How Access to Care Affects Management of Chronic Pain and Injury among Collegiate Equestrians

According to a survey conducted by Kimberly Tumlin, PhD, research assistant professor evaluating horse-human interaction science in the for the Center in Innovation in Public Health and in the Department of Athletic Training and Clinical Nutrition (College of Health Sciences), almost half the members of a UK equestrian team have suffered a suspected concussion and more than half experience chronic pain.

“We recognize that there’s this problem with a very high percentage of suspected concussions and diagnosed concussions, but they are just not seeking care,” Tumlin says.

With funding from the Central Appalachian Regional Education and Research Center (CARERC), Tumlin is seeking to gauge the extent to which collegiate equestrian teams’ access to medical care and patient involvement helps manage chronic pain and injury. As part of her study, she is collecting and analyzing data on two teams: the University of Kentucky Hunt Seat Team, which is not required to provide direct access to health care following an injury, and the Sweet Briar College (Va.) Hunt Seat team, which is required to provide such access to care. Tumlin expects to find that equestrian athletes with direct access to care systems will have less chronic pain than those without.

The objectives of Tumlin’s study are to evaluate equestrians’ use of care systems they have access to, track changes in equestrians’ psychosocial status (experiencing depression and anxiety) after injury, and compare differences in social support of the UK and Sweet Briar teams.

Injury and Collegiate Riding

More than 15,000 riders compete in collegiate equestrian sports in the United States. Of the two major collegiate equestrian sport governing bodies, only one—the National Collegiate Equestrian Association (NCEA), which governs a total of 25 schools—requires teams to have certified and licensed health care professionals who practice sports medicine (athletic trainers) and associated care systems. Most of the remaining programs in the United States are governed by the Intercollegiate Horse Show Association (IHSA), which does not require a team health care professional and leaves it to the athlete to manage his or her post-injury care.

As part of the IHSA, the University of Kentucky Hunt Seat Team is required only to have medical staff present at horse shows. “If you fall, you’re receiving emergency care at an event. But after the fall, more than likely it's up to you to actually seek care,” states Tumlin. Sweet Briar, on the other hand, has an athletic trainer assigned to the team to oversee team members’ post-injury care.

Having an assigned athletic trainer during the post-injury care can have a positive impact on equestrians’ well-being. Allie Kreindler, jumping seat coach for South Dakota State University, an NCEA member, says, “If I notice something is off [with a team member], I do mention that to our sports medicine person, because she will see them again. We have a relationship. She'll tell me if one of my athletes came to her and was in pain.”

One of the primary reasons equestrian competitors avoid medical care from riding injuries is that it will prevent them from riding and competing, Tumlin says. She adds that the athletic trainer at Sweet Briar observed that “when she takes students away from their horses, she feels like they have greater depression and anxiety.”

“For equestrians, your team is often just your horse. We call it an equestrian team, but they all compete individually—not like team sports like soccer. Their social support mostly comes from interacting with the horse,” Tumlin says.

For the student president of the UK hunt seat team, Georgia Murray, riding is a crucial outlet: “I've always worked really hard in school, and I love school, but I think everybody needs some sort of outlet, a break, something that they enjoy. And for me that is riding.”

Allie agrees: “I think they don't always want to confess to their coach that they're in pain, because they think it threatens their ability to be at practice, and they don't want to be sidelined at all.”

“We do think that they would have increased depression and anxiety from loss of interaction,” Tumlin says. “An equestrian athlete that has access to care would have less chronic pain because they're receiving important post-injury care. But they're likely going to have higher rates of depression and anxiety” from being pulled away from their sport as well as their horse.

Assessing Patient Activation

To assess the student equestrians’ knowledge, skills, willingness, and confidence to manage their own health —referred to as patient activation—Tumlin with Michaela Keener, Research Coordinator for the Equestrian Athlete Initiative, and research interns at the Sports Medicine Research Institute began with full performance testing of the UK team members. “We looked at balance, flexibility, strength, and reaction time,” says Tumlin. “We were also able to track these athletes longitudinally [that is, through time], to understand what their performance profile looks like.”

To evaluate the use of care systems and assess changes in the psychosocial factors as a result of riding injury, 29 women from the UK team and 30 women from Sweet Briar self-reported their perceived stresses, global pain scales from injuries they’ve suffered, as well as general life events to factor out how these events might have impacted depression and anxiety over of the semester.

Tumlin hopes that her research will lead to the development of interventions that improve patient activation around chronic pain and injury. “We’re trying to figure out what we can do as an intervention to help them seek care when they don't have this care system around them,” Tumlin says.

Data collection wrapped up in the summer of 2023, and results will be available in later this year.