helmetMakers of polo helmets are being encouraged to incorporate both style and safety in their designs, after a survey of British players found that appearance rated more important than safety certification.

Researchers from the University of Liverpool looked at falls and injuries among those who play polo, with data gathered from 81 horse-owning players aged over 18, who were interviewed by telephone. The researchers paid particular attention to risk perception, mitigation and risk factors.

The findings, published in the journal, Sports Medicine – Open, found injuries to the shoulder or wrist were most common.

The authors, Professor Kenton Morgan, who is the chair of epidemiology at the university’s Institute of Ageing and Chronic Disease, and C.M. Inness, from the School of Veterinary Sciences, said polo, which is played in 80 countries, was unique in that it combined the skills of a person with the agility and performance of an animal in a contact sport.

Among the 81 randomly selected players who responded, 17.3 per cent had sustained an injury requiring a hospital visit.

Players who had higher self-assessed fitness levels were at greater risk of an injury requiring a hospital visit, while those who used wrist supports and undertook gym exercise had a reduced risk.

Falls were reported by 58 percent of players in the previous season. Women faced a significantly lower risk of falling than men, the researchers found.

“Aiming for a better handicap increased the risk,” they reported.

Pre-season training of both horses and riders reduced the fall risk, they found.

“Helmets are compulsory, but players reported that safety certification was not their most important criterion for helmet selection,” Morgan and Inness wrote, noting that 49.4 percent chose appearance as most important.

Only 29.6 percent considered the presence of a safety standard mark to be the most important aspect of helmet purchase; 7.4% rated price as most important.

“Helmet manufacturers should incorporate both style and safety into their designs,” they said.

Attendance of a doctor at polo games was not considered important by 65.4 percent of those surveyed, with the players suggesting the attendance of paramedics and ambulances was of greater consequence.

The polo season in Britain runs from the start of April until the end of September. Membership of the governing body, the Hurlingham Polo Association, stands at almost 3000 full playing members, with more than 13,000 horses registered.

Morgan and Inness said polo was considered a high-risk sport, but in the only previous investigation of injuries – a small prospective study of elite players in Argentina – the incidence of injury was 7.8 per 1000 playing hours.

This, they said, was relatively low when compared with soccer (17–29 injuries per 1000 hours) and rugby (53.8 injuries per 1000 hours).

However, in the case of polo, 64 percent of the injuries were considered serious.

polo-15Arm and head injuries were common and frequently associated with falls.

Among the 81 respondents, the mean age was 41.7, the mean body mass index was 24.8 and the median handicap was 0. Each participant owned between 2 and 110 horses, with a median of seven. Eighty percent were men.

Sixty-three percent described themselves as responsible for day-to-day horse management, and the remainder employed a groom.

Fifty-eight percent of players reported falling in the previous season. The median frequency was once, but 2.5 percent of players reported falling 10 or more times.

Wrist and shoulder injuries were most common among the 17.3 percent who reported injuries. The injuries were a broken collar bone, shoulder injury, wrist injury, damage to tendons in a hand and wrist, dislocated elbow, torn groin ligament, broken rib, damaged cartilage, damage to cruciate ligaments, damaged right leg with torn calf muscle and haematoma, pelvic injury x-rayed but not broken, hamstring injury, and arm and fingers hit by a mallet.

Three patients reported more than one injury. There were reports, too, of players being hit in the mouth by mallets and balls, but none required dental treatment.

Nearly all players reported bruising after playing, with 56.8 percent saying bruising was a regular occurrence.

Fifty-eight percent rated pre-season training as very important.

Players who exercised their horses for longer before the first chukka were less likely to fall; riders who cold-water hosed their horses’ legs after exercise had six times the risk of falling.

Morgan and Inness noted that the use of wrist supports was associated with a decreased risk of injury.

“This applied to all injuries rather than just those involving the wrist. Interpreting this as a proxy measure of risk-averse or safety-conscious riders is not supported by the lack of association between wrist supports and falls.

“Wrist supports may reduce the effect of forces on the wrist caused by swinging the mallet. This hypothesis is biologically plausible and warrants an intervention study.”

Rider fitness was associated with positive and negative risks; perception of self fitness was associated with an increased risk of injury, whereas actual fitness, as measured by gym exercise, was associated with a decreased risk.

Rider falls were common, and they were associated with injury. Risk factors were the sex of the rider, intention to improve handicap, pre-season pony exercise and days from the start of the year.

Females were half as likely to fall as males. “This may be because women are better riders, have better balance, or are more cautious and risk averse during games.

“It could not be explained by physical attributes, such as height and weight, or riding experience, as falls were not associated with these variables.”

Players aiming to improve their handicap were 8.4 times as likely to fall as those who considered that their handicap would remain the same. “This may reflect more competitive players pushing themselves and exceeding their limits in order to improve. It was not associated with rider age.”

The association between rider falls and the number of days of pre-season pony exercise was a surprise, they said.

“Riders exercising horses for a mean of 51.1 days were at lower risk of falling than those exercising for 43.5 days. This suggests that horse preparation is important in preventing rider falls and may reflect improved fitness, reduced excitability or better control.”

“Polo is interesting from a number of scientific perspectives,” Morgan and Inness said.

“The unique relationship between rider and horse in this ancient, unpredictable contact sport offers medics, vets and dentists the opportunity to collaborate in the field of sports injury prevention.”

They recommended that paramedics and ambulances should attend polo games.

C.M. Inness and K.L. Morgan
Falls and injuries to Polo players: risk perception, mitigation and risk factors.
Sports Medicine – Open 2015, 1:2 doi:10.1186/s40798-014-0002-8

The full study can be read here.

Polo study finds helmet appearance outranks safety in buying decisions