PhysioUpdate 19th October 2021

Horse riding's risks are highlighted by researchers who call for focus on rehabilitation costs

Researchers should aim to establish the true cost of rehabilitating patients who have been injured in horse riding accidents, according to the authors of a study appearing in the online journal Trauma Surgery & Acute Care Open.

The Texas-based team, led by Kevin Mutore from the school of medicine at the University of Texas Rio Grande Valley in Edinburg, reached their assertion after analysing records gathered at the National Trauma Data Bank (NTDB) over a 10-year period.

Horses may be well trained, but their behaviour can be unpredictable and lead to accidents

Popular activity

More than 30 million Americans take part in equestrian leisure and sporting activities every year. However, relatively little is known about the prevalence and consequences of the injuries that are sustained.

Dr Mutore and his colleagues found that the risk of incurring an injury requiring hospital admission was greater for horse riding than for other potentially dangerous sporting activities, including football, motor racing or skiing.

Although overall death numbers are low, previous work has shown that the long-term rehabilitation costs to treat these injuries may be high [Kevin Mutore et al.]

Despite this alarming finding, they argue that little is known about the real costs of equestrian injuries. While the authors’ analysis reveals that the chest area is the most common site of injury, injuries to the head and neck were found to be the most lethal.

‘Although overall death numbers are low, previous work has shown that the long-term rehabilitation costs to treat these injuries may be high. Further research looking into the epidemiology and true financial burden of these injuries is warranted.’

Details of 45,671 patients with equestrian injuries were retrieved from the NTDB, but only 24,791 cases were analysed because as the remainder were excluded if the data were incomplete. The average age of those injured was 47, and the proportion of men and women affected was similar. 

The most common site of injuries was as follows

chest: 9,189 (37 per cent)

arms and legs: 6,560 (26.5 per cent)

head injuries: 5,689 (23 per cent)

abdominal injuries: 3,353 (13.5 per cent)

While injuries were mainly categorised as mild (33 per cent) to moderate (43.5 per cent) in severity, most (88 per cent) of these patients required admission to hospital, with more than a quarter (28 per cent) sent to intensive care. Around one person in 10 required surgery.

On average, patients remained in hospital for four and half days, with an average of four days spent in intensive care and six days on a ventilator.

Those aged 50 to 59 were the most likely to present to trauma centres, accounting for more than one in four of all those injured (26.5 per cent).

Small proportion needed rehab

More than half of the patents (57 per cent) were discharged home without any additional healthcare services, while seven per cent were transferred to rehab or a skilled nursing facility. 

A total of 320 people died of their injuries during the study period, with head and neck injuries the leading cause of death in three out of four (75%). Riders with head and neck injuries were 44 times as likely to die as those with arm/leg injuries, while those with chest and abdominal injuries were around six times as likely to do so. 

Public health issues

Acknowledging the observational nature of their study, Dr Mutore and his conclude that: ‘Equestrian-related injuries are a frequently ignored public health issue.’ 

They note: ‘When taken together, these data suggest that the dangers of equestrian activities have been severely underappreciated.’

Though wearing protective gear can save lives it is not always worn, they state. ‘Studies have shown that a large fraction of riders involved in equestrian injuries were not wearing helmets at the time of their accident. It stands to reason that raising awareness of the possible injuries and increasing preventive measures to protect against head injuries would significantly reduce mortality.’

The authors conclude: ‘Interestingly, hospital admission risk from horseback riding is higher than football, auto and motorcycle racing, and skiing.

'Recently, some attention has been paid by equestrian sporting agencies to the use of protective equipment to prevent injuries, especially as it relates to concussion and brain injuries; however, very few public health campaigns have focused on preventing injuries in riders using horses for leisure and work.’ 

The NTDB data was collected from US trauma centres operating at levels I and II from 2007 to 2016. Because rural hospitals and other small community hospitals, for example, do not contribute to the NTDB database, the authors acknowledge their findings could underestimate the true scale of the problem.

To see the full version of the open-access paper, titled Hearing hoofbeats? Think head and neck trauma: a 10-year NTDB analysis of equestrian-related trauma in the USA, visit:

Physiotherapist Brendon Stubbs oversees successful bid to improve town's mental wellbeing

Physiotherapist Brendon Stubbs oversaw an experiment last month in which the residents of Retford in Nottinghamshire experienced a ‘mood uplift’ of 27 per cent.

The event in Retford – dubbed ‘Upliftford’ – is part of a wider international ‘Uplifting Minds’ study involving Dr Stubbs and Japanese sports equipment company ASICS. The aim is to show how moving and exercising can have a profound effect on people’s mental wellbeing. 

On 25 September, the town of Retford was transformed into 'Upliftford'

In the Retford event, which was held on 25 September, Dr Stubbs found that the town’s ‘mental uplift’ score rose from 56 out of 100 to 71 out of 100 (an increase of 27 per cent). Dr Stubbs is a senior clinical lecturer at the Institute of Psychiatry, Psychology and Neuroscience, part of King’s College London

On the day, ASICS transformed the streets of Retford into a ‘movement-inspired gym’. Bus stops became ‘bus steps’, while benches were turned into ‘bench presses’ and lampposts became ‘goal posts’.

Residents, who were joined by mental health advocate Katie Piper, measured the impact of movement on their mind using a special tool.

The Uplifting Minds study is open to everyone. To be part of the research, people are being invited to ‘capture their state of mind’ before and after exercising here:

People who share their research results in Europe on social media with #UpliftingMinds will also help raise funds for mental health charity Mind.

Back to ASICS

Gary Raucher, ASICS’ executive vice president, said the company's history of championing the effects of sport on the body and mind spanned more than 70 years.

‘It’s why we are called ASICS – it’s an acronym from the Latin, Anima Sana in Corpore Sano or a Sound Mind in a Sound Body. The results in Retford really demonstrate the power of movement to have a very significant impact on our mental wellbeing.

'We will continue to shine a light on the role of movement to help people feel better and support the fantastic work of Mind who is fighting for better mental health.'

Council support

There was a real positive vibe in the town, which I hope has rubbed off on other people and has since encouraged them to get out and start to make a positive difference to their health [Councillor Sue Shaw]

Retford mayor and councillor Carolyn Troop said: ‘I’m thrilled that ASICS chose to hold this event in Retford and I would like to thank all of the residents for taking part, as well as the organisations that made it happen. As the name suggests, I’ve no doubt that the event uplifted the town and its people.’

Sue Shaw, a councillor and cabinet member for health and community wellbeing at Bassetlaw District Council, added. ‘It was a fantastic event and inspiring to see that individuals, friends and families of all ages and abilities wanted to be part of something that can really benefit your physical and mental wellbeing.'

Ms Shaw added: 'There was a real positive vibe in the town, which I hope has rubbed off on other people and has since encouraged them to get out and start to make a positive difference to their health.’

To find out more about the experiment, visit:

To watch the official event, visit:

To find out more about Brendon Stubbs’ role, visit:

Physiotherapists shine at 2021 Chief Allied Health Professions Officer (CAHPO) awards
A total of 14 allied health professions celebrated AHP Day on 14 October

Consultant respiratory physiotherapist Stephanie Mansell and a colleague have picked up the AHP digital practice award at this evening’s Chief Allied Health Professions Officer (CAHPO) 2021 awards (14 October).

Ms Mansell, who is based at the Royal Free London NHS Trust, received the award with colleague Iain Loughran, a senior research manager, at a virtual ceremony conducted by Suzanne Rastrick, CAHPO for England.


The pair’s work in developing ONCALLBUDDY, an educational application for AHPs working in the north London trust’s urgent and emergency respiratory areas, caught the judges’ eye. The app provides staff with an accessible overview of common conditions, and assessment and treatment interventions.

In a tweet, Beverley Harden, deputy CAHPO and a physio by background, said ‘well done everyone … this is so exciting delighted to have supported your journey’.

This year’s awards (the fourth) were re-activated after a ‘pause’ last year due to the Covid-19 pandemic and the winners were announced today (14 October) to coincide with national AHP Day.

Compassionate leader

Another physiotherapist to win a category was Sue Ramsey, who picked up the AHP compassionate leadership award. Ms Ramsey is a clinical specialist physiotherapist with East Suffolk and North East Essex NHS Trust.

The award, which was sponsored by NHS Employers, recognised the ‘compassionate leadership’ that Ms Ramsey showed to her colleagues, and the ‘immense dedication’ she showed to patients during the pandemic.  

Ms Ramsey was responsible for creating and delivering respiratory physiotherapy cover on a 24-hour, seven-days-a-week basis in critical care settings.

Lincolnshire values

It means so much to have everyone’s hard work be recognised in a special way. It just shows how great service development can be when the whole system works together! [Lincolnshire Stroke Service]

Meanwhile, AHPs from the Lincolnshire Stroke Service (part of Lincolnshire Community Health Services) won the AHP innovation and delivery of systems awarded, which was awarded by NHS England and NHS Improvement. The AHPs’ aim is to create a service that is ‘fit for our own families’.

The team tweeted: 'Wow!!! We are so honoured and proud to have received this award. It means so much to have everyone’s hard work be recognised in a special way. It just shows how great service development can be when the whole system works together! We will keep going!'

Earlier in the day, Suzanne Rastrick tweeted: 'Happy #AHPsDay to all my fantastic #AHP colleagues in England & elsewhere! Thank you to all of our 14 professions who contribute so much to health & care services across the life course.'

For more information, follow: @SuzanneRastrick

Physio Brendon Stubbs overseeing unique experiment to boost wellbeing in Retford, Nottinghamshire
Brendon Stubbs' growing international reputation has been recognised by the WHO

Physiotherapist Brendon Stubbs is playing a key role in an ambitious one-day experiment that will attempt to boost the mood of the inhabitants of Retford in Nottinghamshire through exercise.

Local people who want to take part in the ‘mind uplifter’ initiative on 25 September have been invited to register on a website being run by Japanese sports equipment company ASICS.

People in Retford are said to be highly motivated, having been identified as such in a recent State of Mind Index conducted by ASICS, with 80 per cent of them supporting the idea.

I expect there to be a marked improvement on the emotional and mental wellbeing of the residents of Retford given the cognitive, emotional and physical benefits of exercise [Brendon Stubbs]

Sport can 'uplift people'

Dr Stubbs, a senior clinical lecturer at the Institute of Psychiatry, Psychology and Neuroscience, part of King’s College London, helped to design the event and will oversee the experiment.  

He said: 'After a prolonged period of uncertainty and restrictions there’s naturally been an impact on people’s wellbeing. However, this summer has shown the transformative nature of sport and the ability it has to uplift people. Never before has a whole town approach to uplifting mood through a day of exercise been attempted and measured in such a robust way.' 

Dr Stubbs added: ‘This is an exciting project with immediate results, and I expect there to be a marked improvement on the emotional and mental wellbeing of the residents of Retford given the cognitive, emotional and physical benefits of exercise.’

Exercise 'pop ups'

Retford’s streets will be transformed on the day into a gym – with many ‘exercise pop-ups’ being available to help get residents start moving.

The Mind Uplifter Tool will be used to measure the residents’ state of mind before and after taking part in an exercise circuit, which is designed to last about 20 minutes.

ASICS said the event will also raise funds for Mind, the mental health charity. Executive vice president Gary Raucher said the company believed that exercise was good for both the body and the mind. ‘Now, we aim to demonstrate our brand belief in action by seeing if movement can uplift the mood of a whole town.'

Local council support

Bassetlaw District Council is backing the initiative. Cabinet member for neighbourhoods Julie Leigh said: ‘To be selected as part of this experience is fascinating and I’m sure our residents will be fully behind it.

'We firmly believe that movement and exercise are key pillars in improving the overall health of our town, so we can’t wait to get started.'

Brendon Stubbs' 'pinch myself' moment 

Meanwhile, writing in his LinkedIn page, Dr Stubbs has described an invitation he received earlier this week from the World Health Organisation to help set its priorities on protecting people's mental health in the wake of the Covid 19 pandemic as a 'real pinch myself moment'.

'I never in my wildest dreams anticipated the World Health Organisation would approach me to become part of their advisory team and a massive honour.'

For more information on the day, visit:

See the council's press release:

To find out more about the Mind Uplifter Tool, visit:

ASICS is an acronym for the Latin expression ‘Anima Sana In Corpore Sano' (You should pray for a healthy mind in a healthy body)


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