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

Abstract

Study Design Case report. Background 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. Case Description A 14-year-old female equestrian athlete presented to physical therapy following her third concussion in three 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 vestibular-ocular reflex (VOR), showed a 3-line symptomatic loss on the Dynamic Visual Acuity Test (DVAT), and had impairments in the Joint Position Error (JPE) test (1/5 correct on the left; 4/5 correct on the right) and Balance Error Scoring System (BESS) (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 non-jumping skills, sport-specific jumping skills, full practice, and return to competition. During the protocol, the patient participated in eight physical therapy sessions over four weeks for vestibular training, aerobic conditioning, and cervical and core exercises, as well as equestrian exercises at her stables. Outcomes At the final evaluation, the patient reported no symptoms at rest, with exercise, or when testing VOR. Improvements were noted in the DVAT, JPE, and BESS, with changes in the BESS exceeding minimal detectable change. The patient completed the full return to riding protocol in eight weeks and was able to return to equestrian competition without complaints. Discussion This case report describes the physical therapy management and an adapted return to sport protocol for an equestrian athlete with a history of multiple sport-related concussions. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther, Epub 27 Jul 2018. doi:10.2519/jospt.2018.8214.

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