You are a professional rider ? let’s talk about your health

At the start of the 19th Century, the Medical science dictionary dedicated a chapter to equestrianism « A type of exercise praised by our elders as being a highly therapeutical method ». Surgeons and authors from the Medical society, frequently quote « the power of riding on the human body » and founded their theory on communication of movement from the horse to man,  man being described as inactive. « Mechanical jolting, repeated shuddering resonnate throughout the body tissues, rendering organs stronger ».
The Medical dictionary dedicates 20 pages to equestrianism. The following notes could be considered a summary… (figure 1) :

But from the begining of the 20th century , horse-riding is blamed for its negative effects on the spine and on muscular groups such as adductor muscles.

Multi-year occupational health and safety plan

Today, from a professional point of view, the equestrian sector is considered as a priority in the PPSST 2016-2021 (Plan pluriannuel de santé sécurité au travail = Multi-year occupational health and safety plan). The accident rate has been calculable since the existance of compulsary declarations (1898).  In 2012, the horse sector had one of the highest rates of occupational accidents in all agricultural branches.

From a sports point if view, horse riding is identified as a dangerous activity, on a par with skiing, with numerous fractures and a high hospitalisation rate (INVS (National health monitoring agency), 2008). The studies mostly established from emergency ward data, describe a high risk sport with repeated injuries to head and torso. This is detrimental to the  ensuing image of the sport.

Both of these obsevations, professional and sporting, are compiled  from accident rates. Another essential aspect, would be to add to these the aches and pain linked to everyday work and competition situations.

The relationship between a professional rider’s aches and pains and his work activity, not exclusively in competitions, were investigated by means of an epidemiological study. This study was carried out jointly by the Ifce, and the Occupatinal health Ergonomy and Epidemiology laboratory ( Laboratoire d’Ergonomie et d’Epidémiologie en santé au travail (LEEST) ) at Angers University.

A questionnaire was given out via social network, particularly via Facebook. The questionnaire compiled general information, lifestyle, medical information and professional track record.

Description of the population studied

258 completed questionnaires were analysed. Much as with the other figures concerning the sector, the sample of people in the study concerns mainly a  young female population (72,5 % female, aged  32,5 + 10,5 year the average age being 30), having 23 years + 9 years riding experience, with 10 years + 9 years professional experience, with a majority of farm-workers, with little seniority in their present employment.

The riders having answered the questionnaire were then divided into 4 groups according to the tasks described in an open-ended question consisting in « describing the main activities or tasks inherent to the present job. Assessing the % of work time.» :

• Group predominantly engaged in teaching or administrative tasks, principally people in charge of equestrian structures, all possessing a teaching diploma (BPJEPS, BEES1), and statistically a little older (38 years old on average). Even when predominantly engaged in teaching or administrative activities, some time is still dedicated to riding on a daily basis.
• Group predominantly engaged in « working out horses ». The population in this group corresponds to the idea we have of a professional rider, and the definition given by the professional reference document (equi-ressources, 2014). This group is mostly male possessing few diplomas.
• Group predominantly working as « stablehands or grooms ». In this group the population is again mostly female, and works essentially in the horse’s environment,  welfare and upkeep, while retaining time to ride on a daily basis. The majority in this category possess a diploma (BPJEPS, BEES1).
• Group predominantly « working with young horses ». This group is dedicated to breaking in young horses, and is a statistically younger male population (average age 28).

This classification reveals a certain versatility in competences and activities, but also a tendancy towards specialisation in the search for performance. This search for specialisation, but at the same time requiring a certain versatility is likely not linked to the horse sector, but more to the size of the structures (very small companies, or self-employed structures).

Painful areas noted for professional riders

The inventory of painful zones over the last 12 months preceeding the study showed a predominance of lower back pain (lumber region), shoulder pain, neck pain, and upper back pain (dorsal area).

Theses results led to spinal pain (cervical, upper back,and lower back pain) being studied more in depth.

Backaches

Backache is a frequent disorder in the population in general. Depending on the length of the painful episode, and the repetition, backache can have serious consequences on a person’s quality of life and his ability to pursue professional or sports activities.

Some professional activities are more concerned by backaches, particularly activities which are physically demanding, static postures having to be maintained, or repetitive gestures.

Other psychsocial factors at work are also quoted in relevant litterature, such as factors relating to work demand and control over work (autonomy, responsibility, monotonous tasks etc.), and factors relating to social support (colleague or hierarchcal support) , symptoms of stress….

Prevalence

The prevalence of backaches noted in this study is high compared to that in the general population (see figure 2). Contrary to data from litterature, backaches among professional riders from our study are linked neither to age, sex, size nor body mass index (BMI). In addition, there was no link found to the type of job, the volume of weekly work nor  to seniority in the company.

What the study does reveal however, is a link to the type of activity : it is the group principally engaged in caring for horses and maintenance of infrastructures which is the most affected (figure 3).

The type of backache noted for these groups are cervical pains, and backaches in the dorsal region, whereas pain in the lumbar region, which is much more common in the general population, affects all groups.

Medical check-ups

In parallel to these high figures, the questionnaire revealed two things : a high number of professional riders pays regular visits to osteopaths and physiotherapists, and has a positive opinion of their health despite the pains expressed. 

« I’ve got backache, but I find ways of carrying on with my activities... »

Riders tend to have regular medical check-ups, at an identical frequency to the general population. But there is also, as noted in this study, a high % of regular visits to physiotherapists (61%) , to osteopaths (81%), and to chiropodists (26%). When pain becomes chronic, riders tend to drop the osteopath and reinforce physiotherapy sessions. These practices enable them to carry on with their activities despite the pain felt. When the situation allows, reorganisation of the daily tasks is considered, usually meaning a decrease in working time.

« I’ve got backache, but I’m fine…. »

In answer to the question « Do you think your health is bad, mediocre, good, very good, excellent ? », 84 of the people suffering from cervical pain, or backache in the dorsal region expressed a positive opinion of their health !

Studies have shown that people in manual jobs have a lower tendancy to declare their pain than people in office jobs. But for professional riders, the way they perceive their health seems to depend on the manner in which it contributes to acheiving their professional goals. From this point of view, health is synonomous with acheiving a professional project. If health problems get in the way of this acheivement, then the direction taken will consist in finding the necessary physical and socio-economic resources.

Physiotherapy for backache in the lower back has evolved. It is now commonly admitted that it is better to favour exercise over immobilisation. Studies have demonstrated the need to carry on exercising despite episodes of lumbago.

Horse riding can be considered a physical exercise contributing to physiotherapy. Riding helps work out the paraspinal muscles. These muscles are precisely those that physiotherapy exercises aim to strengthen (torso flexor and extensor muscles, and local spinal stabilising muscles) during sessions with patients suffering from lumbago. Continuing exercises which are compatible with the pain felt, seems to be desirable. Exercise is an efficient way to prevent pain in the lower back, but the intensity of the exercise for riders when in a work situation, is as yet unknown, unmeasured and not assessed.

Riding could actually be one of the ways to treat lower back pains for riders, this seems to be confirmed br the disappearance of pain when riding. Some authors even describe horse riding as beneficial for the back, due to sensory effects transmitted through the rider’s seat, all the while retaining an « upright position » so as to respect the natural spinal curves which can then act as shock absorbers. The balance between abdominal and dorsal muscles, and the endurance of spinal extensor muscles, are essential factors in protecting the spine.

Muscular exercise when riding can be supplemented with another complementary form of physical activity. But only 38 % of professional riders in this study do another sport, mainly running and swimming, and on an irregular basis for the main part.

The repercussions of health on work activities is probably under-estimated. Even if pain seems to disappear on horseback, the repercussions of a bout of lumbago on the body and the risk of an impact on performance on horseback, should not be ignored. Coordinated  activity of paraspinal, abdominal and interspinal muscles is essential for stability of the spine. In people subject to lumbago, this coordination is altered, and spinal stability no longer ensured, which can in turn lead to spinal structural deterioration. In addition, this leads to longer muscular response time in the pelvic and lumbo-sacral areas, and reduced neuromuscular control due to tiredness. A rider suffering from lumbago tires more easily, and is less reactive...

The prevalence of chronic backaches in professional riders is high. Horse riding itself does not seem to be the cause of these backaches. The pain appears to concern more specifically those professionals whose main tasks consist in caring for the horses, and maintenance of the stables. This group of professionals is largely feminine, and is a reflection of the entire horse sector. Reorganisation of the tasks when possible, and a serious medical monitoring programme, will enable the professional rider to carry on with his/her activity, at least in the short term.

Limiting pain is conceivable by looking into working conditions, and particularly into the hazardous situations that are the tasks associated with horse care and maintenance of the infrastructures.