Brain Injuries at the Barn: How to Spot and Prevent Concussions

Approximately half of all riders experience a head injury at some point in their career, but most return to riding without ever seeking medical clearance. These concussions can cause your riding, your horse, and you to suffer.

“You do not have to be rendered unconscious to have had a concussion. Actually, you don’t even need to hit your head”, says Dr. Emily Kalambaheti, a board certified functional neurologist and senior staff clinician at PlasticityⓇ Centers.

So just how easy is it for riders to hurt their brains? We sat down with Dr. Kalambaheti to talk about how concussions affect equestrians and what you can do to keep your brain safe at the barn.

Q: How easy is it to hurt your brain?

A: “Anytime you experience an acceleration or deceleration event–which is when you’re moving quickly followed by a fast stop–you can hurt your brain. Some examples of this are when you’re falling and then abruptly stop when you hit the ground or when you’re riding and your horse stops suddenly causing a whiplash-like injury. Concussions can happen from being kicked or stepped on, thrown or fallen from your horse, or by your horse falling on you.

It takes a lot less than you might think to get a concussion. Even a minor fall where you seem uninjured can possibly give you a concussion.”

Q: How do I know if I hurt my brain? What are the signs?

A: “Most people experience symptoms the day of or in the days following the injury. These symptoms can include headache, dizziness, nausea, light sensitivity, sound sensitivity, motion sensitivity, fatigue, and exercise intolerance. Sometimes the injury can be subclinical, meaning you may not notice huge symptoms due to your brain’s ability to compensate. For riders, symptoms may include difficulty with balance, timing, and accuracy of movements when riding.”

Q: Are all concussions the same?

A: “No, research has found that there are five main types of concussions:

  • Headache/Migraine: Headache is the most common symptom following concussion and different types of headaches can occur following head injury. Migraine is a type of headache with associated symptoms including nausea, vomiting, and sensitivity to light, sound, or smell. Headaches and migraines can have various origins, but if they worsened following a concussion, neurorehabilitation and hyperbaric oxygen therapy may decrease the intensity and/or frequency of the headaches/migraines.
  • Vestibular: A concussion can cause dysfunction of the central vestibular system that involves movement and orientation of the body to space and time. Symptoms include dizziness, fogginess, lightheadedness, nausea, vertigo, disequilibrium, difficulty with walking or balance, and symptoms that are exacerbated by movement. Vestibular rehabilitation is excellent to treat this type of concussion.
  • Cognitive: The cognitive type of concussion involves the primary dysfunction of specific cognitive abilities following injury including: attention; impaired reaction time; speed of processing/performance; working memory; new learning; memory storage; memory retrieval; organization of thoughts and behavior. Cognition is the pinnacle of brain function and can often be jeopardized if the other more foundational brain areas are not working well. Diagnostic testing by a trained functional neurologist can pinpoint which brain regions may be “slowing down” or interfering with cognition following a concussion.
  • Oculomotor: Oculomotor means eye movement, and the oculomotor type of concussion involves dysfunction of the visual system. Ocular-motor and visual dysfunction can cause difficulty obtaining, understanding, and processing visual stimuli. Symptoms can include difficulty with screen time, reading, riding, driving, etc; eye strain and eye fatigue; problems with visual focus including changing focus from near to far or far to near; light sensitivity; blurred or double vision; eye pain/pressure behind the eyes; difficulty judging distances. Vision therapy or eye movement based neurological rehabilitation can help people with this type of concussion get back to work and back on the saddle.
  • Anxiety/Mood:The anxiety/mood type of concussion is characterized by increase in anxiety and mood-related symptoms including nervousness, feeling more emotional, feelings of being overwhelmed; depression, sadness, anger, irritability, fatigue, and feelings of hopelessness.This type of concussion is often accompanied by sleep disturbance which can snowball the mood irregularities. When people understand that mental health is a facet of brain health, it makes sense that brain injuries like concussion can cause mental health challenges, and that brain rehab can get to the root of the problem.

Many people have a combination of two or more subtypes. This means that some people may get a concussion and their only symptom is headaches, while other people can have changes in their emotional state and difficulty maintaining balance, and other people may have headaches, fatigue, and digestion issues. This also means that your first concussion can feel different than a subsequent one.”

Q: How serious are concussions? How long can injuries to my brain affect me and my quality of life?

A: “Your brain controls every part of your body. Even a small injury can cause large effects down the line if unchecked. Many injuries can be treated and, if treated, may not affect your life very much. Without treatment, symptoms can persist and you can be at a greater risk of another head injury.”

Q: How does brain injury affect mental health?

A: “Mental health is a facet of brain health. Neurology, the branch of medicine or biology that deals with the anatomy, functions, and organic disorders of nerves and the nervous system, and psychology are two halves of the same coin. When the neurons inside our brain are damaged, they may have a harder time creating neurotransmitters like serotonin and dopamine, which can lead to depression and mood dysregulation. Head injuries can also affect sleep, which in turn can further degrade your mental health.”

Q: How can I help rehabilitate my brain after a concussion?

A: “Thankfully, there are ways to recover from concussions. It’s recommended to rest for up to but no more than 72 hours, increase your omega-3 fatty acid intake, and begin active neurological rehabilitation. The best treatment is active rehabilitation. This includes vestibular rehabilitation, vision therapy, and neuromuscular re-education. Neuromuscular re-education is a therapy category that stimulates the receptors throughout the joints of the targeted body part to send accurate information to the brain about it’s positioning. This in turn leads to improved muscle tone regulation and coordination. It is important that you find a physician who understands how to test and treat all subtypes of concussion.”

Q: Is rehabilitation only important if I have a serious fall or injury?

A: “While serious falls or injuries call for intense rehabilitation, the gradual accumulation of small injuries can also cause larger issues down the road.”

Q: What can I do to protect myself?

A: “Helmets are a great first step. Helmets save lives by providing an additional layer of protection to decrease skull fractures and potentially fatal severe brain injuries. Unfortunately, helmets cannot stop the brain from hitting the inside of the skull during a head injury. Helmets also cannot help stop the neuronal shearing that the brain can encounter inside the skull.

Annual neurological examinations can help identify any dysfunction before it becomes an issue. Seeing a functional neurology practitioner or going to a neurological rehabilitation facility after a fall is another way to ensure your best performance.”

Recovering from a concussion isn’t something you have to do on your own. The doctors at Plasticity Centers know that no two brains are alike and no two concussions are the same, so every treatment plan and home exercise program is completely customized to the individual. Every Plasticity Centers location has an experienced team of functional neurologists and neurotherapy assistants to provide vestibular rehabilitation, eye movement exercises, neuromuscular re-education and hyperbaric oxygen therapy. For more information regarding PlasticityⓇ Centers and to learn how they can help you recover from a concussion, visit

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