Post concussion recovery and helmets

[pony_powered]

This is my allotted 5 minutes on the computer, and yes…I’m getting off as soon as I post this (just in case my Dr. is online).

So I got dumped and have a concussion. My Dr. told me 4 to 6 weeks before riding again, which is fine with me because I’m not taking any chances.

I have to get a new helmet and just wanted to ask about what brands might be more protective and won’t cause me to go broke?
Is titanium better? My budget is around $350

I was wearing an older Charles Owens when I hit the ground.

[CindyCRNA]

I will be interested to see the responses but I think the consensus is buy what fits as they all protect about the same. My issue is helmets are too hard on the inside. Your head slams into the hard foam without slowing down. There needs to be a lower density foam or gel to cushion the head head before it finally hits the hard high density stuff.

[blackwly]

Sorry for your fall! My advice follows… I’m a neurosurgeon who consults in sports-related TBI for the USEF, NFL, and others so this issue is something I lecture on in an official capacity frequently. I’m assuming that you have a concussion only and no structural brain injury identified on imaging or significant past medical history.

First of all, no need to take 4-6 weeks off. All the literature is quite clear on this. After a concussion you need to rest (no athletic activity or high risk activity) until all symptoms have cleared and you are back to normal. At that point you resume your activity in a stepwise fashion. For most equestrians that might entail a day of vigorous walking on foot for a couple of miles, then a day of jogging or other light cardio, then a day of full cardio. If all feels good, get back on and add a light day of riding, and up the effort to your usual effort over the next few days. If no symptoms recur, you are good to go. If symptoms recur, STOP, rest, and return to the beginning. The process should take about a week.

This is called “stepwise return to play” and is highly validated in many sports. Random fixed time periods of avoiding activity is, honestly, old school and not evidence-based medicine.

Average time to become symptom free (if you really rest) is 3 days. 80% are symptom free within 1 week of concussion. A very small number are never symptom free and can not ever return to sport. So you have to let your body be the guide.

In terms of helmets, in my educated opinion, there is no commercially available ASTM equestrian helmet that is any safer then any other. Find one that fits well (critical) and that you like. Price is all about style, not safety, unfortunately. Treat it well and replace if it is left in the hot trailer, has a significant blow, etc. for all these reasons I tend to ride in helmets that run around $40!

Hope that helps. My non-COTH name is Lola Chambless, MD as most in here know, but in case you were worried I was an internet quack

[vineyridge]

What about the Devon-Aire Cone head helmet? Is it still for sale?

[BigPaintHorse]

“Hope that helps. My non-COTH name is Lola Chambless, MD as most in here know, but in case you were worried I was an internet quack”"

Dr. Chambless, I have had a few concussions many years ago but have some neurological symptoms that mimic MS with out being positive on a spinal tap or an MRI. I was curious if you take referrals or see patients? Nothing really adds up and treating symptoms doesn’t make anything better.

[blackwly]

[QUOTE=BigPaintHorse;8741726]
“Hope that helps. My non-COTH name is Lola Chambless, MD as most in here know, but in case you were worried I was an internet quack”"

Dr. Chambless, I have had a few concussions many years ago but have some neurological symptoms that mimic MS with out being positive on a spinal tap or an MRI. I was curious if you take referrals or see patients? Nothing really adds up and treating symptoms doesn’t make anything better.[/QUOTE]

I’m so sorry to hear that. I do have a big clinical practice but honestly I doubt I would have much to add if your imaging (MRI) is normal. When people have persistent functional symptoms without imaging abnormalities we really depend on neurology. Neurosurgeons are involved in the concussion world because we treat the full spectrum of traumatic brain injury, but when dealing with long term sequela a neurologist will have a lot more to offer. There are definitely some rare syndromes that can mimic MS and can be hard diagnostically. If you let me know where you’re located I can do my best to suggest the a physician nearby! Neurology and neurosurgery are small worlds so we often know each other.

[Groom_amp_Taxi]

@blackwly;8741645

In terms of helmets, in my educated opinion, there is no commercially available ASTM equestrian helmet that is any safer then any other. Find one that fits well (critical) and that you like. Price is all about style, not safety, unfortunately. Treat it well and replace if it is left in the hot trailer, has a significant blow, etc. for all these reasons I tend to ride in helmets that run around $40!

Is there anywhere on the interwebz where I could find what I’ve quoted above as a shareable infobyte attributable to you as a neurosurgeon, head injury consultant, and eventer? Seems like the question of “should I replace my helmet - I didn’t hit my head THAT hard” comes up frequently in the circles I frequent. Lots of folks seem to want the cachet of the higher end helmet but then don’t want to replace them because $300. I’m thinking a person with your creds saying the $40 helmet will protect you as well as the $300 one might change some minds that I can’t.

[Black_Points]

Helmet fit and brand

Adding my 2 Cents. I have had 3 concussions - non of which showed any problems from CT. I don’t remember much about what happened before or after each concussion though.

What I want to share is that 2/3 were wearing the USA approved CO helmets and I had both replaced by CO. The other was wearing a brand new IRH helmet and it cracked open so I naturally replaced it. I never felt that either of those brands fit me perfectly so went searching. Found Champion jockey skull caps that fit like a glove and also the Gatehouse HSI helmets. The HSI has a more advanced inner helmet make-up from what I’ve read. Tested for oblique impacts, not just top of the head impacts. ISH fits very well so now I only ride in Champion or ISH.

Just was in the UK and found out that they now have an updated safety requirement for their helmets so I bought a new Champion while there.

I got talked into a GPA because it was supposed to be so great and at such a high $ but it just doesn’t fit my head right so I don’t wear its

Conclusion: helmet has to fit properly and be comfortable for you!

Mary

[beowulf]

A CO saved my life; not once, but twice. Technically two different COs. I suffered an under-diagnosed TBI in college. I am absolutely certain if I had of been wearing any other helmet that it would have been much, much worse.

That and Charles Owen is one of the only helmet manufacturers that have actually actively participated in scientific studies… so… they definitely have my vote. I do think they are safer. They also replaced BOTH of my helmets when I wrote to them the very detailed, somewhat horrific crash report. It was not pretty.

I hope you feel better soon OP, and good luck moving forward.

[pony_powered]

Thank you all for your input on recovery as well as helmets! Thank goodness the CT scan I had on the day of the injury was normal.

Dr. Chambless, a special thank you for the information on your approach to getting back to full activity!

The CO I was wearing when I fell was pretty old, decrepit, and due for replacement. It held together thankfully. They fit me really well, so I think I’ll probably go for another one :yes:

[RedHorses]

Regarding the hard foam inside helmets - gel, rubber and soft foam are not desirable in a helmet because they are materials that return to their former shape after being squashed. This means that they exert an opposing force on the head after impact.

The hard foam is designed to slow the skull down before it reaches the ultimate stop before bouncing as it is the stop/bounce that allows the brain to slam into the skull. It’s a bit like an airbag in your car. Having materials that exert an opposing force after impact would increase the skull’s bounce back and increase the force of the brain’s impact with the skull.

This hard foam that squashes, and does not return to shape after impact is why helmets must be replaced after a fall. Even if the rider’s head doesn’t impact the ground very hard, the foam has been partially squashed which reduces its effectiveness in a future impact.

My choice of helmet is one that fits and costs less than $100CDN. I never have to think about replacing it after a fall. I just do it.

[kashmere]

My last helmet was a brand that’s in style, and cost me about $400 when I bought it 7 ish years ago. It fit well and is a nice helmet, but I absolutely put off replacing it because of the cost, and “I haven’t had a fall in it, sooo…” And then earlier this year I bought a greenie and went “no, dummy, replace the stupid helmet.”

I tried on the whole tack shop and bought a Troxel for 70 bucks. It fit me the best of any helmet, and actually looks pretty nice, if I say so myself:

http://www.troxelhelmets.com/products/intrepid?variant=2333281027

If you can replace a $500 or $700 helmet at the drop of a hat (har har), and those helmets are what work for you - no judgement whatsoever, and more power to you. I have pretty much made the decision that I want to be able to replace a helmet at a moment’s notice, and even kind of hesitate because it was an expensive item.

Try on a ton, buy what fits, replace regularly.

[pony_powered]

That Troxel is really nice looking!

[Groom_amp_Taxi]

There are currently a couple of new lower priced helmet models that do a pretty good job of replicating the profile of much pricer helmets - check out this Troxel and the similarity to some CO models -
https://www.smartpakequine.com/pt/troxel-es-helmet-13563

Time for the $300 and up market to evolve…

[woodhillsmanhattan]

Speedy recovery!

[BigPaintHorse]

[QUOTE=blackwly;8741733]
I’m so sorry to hear that. I do have a big clinical practice but honestly I doubt I would have much to add if your imaging (MRI) is normal. When people have persistent functional symptoms without imaging abnormalities we really depend on neurology. Neurosurgeons are involved in the concussion world because we treat the full spectrum of traumatic brain injury, but when dealing with long term sequela a neurologist will have a lot more to offer. There are definitely some rare syndromes that can mimic MS and can be hard diagnostically. If you let me know where you’re located I can do my best to suggest the a physician nearby! Neurology and neurosurgery are small worlds so we often know each other.[/QUOTE]

I so appreciate your response. I also have pseudo tumor and live close to Lexington KY. I have seen a few neurologists with out any real answers and use Dr. Curtis Givens at Baptist as my neurosurgeon. He is a neurointerventional radiologist and has placed two stents in my right transverse venus sinus? To open a blockage and to allow the spinal fluid to drain better. That helps the headaches and vision problems but not much else

I would appreciate any recommendations you have.

[goodmorning]

I suffered my worst concussion in a GPA, it was relatively new, never been in a fall, so I won’t use them. These anecdotal stories likely exist for every brand, but, one concussion that leaves you vomitting for days - nope, never again.

I stick to CO helmets now. I have a roundish head and many helmets aren’t as stable as I’d like, CO is a nice snug fit. I’d love for it to be less $$ but its a ‘small price to pay’ I’m always suspicious of the new helmet brands, quality control, how long has the foam been sitting around in a steamy warehouse?, but Troxel & CO have been around forever.