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Home / Equine Research Bank / J Orthop Sports Phys Ther / Rehabilitation of an Adolescent Equestrian Athlete With a Hi...
The Journal of orthopaedic and sports physical therapy2018; 48(12); 934-942; doi: 10.2519/jospt.2018.8214

Rehabilitation of an Adolescent Equestrian Athlete With a History of Multiple Concussions: A Case Report Describing an Adapted Return-to-Sport Protocol.

Abstract: Equestrian riding is a sport with a high risk of concussion. Currently, the literature guiding rehabilitation for concussions in equestrian athletes is limited, especially for directing return to sport. In this case report, a 14-year-old female equestrian athlete presented to physical therapy following her third concussion in 3 years. Her primary complaints were headaches, dizziness, difficulty concentrating, light sensitivity, and neck pain. On examination, the patient demonstrated reproduction of symptoms during testing of the vestibular-ocular reflex, showed a 3-line symptomatic loss on the dynamic visual acuity test, and had impairments in the joint position error test (1/5 correct on the left, 4/5 correct on the right) and a Balance Error Scoring System (BESS) score of 38/60 errors. A return-to-riding protocol was adapted from general return-to-sport guidelines and tailored to meet the unique demands of the patient's equestrian sport. The protocol included phased progression through no activity, light aerobic activity, moderate aerobic activity, sport-specific nonjumping skills, sport-specific jumping skills, full practice, and return to competition. During the protocol, the patient participated in 8 physical therapy sessions over 4 weeks for vestibular training, aerobic conditioning, and cervical and core exercises, as well as equestrian exercises at her stables. At the final evaluation, the patient reported no symptoms at rest, with exercise, or when testing vestibular-ocular reflex. Improvements were noted in the dynamic visual acuity test, joint position error, and BESS, with changes in the BESS exceeding minimal detectable change. The patient completed the full return-to-riding protocol in 8 weeks and was able to return to equestrian competition without complaints. This case report describes the physical therapy management of an adapted return-to-sport protocol for an equestrian athlete with a history of multiple sport-related concussions. Therapy, level 5. J Orthop Sports Phys Ther 2018;48(12):934-942. Epub 27 Jul 2018. doi:10.2519/jospt.2018.8214.
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Publication Date: 2018-07-27 PubMed ID: 30053793PubMed Central: PMC6671687DOI: 10.2519/jospt.2018.8214Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The study presents a rehabilitation case report of a teenage equestrian athlete who experienced multiple concussions, detailing an adapted return-to-sport protocol tailored to her sport-specific needs.

Patient Presentation

  • The patient was a 14-year-old female equestrian athlete who had suffered three concussions over three years. Her symptoms included headaches, dizziness, difficulty focusing, sensitivity to light, and neck pain.

Initial Examination

  • During her physical examination, the patient exhibited symptom reproduction during vestibular-ocular reflex testing. She showed a 3-line symptomatic loss on the dynamic visual acuity test, scored poorly on the joint position error test, and made 38/60 errors on the Balance Error Scoring System (BESS).

Treatment Approach

  • A return-to-equestrian riding protocol was developed for the patient, incorporating general return-to-sport guidelines but amended to suit the specifics of equestrian sports. The protocol was divided into seven phases: no activity, light aerobic activity, moderate aerobic activity, sport-specific nonjumping skills, sport-specific jumping skills, full practice, and return to competition.
  • Over four weeks, the patient underwent eight physical therapy sessions that consisted of vestibular training, aerobic conditioning, cervical and core exercises, and equestrian exercises at her stables.

Results and Conclusion

  • At her final evaluation, the patient reported no symptoms at rest or during exercise, and also showed no symptoms when testing vestibular-ocular reflex.
  • She also showed improved dynamic visual acuity, joint position error, and Balance Error Scoring System (BESS) scores, indicating significant progress.
  • The patient successfully completed the full return-to-riding protocol in eight weeks and could return to equestrian competition without complaints.
  • The research suggests the potential success of an adapted return-to-sport protocol for rehabilitating athletes with multiple sport-related concussions, specifically in the context of equestrian sports.

Cite This Article

APA
Gunter KB, Shields CJ, Ott SD, Coronado RA. (2018). Rehabilitation of an Adolescent Equestrian Athlete With a History of Multiple Concussions: A Case Report Describing an Adapted Return-to-Sport Protocol. J Orthop Sports Phys Ther, 48(12), 934-942. https://doi.org/10.2519/jospt.2018.8214

Publication

The Journal of orthopaedic and sports physical therapy
ISSN: 1938-1344
NlmUniqueID: 7908150
Country: United States
Language: English
Volume: 48
Issue: 12
Pages: 934-942

Researcher Affiliations

Gunter, Kelli B
    Shields, Christopher J
      Ott, Summer D
        Coronado, Rogelio A

          MeSH Terms

          • Adolescent
          • Animals
          • Athletic Injuries / diagnosis
          • Athletic Injuries / therapy
          • Brain Concussion / diagnosis
          • Brain Concussion / therapy
          • Clinical Protocols
          • Dizziness / etiology
          • Female
          • Headache / etiology
          • Horses
          • Humans
          • Neck Pain / etiology
          • Photophobia / etiology
          • Physical Therapy Modalities
          • Recurrence
          • Reflex, Vestibulo-Ocular
          • Return to Sport
          • Treatment Outcome

          Grant Funding

          • K12 HD055929 / NICHD NIH HHS

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          Citations

          This article has been cited 3 times.
          1. Kennedy E, Chapple C, Quinn D, Tumilty S. Can the neck contribute to persistent symptoms post concussion? Long-term follow up from a prospective descriptive case series. J Man Manip Ther 2021 Oct;29(5):318-331.
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          3. Tiwari D, Erdal M, Alonzo K, Twombly V, Concannon P, West A, O'Byrne M. Effectiveness of Vestibular Rehabilitation in Children Post-Concussion: A Systematic Review. Int J Sports Phys Ther 2025;20(2):142-156.
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