Older Rider with Broken Ribs & Major Bruising

[swnest]

Last week my rescue gelding spooked and bucked me off—I scared him by asking him to handle something different too prematurely. I fell hard on compressed sand on my right side. With the rush of adrenaline in my system, I was able to put away my horse and all my equipment. If another rider had not shown up, I would have been forced to call 911 to get to the ER. On the CT scan there were no pelvic, vertebral or femur fractures but 2 non-displaced rib fractures (7th and 11th) and a large gluteal hematoma with several smaller ones extending into my abdomen. This is the only bad fall I’ve ever had in 65 years of riding and I feel lucky that it wasn’t worse.

I could not really walk for several days (the swelling seemed to compress the muscles so they couldn’t contract) and had to order a walker to get around the house. Now that the acute injury stage is over, my regular primary care doctor doesn’t really know what to do with me. I wonder if I should consult a sport medicine specialist or just go directly to physical therapy. I’ve done PT for non-riding orthopedic injuries but this injury is a bit different. Although I may not have any pelvic or vertebral fractures, there might be ligament and muscle damage. My ribs are beginning to heal (able to shift in bed now) but the swelling from the hematomas is still very painful. I’m hoping to start non-weight bearing ROM exercise in the warm therapy pool at the local gym soon.

As for riding my three horses (all in full training at a dressage barn an hour away), I hope to be able to visit them next week and maybe sit on one to walk. At 69 I mostly ride for enjoyment and do minor supplementary training and conditioning. I take great pleasure in my relationship with the horses and watching my trainer compete. I know it will be a while before I’m fully back in the saddle. I miss riding but know that starting back too soon will delay my recovery. After all I’d never rush rehabbing a horse from an injury.

[LCDR]

I wish you luck getting a timely appointment with any clinician. I would shoot for a sports medicine clinic if possible. I was amazed at the number of fellow riders I met at mine. I had thought it would be filled with high school and college jocks, but some days the rehabiltating 2-6x their ages equestrians would outnumber them.

[Jackie_Cochran]

I am 4 years older than you.

A few years ago I fell off and cracked 2 ribs. 6 weeks of no riding by the doctor’s orders.

On May 15 this year I fell off again. I did not have any cracked/broken bones this time but the pain was a lot worse because I fell directly onto my hip joint.

This time it took me 9 weeks to get back in the saddle. Soft tissue injuries can take longer to heal than bones. This time it was not because of anything the doctors said, it took me so long because I just hurt too darn much to mount or dismount from the horse.

The only time I had been in more pain was both times when I gave birth, when a drunk driver drove headlong into my much smaller car, and when my fibromyalgia first happened 30 years ago.

Yesterday I finally stopped the pain medicines the doctors put me on. I finally got a riding lesson on Wednesday this week. As I get older it seems to take me longer to heal from falling off a horse.

I can remember when I used to bounce right back up. Alas that was long, long ago.

Do NOT rush getting back into the saddle. There are few worse feelings than realizing that you hurt too bad to be able to get down from the horse without major help from multiple people.

[LCDR]

I hope you have a support group helping to motivate you to get back in the saddle. That plus your positive mental outlook and drive will do wonders.

My SO almost died in a riding accident, and while in recovery and therapy and follow-up surgeries, it appalled me how many non-equestrian friends and relatives just spouted off negative and give-up-riding comments.

That’s why sports medicine clinics rock - they are populated by people driven to progress and get back into their sports. And take no crap from anyone who tries to tell you that your riding isn’t a sport.

[MsM]

My mostly-sensible horse spun me off last February when a piece of ice crashed off the roof of the indoor. Like you, I was able to put the horse away, I felt bruised and battered but didnt think there was anything more. The next day I felt worse and then the following day my side/back was suddenly extremely sore and I had trouble sitting up, turning, etc.

When it didnt let up after a few days, I went to a walk in clinic. They were concerned about my back and sent me for xrays. That got me referred to a back specialist and he ordered a bone scan. Good news - spine looked okay. Bad news - there were spots on my ribs that he did not think were from trauma. As a cancer survivor, any abnormalities send up red flags to doctors.

That got me sent back to my oncologist who ordered a PEI/CT scan. Still had one spot which the radiologist thought was likely metastasis. Fortunately, the other tests showed no cancer and my oncologist had other radiologists read it. They decided it was trauma. Did another xray and found evidence of a fractured rib eight. Finally got a clean xray last week!

So I dont bounce as well, or heal as quickly at 70 as I used to! And medical history can add complications to the whole mess.

I did get some pain relief from prednisone early on. And I found a great PT. She understood riding and helped me strengthen my core (ended up with better half halts!). Only hindered by the uncertainty about what we were dealing with.

I got on my horse a couple of weeks out and realized that I would only walk for a few minutes for psychological reasons. First real riding was about six weeks out and it was painful but tolerable. By June I didnt have to think about my side.

[NoSuchPerson]

In my late 50’s, following what I jokingly call a cascade of bad decisions on my part, my horse bucked me off and I landed on my hip. No broken bones, but I ended up with a giant hematoma on my hip. It was the most acute pain I have ever been in in my life, including childbirth, 5 broken ribs, and a severe gall bladder attack. I have no words to adequately describe it. Afterwards, rather than physical therapy, my doctor recommended an orthopedic massage therapist who was absolutely fantastic. She worked on releasing scar tissue and restoring mobility. It was a long slow process, but I was amazed at how much improvement I saw with regular massage therapy.

[swnest]

I’m fairly sure much of the pain is due to the ginormous hip hematoma and its two smaller siblings. Great suggestion for finding an orthopedic massage therapist to deal with this. My regular massage therapist won’t work on anyone with a recent injury.

[swnest]

Thank you for replying. It has been quite a rude awakening to realize that I cannot count on just brushing myself off after a fall regardless of my level of fitness. When I’m ready to start riding again I have a wonderful mare whose former owner rode her (to the Arabian PSG championship) after rehabbing from a broken hip. Pain (with my trainer as a back up) will probably prevent me from getting back in the saddle too soon.

[Jackie_Cochran]

I find with the lesson horse Arabians I have ridden that I get off to a rather smooth start if I stand looking at the horse’s eyes, “open my heart”, and verbally explain to the horse what is wrong, how I hurt, what I think I can do, and a heartfelt plea for the horse to cooperate with me.

This has not failed me yet. I think the Arabs really appreciate when their riders are honest about their physical abilities, and this puts them in a more cooperative mood.

[RMJacobs]

Have you had a discussion with a doctor about the hematoma? I had two ginormous ones, two different times, and they needed medical intervention.

The first one was from a fall on broken concrete at work, so I saw a doctor with my company’s worker’s comp plan. He was really good, but thing went very downhill. The hematoma wasn’t reducing on its own, I was battling cellulitis, and he sent me to get the hematoma drained. Nothing would drain, and I was sent for immediate emergency surgery. The surgery got rid of the bulge and the cellulitis healed. I was supposed to wear compression stockings for months, but they were aggravating the cellultiis, So my husband vet wrapped me every morning after I showered. It worked great, and I could play around with different colors.

The second one was really stupid (not on my part). I’ve written about this before: I got hit by my own car. I was out driving my pony, and it wasn’t fun because I kept getting interrupted with work calls, and the pony was very spooky (due to cataracts, so I decided during that drive I was going to retire him). When we got home and we were going up our steep driveway in the grass next to it, my car, which had been parked at the top, started backing down. I figured DH was driving it, but then it didn’t follow the curve in the driveway and hit me, blowing me out of the cart. Luckily, my pony was fine. This resulted in a huge hematoma on my leg that kind of exploded, leaving a gaping hole. I ended up going to a wound care doctor, and had to pack it with collagen for months. During this time, we were traveling around the country to pick a place to live when we retired. So I did all the collagen packing in hotel rooms. Fun. But it did heal, and looks kind of like a bullet wound.

The reason I mention all this is that I was on heavy duty antibiotics for a month with the first one, and I think also for some time with the second. A hematoma can get infected, and that can be serious. I was told I might lose my leg (but I didn’t). Please get checked if you haven’t already.

Rebecca

[swnest]

Rebecca,

Wow—driving accidents are, I think, the scariest. Your injury sounds horrible but I’m glad you’ve recovered. Decades ago I did some driving and might take it up again if I’m unable to ride.

I’m a bit at loose ends finding someone to treat my injuries. I called the orthopedic group that I’ve used before and their response was “we don’t treat ribs”. My internist just shook her head and said there was really nothing that could be done about hematomas. I found an area sports medicine/chronic pain clinic but they lost me when they started talking about harvesting stem cells from my bone marrow. Yikes!

I’ll ask around and see if anyone can recommend a doctor capable of treating soft tissue injuries. I do know a doctor who used to work in shock trauma. In the meantime both the pain and swelling are going down. Today I managed to go to the pool and swam 2 laps. The non-weight-bearing movement felt great, so I’ll probably do this every other day.

Felicia

[RMJacobs]

I haven’t actually recovered. I have ongoing problems with severe leg pain. I managed to wipe out the other one in a bike crash in December 2018. We’ve named these incidents Leg I, II and III, to differentiate between what is hurting.

My husband claims he made a deal with the local vultures when we lived in South Carolina, giving them an option on my right leg. My neighbors all remarked on the fact that they knew where I was biking by seeing where the vultures were circling. We moved back to Colorado, but I’ll still occasionally run across a vulture that seems to be eyeing me a little too intensely.

I have to joke and laugh at this stuff, or else I would cry. It astounds me that I still have such a high level of pain. Leg I was 2015, Leg II was 2016, and Leg III was 2018. I demoted myself to riding an adult tricycle when I became unreliable on my beloved Trek hybrid bike. Every ride hurts, but I’d go nuts if I gave up riding.

Rebecca

[Manni01]

Ouch . very sorry about your accident!! But the good part is that it wasn’t worse. you did not fall on your head…. I had a very similar accident 5 years ago and when I was laying on the ground trying to get my things together (of course I was all by myself and no soul close to me) that’s what I told myself to cheer me up .

It hurts a lot!! And it will take some time. my recommendation would be to start Pilates classes as soon as you can…. i found out the hard way that this really helps especially if you are older…. I simply thought it will heal and all is good, but somehow even after it healed I was still not really able to ride on the same level as I was before…. Finally my family pressured me into starting to work out (running and Pilates) and it was amazing what a difference this made .

So best wishes for your recovery and you will be back!!!

[Bogey2]

My Chiro has me use moist ice, then moist heat then moist ice again a couple of times a day. I have had a couple of hematoma this year and one was from a kick that landed near the hip. It really screwed with my mobility and of course eventually ended up traveling down my leg.
Ibuprofen helped a lot as well!. Feel better soon!

[candyappy]

@swnest

Thank you for replying. It has been quite a rude awakening to realize that I cannot count on just brushing myself off after a fall regardless of my level of fitness. When I’m ready to start riding again I have a wonderful mare whose former owner rode her (to the Arabian PSG championship) after rehabbing from a broken hip. Pain (with my trainer as a back up) will probably prevent me from getting back in the saddle too soon.

Not to say you will but just be prepared for the possibility of having some fear or anxiety when you first start back riding and especially when on the horse who you parted company with.

It can take time to work through that as well.

I hope you heal quickly and can get back to riding.

[sami-joe]

I’m 65. About a year ago, I had a similar unplanned suborbital flight and hard sand landing. Remounted, walked and trotted a bit, because, who knows? Put my launchpad, er, horse away, then loaded the hay cart and fed him and 58 other horses.

As long as I was up and marching around, I felt okay. Sitting, rising, driving, reaching, not so much. Lying down and standing up that night were worse than any part of childbirth. The only way I could sleep was with some drugs left over from my son’s ankle surgery. I diagnosed myself with broken ribs, got an order from my doctor’s office and had an x-ray mid-morning the day after my crash landing. Luckily, I didn’t have to feed the ranch that night, but I did pretty much my normal stuff much more slowly while I waited for my doctor’s office to call. Crickets.

Went through worse-than-childbirth again that night. Strongly considered buying a recliner, despite the fact that I have neither the money nor the space. (I suspect one would not fit through either of my doors.) Back at the ranch the next day, two days post surprise dismount, longeing my horse and farting around, finally the doctor calls to tell me I have five broken ribs, 5-9. Grateful I hadn’t punctured a lung, I asked when I could make an appointment for PT, and she said there was no point until the ribs had healed, four weeks minimum. She prescribed me some way too powerful drugs, so I stuck with layering ibuprofen and tylenol.

What saved me was my dear friend and neighbor who loaned me her daughter’s lockdown bolster, sort of the top half of a puffy chair that sits on my bed. It was a life changer. Although getting in and out of bed kicked my arse, I could somewhat sleep. With my friend’s help loading the hay cart for the next week or so, I could feed the ranch, too.

Three and a half weeks later, because I was losing my mind not riding, I wrapped myself up in my late-1980s vintage Ye Olde Jump Vest, pulling the velcro closures as tight as I could tolerate, and went for a little walk on my horse. Though trotting was a bit of an adventure and I needed the support from the vest for another three weeks, by week six I was almost back to normal, though weaker and a little chicken for at least another month.

All of this is to say, you’ll be fine. While I didn’t have the mega-bruising you have, once I got a routine for sleep, everything got better. My family generally die of strokes and heart attacks, so blood clots were definitely on my mind. That’s also why I did my darnedest to keep to my routine at the ranch. I take a quarter-aspirin every night anyway, so I crossed my fingers that the other analgesics I was pounding didn’t have a negative effect while I was sitting on the couch in the evenings and leaning on my bolster overnight.

As for geriatric sports medicine, it does not exist, at least not in any form I can find or gain access to on Medicare. (This irks me, since I’ve basically been treading water with the ACA off and on more than a decade, waiting to be a member of the closest thing to UHC in the US.)

My doctor told me she cannot relate to, as she described them, “big outdoorsy sports,” so I wonder whether I’m in the right doctor’s practice anyway, right now.

Hilda Gurney, 80, runs her ranch two valleys over from me. I see her at nearly every show I attend. She must have a team of experts keeping her fit – she looks better in the saddle now than she did when I first came back to California in 2016.

I think we all need Hilda’s team from here on out.

Not sure how to find them, but I’m asking around.

You’re a week or so out. How are you doing?

[swnest]

Thanks for the encouragement: it helps me so much to hear from other “vintage” riders who’ve come back from similar injuries. Although I’ve been sending and receiving digital equine radiographs by email for nearly a decade, today I must travel to the hospital to pick up an actual CD of my CT to deliver to the ortho doctor. At two weeks out I’m over the worst of the rib pain and the monster hematomas (named Franklin, Norma and Ron) are finally going down. Sleep for several hours in a stretch happens now on a regular basis. Sciatic pain in the leg opposite the impact is my biggest concern and causes walking to be very uncomfortable. TENS helps more with this than meds, a SI cinch belt is arriving soon and I’ll see a spine guy next week. I’ve amassed an impressive collection of ice packs and shaped cushions—almost as large as my array of therapeutic riding pads.

My own PT routine with swimming and ROM exercises has kept me from going totally insane. The best thing—I’m visiting my horses this week! Someday I’ll be back in the saddle—even if I have to be all cinched up & plugged into a TENS—whatever it takes.

[TWH_Girl]

Glad you’re feeling better! I love swimmming and being in the water. It’s great exercise and so therapeutic. I might try joining a pool again this winter. Unfortunately we are in a more rural area so nothing is very close.

I have a suspected mensical tear from my fall in May and the pain is finally better so I can do some yoga. Once I get my husband through his bladder cancer surgery, maybe I will take care of my knee. Maybe

[swnest]

I don’t think I could have bounced back so quickly without swimming—only when I was in the water that I was pain-free (even on meds). I’ve also been using a wonderful rehab app called Prehab for about a week and would recommend to others recovering from an injury or surgery. My regular rider strengthening exercises (DRT) and yoga were just too painful. I’ve finally been able to cut my pain meds in half and can walk without a cane most of the day. In a few weeks I’ll probably be cleared (medically and more importantly by my trainer) to start riding. My ultra quiet Morgan stallion has been designated as my therapy horse.
Good luck with your knee and your husband’s surgery.

[atr]

There is something to be said for living in a ski town full of ageing Olympians in the West where there is a large concentration of orthopedic surgeons and PTs who spend their lives dealing with “go big or go home” injuries from older outdoor sporty people or cowboys