Ask a Vail Sports Doc column: Horseback riding can affect the body in ways often overlooked
Ask a Vail Sports Doc
If you’re an equestrian athlete, you know the physical and mental demand that comes with riding a horse. An equestrian myself, I have experienced firsthand the challenge and coordination that comes with trying to effectively perform a set of skills or patterns while sitting upon a moving animal weighing upward of 1,000 pounds.
Would I be lucky if I had a dollar for every time I have been asked, “So you provide medical care to the horses?” After all, the horses are doing all the work, right? My education as an athletic trainer combined with my knowledge of the sport on a personal level tells me riding, whether of the English or western discipline, is more than just sitting on a horse.
Equestrian athletes are athletes not unlike dancers, skiers and tennis players, with a unique experience in coordinating one’s own athletic abilities with that of an equine partner. A horse can move at speeds up to 40 mph, with a rider elevated 10 feet off the ground, and they can change speed and direction in less than a second. Muscle control, flexibility, posture and balance are coordinated and adjusted with each stride so as to maintain proper leg positioning and posture without lifting your hands or dropping your head.
In my experience as an athletic trainer for an NCAA collegiate equestrian team, horseback riding can be a significant contributor to major injury, including head injury, fracture and injury to major organs; however, the daily demand of riding can affect the body in ways often overlooked.
• Iliotibial band syndrome — The iliotibial band is a long band of fascia that runs from the outer hip down the outside of the thigh to the outside of the knee on the tibia bone. An overuse injury, IT band syndrome is caused by repetitive trauma, rather than a specific incident. The IT band tightens, causing it to slide back and forth across a bony protuberance at the knee.
Repetitive sliding can create excess friction, especially when the knee is bent at 30 degrees, commonly seen with leg positioning during equine events. IT band syndrome can be treated with foam rolling at the outer thigh, stretching of the IT band and hamstrings and soft tissue modalities.
• Patellofemoral pain syndrome — Patellofemoral pain is associated with pain felt behind the kneecap where your patella sits on the femur. If the patella does not glide normally within the groove, tracking more to one side, it can rub against the femur, resulting in pain. The most common causes of patellar malalignment are abnormal muscle imbalance, IT band tightness and poor biomechanical control.
Correcting muscular imbalances such as strengthening of the glutes and hamstrings and stretching the IT band can treat patellofemoral pain syndrome. Over-the-counter anti-inflammatories and sometimes a topical anti-inflammatory can help reduce pain associated with the condition.
• Patellar dislocation — A patellar dislocation can result from a large inward force applied to the outside aspect of the knee, causing the knee to collapse inward and the patella to forcefully track laterally out of the groove. This can occur when the foot becomes entrapped in a stirrup during a fall or impact with the ground. Lateral dislocations of the patella are most common and sometimes require reduction by a skilled professional.
A patellar dislocation can cause injury to the medial patellofemoral ligament, which helps with normal stabilization of the patella. Patellar dislocations are commonly treated with four to six weeks of conservative treatment including rest, ice, compression and elevation (RICE); anti-inflammatories and formal physical therapy. However, if the patella experiences subsequent dislocations, it can result in a surgical procedure known as a medial patellofemoral ligament reconstruction.
• Trapezius spasm — Over-exaggerated posturing during events such as horsemanship or equitation on the flat can cause spasms or trigger points to develop within the neck and upper back musculature, particularly the trapezius muscle with tensing of the shoulders. Tension can cause headaches, neck pain and limited range of motion. Treatment can include trigger-point releases, dry needling and cervical stretching. Graston technique or massage can be helpful when performed by a trained professional.
• Low-back pain — Low-back pain can result from fatigue, excessive loads, poor lifting technique or poor posture. Inefficient, weak or fatigued muscles can lead to poor lumbar and hip stabilization, resulting in pain. Athletes of the reining discipline can see an increase in low-back pain due to a weak core with maneuvers such as with a rundown to sliding stop and spins.
Treatment includes core stabilization with correction in muscular imbalances. A spine specialist should evaluate persistent low-back pain or radiating pain into the buttocks or lower extremities.
Victoria Stanislawski, athletic trainer to Dr. Richard Cunningham, M.D., at Vail-Summit Orthopaedics and received her undergraduate degree in athletic training and health education from Kean University and her master’s from the University of South Carolina. She completed The Steadman Clinic’s Athletic Training Fellowship program in 2013 and is a board-certified orthopedic technologist and licensed surgical assistant.