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Hip arthroscopy specialist advanced continuity of care for steeplechase riders
A lack of standardized care for steeplechase jockeys led a surgeon to volunteer his services.
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Before J.W. Thomas Byrd, MD, became involved in hip arthroscopy and orthopedic sports medicine, he helped standardize the continuity of care for steeplechasers and other equestrians.
Steeplechasing, a sport in which jockeys of thoroughbred horses ride cross country and jump high timber fences, gallop through hedges and bodies of water, presents opportunities for falls with every hazardous hurdle. Accidents in steeplechasing are rare, but often result in severe trauma, according to Byrd.
In the 1980s and 1990s, Byrd became interested in this area of medicine and noted a lack in continuity of care for riders. To address those concerns, he wrote the booklet, “Planning Event Coverage.”
“It is interesting, you [would] go to Lexington and see the multimillion dollar facilities for taking care of the horses, but not much that has ever been spent on the riders,” Byrd told Orthopedics Today. “One of the things we tried to implement was continuity of care for riders so if somebody gets hurt at one meet, it is recognized and cleared by a physician before the athlete is ready to ride at the next meet.”
J.W. Thomas Byrd, MD, examines a jockey.
Images: Byrd JWT
Interest in steeplechasing
Byrd’s fascination with steeplechasing began on his family’s farm near Nashville, Tenn., where he rode horses and participated in shows. Although not a steeplechaser himself, several of Byrd’s five older siblings rode competitively in equestrian events. His cousin George Sloan, one of the winningest amateur U.S. steeplechase jockeys, was the only American to take the top spot in a British steeplechase championship.
Byrd completed his sports medicine fellowship with James Andrews, MD, in Birmingham, Ala., and trained in total joints at New England Baptist in Boston. During his residency at the University of Louisville, he attended steeplechase events as a spectator and found himself treating injured riders.
A friend of Byrd’s was wearing this helmet when he fell off his horse and was stepped on by a following horse on the right side of his forehead.
“There were a number of times that I was just there as a guest, and I was called to look after some of the injuries,” Byrd said.
Early days of care
In the 1980s and 1990s, Byrd noticed that steeplechase jockeys’ passion to ride and reliance on their horses for a steady paycheck drove riders to compete even when injured. Byrd recalled one incident in which a rider went down in a steeplechase with timber fences.
“When we got to him, we realized he was riding with two broken wrists from the week before,” Byrd said. “Unfortunately, he was an owner/rider and he lost his horse in that accident and also a couple other people got banged up. That is the level of passion these people have. They are going to ride no matter what. Also, for some, it is their paycheck. If they do not ride, they do not get paid.”
Byrd recalled the creative ways he and other volunteers treated injured jockeys.
“Early on, when we did not have many resources. We [had] to fashion splints out of cardboard or rolled-up newspaper to get them stabilized,” he said. “I have had to care for everything from maxillofacial injuries to spine injuries to dislocated knees.”
This facial CT scan shows the severe nasal fracture and bilateral orbital blow-out fractures from the crush injury to the face of Byrd’s friend. The helmet saved the jockey’s life and helped him avoid severe cranial trauma. Although only a visitor at the race, Byrd managed his friend’s trauma and got him transported to the hospital
The days of makeshift and fragmented care for injured steeplechase jockeys are gone, thanks in part to Byrd’s efforts. More commonly, riders must now obtain clearance from an orthopedic physician before entering races to prevent them from riding while injured. Byrd’s booklet, published in 1994, provides orthopedists and race officials with a roadmap for continuity of care across all tracks.
Byrd and other volunteers have conducted studies on the injuries riders sustained and detailed the frequency of their falls to ascertain the magnitude of the problem, and developed standardized solutions. The booklet describes risks for riders, how to plan for injuries and ways to manage crowd-based cases such as heart attacks. It also addresses common racing injuries, such as concussions and clavicle injuries caused by riders performing a “tuck and roll” technique that allows them to land on their shoulders after a fall.
“They try to make themselves as small a target as possible, because there are other horses coming up behind them,” Byrd said. “Somebody described it as getting pushed off the back of a pickup truck at 30 mph.”
Helmet safety
Another major issue Byrd helped resolve was the lack of good safety helmets.
“Riders were resistant to using better safety helmets that had established track records in terms of protective quality,” Byrd said. “They used protective vests, but they would not use the right quality protective head gear because they felt with the vest on they [were] secure, even though the protection was limited vs. the ASTM-certified helmets that provided much better protection against head injury.”
Byrd went on to become a leader in equestrian medicine as president of the American Medical Equestrian Association, a position he said he accepted to fill a void that was present in the care of riders.
Today, Byrd feels his career has come “full circle.” He is the team physician for the National Football League Tennessee Titans and is again involved in equestrian medicine treating many bull riders and rodeo cowboys. Byrd sees looking after these riders as a continuing concern for the future.
“Sometimes you have to protect them from themselves,” he said. – by Renee Blisard
For more information:
- J. W. Thomas Byrd, MD, can be reached at Nashville Sports Medicine Foundation, Baptist Medical Plaza I, 2011 Church St., Suite 100, Nashville, TN 37203; 615-284-5800; email: byrd@nsmoc.com.
- Disclosures: Byrd has no relevant financial disclosures.