The most common jockey injuries are orthopedic soft-tissue injuries.

A four-year study of jockeys in Maryland found the area of the starting gate — either entering the gate, while in it or shortly after exiting — accounted for 41% of injuries.

Three-fourths of jockey injuries — regardless of where on the track — were the result of being thrown from the horse. The study showed jockeys experienced an average of 1.1 injuries per fall, with a fall happening every 4.6 race days.

Most common body parts injured, according to the study published in 2020 in BMJ Open Sport & Exercise Medicine, were:

• Lower extremity (30.9%)
• Upper extremity (25.5%)
• Head (15.2%)
• Shoulder (11.8%)

“When a jockey is injured, it’s often a soft-tissue injury such as a torn or pulled muscle, ligament or tendon. Of the jockeys in this study, about 80% had soft-tissue injuries,” said Ryan J. Krupp, M.D., an orthopedic surgeon and shoulder specialist who is executive medical director of Norton Orthopedic Institute and Norton Sports Health.

Concussions are the second most common injury that occur with the jockeys. According to a study led by Carl Mattacola, a kinesiology professor and researcher, from 2012 to 2017 approximately 14% of jockey injuries were concussions.

Riders may not be aware they have experienced a concussion, since symptoms such as memory loss, confusion and disorientation may not present immediately; it can take two to six weeks to fully recover from a concussion injury.

Norton Healthcare is now the official medical provider of Churchill Downs.

As part of the agreement, Norton Sports Health will provide medical support for jockeys at the world-renowned race track. Norton Healthcare will hire two sports medicine-trained physicians to be on-site for the spring and fall meets, including the Kentucky Derby. Norton Healthcare also will outfit Churchill Downs’ jockey first-aid space with medical equipment for the triage and evaluation of possible injuries.

In addition to offering its team of health providers, Norton Sports Health also will provide annual physicals for jockeys, including baseline concussion testing, lab work and other preventive care. In addition, the athletes will have access to Norton Healthcare’s vast specialty services and providers to ensure quick, convenient care for any medical needs.

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The entire process can take as little as six to seven days, although this is somewhat atypical. Steps progress in terms of intensity and duration of physical activity, starting with noncontact activity for the first 72 hours.

Caution is required, as a second injury within a short period of time, from 24 to 48 hours, or possibly as long as 10 to 15 days, significantly increases the risk of catastrophic effects — and a much more prolonged recovery.

“If you can’t wake someone up or have someone alert enough to at least carry on a basic conversation, that’s a worrisome sign.”

— Tad D. Seifert, M.D.

“You don’t have to be hit directly on the head to be concussed,” said Dr. Seifert, a neurologist. “You can be hit in the torso or body, or have just simply a sudden whiplash-like movement of the head and neck, and that can induce the injury.”

Concussion healing process

As the athlete can progress through the steps without concussion symptoms returning, more sports-specific activity is added in. Ultimately, the athlete resumes contact in practice to make sure contact is tolerated. If so, the athlete can be cleared for full game participation.

Understanding changes in the athlete’s mood and behavior also provides information key to gauging recovery, according to Dr. Seifert, an unaffiliated neurotrauma consultant with the NFL and NASCAR, as well as the former chairman of the Kentucky Boxing and Wrestling Commission Medical Advisory Panel.

The athletes, their parents, roommates and coaches can provide valuable information to help guide the recovery.

“That history is just invaluable to being able to diagnose what happened and then help institute a plan going forward,” Dr. Seifert said during a recent episode of the “MedChat” podcast, “Identification and Management of Sports-related Concussions.”

Sleeping after concussion

“If you can’t wake someone up or have someone alert enough to at least carry on a basic conversation, that’s a worrisome sign,” Dr. Seifert said.

Contrary to the widely accepted belief 15 to 20 years ago, it’s not necessary to wake up someone who’s had a concussion every hour on the hour all night after the injury, according to Dr. Seifert.

Dr. Seifert recommend waking the individual up over the first four hours to ensure they can be awakened easily, and using the opportunity for a cognitive check. After that, sleep can be beneficial.

“The brain loves sleep after an injury like this, and, in fact, most people will find that they’re sleeping more than they typically do over the first two or three days,” he said.

Post-concussive syndrome

Post-concussive syndrome is defined by concussion-related symptoms that last more than three months. Post-concussion syndrome is treatable, potentially with psychiatric medications for underlying anxiety, depression or mood instability. Typically, these patients also need ongoing headache treatment. They often also need therapy for lightheadedness, balance issues or eye movement.

“Most people tend to respond really well to a multifaceted approach like that,” Dr. Seifert said.

Chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE) can occur in athletes who have careers with a lot of head or brain trauma. As they reach middle age, they can experience difficulty with speech, balance, memory and mood. No test exists to diagnose CTE. The condition can be confirmed in an autopsy.

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The study, which examined thousands of high school athletes across 20 different sports, found that the rate of repeat concussions across all sports has dropped. But several sports still pose higher risk.

The three sports with the highest concussion rates were:

• Boys’ football, 10.4 concussions per 10,000 athlete exposures
• Girls’ soccer, 8.19 per 10,000 athlete exposures
• Boys’ ice hockey, 7.69 per 10,000 athlete exposures

“These are sports that involve a lot of impact — either with the ball or another athlete,” said Tad D. Seifert, M.D., neurologist with Norton Sports Health and Norton Neuroscience Institute.

Recurrent Concussions Dropping

The good news, according to the study, is that less than 10% of reported concussions were recurrent — meaning an athlete had suffered multiple concussions — which is a decrease over the past several years.

“We continue to see improvement in how we diagnose, treat and monitor concussions,” Dr. Seifert said. “I think this also shows that legislation to regulate when players can return to the field is working.”

Practice Versus Game Injuries

The study found that across all sports, nearly two-thirds of concussions occurred during competitions. Only one sport had a concussion rate higher in practice than in competition: cheerleading.

“In football, there have been significant changes made to reduce contact exposure during routine practices, which has reduced the amount of player-to-player collisions and other mechanisms that contribute to head injury,” Dr. Seifert said. “However, the intensity of a competitive game atmosphere is also something that’s very difficult to reproduce in a practice setting.”

According to Dr. Seifert, cheerleading practices generally take place on hard gymnasium floors that are made of vinyl or rubber and are designed for sports other than cheerleading. These surfaces likely increase the risk of brain injury when falls occur.

“There is also a cumulative increased risk of concussion in practices simply due to the amount of repetition incurred with each practice session compared with game or competition,” Dr. Seifert said.

Does the Risk of Sports Outweigh the Reward?

According to the Centers for Disease Control and Prevention, more than 800,000 traumatic brain injuries occur in children every year. These types of injuries have become more concerning as research has shown that they can lead to long-term memory loss, dementia and other serious health issues. Still, Dr. Seifert encourages parents to let their kids play sports.

“There’s always a risk when playing sports,” he said. “But, in my opinion, the benefits — exercise, teamwork, socialization — outweigh the risk. With that being said, health is the most important component. Any teen with a concussion should be closely monitored and cleared by a professional before resuming activity.”

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