Falls and injuries to Polo players: risk perception, mitigation and risk factors

Response rate

The useable response rate was 73% (81/112). Eighty-four polo players responded, but
two no longer kept polo ponies and one had kept them in work over winter.

Participants

The participants’ mean age was 41.7 years (standard deviation [SD] 10.7), the mean
body mass index (BMI) was 24.8 (SD 1.9) and the median handicap was 0 (interquartile
range [IQR] 0–1). Each participant owned between 2 and 110 horses, with a median of
seven (IQR 5.0–10.0). Eighty percent (CI 71.6–88.9) of respondents were men. Sixty-three
percent (CI 52.5–73.5) were responsible for day-to-day horse management, and the remainder
employed a groom.

Falls

Fifty-eight percent (CI 47.3–68.8) of players reported falling in the previous season.
The median frequency was once (IQR 0–2), but 2.5% (CI 0.0–5.9) of players fell 10
or more times.

Injuries to riders

Fourteen riders (17.3%, CI 9.1–25.5) reported injuries. Wrist and shoulder injuries
were most common. The injuries were a broken collar bone (2), shoulder injury, wrist
injury (3), 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.
Players were hit in the mouth by mallets (9.9%, CI 3.4–16.4) and balls (3.7%, CI 0.0–7.8).
None required dental treatment. All but 1.2% (CI 0.0–3.6) of players reported bruising
after playing, and 56.8% (CI 46–67.6) were bruised regularly.

Pre-season exercise and fitness levels

Just over half of the respondents (54.3%, CI 43.5–65.2) rode during winter, 37% (CI
26.5–47.6) played winter polo and 86.4% (CI 79.0–93.9) reported gym exercise, hockey,
running, swimming, yoga, squash, weight training, Pilates, cycling and walking either
singly or in combinations. The frequencies of these different types of exercise are
shown in Table 1.

Table 1. Frequencies of winter exercise and use of protective apparel reported by players

Over half of the players (58.0%, CI 47.3–68.8) considered their exercise intensity
to be less than the recommended UK adult level of ‘moderate exercise for 30 min or
more five times per week’. Their median self-assessed fitness to play polo was 5 (IQR
4–7) with a range of 2–10.

When asked for their opinion on the importance of pre-season training, 58% (CI 47.3–68.8)
scored it a very important 4; 35.8% (CI 26.5–47.6) scored it 3; 4.9% (CI 0.2–9.7)
scored it 2 and 1.2% scored it 1.

Use of protective apparel

The use of protective apparel is shown in Table 1. Wearing a helmet is compulsory in the UK, and all respondents reported wearing one.
The next most common item was knee pads, followed by goggles, wrist supports, face
guards, elbow pads, gum shields and back supports.

Perception of risk

Although it is compulsory for helmets to carry a safety standard mark, only 29.6%
(CI 19.7–39.6) of riders considered it the most important aspect of helmet purchase,
49.4% (CI 38.5–60.3) chose appearance and 7.4% (CI 1.7–13.1) chose price.

Perception of risk changed with the stage of the season. Forty-three percent (CI 32.4–54.0)
of respondents considered it highest in the first third of the season, compared with
1.2% (CI 0.0–3.6) in the last third. Thirty-seven percent (CI 26.5–47.6) considered
the risk constant throughout the season.

The presence of doctors at games was considered of low or very low importance by the
majority of participants (65.4%, CI 55.1–75.8), but a significant minority (23.5%,
CI 14.2–32.7) considered it highly important. Many participants volunteered the opinion
that the attendance of paramedics and an ambulance was of far greater consequence.

Risk factors for injury

Risk factors for serious rider injury are shown in Table 2. Rider age, sex, height, weight, BMI and experience did not influence the risk of
injury. In univariable analysis, risk factors were a fall, higher self-scored fitness,
participation in gym exercise and yoga, use of wrist supports and the number of days
from the start of the year to the first chukka.

Table 2. Risk factors for serious rider injury

After adjustment for confounding, falls were associated with an increased risk of
injury (odds ratios [OR] 6.6, CI 1.4–31.9), as was higher self-scored fitness (OR
1.7, CI 1.2–2.4). In contrast, gym exercise reduced the likelihood of injury (OR 0.14,
CI 0.03–0.9), as did use of wrist supports (OR 0.17, CI 0.02–0.9). Use of goggles
and face protectors had no effect.

The model had sensitivity of 50%, specificity of 92.5%, accuracy of 85.2% and an area
under the ROC curve of 0.87. The Hosmer–Lemeshow goodness-of-fit statistic was 4.2
(p?=?0.84).

Risk factors for falls

Risk factors for falls during polo games are shown in Table 3. In univariable analysis, risk factors for falls were the sex of the rider, yoga
and squash as out-of-season exercise, aiming for a lower handicap, cold water hosing
of the horse’s legs after exercise and the duration of pre-season horse training.

Table 3. Risk factors for falls during polo games

After adjustment for confounding, the odds of women falling was a third of that of
men (OR 0.3, CI 0.1–0.9). Players who aimed to improve their end-of-season handicap
had eight times the risk (OR 8.4, CI 1.2–57.0) of those who did not aim to improve
their handicap. All eight riders who reported playing squash experienced at least
one fall, and those who reported doing yoga had 20 times the risk (OR 20.7, CI 1.6–262.6)
of those who did not report doing yoga.

Players exercising their horses for longer prior to the first chukka (51.1 versus
43.5 days) were less likely to fall; the OR was 0.93 for every day increase. Riders
who cold-water hosed their horses’ legs after exercise had six times the risk of falling
(OR 6.1, CI 1.5–25.4).

This model had sensitivity of 80.9%, specificity of 73.5%, accuracy of 77.8% and an
area under the ROC curve of 0.87. The Hosmer–Lemeshow goodness-of-fit statistic was
7.92 (p?=?0.44). When squash was excluded from the model, the AIC was 89.8, compared with
82.7 when squash was included; the latter was selected.