By April Clay, Registered Psychologist

It had been three months since Laura, a junior rider, had sustained a simple concussion during a fall from her horse. Her parents were becoming increasingly concerned that she was not progressing in her recovery. Laura was having difficulty focusing at school, disrupted sleep patterns, and intermittent headaches. Fearful of creating any further escalation in her symptoms, she had not returned to riding or any activity.

Laura was frustrated about not being able to ride, while her parents feared the worst may have happened: Could their daughter be suffering some sort of permanent brain damage?

Laura and her family decided to consult a neuropsychologist for an assessment. The consultation revealed no evidence of physical damage, and the neuropsychologist informed them that from a concussion perspective, Laura had likely healed. Further, the sum of objective testing and clinical interviews suggested that Laura was most likely suffering from moderate levels of anxiety and some mild depression.

After a traumatic riding accident, emotional and psychological factors such as post-traumatic stress, depression, and anxiety may hinder full recovery. Psychological help should be considered if symptoms linger beyond the expected recovery period. Photo: Shutterstock/Pirita

It turns out Laura and her family had been given considerable mixed messages and misinformation during their initial emergency room care and from well-meaning family and friends. This included staying in a dark room and avoiding all electronics, physical activity, and social interaction. Laura had become increasingly frustrated with her situation, and began to develop feelings of hopelessness about her recovery. This led to difficulty sleeping and escalating fears that she may never again be allowed to ride. She also felt as if she was living under a magnifying glass, with her parents watching her every move and often denying her requests to be social and insisting she needed rest.  

Emotional and psychological aspects of concussion are emerging as important factors in recovery. Responses to an injury of this nature can produce a sense of loss in skills, normalcy, and physical activity. Others, like Laura, begin to develop symptoms of depression and anxiety, which can go undetected and untreated, masquerading as “post concussive symptoms.” Many can experience confusion (I just don’t feel like myself now) and feel vulnerable and isolated. Without a bandage or cast, others may not be understanding of their invisible injury, and view their non-participation in school or sports in a negative light.

Now cleared of her physical concussive symptoms, Laura was referred to a psychologist to begin to untangle the sources of her anxiety. She was given accurate information regarding concussion recovery, and underwent cognitive behavioral therapy to correct thinking errors that sparked anxiety and fear.

For example, she discovered that thoughts such as What if I’m not as smart as I used to be?, or What if I can’t ride as well as before?, or Why did this happen to me? were causing considerable stress, which in turn caused her to lose sleep and not perform as well on school tests. Her parents’ reluctance to allow any physical activity, however well-meant, made her feel isolated from her sport and doubt her future.

After a few sessions with the psychologist, Laura’s symptoms began to clear, her focus returned, and she was engaging in a gradual return to her beloved sport. 

This family’s story offers a poignant example of how important accurate information and appropriate messaging can be to concussion recovery. Excessive media coverage of traumatic brain injuries of high profile athletes has, to some extent, created a culture of fear. Understandably, parents are worried their child may suffer similar permanent consequences. Laura and her family were unfortunately exposed to inaccurate information, which sparked fear and hindered her recovery.

The research suggests that most concussions or mild traumatic brain injuries (mTBIs) usually resolve within days to three months. No prolonged sequestering in dark rooms is required, nor is a complete cessation of thinking and movement. Rather, a gradual return to normal activity is recommended with supervision and follow-up. Equestrian Canada now has a Return-to-Play concussion protocol to assist riders in navigating a safe return to sport. 

There will always be a psychological response to physical trauma. Recovery can go awry if psychological and emotional factors, both present and preexisting, are not taken into consideration. Successful recovery is best obtained through a multi-disciplinary approach, utilizing qualified physicians, neuropsychologists, physiotherapists, and clinical psychologists. The latter can ensure that relevant psychological factors are managed and provide useful guidance in navigating the various challenges a concussion can entail. With the right support on your side, a return to the saddle might not be as far off as you first thought.

Consider psychological help if:

• Symptoms persist beyond expected recovery. If physical and psychological symptoms linger, it can be a sign other factors are at play.
• The concussion occurred as result of traumatic incident.  Riding accidents can result in post-traumatic stress, which requires assessment and appropriate treatment.
• Anxiety about return to riding interferes with recovery. If riders are struggling with anxiety and fear issues, sport and rehabilitation psychologists can help break down and manage individual barriers. 

More by April Clay

Main image: Pictured is Sharon White on Rafferty’s Rules at Rolex, taking a fall. Fortunately horse and rider were not seriously injured. Photo: Clix Photography