











































MANUSCRIPT TYPE


QUALITY IMPROVEMENT REPORTS 

 

15 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020 
 

Implementation of a Novel Return-to-Ride Concussion Management 
Policy for Collegiate Hunter/Jumper Equestrian Athletes 
Devon Serrano, DAT, LAT, ATC, NREMT* & Velyn Wu, MD† 
*Sweet Briar College, Sweet Briar, VA; †University of Florida, Gainesville FL 
 

 
ABSTRACT 

A concussion return-to-participation protocol specific to 
equestrian is critical in the safe return of athletes to their 
respective discipline. When the care of the hunter/jumper 
equestrian teams became the responsibility of the Sports 
Medicine staff at Sweet Briar College, a return-to-
participation concussion management policy was needed to 
ensure the safety of the equestrian student-athletes. A 
quality-improvement project focusing on the development of 
a “Return-to-Ride” protocol was started in the fall semester 
of 2016.  The Sports Medicine staff collaborated with the 
Sweet Briar College riding center to create and ensure 
compliance of the protocol. The intended aim of developing 
this protocol was to create a guideline for concussion 
management of the equestrian student-athlete that would 
standardize care across sports and between providers. At the 
time of this quality improvement cycle, no specific concussion 
management protocol had been adopted or approved for 
any discipline of equestrian. Due to the differences between 
equestrian sports, changes would be need to be made in 
order to best serve the athlete(s) affected. Using a traditional 
five-day return-to-play program as an example, the Return-
to-Ride (RTR) protocol is seven days of gradual riding for 
equestrian athletes.  This protocol accounts for the specific 
physical demands and vestibular disruptions associated with 
equestrian. This Plan, Do, Study, Act (PDSA) cycle was 
conducted during the fall semester of 2016 to the fall 
semester of 2019. The purpose of this PDSA cycle was to 
provide athletic trainers and other healthcare providers with 
insight on the development and outcomes of a concussion 
return to participation protocol for equestrian athletes. 
Key Phrases 
Policy and procedure development, risk management and 
mitigation, professional standards 

Correspondence 
Dr. Devon Serrano, Sweet Briar College, 134 Chapel Rd., 
Sweet Briar, VA 24595. 
E-mail: dserrano@sbc.edu  
Twitter: @devonserrano   

Full Citation 
Serrano D & Wu V. Implementation of a Novel Return-to-
Ride Concussion Management Policy for Collegiate 
Hunter/Jumper Equestrian Athletes. Clin Pract Athl Train. 
2020;3(2): 15-30. 
https://doi.org/10.31622/2020/0002.4.   
Submitted: October 15, 2019 Accepted: June 14, 2020 

CURRENT MODEL  

In 2017, the Sport Science Institute (SSI) of the 

National Collegiate Athletic Association (NCAA) 
released updated recommendations on concussion 
safety management in intercollegiate athletics.1 
The Concussion Safety Protocol Checklist and 
Diagnosis and Management of Sport-Related 
Concussion Best Practices interassociation 
consensus documents serve as the standard to 
which colleges and universities associated with the 
NCAA hold their concussion safety management 
programs.1 Athletic trainers often serve as the 
management personnel of student-athletes with 
concussions from initial evaluation to return to 
activity.2 In order to best serve athlete 
populations, concussion management 
recommendations state that Return-to-Play (RTP) 
protocols must include sport-specific exercise.1 In 
August 2016, equestrian was granted full access 
to the Sports Medicine Clinic at Sweet Briar 
College. The Sports Medicine staff had limited 
knowledge regarding the demands of the sport, 
especially when it came to sport-specific activities 
for concussion management. A RTP protocol 
specific to equestrian did not exist.   

Presently, no aspects of equestrian are considered 
champion sports in the NCAA, though it has been 
considered an emerging sport for women at 
Division I and II since 2002.3-5 As of September 
2019, the NCAA Committee on Women’s Athletics 
voted in favor of a proposal to add equestrian to 
the NCAA Emerging Sports for Women program 
at the Division III level.5 A vote by the Division III 
membership on the proposal, conducted in 
January 2020, was narrowly defeated.5 In order 
to be considered a champion sport and have 

mailto:dserrano@sbc.edu
https://doi.org/10.31622/2020/0002.4


Implementation of a Novel Return-to-Ride Concussion Management Policy for Collegiate Hunter/Jumper Equestrian Athletes 
 

 

16 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

recognized competitive seasons that end with a 
championship, 40 programs must declare intent to 
have a varsity program.3 For collegiate programs, 
the options for competition associations include the 
Intercollegiate Horse Shows Association (IHSA) 
and National Collegiate Equestrian Association 
(NCEA).6.7 At the time of publication, membership 
in the NCEA extends over all three NCAA divisions 
with 17 schools in Division I, five in Division II and 
three in Division III.8 The IHSA membership extends 
to 48 states and Canada with over 10,000 
participating student-athletes from 577 member 
schools.6 No specific concussion management 
protocol has been adopted or approved by either 
organization, leaving each member school to 
manage concussions individually.6,7 The 
availability of a concussion management protocol 
specifically for equestrians would allow for a 
consistent level of care among member schools 
within an association.  

The purpose of the following document is to 
describe the use of a quality improvement process 
in developing an equestrian-specific Return-to-
Ride (RTR) concussion management protocol for a 
collegiate equestrian program. The aim was to 
develop and implement a guideline for concussion 
management of the equestrian student-athlete 
that would standardize care provided by all 
members of the sports medicine team to the same 
level given to all other existing sports managed 
by the sports medicine department.  The process 
for the development and implementation of a 
sport-specific concussion management protocol, 
challenges and barriers and outcomes will be 
discussed.  

PDSA CYCLE  

Plan 

The first step of the development phase was 
determining individuals who would be critical in a 
successful creation of a protocol. The primary 
writer on the protocol in this instance was the 
Director of Sports Medicine for Sweet Briar, with 
input and direction from the Team Physician for 

Sweet Briar Athletics and the Director of Riding at 
the College.  

Equestrian access to sports medicine services 
varies on the institution. According to the IHSA 
2018-2019 Rulebook and NCEA Rulebook 
(revised in February 2019), a qualified medical 
professional must be on site for all schooling 
sessions and the entire length of a performance or 
show.10,12 A qualified medical professional is listed 
as a certified and/or licensed emergency medical 
technician, paramedic, physician or nurse who is 
trained in pre-hospital trauma.10,12 At the 
collegiate level, access to sports medicine services 
vary based on the school’s distinction of the team, 
whether it be club or varsity status. Further 
research and advocacy is currently being 
conducted to propose the creation of a standard 
by which collegiate equestrian teams receive 
access to sports medicine services and the 
allowance of athletic trainers to be deemed 
qualified medical professionals by IHSA and 
NCEA standards.  

Researching the specific demands, physical and 
mental, is needed for the creation of sport-specific 
policies. Although created and initially 
implemented using hunter/jumper athletes, the 
goal of the protocol was to allow for adjustments 
to fit the needs of all equestrian athletes based 
on the demands of the sport. This included 
development of skill session parameters for 
traditional five-phase policies.1 There were 
several physical demands that needed to be met 
in order to have the protocol be successful. 
Hunter/jumper equestrian is about the relationship 
between the rider and the horse. The two are 
teammates and the success of one is equally 
dependent on the success of the other.9 Due to the 
changes in pace (walk, trot, canter and/or gallop) 
and height variations, there are also vestibular 
disruptions that must be accounted for. Jumps in 
collegiate competition in the NCEA and IHSA can 
range from two feet six inches to three feet six 
inches in height.8,10 Theses demands on the rider 
were discussed with the Sports Medicine staff by 



Implementation of a Novel Return-to-Ride Concussion Management Policy for Collegiate Hunter/Jumper Equestrian Athletes 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

the Riding Center staff, including physical 
demands (particularly on the hip, back, shoulder 
and lower leg) and vestibular disruptions 
throughout the pace and height variances.9,11 

Do 

The Sweet Briar College Return-to-Ride protocol 
was developed for hunter/jumper equestrian 
athletes in the fall semester of 2016.  The protocol 
(Appendix A), was created in conjunction with the 
Director of the Harriet Howell Rogers Riding 
Center at Sweet Briar College in Sweet Briar, 
Virginia. The protocol was designed to slowly 
increase the rider’s control over the horse, 
cardiovascular intensity, musculoskeletal 
involvement and changes in vestibular disruption.  
The purpose of the protocol was to outline an 
equestrian-specific return to participation for 
student-athletes competing on the College’s 
competitive equestrian teams. It also served as a 
way to build a rapport and relationship with the 
College’s equestrian program’s student-athletes 
and coaches. Prior to the 2016-2017 academic 
year, there had been no significant interaction 
between the equestrian program and the sports 
medicine team.  

The RTR protocol was designed in compliance with 
the NCAA Interassociation Consensus: Diagnosis 
and Management of Sport-Related Concussion 
Practices.13 At the initial conception of the RTR 
protocol, a five-phase policy was proposed to the 
Director of Riding at Sweet Briar (Table 1) after 
discussing with the Director the demands placed 
on equestrian athletes as they return after any 
injury. Table 2 outlines the sections present in the 
RTR policy and procedure document that were 
developed using best-practice guidelines. The 
proposed protocol followed the standard five-
phase outline as expected by the NCAA.1 The 
purpose of the original five-phase protocol was to 
serve an outline for all three members of the 
creation team to follow and work from as well as 
giving the Director of Riding an idea as to the 
types of activities that might be needed in a final 
version of a protocol.   

The decision to extend the protocol from five days 
to seven days was jointly made by the Director of 
Sports Medicine, the team physician, and the 
Director of Riding. One of the concerns when a 
five-phase protocol was proposed was that the 
athlete might not have enough time to gain 
confidence on the horse and manage the fine and 
gross motor control demands put on the body as 
well as vestibular disruptions. The extension of the 
RTR protocol to seven days also accounted for the 
addition of the horse as part of the student-
athlete’s full participation in equestrian events. 
Because the horse is a significant part of the sport, 
it was important to involve use of a horse in the 
protocol to allow for the student-athlete to work 
on gaining control in gradual monitored steps.  A 
RTR protocol completion sheet was created with 
the return to ride phases and places for instructor 
sign-off after completion of each phase. This sheet 
was created to track rider progression throughout 
the protocol.  

The RTR protocol consists of seven days of gradual 
increases in riding under the participation 
direction of a coach and medical direction of a 
certified athletic trainer. Athletes are able to 
proceed to the next phase if they are 
asymptomatic at the satisfaction of the current 
phase and the subsequent 24 hours.2 If symptoms 
occur during activity, the athlete is removed from 
activity and instructed to rest for 24 hours prior to 
considering starting from the previous level that 
did not produce symptoms. Symptoms that were 
exacerbated at this progression stage must 
dissipate prior to attempting the previous stage. 
Per the recommendation of the National Athletic 
Trainers’ Association (NATA) position statement, 
final clearance for full participation following 
completion of the protocol is required from a 
medical doctor.2  

During the creation of the policy and procedure, 
several audiences had to be considered including 
student-athletes, coaches, horse trainers, and 
stakeholders. As access to sports medicine services 
varies across secondary school, collegiate, and  



Implementation of a Novel Return-to-Ride Concussion Management Policy for Collegiate Hunter/Jumper Equestrian Athletes 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020 
 

 

 

private settings, it is important to educate 
coaches and horse trainers on the impact of 
concussions and the importance of progression-
based concussion management in the return of a 
student-athlete to activities of daily living, 
academics and riding participation.13 This also 
serves as an opportunity to educate stakeholders 
on the value of athletic trainers and their  

 

 

possible collaboration when working with 
student-athletes who compete in equestrian 
sports. The final policy and procedure document 
as updated in September 2019 (Appendix A) 
outlines the purpose of concussion management 
for student-athletes as well as the full policy for 
pre-participation examinations, return-to-learn 
(RTL) progression, and RTR policy (Table 3).  

Table 1. Original Proposed Five-Phase Return-to-Ride Protocol  
Phase 1: Light 
aerobic exercise 

20 minutes stationary bike at 70% maximum heart rate 

Phase 2: Moderate 
aerobic exercise 

Interval bike ride: 10 sets of 30 second sprints/30 seconds recovery 
Body weight circuit: Squats/Push-Ups/Sit-Ups: Three sets of 20 each 

Phase 3: Sport-
Specific Exercises 

60 yard shuttle run 
Plyometric Circuit (examples): 10 yard bounding/10 medicine ball throw/10 
vertical jumps; three times each 
15 minutes of walking on a horse with trotting (based on the rider’s abilities)  

Phase 4: Full-
contact practice 

Limited participation in full contact practice and monitoring of symptoms  
Inclusion of jumping small obstacles (based on the rider’s abilities)  

Phase 5 Full participation in practice 

Table 2. Sections of the Return to Ride Policy and Procedure Document 
Education  Mandatory educational session for all student-athletes and coaches, 

informational document provided to all student-athletes and coaches, 
acknowledgement of concussion understanding for all student-athletes and 
coaches 

Pre-Participation 
Assessment  

Completed annually for all student-athletes and includes the competition of the 
most current version of the Sport Concussion Assessment Tool (SCAT) with full 
Balance Error Scoring System (BESS) test. All history questions must be 
completed as part of the SCAT assessment. 

Post-Concussion 
Management 

Immediately upon suspicion of concussion:  
• Removal from participation 
• Completion of SCAT test with balance (BESS or tandem walk as 

available)  
• Evaluation of head and cervical spine 
• Initiation of Emergency Action Plan if necessary  
• Serial evaluation and monitoring for deterioration post-injury.  
• Home instructions with discharged from medical care  

Return to Academics A four-phase stepwise progression that works to allow student-athletes to 
increase in their workload and class attendance safely with multiple evaluations 
with the managing athletic trainer with communication with members of the 
academic community necessary for the student-athlete’s success.  

Return to Activity Utilized in initial recovery, return to learn (RTL) progression and return to 
play/ride progression  

Return to Play Termed “Return to Ride” for Equestrian athletes in this policy and procedure. 
Appendix A.  



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020 
 

Table 3. Seven-Day Return-to-Ride Protocol 
Phase 1 • Mount/Dismount/Lead in 

Hand/Walk Undersaddle 
(mounted) 

• Mount/Dismount, lead for five 
minutes (Complete two times) 

• Mount, walk undersaddle for 15 
minutes 

• Dismount and put the horse away 
Phase 2 • Mount and walk for 10 minutes 

• Trot two laps around the indoor 
arena 

• Walk five minutes 
• Trot two laps around the indoor 

arena 
• Walk for 10 minutes  
• Dismount and put the horse away 

Phase 3 • Mount and walk for 10 minutes 
• Trot four laps around the indoor 

arena 
o Walk two minutes 

• Trot four laps around the indoor 
arena 

• Walk for 10 minutes  
• Dismount and put the horse away 

Phase 4 • Mount and walk for 10 minutes 
• Trot four laps around the indoor 

arena 
o Walk two minutes 

• Trot four laps around the indoor 
arena 

• Walk for one minute 
• Canter a lap in each direction 
• Walk for 10 minutes 
• Dismount and put the horse away 

Phase 5 • Mount and walk for 10 minutes 
• Work at the trot and canter for 

15 minutes with periods of walk 
• Finish with walk for 10 minutes  
• Dismount and put the horse away 

Phase 6 • Repeat Phase 5  
• Add jumping small obstacles  

Phase 7 • Full participation in practice or 
lesson without restrictions  

 

 

 

Study  

The RTR protocol was created, developed and 
implemented at the beginning of the Fall 2016. 
The first equestrian related concussion occurred in 
Spring 2017. To determine how the RTR protocol 
compared to the RTP protocol, the following items 
were collected:  

• Date of Injury 
• Date of Evaluation 
• Number of Days from Injury to RTL phase 

4 (RTL 4) 
• Dates each phase of the student’s 

respective return to participation protocol 
was completed  

• Number of days from the date of injury 
to date of protocol completion 

All the collected dates were placed in a password 
protected spreadsheet and updated daily 
throughout the athlete’s recovery. The average 
number of days from injury to RTL4 and from 
injury to concussion resolution were collected for 
all athletes in sports managed by the Sweet Briar 
College Sports Medicine Department.  This 
included athletes who completed any of the three 
concussion return to participation protocols (RTP, 
RTR or a combination protocol). Any observations 
were documented on the athletes’ concussion 
evaluation for that day and/or in the notes section 
of the athlete’s injury in the electronic medical 
record system.  

At the time of submission, the protocol had been 
completed a total of 16 times with collegiate 
hunter/jumper equestrian athletes. As with all 
student-athletes, they were required to also 
complete their four-phase RTL protocol prior to the 
RTR protocol. Since the introduction of the RTR 
protocol in September 2016, a total of 85 return 
to participation protocols for all sports at Sweet 
Briar college were completed (69 RTP and 16 
RTR) (Figure 1). A total of seven NCAA varsity 
programs and two competitive equestrian teams 
used the appropriate return to activity protocol. 
Five concussion management cases (four RTP and 
one RTR) were not included in this analysis 



Implementation of a Novel Return-to-Ride Concussion Management Policy for Collegiate Hunter/Jumper Equestrian Athletes 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

because the return to participation protocol was 
not completed for reasons such as medical 
withdrawal, athlete non-adherence, athlete 
transfer to another institution and graduation from 
the institution. Concussions included in this analysis 
were categorized as incoming (occurred prior to 
enrollment at Sweet Briar College), athletic 
mechanism of injury or non-athletic mechanism of 
injury.   

In this analysis, the average number of days lost 
to concussion recovery was followed (Figure 2). 
This was defined as the time frame from the date 
of injury evaluation to the date of full athletic 
return. It is important to note that the averages 
from the Fall 2018 semester were higher due to 
several protocols implemented over Winter Break 
and being completed at the start of the Spring 
2019 semester. In both the Spring 2018 and 
Spring 2019 semesters, protocols were delayed 
due to Spring Break and were completed when 
the student-athlete(s) returned to campus. Overall 
as of September 30, 2019 the seven-day RTR 
protocol presented similar averages of days lost 
to concussion as its five-day RTP counterpart. Due 
to the additional two days in the RTR protocol, it 
was surprising to see that the averages of days 
lost was as close as they were.  

A major success was the quick adaption of the 
protocol by the equestrian staff. The coaches and 
instructors were open to the use of the protocol 
and served as advocates for the athletes if an 
injury (concussion or other) occurred as well as 
encouraging them to seek medical attention. They 
were receptive to education relative to 
concussions and were willing to assist in concussion 
management when needed and necessary.  

As in any setting with a new possible policy, there 
were challenges to implementation of the new 
concussion policy with procedures. The RTR 
protocol was designed for use with collegiate 
hunter/jumper equestrian student-athletes who 
had limited to no prior access to an athletic trainer 
either at the institution or at their high school 

and/or private barn. The initial challenge was 
working with the student-athletes to gain their 
buy-in into being able to use an athletic trainer, 
not just for concussion management, but also for 
general athletic health care. Cooperation from the 
student-athletes began with an introductory 
meeting at the beginning of the year to introduce 
the athletic trainer and explain offered services 
with locations and available times. This 
introduction is now offered annually as part of the 
onboarding experience for both new and 
returning student-athletes. Another step towards 
buy-in of the policy was meeting with student-
athletes at the barn and campus arenas. This was 
a time for both the athletic trainer and student-
athletes to ask questions. This allowed for the 
athletic trainer to speak with the coaching staff 
and build relationships with them as to how to best 
utilize the athletic trainer for their student-athletes. 
At the beginning of the research phase of writing 
this protocol, the majority of student-athletes were 
very open to explaining the sport of 
hunter/jumper equestrian and the psychological 
connect they have with the barn, as well as the 
importance of the barn to their personal identify.  

A second challenge was that no specific training 
with the sports medicine team or equestrian 
coaches was conducted on the implementation of 
the protocol. The athletic trainer met with the 
equestrian coaches to discuss the new protocol, 
athlete evaluations, completion of phases and how 
to respond if an athlete reports symptoms at any 
point (during recovery or return to ride phase).  

Act 

For clinicians in settings where they are building 
new relationships, it is important to learn about the 
sport they are working with. This includes 
understanding the physical competitive aspects of 
the sport as well as the psyche of the athletes and 
how their sport impacts their lives. In terms of 
understanding the sport, it is important that 
policies reflect sport participation and serve as a  



Implementation of a Novel Return-to-Ride Concussion Management Policy for Collegiate Hunter/Jumper Equestrian Athletes 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020 
 

Figure 1. Number of Return to Participation Protocols Completed from August 2016 to September 2019 

Academic Term Number of RTP Protocols 
Completed 

Number of RTR Protocols 
Completed 

Fall 2016 22 0 
Spring 2017 7 5 
Fall 2017 20 3 
Spring 2018 6 1 
Fall 2018 10 4 
Spring 2019 3 2 
Fall 2019 (as of September 23, 2019) 1 1 
Total Number Completed 69 16 

Figure 2. Average Days Lost from Evaluation to Completion of Designated Return to Participation 
Protocol 

Academic Term Average Days from 
Evaluation to RTP 5 

Average Days from 
Evaluation to RTR 7 

Fall 2016 20.4 - 
Spring 2017 16.2 16.8 
Fall 2017 20.7 24.3 
Spring 2018 20.0 32.0 
Fall 2018 48.1 21.25 
Spring 2019 19.0 27.0 
Fall 2019 (as of September 30, 2019) 12.0 12.0 
Average Number of Days Lost 22.3 25.4 

guide to clinical practice. This creates a standard 
for patient care and protects the clinician legally. 
When creating a new policy and procedure, 
especially when working with a new program or 
a program that has had little to no interaction with 
an athletic trainer, policy development serves as 
a good opportunity to learn about the sport and 
build strong relationships with coaches and other 
stakeholders.  

One potential barrier to implementation of the 
RTR protocol is how the protocol needs to be 
adjusted when an athlete only rides two to three 
times per week. A lesson-based schedule can 
delay the completion of an athlete’s protocol so 
adjustments might be necessary to keep the 
protocol from being completed over several 

weeks. This barrier can be overcome by working 
with the equestrian coaches and instructors to 
allow the athlete to complete supervised rides 
outside of their designated lesson times.  

Another barrier is the skill level of each athlete. 
With abilities ranging from beginner Walk/Trot 
up to those able to jump three feet six inches, it is 
important to make sure the athlete can complete 
their protocol safely and in their own skill range. 
In the event an athlete does not canter and/or 
jump, it may be necessary to modify the protocol 
phase to make sure the intensity is increased 
without putting the athlete at risk due to lack of 
skill.  



Implementation of a Novel Return-to-Ride Concussion Management Policy for Collegiate Hunter/Jumper Equestrian Athletes 
 

 

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An opportunity for further research includes 
applying the RTR protocol to all equestrian 
athletes such as those who compete in eventing 
(dressage, jumpers, and cross country), fox 
hunting, polo, competitive trail riding, endurance 
riding, Western Styles (pleasure, reining, cutting, 
team pinning, working cow horse, trail class, 
halter), and rodeo events. This protocol was 
written to serve as a general outline for other 
competitive sanctions of equestrian so testing and 
utilization in those sanctions would be needed to 
determine how effective the policy is in return-to-
ride participation for equestrian athletes. Further 
research is also needed to determine the 
psychological effects of concussion on the psyche 
of equestrian athletes and is currently in the initial 
stages of development. 

Clinical Bottom Line 

Equestrian currently is working towards becoming 
recognized as an emerging sport within the NCAA 
and over 10,000 students participate in the sport 
at the collegiate level annually. Therefore, more 
research and policy development is needed to 
ensure that sport-specific policies are created to 
fit the needs of the athletes competing and 
participating. Steps in this process include 
researching statements from the NCAA and sport’s 
governing bodies to determine how one’s current 
policies align with the expectations and standards 
set forth. It is important to involve important 
stakeholders in policy creation, editing and 
implementation. This allows for them to understand 
the standards expected of the policy as well as 
give valuable input on needed changes or 
recommendations. Education and evaluation by 
staff members and stakeholders are both part of 
the development and implementation processes. 
As equestrian continues to rise in status and 
participation numbers, it is important to develop 
policies that are sport-specific and align with 
standards of the sport’s governing bodies, NATA, 
and NCAA. Creation, evaluation and 
improvement of policies allow for improved 

patient care that is specific to the needs of 
athletes and their sport.  

REFERENCES 

1. National Collegiate Athletic Association. 
Concussion Educational Resources. Sport 
Science Institute, National Collegiate Athletic 
Association, Indianapolis, IN. 2017. 
Available at: http://www.ncaa.org/sport-
science-institute/concussion-educational-
resources. Accessed July 2018 and 
September 2019. 

2. Broglio SP, Cantu RC, Gioia GA, Guskiewicz 
KM, Kutcher J, Palm M, et al. National 
Athletic Trainers’ Association Position 
Statement: Management of Sport Concussion. 
J Athl Train. 2014; 49(2):245-265. 
https://dx.doi.org/10.4085%2F1062-
6050-49.1.07.  

3. National Collegiate Athletic Association. 
Sports. National Collegiate Athletic 
Association, Indianapolis, IN. 2017.  

4. Stark-Mason R. Still in the Saddle: Equestrian 
association working to rally support for the 
sport. NCAA Champion Magazine. December 
2015. Available at: 
http://www.ncaa.org/champion/still-saddle. 
Accessed July 2018 and September 2019. 

5. Stark-Mason, R. Committee on Women’s 
Athletics supports Division III equestrian 
proposal. National Collegiate Athletic 
Association. National Collegiate Athletic 
Association, Indianapolis, IN. 2017. 
Available at: 
http://www.ncaa.org/about/resources/medi
a-center/news/committee-women-s-athletics-
supports-division-iii-equestrian-proposal. 
Accessed September 2019. 

6. Intercollegiate Horse Show Association. 
About: General Information. Intercollegiate 
Horse Show Association. 2018. Available at: 
https://www.ihsainc.com/about-us/general-
information. Accessed July 2018 and 
September 2019. 

http://www.ncaa.org/sport-science-institute/concussion-educational-resources
http://www.ncaa.org/sport-science-institute/concussion-educational-resources
http://www.ncaa.org/sport-science-institute/concussion-educational-resources
https://dx.doi.org/10.4085%2F1062-6050-49.1.07
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http://www.ncaa.org/champion/still-saddle
http://www.ncaa.org/about/resources/media-center/news/committee-women-s-athletics-supports-division-iii-equestrian-proposal
http://www.ncaa.org/about/resources/media-center/news/committee-women-s-athletics-supports-division-iii-equestrian-proposal
http://www.ncaa.org/about/resources/media-center/news/committee-women-s-athletics-supports-division-iii-equestrian-proposal
https://www.ihsainc.com/about-us/general-information
https://www.ihsainc.com/about-us/general-information


Implementation of a Novel Return-to-Ride Concussion Management Policy for Collegiate Hunter/Jumper Equestrian Athletes 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

7. National Collegiate Equestrian Association. 
About. National Collegiate Equestrian 
Association, Waco, TX. 2018. Available at: 
https://collegiateequestrian.com/sports/201
9/4/3/_131987884238679712.aspx. 
Accessed July 2018 and September 2019. 

8. National Collegiate Equestrian Association. 
Schools. National Collegiate Equestrian 
Association, Waco, TX. 2018. Available at: 
https://collegiateequestrian.com/sports/201
9/5/2/EQUEST_0502195449.aspx. 
Accessed July 2018 and September 2019.  

9. Pilato M. A New View: Bringing Sports 
Medicine to the Equestrian Athletes. American 
Medical Equestrian Association Safe Riders 
Foundations News. American Medical 
Equestrian Association Safe Riders 
Foundations, Albuquerque, NM. Winter 
2005-2006. Accessed September 2019 

10. Intercollegiate Horse Show Association. 
2018-2019 IHSA Rulebook. Intercollegiate 
Horse Show Association. 2019. Accessed 
September 2019 

11. Nelson DE, Pivara FP, Condie C, Smith SM. 
Injuries in Equestrian Sports. Phys Sportsmed. 
1994: 22 (10); 53-60. 
https://doi.org/10.1080/00913847.1994.
11710501.  

12. National Collegiate Equestrian Association. 
Rulebook. National Collegiate Equestrian 
Association, Waco, TX. 2019.  

13. National Collegiate Athletic Association. 
NCAA Interassociation Consensus: Diagnosis 
and Management of Sport-Related Concussion 
Practices. Sport Science Institute, National 
Collegiate Athletic Association, Indianapolis, 
IN. 2017. Available at: 
https://www.ncaa.org/sites/default/files/SS
I_ConcussionBestPractices_20170616.pdf. 
Accessed September 2019.  

 

 

  

https://collegiateequestrian.com/sports/2019/4/3/_131987884238679712.aspx
https://collegiateequestrian.com/sports/2019/4/3/_131987884238679712.aspx
https://collegiateequestrian.com/sports/2019/5/2/EQUEST_0502195449.aspx
https://collegiateequestrian.com/sports/2019/5/2/EQUEST_0502195449.aspx
https://doi.org/10.1080/00913847.1994.11710501
https://doi.org/10.1080/00913847.1994.11710501
https://www.ncaa.org/sites/default/files/SSI_ConcussionBestPractices_20170616.pdf
https://www.ncaa.org/sites/default/files/SSI_ConcussionBestPractices_20170616.pdf


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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
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APPENDIX A: Return-To-Ride Protocol 

Management of a concussion in sport can be challenging, as there are no universal standards on concussion care 
and return to play guidelines. The following document is a concussion policy and management plan that 
specifically outlines the role of the Sweet Briar College Sports Medicine health care providers. The goal of this 
protocol is to give athletic trainers and physicians dealing with concussions a common student-athlete concussion 
management program.    

 

This policy is for the concussion care and management of student-athletes in the competitive programs of SWEET 
BRIAR COLLEGE Athletics and Riding. The Sports Medicine staff will provide concussion healthcare through baseline 
testing, education, injury diagnosis, management and rehabilitation. In order to return to participation, the student-
athlete must complete the Return to Learn and Return to Play/Ride protocols through the Sports Medicine staff and 
be cleared to return to participation by the Team Physician or their designee.  

 

Education 

 SWEET BRIAR COLLEGE will present all student-athletes with the NCAA Concussion Fact Sheet for Student-
Athletes. Student-athletes are required to sign a Student-Athlete Acknowledge Statement annually stating that they 
received, read and understand the NCAA Concussion Fact Sheet. This document on concussions includes the 
definition of a concussion, how to reduce the risk of concussions, symptoms of concussions, and how to report any 
concerns for themselves or a teammate regarding a concussion. Student-athletes are required to attend a pre-
season brief session with the athletic trainer prior to participation. Concussion education is also included in this 
meeting.  

 

Coaches at SWEET BRIAR COLLEGE will receive the NCAA Concussion Fact Sheet for Coaches annually. They are 
required to sign the Coach Acknowledge Statement annually prior to the start of their season. Additional 
educational opportunities in relation to concussions is available upon request, as needed and/or when new 
information regarding concussions becomes available.  

 

Members of the Sports Medicine staff will receive a copy of the NCAA Concussion Fact Sheet for Coaches and 
Student-Athletes annually to have as reference. In addition, all members of the Sports Medicine staff will 
participate in concussion education annually including a review of the concussion management policy during the 
Emergency Action Plan annual review.  

 

Baseline Testing 

Upon enrollment at SWEET BRIAR COLLEGE and before the first day of practice/tryouts, every student-athlete will 
undergo baseline testing. Baseline testing must occur annually prior to the student-athlete’s first day of their first 
season for the academic year. If a student-athlete sustains a concussion during the academic year, a new baseline 
will be completed prior to their return to participation. In compliance with the Arrington Settlement and as 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

recommended by the NCAA, and the SWEET BRIAR COLLEGE Athletic Conference the baseline assessment for all 
SWEET BRIAR COLLEGE student-athletes will consist of the following: 

• Sport Concussion Assessment Tool- 5th Edition (SCAT5)  
• Balance Error Scoring System (BESS) Test  
• ImPACT Computerized Concussion Test (Baseline) 

 

Concussion 

The SWEET BRIAR COLLEGE Sports Medicine Staff will determine whether or not a concussion has occurred, 
realizing that each concussion and each student-athlete is different, and individual treatment plans are necessary. 
A concussion is a brain injury that may be caused by a blow to the head, face, neck or elsewhere on the body 
from an impulsive force transmitted to the head. Concussions can also be a result from contact with another player, 
hitting a hard surface such as the ground, or being hit by a piece of equipment such as a bat, basketball or 
softball. A concussion may present differently from one student-athlete to another.  

A concussion can happen even if the athlete DOES NOT lose consciousness. 

 

Following a concussion, a student-athlete may exhibit the following signs and symptoms:  

Physical Symptoms Cognitive Symptoms Emotional Symptoms  
Headache 
Vision Difficulty  
Nausea and/or Vomiting 
Dizziness and/or Lightheadedness  
Balance Difficulties  
Light Sensitivity  
Noise Sensitivity  
Fatigue 
Slurred/Incoherent Speech 
Ringing in the Ears 
Loss of or Altered Consciousness 
Vacant Stare  
Loss of Bowel Control 
Loss of Bladder Control 
Seeing Bright Lights or Stars  

Memory Loss 
Attention Disorders 
Concentration Problems 
Confusion 
Disorientation 

Irritability  
Sadness 
Nervousness 
Sleep Disturbances 
Personality Changes  
Feeling of Being Stunned 
Depression 

 

When a student-athlete exhibits signs, symptoms or behaviors consistent with a possible concussion, they 
shall be removed from practice or competition and evaluated by the Certified Athletic Trainer and/or 
Team Physician. Signs and symptoms of a concussion can take up to seven (7) days to present fully. It is 
important that student-athletes be truthful and forthcoming about signs and symptoms of a concussion as 
soon as they present. The student-athlete will be evaluated and monitored to determine their status as it 
relates to being concussed. Once a student-athlete has been diagnosed with having a concussion, they shall 
be removed from physical activity for the remainder of that day, and not allowed to participate in 



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academic activities for the remainder of that day. The student-athlete, or their parent, guardian or 
roommate (as needed depending on the needs and requests of the student-athlete), will be provided with 
instructions on further care and the Home Concussion Information Sheet upon discharge.  

 

The student-athlete will be monitored for progression of symptoms during the ongoing course of their 
concussion by the SWEET BRIAR COLLEGE Sports Medicine Staff. Immediately following injury, the student-
athlete will be placed on cognitive brain rest for 24-48 hours unless noted by the athletic trainer and/or 
team physician. The SWEET BRIAR COLLEGE Sports Medicine Staff will use the SCAT5 and BESS tests 
daily, along with other examinations deemed necessary during the evaluation of the concussed student-
athlete until the symptoms have subsided and/or have been resolved. All of these evaluations will be 
compared to the baseline scores of the student-athlete and will aid in the Return to Learn and Return to 
Play/Return to Ride progressions.  

 

Once the student has sustained a concussion, the athletic trainer will set up an appointment for evaluation 
with the team physician during their the next sports medicine clinic day. When the student-athlete is either 
approaching the end of Return to Learn Phase 1 or enters Return to Learn Phase 2, the athletic trainer will 
notify the Director of Academic Resource Center so they can arrange a meeting with the student-athlete to 
create a plan for post-injury academic success.  

 

With permission for release of information from the student-athlete, the Academic Resource Center will be 
notified and updated on the condition of the student-athlete after they suffer a concussion in order for the 
Dean’s Office to notify professors. Notifications include: 

• The Office of the Dean (Dean and Secretary)  
•  Team Physician  
• Dean of Students 
• Director of the Academic Resource Center 
• Athletic Director 
• Riding Director (in the event the injured student-athlete is on an equestrian team) 
• Head Coach(es) of the team(s) the injured student-athlete is a member of  

The Dean of Students, the Office of the Dean and Director of the Academic Resource Center will be 
notified during the student-athlete’s Return to Learn protocol. Once the student-athlete progresses out of 
Return to Learn and into Return to Play and/or Return to Ride, they will no longer receive email updates as 
the student will be returned to full academic participation at this point.  

 

Student-athletes will complete the ImPACT test as part of their concussion recovery plan. They will take the 
test a total of three times: 48 hours post-injury, at the completion of Return to Learn phase 4 (RTL 4) and at 
the completion of Return to Play day 5 (RTP 5) or Return to Ride day 7 (RTR 7).  

 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

It is important to note that all Return-to-Learn, Return-to-Play, Return-to Ride, and Return-to-Play/Return-
to-Ride Combination protocols are individualized on a case-by-case basis, allowing for the student-athlete 
to receive the best available and most accurate care to aid in their recovery.  

 

Return to Learn (RTL) 

The SWEET BRIAR COLLEGE Athletic Training Staff, Team Physicians, and the Academic Resource Center 
will work together to determine Return to Learn status of a post-concussed student-athlete. The Office of 
the Academic Dean will inform the student-athlete’s professors and any accommodations that may be 
necessary in their return to the classroom and activities that are associated with their full academic return.  

 

Once a student-athlete has been diagnosed with having a concussion, they shall be removed from physical 
activity for the remainder of that day and not allowed to participate in academic activities. The Office of 
the Academic Dean will be notified of the status of the student-athlete.  

 

Following a concussion, the student-athlete will be seen daily by a SWEET BRIAR COLLEGE Athletic Training 
Staff member prior to the start of their first academic class. At that time, the decision will be made if the 
student-athlete’s symptoms have progressed to allow them to attempt to attend class, study hall, and 
tutoring sessions that day. The Office of the Academic Dean will then convey the status of the student-
athlete to their professors. If a student-athlete is allowed to return to class, they will be evaluated that 
afternoon in order to complete an updated SCAT5, to aid in determining how the day of learning 
progressed. This is repeated until the student-athlete successfully completes RTL 4; then they will be seen 
once per day until the completion of their designated return to participation protocol.  

 

Guidelines for Progression 

• Student-athlete proceeds to the next level only if asymptomatic at the current level of progression.  
• Following a recovery phase, if they are symptom-free for 24 hours they will progress to the next 

level. 
o If symptoms occur, they rest until they are symptom-free and return to the previous stage 

that did not produce symptoms.  
• During recovery, it is important for the student-athlete’s work and assignments to be prioritized so 

they can make up all missed work without inducing additional stress and emotional distress.  
• Phases of Recovery 

o Phase 1: Complete Physical and Cognitive Rest 
 No school attendance 
 Strict limitations on technology usage and reading 
 Rest 

o Phase 2: Return to School with Academic Accommodations  
 Initiated once student-athlete reports four or less symptoms with a total severity 

score of four or less 
 Continue limits on technology usage 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
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 Avoid heavy backpacks 
 No tests/exams/quizzes/reading/homework, athletics, band or chorus  
 Monitor symptoms  
 Rest at home 

o Phase 3: Continue Academic Accommodations 
 Attend school full-time if possible  
 Increase workload gradually (testing, homework, etc)  
 Monitor symptoms 
 Rest at home 

o Phase 4: Full Return to Academics 
 Attend school full-time 
 Self-advocate at school (meet due dates, etc)  
 Resume normal activities    

 

In any concussion case when a student-athlete needs or requests counseling, the Sports Medicine Staff will 
assist in referring them to a Counselor, located at on the second floor of Protho Hall in Student Life.  

 

Return to Play (RTP) 

The gradual exertion return to play process is designed to allow for a gradual increase in exercise volume 
and intensity during the return to play process.  

 

Guidelines for Progression 

• Student-athlete proceeds to the next level only if asymptomatic at the current level.  
• If symptoms occur during activity: Stop activity, rest for 24 hours and begin at the previous level 

that did not produce symptoms.  
• Levels of Progression 

o Phase 1: Light aerobic exercise 
 20 minutes stationary bike at 70% maximum heart rate 

o Phase 2: Moderate aerobic exercise 
 Interval bike ride: 10 sets of 30 second sprints/30 seconds recovery 
 Body weight circuit: Squats/Push-Ups/Sit-Ups: Three sets of 20 each 

o Phase 3: Sport-Specific Exercises 
 60 yard shuttle run 
 Plyometric Circuit (examples): 10 yard bounding/10 medicine ball throw/10 vertical 

jumps; three times each 
 15 minutes of sports-specific non-contact drills 

o Phase 4: Full-contact practice 
 Limited participation in full contact practice and monitoring of symptoms  

o Phase 5: Full Participation in Practice 
 

Return to Ride (RTR) 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

The gradual exertion return to ride process is designed to allow for a gradual increase in exercise volume 
and intensity during the return to ride process.  

 

Guidelines for Progression 

• Student-athlete proceeds to the next level only if asymptomatic at the current level.  
• If symptoms occur during activity: Stop activity, rest for 24 hours and begin at the previous level 

that did not produce symptoms.  
• Due to the nature of the aerobic and anaerobic demands of the sport of equestrian, each phase 

increases in the demand of those systems on the body during sport-specific controlled activity.  
• Levels of Progression 

o Phase 1 
 Mount/Dismount, lead for five minutes (Complete two times) 
 Mount, walk undersaddle for 15 minutes 
 Dismount and put the horse away 

o Phase 2 
 Mount and walk for 10 minutes 
 Trot two laps around the indoor arena 
 Walk five minutes 
 Trot two laps around the indoor arena 
 Walk for 10 minutes  
 Dismount and put the horse away 

o Phase 3 
 Mount and walk for 10 minutes 
 Trot four laps around the indoor arena 
     Walk two minutes 
 Trot four laps around the indoor arena 
 Walk for 10 minutes  
 Dismount and put the horse away 

o Phase 4 
 Mount and walk for 10 minutes 
 Trot four laps around the indoor arena 
      Walk two minutes 
 Trot four laps around the indoor arena 
 Walk for one minute 
 Canter a lap in each direction 
 Walk for 10 minutes 
 Dismount and put the horse away 

o Phase 5 
 Mount and walk for 10 minutes 
 Work at the trot and canter for 15 minutes with periods of walk 
 Finish with walk for 10 minutes  
 Dismount and put the horse away 

o Phase 6 
 Repeat Phase 5  
 Add jumping small obstacles  

o Phase 7 
 Full participation in practice or lesson without restrictions  

 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

 

Return to Play/Return to Ride Combination 

In the case of students who are both considered student-athletes for both an NCAA team and a 
competitive equestrian team, they will complete a combination of the Return to Play and Return to Ride 
protocols. Completion of this combination protocol will be considered sufficient in allowing them to return to 
both activities. This protocol is a guideline and can be adjusted by the Director of Sports Medicine and 
designated Team Physician to best accommodate the recovery of the student-athlete and their 
participation schedules.  

• Student-athlete proceeds to the next level only if asymptomatic at the current level.  
• If symptoms occur during activity: Stop activity, rest for 24 hours and begin at the previous level 

that did not produce symptoms.  
• Levels of Progression 

o Phase 1: Return to Ride Phase 1 
 Mount/Dismount/Lead in Hand/Walk Undersaddle 
 Mount/Dismount, lead for five minutes (Complete two times) 
 Mount, walk undersaddle for 15 minutes 
 Dismount and put the horse away 

o Phase 2: Return to Play Phase 2 
      Interval bike ride: 10 sets of 30 second sprints/30 seconds recovery 
     Body weight circuit: Squats/Push-Ups/Sit-Ups: Three sets of 20 each 

o Phase 3: Return to Play Phase 3 
 60 yard shuttle run 
 Plyometric Circuit (examples): 10 yard bounding/10 medicine ball throw/10 vertical 

jumps; three times each 
 15 minutes of sports-specific non-contact drills 

o Phase 4: Return to Ride Phase 5 
 Mount and walk for 10 minutes 
 Work at the trot and canter for 15 minutes with periods of walk 
 Finish with walk for 10 minutes  
 Dismount and put the horse away 

o Phase 5: Return to Play Phase 5 
 Full Participation in Practice 

o Phase 6: Return to Ride Phase 6 
 Repeat Phase 5 

• Mount and walk for 10 minutes 
• Work at the trot and canter for 15 minutes with periods of walk 
• Finish with walk for 10 minutes  
• Dismount and put the horse away 

 Add jumping small obstacles  
o Phase 7: Return to Ride Phase 7 

 Full participation in practice or lesson without restrictions  
 

No student-athlete will be allowed to return to full activity or competition until they are 
asymptomatic in limited, controlled, and full-contact activities. Any student-athlete diagnosed 
with a concussion must be medically cleared by a Team Physician before returning to 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
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competition. This includes any student-athlete who arrives to SWEET BRIAR COLLEGE with a 
pre-existing concussion, and/or have continuing symptoms from a resolved concussion.  

 

The Return-to-Learn, Return-to-Play, Return-to-Ride and Return-to-Play/Return-to-Ride Combination 
protocols are different and can be completed at different times. Return-to-Learn will be initiated before 
Return-to-Play, Return-to-Ride and Return-to-Play/Return-to-Ride Combination. They can also occur 
simultaneously. For student-athletes who also participating in the Equestrian Program, they must complete 
the Return-to-Play/Return-to-Ride Combination protocol. It is important to note that the listed progression 
timelines can take place over a period of days, weeks, or months. It could potential result in medical 
disqualification from participation in SWEET BRIAR COLLEGE Athletics and Equestrian for a season or 
indefinitely.  

 

Athletes with Multiple Concussions 

The SWEET BRIAR COLLEGE Athletic Training Staff and team physicians have the right to review all 
student-athlete’s medical history, both previous and current, and reserve the right to withhold from 
participating in college sponsored athletic events (i.e., practices, game, weight-lifting, conditioning, shows, 
competitions, travel, etc).  

 

Travel with Athletes Recovering from a Concussion 

The ability of a student-athlete recovering from a concussion to travel to athletic or equine competitions or 
trainings with their team is at the discretion of the SWEET BRIAR COLLEGE Athletic Training and Sports 
Medicine Staff. The SWEET BRIAR COLLEGE Athletic Training Staff and team physicians have the right to 
forbid travel for a student-athlete recovering from a concussion until they are cleared for full athletic, 
equine and academic participation.  

 

Returning to Work 

In the case that a student-athlete sustains a concussion, they will be recommended to refrain from work (on 
or off campus) while in the initial phases of recovery. Once a student-athlete has completed Return to 
Learn Phase 4 (RTL 4), they can consider returning to work. If a student-athlete is on work-study at the 
College, a member of the Human Resources team will be put on the student-athlete’s release and notified 
of the student-athlete’s injury as well as when they are permitted to return to work.  

 

Returning to Drive 

When a student-athlete sustains a concussion, they be recommended to refrain from driving a motorized 
vehicle. This includes but it not limited to a car, trunk, motorcycle, motorized scooter, gator, golf cart. They 
will also be recommended to refrain from riding in a motorized vehicle driven by another person, unless in 



Implementation of a Novel Return-to-Ride Concussion Management Policy for Collegiate Hunter/Jumper Equestrian Athletes 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 3 – Issue 2 – June 2020  

the case of an emergency. Once a student-athlete completes Return to Ride or Return to Play Day 3 (RTR 3 
or RTP 3), they consider returning to driving and riding in motorized vehicles.  

 

Annual Review 

In accordance with the NCAA, this policy will be reviewed annually by the institution’s athletic health care 
administrator (AHCA). The AHCA is a designated health provider within the athletic department who 
oversees the administration and delivery of healthcare for the institution’s student-athletes.  

 


