Riding Smart: For Brain Health, Don’t Get Back on the Horse After a Fall

As a child growing up in the Chicago suburbs, Stephanie Bajo fell in love with competitive horse riding and its inherently rugged way of life.

“The equestrian community is pretty tough,” she said. “We’re getting up in the dark and cold and crushing ice in buckets because our horse’s drinking water has frozen. ... Serious riders are pretty stubborn and if they get injured, they just grin and bear it. Horse riding makes people extremely resilient, but it also puts them at risk when they experience a concussion and say, ‘I’m fine,’ and want to keep riding.”

Bajo knows this mindset firsthand: “Now looking back,” she said, “there were probably two or three times where I had fallen and definitely had some confusion or seeing stars and developed some sort of headache. I got back on and kept riding. In a lesson with a riding instructor, I remember I was told to get back on.”

Time to Recover is Key

Today as a UVA Health neuropsychologist, Bajo knows well that this deeply ingrained attitude in the riding community needs to change. She shares with parents and coaches that it’s important to take concussion symptoms seriously, but to also realize that the vast majority of people will recover in a matter of days or weeks – and without lingering brain damage.

“When I talk to equestrian groups,” Bajo said, “I tell them, ‘Do not have your students get back on until they’ve been assessed for concussion symptoms and their symptoms have cleared up.’ It would be very detrimental to fall again before recovering. And what is the detriment of ending the ride that day?”

As a longtime rider, Bajo said she understands that falls will always be a part of riding. Riders are taught how to roll to avoid injury. And sometimes it is important to get back in the saddle quickly in order to work through the challenges and help the rider gain confidence rather than fear.

Stephanie Bajo, a UVA assistant professor of psychiatry and neurobehavioral sciences, also attended UVA for a two-year clinical training in neuropsychology. (Contributed photo)

Not all falls will result in a concussion, Bajo said, but it’s important to know too that a concussion can occur after a high-impact fall even when a rider does not hit their head. A helmet, she added, won’t protect a rider from concussion, but can help prevent a skull fracture.

Riding immediately after a concussion, Bajo said, means your balance is going to be off and you’re not going to be able to process information as effectively, putting you at a greater risk for a second injury and prolonging your recovery. “No one, especially horse riders,” she said, “want to be out of their normal routine for longer than they have to be.”

Adolescents can take anywhere from a few to 30 days before their concussion symptoms clear up and they can safely return to their sport. Collegiate athletes tend to recover in seven to 10 days, Bajo noted.

As a mild brain injury, concussions can typically be assessed by a primary care provider. If someone’s symptoms are getting worse – like confusion, dizziness or an extreme headache – it’s important to seek medical care right away to rule out a more serious injury like a brain bleed or swelling.

Bajo has been tracking emergency visits to UVA and has found a higher rate of concussions among horse riders than even football players and athletes in other high-impact sports. While she knows horse riding and other high-impact sports can temporarily injure the brain and its processing, she’s also aware that the benefits far outweigh the risks.

“While it’s understandable to have concerns when your child wants to participate in a high-impact sport, there’s also a detriment that can occur by not allowing your child to have the support and community that sports allow and bring to people,” she said. It’s very rare, she added, that she ever needs to advise an athlete to stop playing altogether because they’ve experienced eight or nine concussions, which can have a compounding effect and lead to lasting damage.

Activity is Best for a Healing Brain

As a neuropsychology expert, Bajo sees patients who are still having symptoms four to six months after a concussion or other brain injury. Her job is to determine what other factors might be delaying recovery and causing memory or processing problems.

“With concussion, we expect people to improve back to their baseline functioning and not to have lifelong disturbances to their brain functioning,” Bajo said. When people don’t improve in a normal window of time, it can be due to reasons not related to the brain injury, such as stress, anxiety or by following outdated medical advice. Being sedentary and cooped up in a dark room for many days will only prolong recovery from a concussion, Bajo advised.

Instead, the new recommended standards indicate a person should begin an active recovery after rest for 48 hours, and start with walking fast enough to get your heart rate up or riding a stationary bike as long as symptoms are improving.

Returning to Her First Love

Bajo gave up riding for a few years during graduate school. But when she went looking for the best place to complete her two-year clinical training to become board-certified in neuropsychology, she knew UVA was a good fit.

She later joined the faculty in the UVA Department of Psychiatry and Neurobehavioral Sciences, deciding to stay partly because Charlottesville happens to be in a major center for eventing, which combines cross-country jumping, stadium jumping and a style of riding called dressage, which is a series of choreographed movements in a riding arena. In June 2019, she purchased a white and gray mare named Tika and started training at a farm about 8 miles past Charlottesville’s popular Foxfield horse races.

“I chose UVA to do my fellowship because it has a very, very good program in sports concussion, but also epilepsy,” she said. “When I was looking at where to do my clinical training, I had retired my [previous] horse, so I wasn’t in that mind space when I first came here. But being in horse country is absolutely a draw to stay. ... Not only do I love UVA, but it would be hard for me to be anywhere else now. There’s such a strong community here for equestrian sports. I really did luck out.”

Think you have a concussion?

A physical blow to the body or head can lead to concussion. Signs include a dazed feeling, confusion, nausea and blurred vision. Symptoms typically resolve within days or weeks. For more facts about concussion, visit uvahealth.com/concussion.