ABSTRACT: Using a cross-sectional survey design, this study sought to determine usage rates and barriers to the use of protective equipment in roughstock athletes. Between 2004 and 2006, amateur, collegiate, and professional roughstock athletes were surveyed using national organizational mailing lists. Findings revealed that during competition, 69% never wore a helmet. Barriers were a negative effect on performance and sport persona. Conversely, 88% always wore a vest. The perception that vest usage was required encouraged roughstock athletes to wear them. Mouthpiece use results were mixed; 58% always used and 21% never used a mouthpiece. Barriers were discomfort and frequent forgetfulness. Reported injury rate was high, with users noting fewer injuries to head and ribs than nonusers, and riders agreed that protective equipment prevented injury to the head, ribs, and mouth. However, equipment usage rates varied widely by type and seemed to be underutilized because the equipment affected performance, was uncomfortable, and "not cowboy."
1Geisinger Health System Primary Care Sports Medicine Fellowship, Temple University School of Medicine, Wilkes-Barre, PA; 2University of Arkansas, Fayetteville, AR; 3Penn State University, Penn State Orthopaedics, University Park, PA; 4Primary Care Sports Medicine Fellowship, Greenville Hospital System/University of South Carolina Program, SC
Address for correspondence: David S. Ross, M.D., FACP, Director, Geisinger Health System Primary Care Sports Medicine Fellowship, Associate Professor, Temple University School of Medicine, MC 37-51, 1000 East Mountain Blvd., Wilkes-Barre, PA 18612 (E-mail: Dsross1@geisinger.edu).
Roughstock events, including bull riding, saddle bronc, and bareback riding, are thought to be responsible for the majority of injuries seen in rodeo. However, data on injury rates for these events are scarce. In a 2002 study of Canadian bull riding from 1995 to 1999, 32.2 of 1000 competitor exposures resulted in injury. The most common of these injuries was concussion (4). In a more general report, the Justin Sports Medicine Team reported in 2006 that 88% of rodeo injuries were related to roughstock events (9).
Protective equipment, including helmets, vests, and mouthpieces, are available to rodeo athletes, but usage rates remain unknown and variable. After the goring death of Lane Frost during a bull-riding event in 1989, leaders in the sport emphasized the use of protective equipment. An agreement statement from the 1st International Rodeo Research and Clinical Care Conference in 2004 recommended that bull and steer riders 18 yr and older at all levels of participation be encouraged to wear protective head gear when riding in competition or practice. They recommended that those athletes younger than 18 yr be required by schools, organizations, and promoters to wear protective head gear during participation (3). The National High School Rodeo Association requires the use of only protective vest and mouthpieces for high-school roughstock events (8). However, the sport's other governing bodies currently do not require the use of protective equipment. The use of protective equipment is at the discretion of the individual athlete (3,10,11). The actual benefit of protective equipment for roughstock riders is unknown. Research in roughstock rodeo events is limited, but the equipment is believed to be beneficial in the reduction of injuries. One of the few studies available found a reduction of head injury with the use of a bull-riding helmet (2). The use of protective helmets in equestrian sport also has been documented to reduce the incidence of head injuries based on surveys and surveillance of injury data (6). The utility of helmets in reducing injury across a variety of sports is inconclusive. In a systematic review of helmet use across sports, authors found evidence that use of helmets in skiing, snowboarding, and bicycling reduce head injury risk, but evidence is inconclusive for reduction of concussion risk for these sports (1). The goal for this exploratory study was to measure the use of protective equipment by roughstock riders and investigate barriers to use. Ethics approval for this study was obtained from the Methodist Health Care System Institutional Review Board, Dallas, TX.
An exploratory, descriptive design was used to collect data for this study. Between January 2004 and June 2006, survey packets were sent by mail to approximately 3000 members of the major United States professional and collegiate rodeo organizations. Organizations were selected based on the number of members and the organization's willingness to participate in the study. Additional survey packets were presented to rodeo athletes at professional events held in the Dallas/Fort Worth, TX, area during the same time period. Athletes who were 18 yr of age or older from high school, college, and professional levels were included to obtain a broad prospective.
Survey packets contained a letter that explained the purpose of the study, as well as each athlete's rights as a research subject. The packets also contained a 19-item questionnaire with multiple-choice and open-ended questions, a return envelope with postage, and information about participation in an appreciation drawing for eight American Express gift cards.
The survey instrument for this study was designed to collect exploratory data and contained both multiple-choice and open-ended questions. Content validity was established through review of the completed survey by an experienced survey researcher, rodeo physicians, and a rodeo athlete. Much of the information was gathered through short answer items, multiple-choice questions, or checklists. General demographic information was collected and included current age, age that participation in rodeo started, type of events entered, and level of experience (professional, collegiate, or amateur). Type of injuries sustained both in general and specifically when wearing protective equipment also was collected. Athletes were asked specifically about their use of mouthpieces, protective vests, and helmets. They were asked for their opinions about the utility of this protective equipment in reducing injury and their knowledge about rules on the use of the equipment. A series of open-ended questions asked athletes to elaborate on why protective equipment was not used and, if possible, to describe their experiences with its use.
Roughstock riders who were 18 yr or older were selected for participation. Only athletes who reported participation in roughstock events were included in the final sample. A total of 189 usable surveys were collected. The age range of responding athletes was 18 to 36 yr, with 94% of the athletes surveyed between 18 and 23 yr of age. Athletes reported competing between 0 and 22 yr, with a mean number of years competing reported at 7.92 yr and 90% of the sample competing less than 15 yr. Bull riders comprised the majority of the sample at 48%, while saddle bronc riders comprised 16%, and bareback riders comprised 11%. Approximately 25% of respondents reported participation in multiple roughstock events. When considering the number of athletes who reported participation in multiple events, the number of bull riders rose to 65% of the sample, with 35% of the sample riding only horses (saddle bronc and bareback). Of those surveyed, 25% reported their participation level as that of amateur, with 13% reporting participation at the college level, and another 13% participating at the professional level. The remainder of the sample reported participation at multiple levels: 24% at both professional and college level, 14% at both college and amateur level, and 7% reporting participation at all three levels. Because of the overlap in participation level among respondents, only use of equipment will be considered across groups. There will be no comparisons made between different participation levels.
Survey results indicate that 69% of the athletes never wear helmets, while 10% wear a helmet on occasion, and only 21% always wear helmets during competition. A total of 88% reported that they always wear a protective vest and another 8% sometimes wear a vest during competition. Only 4% of those surveyed never wear a vest. Approximately 58% always use a mouthpiece, with another 21% sometimes and 21% never using one.
A subanalysis of the sample indicates that athletes who reported riding bulls (exclusively or in combination with horseback events) were more likely to wear protective equipment than athletes who never rode bulls. The bull riders in the sample reported always wearing a helmet at 31%, compared to 2% of those athletes who rode only horses (saddle bronc or bareback). At 95%, bull riders were more likely always to wear a protective vest, compared with horseback riders at 75%. At 61%, bull riders also were more likely to always wear a mouthpiece compared with only 53% of horseback riders.
Injuries are very common. Only 7.5% of respondents reported no injuries during their careers. Reported injury rate was lower for athletes who wore helmets and vests than those who did not. Athletes who wore a helmet reported concussion at 44% compared with 61% in those who did not wear a helmet. Similarly, helmet wearers reported loss of consciousness at 39% compared with 59% in nonwearers. An increased injury level also was reported among those athletes who never or only sometimes wear a protective vest. Nearly 39% of those who never wore a vest reported broken ribs compared with 24% of those who always wear a vest. Mouthpiece use was less decisive. Teeth and jaw injuries were virtually the same for mouthpiece wearers and nonwearers at 18.5% (Fig. 1).
A subanalysis to determine whether age of the rider and the number of years spent riding was associated with protective equipment use did not find any significant correlations. Helmet and mouthpiece use was virtually the same across both age and number of years spent riding. Because almost all of the riders surveyed used protective vests, there was no correlation to be made between these two variables.
When asked about the utility of protective equipment in injury prevention, the respondents overwhelmingly agreed that equipment prevents injury, with 75% of those surveyed agreeing that a helmet will prevent head injuries, 97% agreeing that the vest will prevent rib injuries, and 85% agreeing that the mouthpiece will prevent mouth and teeth injuries.
The majority of those athletes surveyed do not believe that either helmets (99%) or mouthpieces (80%) are mandatory. More than half of the athletes surveyed believe that protective vests are mandatory. However, neither the National Intercollegiate Rodeo Association (NIRA) that governs college rodeo athletes nor the International Professional Rodeo Association or the Professional Rodeo Cowboys Association (PRCA) that governs professional rodeo athletes require the use of any protective equipment for athletes 18 yr and older (Professional Rodeo Athlete Association, personal communication, December 16, 2009) (10,11).
Respondents reported reasons for not using protective equipment qualitatively in short answer form. Information was coded into broad categories for reporting purposes. Riders reported that helmets restrict vision at 17% and are too heavy at 16.4%. Riders also reported that helmets affect riding at 14%. Other important factors related to riders not wearing helmets included that helmets are "not cowboy" (9%), "don't like" (9%), "never wore one" (7%) and "uncomfortable" (7%) (Fig. 2).
Vests commonly are worn. Riders who do not wear vests cited that the vests are restrictive (8%) and they "ride better" without them (1%) (Fig. 3). Mouthpieces most often are not used because the rider forgets or loses it (11%). Other somewhat important factors reported include the device being uncomfortable (10%), the effect on breathing/speech (4%), and that the mouthpiece is unneeded or dumb (3%) (Fig. 4).
The majority of roughstock athletes in this sample clearly believe that protective equipment will reduce injuries. One rider commented, "…the doctor (surgeon) said if I had not had them [protective equipment] on then I would not have survived due to the bull kicking and throwing me into a fence." Another rider stated, "I went head to head while riding a bull. It bent the facemask on my helmet. I was knocked out and had a concussion. But it could have been major face injuries without a face mask." Even though athletes believe that protective equipment prevents or reduces injury, almost 70% report that they do not wear helmets and approximately 42% do not routinely wear mouthpieces, although most of the athletes surveyed wear protective vests.
The most common reasons given for not using helmets were related to performance. One rider wrote, "The weight of the helmet affects my ability to ride…" Another rider commented, "A helmet weighs more and impairs your vision and range of vision." Other important reasons were related to appearance or persona and comfort. "Not cowboy" and "I'm a cowboy and I wear a cowboy hat" illustrate comments made by several of the respondents in this study. Mouthpieces often are forgotten or lost, but they also are uncomfortable for many riders. The high usage of vests may be related to the perception that vests are required. Vests are less visible than helmets and may be seen as appearance-enhancing.
The data presented here imply a reduction of injury in rodeo athletes who wear protective equipment. These findings are congruent with previous studies that have looked at the incidence and type of injury and deduced that protective equipment would be beneficial in reducing injury among these athletes (5,7,9) Only one study was found that concluded that protective headgear for rodeo athletes is unwarranted based on low morbidity and no mortality among their study participants after a retrospective record review of morbidity and mortality among rodeo and nonrodeo accidents with large animals (8). This study was limited by retrospective design, a small sample size, and a focus on head injury. In this study, the reason for limited use of protective equipment can be separated into two broad categories: athlete education about protective equipment and equipment design or appearance. Many of the athletes who ride horses (bareback and saddle bronc) revealed that they did not feel helmets were necessary because the risk of head injury was low. One athlete commented, "I'm a bareback rider. Injuries to the head and face are almost nonexistent unless you get stepped on or kicked." Athletes who ride horses also report that helmets are not necessary or are not allowed. One rider said that he "can't wear a helmet in saddle bronc," and another stated simply, "not required." Educating roughstock riders about injury types commonly encountered in their specific sport and ways to prevent injury with the use of protective equipment might increase compliance. Athletes should be educated about the risk of injury in these events and encouraged to use protective equipment.
Equipment design is the other broad category of reasons why athletes do not use the equipment. Several of the cowboys commented that the helmet was heavy or restricted sight. Others reported that the weight of the helmet made their necks hurt when the horse bucked. One rider stated that the helmet gives him "whiplash" when he rides. Several of the cowboys surveyed admitted that appearance was at issue; with one cowboy stating the hat "looks better for pictures" when asked why he did not wear a helmet.
Future advances in constructing devices that are more aesthetically pleasing, lightweight, and readily available may increase use. Future data from the work of the Justin Sports Medicine Team and others may increase acceptance of equipment use and governing rodeo bodies may implement rules requiring the use of specific protective equipment, particularly if interventional research proves protective equipment reduces the risk of injury.
This study had several limitations. There were a relatively low number of participants and the data reported were based on participant recall and self-diagnosis. There is a small possibility that there were repeat responders. Bias may have been introduced into this study by the researcher's interpretation of open-ended responses; however, the researchers felt this risk was necessary in order to expand the knowledge base about the use and the barriers to use of protective equipment in this population.
Protective equipment is underutilized by roughstock athletes. Most rodeo athletes never wear helmets, with only 21% reporting that they always use them. The same athletes are more likely to wear mouthpieces, with more than 50% always using them. Virtually all the athletes surveyed always or sometimes wore a vest, with only 4% reporting never wearing them. Athletes view equipment as unnecessary, uncomfortable, and unattractive. Helmets are thought to be heavy and to restrict vision. Those who do not normally wear vests find them restrictive. Mouthpieces frequently are lost or forgotten.
The use of helmets and vests may reduce certain types of roughstock injuries. Further research should focus on prospective information for equipment utility and athlete education. Technological advances are needed to develop good, lightweight, and comfortable equipment that cowboys might be more likely to wear. After all, can't someone make a helmet that looks like a cowboy hat?
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