Concussion… more than just a bang on the head?

Concussion is something which has been taken very seriously in contact sports for many years and research is ongoing about what we should consider as a lot more than, just a bang on the head.

EquiTeam and The First Aid Training Cooperative look why it’s important to take time and not just get back on after a bang to the head.

Falling off horses is something that happens, we can control it to some extent, by being fit to ride, schooling our horses, and setting ourselves up to win rather than to fail. But accidents will still happen and sometimes injuries too. We can protect ourselves by wearing the current standard hats, body protectors and air jackets but it still usually hurts.

Concussion is something which has been taken very seriously in contact sports for many years and research is ongoing about what we should consider as a lot more than, just a bang on the head.

British Equestrian have recently developed new guidance about concussion and the return to riding after a head injury.

The key part of this is:

‘While helmets save lives, concussions can still occur and can threaten the long-term health of participants. At all levels of equestrian activity, a participant must be immediately stood down from riding and any potentially strenuous mental and physical activities if they are suspected to have a concussion.’

What is a concussion?

Concussion is an injury to the brain resulting in a disturbance of brain function. It can be caused by a direct blow to the head, but can also occur when a blow to another part of the body results in rapid movement of the head, such as whiplash type injuries.

Loss of consciousness occurs in less than 10% of concussions.

Concussions can happen to participants at any age, however, those aged 18 and under

  • are more susceptible to brain injury
  • on average take longer than adults to recover – usually four weeks compared to two weeks
  • have more significant memory and mental processing issues
  • are more susceptible to rare and dangerous neurological complications, including death caused by a single or second impact.


A history of previous concussion increases the risk of further concussions, from which it may also take longer to recover.

Recognising a concussion

The severity of concussion is often underestimated.  Head injury is the leading cause of death and disability in children. Some concussions can lead to compression (also known as a bleed on the brain) which is a life-threatening condition. The challenge in recognising concussion is that symptoms may change and / or get worse over time.

The maxim for all sports in dealing with head injuries is ‘If in doubt, sit them out’.

The table shows some of the symptoms of concussion to watch out for.

Table © First Aid Training Cooperative

Some of these symptoms seem obvious after ‘a bump on the head’ but they may also be symptoms of an injury to the brain.  The important aspect in recognising some of these symptoms is that the behaviour, sensitivity or feeling is ‘not normal’ for this person. Also, the symptoms won’t all appear at the same time and only some of them may appear, depending on the severity of the impact and over a period of time.

This is why activities are suspended for between 24hrs and up to 6 weeks for some sports and ages. It gives the brain time to heal and recover fully.

What to do next

To ascertain the level of concussion and any changes ask the casualty these questions. They are called Maddox questions and help assess the brain’s cognitive abilities.

  • Where are we now?
  • What time of day is it?
  • How did you get here today?
  • Where were you on this day last week?
  • A simple mathematical or alphabetical question. E.g. counting from 50 backwards in 3s.

You can change the questions to suit the age and ability of the casualty.  It’s important to note that these questions go back in time from now to last week and are also used in hospital to ascertain their brain’s response to questions. You can repeat the questions or subtly change them over a period of time to check their general brain health.

Anyone who has not been fully responsive for any time after an impact to the head should go to hospital for observation as soon as possible. ‘Not fully responsive’ includes initially  ‘seeing stars’, being ‘stunned’ or momentary blackouts.

Whilst waiting for an ambulance, get them to lie down with their head and shoulders slightly raised. This is best done in a quiet darkened place if available. No phones or other devices, they need to rest! If the casualty is drowsy or nauseas, put them in the recovery position.  Keep them warm and keep talking to them and don’t leave them alone.

Monitor using the Maddox questions or similar questions and reassure them until help arrives. Make a note of any symptoms over time and hand these to the emergency services team when they arrive.

If an injured rider is going to hospital, send their helmet with them. This will enable medical teams to assess the severity and location of the impact.

Returning to riding

The first 48 hours are critical to recovery. Rest is advised for the first 48 -72 hours and screen use should be avoided/minimal for 48hours. This means resting the body and brain from physical activities – riding, running, cycling, swimming or physical work and mental activities such as school work, reading, watching TV, playing video games or spending time online/looking at a screen. Light physical activity can resume after the 48-72 hour period and this can help recovery. A graduated return to sport can begin when the person has returned to normal education.  The ACoRN Traffic Light System has more information. 

If symptoms persist after 21 days professional advice should be sought from a GP

Standard return to riding pathway from British Equestrian

The participant should not move onto the next stage in the recovery pathway if any symptoms are still in effect or become evident during the activity or the following day. 

If symptoms are experienced either during the activity or the following day after introducing a new activity, return to the stage where symptoms were not triggered and only move to the next stage when you are able to do so without experiencing any symptoms.

Concussion and your mental health

A mental health study, conducted by Charles Owen revealed that 6 in 10 riders suffer from depression after a concussion. In response to this survey Riders Minds launched their Head First campaign which aims to get equestrians to re-think concussion.

If you have suffered from a concussion you can use their tool to regularly check signs of deterioration and/or poor mental health, or the mental health checker. 


If you need support contact Riders Minds.

Live text support:

07729 774 117

Call the helpline:

0800 088 2073

Thank you to Ann McKillop of First Aid Training Cooperative for providing the information for What is a Concussion and What to do Next.

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