and you come back and that changes, we can try to determine the underlying factors or the underlying mechanisms that contributed to that change,” he said. “Similarly, the baseline assessment provides additional information to the health care provider when a jockey falls, which can help him/her make a decision about whether to suspect a concussion.”

Establishing a strong rapport

Jockeys’ Guild National Manager Terry Meyocks said that the Equine Jockey/Rider Injury Prevention Initiative is a logical extension of the Jockey Health Information System (JHIS), a database that stores jockeys’ medical histories for access by racetrack medical personnel in the event of an injury.

“Our job is to protect jockeys by making sure that they operate in a safe racing environment,” Meyocks said. “As the issue of concussions has come to the forefront, we’ve made it a priority to educate our jockeys and find ways to protect them, which is in everybody’s best interest.”

At the Jockey’s Quarters on Keeneland’s opening day, the Clerk of Scales sends a jockey to Carolina Quintana, a certified athletic trainer and a doctoral student from the UK College of Health Sciences, who administers the SCAT-5 assessment tool, which gathers injury history and data related to cognitive and neuromuscular performance. Then the jockey completes several simple tasks, such as counting backward by threes and standing on one foot.

The jockey acts a bit sheepish as his friends look on in amusement, but this testing, which will be entered into his JHIS record, will be invaluable should he suffer a head injury.

There was not instant buy-in among jockeys, however, who were concerned that the project might affect their livelihood. But Mattacola and Quintana quickly won them over in a series of meetings as the pilot project took shape.

“We – but especially Carolina – have established a strong rapport with the jockeys and they now recognize that we are not here for any other reason than to help them. If they were to be injured, we would have the data to make a healthy decision on their behalf,” he said.

Building on previous research

This is not Mattacola’s first foray into the jockeys’ world. In 2015, he conducted a series of tests to determine how well several equine helmet models protected wearers from repeated impacts, which helped inform guidelines for replacing helmets after a fall and prompted the Jockeys’ Guild to reinforce that all riders wear ASTM-approved helmets. His work on helmet safety lent him credibility with the jockeys as he nudged the concussion pilot study to fruition. “It’s impossible to eliminate all concussions in sports, but we’re obligated to do what we can to prevent it, to recognize it when it occurs, and to keep the jockey’s long-term health and safety first in mind,” he said.

His next great chapter may well be applying the resources of the UK Sports Medicine Research Institute (SMRI), a state-of-the-art multidisciplinary research center dedicated to improving athletes’ performance and preventing injuries, to helping the jockeys.