Concussions- A Major Focus of Horsemen’s Health System

Agent Frankie Douglas, a former jockey, recalls he had a head injury while riding at Timonium in 1997. When he finally came back to riding, eight months later, it was with a doctor’s OK, but he adds “even then, it wasn’t a good idea.”

When Douglas, now 55, rode, there were no restrictions for concussions.

“If my head hurt or my leg hurt I had to ride,” he says. “Now, MedStar pays more attention to the riders than before. They take you off the horses until you do all the [protocols]. If you are not OK, they won’t let you ride. This is very, very good.

“Jockeys are athletes and need to be taken care of. . . Head injuries, we should take all the precautions necessary . . . It is the right thing to do.”

Last October, Maryland became the first state in the country to establish a protocol for concussions at its thoroughbred racetracks when the Maryland Thoroughbred Horsemen’s Association and Maryland Jockey Club launched the Horsemen’s Health System in conjunction with MedStar Sports Medicine.

But because there had – fortunately – been no head injury incidents until mid-April, jockeys and other horsemen were caught by surprise when a jockey, after being thrown from his mount and hitting his head, was told he would not be riding until he completed the protocol.

Any jockey who sustains a head trauma or suspected head trauma and exhibits any physical, cognitive, emotional or sleep symptoms must wait at least 72 hours and be symptom free before passing through the protocol, which consists of five phases.


The four steps leading to the fifth, end phase, which is returning to racing, are:

1.   a 30 minute continuous jog or stationary bike ride

2.   a 30 minute simulated ride

3.   a 30 minute mounted individual trot on a horse

4.   then, a more intense mounted individual gallop, progressing to race speed

5.   return to racing.

Each phase is conducted on a separate day and a rider must remain symptom-free during each phase and during the 24 hours between phases.

He/she also must be examined by a track physician prior to step 1 and steps 4 or 5.

Dr. Kelly Ryan, one of four rotating physicians in the Horsemen’s Health System and the one who is most often at the track, says jockeys and others in the racing community, while aware of what concussions are, lack an understanding of the long-term consequences.

“It’s not always the initial concussion so much as going back to work too soon and absorbing another hit,” she says. “We call that the Second Impact Syndrome. It occurs in a period of time when the brain isn’t healed, gets hit again and results in serious disability and even in death.”

She points out concussions can cause jockeys to have balance issues, slow reaction times and even depth perception issues that make the jockeys dangerous to themselves and others.

“Those symptoms make racing a horse through a tight curve very difficult,” Ryan says. “A jockey riding like this [dizzy, off-balance or with compromised depth perception] can be very dangerous, almost as if they were riding intoxicated.”

The situation could result in many different scenarios, all of them bad.

It’s why, Ryan says, if a jockey exhibits symptoms during or after an individual test phase, he or she will be required to repeat that phase again 24 hours later, and again if necessary until showing no ill effects.

“When you exercise the pressure in your brain increases and it can worsen the symptoms and the duration of a concussion,” she says. “That’s why we’re doing this. To make sure the rider can tolerate the pressures of his job.”

Impact Beyond Maryland

With being the first state to install a protocol for head trauma comes some new problems that need to be sorted out, says MJC president and general manager Sal Sinatra. One of the most pressing is developing a working agreement and communication with other racetracks.

“We are trying to be judicious as the other sports are,” Sinatra says. “MedStar is protecting our jockeys. They’re young guys. They feel good. Summer is coming and they want to ride every day. But for their protection, if they have a concussion, he/she isn’t being allowed to.”

But what happens when a jockey who is sat down in Maryland goes to ride at an out-of-state racetrack?

 “We can sit someone down to go through our protocol,” says Sinatra, “But will it be reciprocal at those other tracks in Delaware, Pennsylvania and West Virginia? If we say they can’t ride through Wednesday here, will they not let them ride through Wednesday there?”

 Sinatra is concerned because a decision made in Maryland a day or two before a race in another state won’t even make it into a computer system in time to be caught by an out-of-state track.

“We’re working on the communication, but right now, agents have to have the responsibility to take their riders off the horses elsewhere,” Sinatra says. “We’re hoping people don’t not tell. That would get stewards involved with insurance issues.”

Drawing New Conclusions

Agent Tom Stift, who represents jockey Victor Carrasco, says he always tries to talk Carrasco and his other riders into getting checked out, whatever the injury.

“My feeling is it’s not going to help them to ride a race if they’re not going to ride it right. The jock always gets blamed if the horse doesn’t do well and it just hurts your business.

“So, I think the new concussion protocol for head injuries is good.” 

Carrasco, sitting on a bench outside the jockey room at Laurel Park, agrees.

“I think this protocol is really good,” he says. “I think it is one of the most important things in the new medical program. I didn’t know we had this.”

When told Maryland officials are working to keep jockeys benched by the protocol in Maryland from riding in other states, Carrasco is initially less supportive.

“We are self-employed,” he says. “If we choose to ride in other states we can.”

Then Carrasco begins to think about the consequences of that; and slowly, as he talks through his thought process, he changes his mind.

 “You want to ride, but riding isn’t just about you,” he begins. “If you are in the lead and fall, the guys behind you could get hurt. They could die, even though maybe nothing happens to you. You can’t be selfish.”

And then he adds, “I try to be a leader in the jocks room. I can talk to people about this. I will talk to people about this, about doing the right thing.”

Jockey Sheldon Russell is in the process of coming back from a broken shoulder he sustained last November. He said he has had concussions in the past, but always in accidents in which he also has had broken bones.

“If I hadn’t had the broken bones – the back, the arm – I probably would have gone back to riding,” he says. “But now we have this protocol and it is absolutely a good thing.

“We’d all like to keep riding. But if you’ve got a concussion, sitting down for three-to-five days, everyone will adjust to that . . . It’s the right measure to take. What’s three days or so, when you know you’ll be so much better, be back to the level we were mentally and physically before we go back to ride.”

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