Home » UK SMRI researchers protecting jockey livelihoods with ‘the Graham Test’

UK SMRI researchers protecting jockey livelihoods with ‘the Graham Test’

Jockey concussion protocol was developed by researchers with the Sports Medicine Research Institute and the Equestrian Athlete Initiative Photo by Arden Barnes | UKPhoto

LEXINGTON, Ky. — Jockeys, who weigh around 110 pounds and stand anywhere between 4 feet, 10 inches and 5 feet, 9 inches, can be thrown from their horse in an instant — especially as they perch on their toes over their horse at speeds up to 40 miles per hour.

“I don’t know if any jockeys haven’t ridden with a cracked or broken bone in their body before,” said well-seasoned Irish jockey James Graham. “I know we all have. We have a ton of physical injuries, from back, face, arms, hands, knees, ankles — you name it. And we want to ride. We’re resilient. So, many of us just push through.”

The most severe injuries that jockeys face are head injuries. In fact, horse racing is the most dangerous sport for concussions, even surpassing American football. Yet, horse racing is behind many other professional sports in terms of caring for and protecting against injuries like concussions.

“I’ve had my head rattled around quite a bit the last few years I’ve been racing,” said English jockey Jack Gilligan. “And many of my injuries went undiagnosed, probably just due to not being educated about them. Us jockeys don’t like to admit we’re injured so we can keep riding, which sometimes forces us out of the saddle for extended periods when those injuries accumulate.”

Jockeys ride 12 months out of the year, and these “forced vacations” present several physical and emotional and financial challenges.

“We lose a lot of business if we’re forced to be out of work for 12-18 months, which isn’t ideal for most of us who have families.,” said Peruvian jockey Rafael Bejarano. “Every day in this career is a competition.”

If not properly assessed and cared for, repeat concussions can be detrimental to the career and life of any athlete. Therefore, it is crucial for athletes of all kinds — including jockeys — to have adequate athletic training and sports medicine care. Researchers at the University of Kentucky Sports Medicine Research Institute (SMRI) recognize this need, especially in the local horse racing community, and are actively working toward developing research to inform and support policy.

Thankfully, the horse racing world is now enforcing these tests — but the next challenge is ensuring that the established tests are working for this unique demographic.

Athletic trainers in most sports assess concussions using the Balance Error Scoring System (BESS) test, which measures the postural stability of an athlete after a mild brain injury like a concussion. The test asks the athlete to stand in three positions: with their feet together, with their feet tandem and then on one foot. These three positions are performed on a stable surface, like the ground, and then on an unstable surface, like a foam pad, with their eyes closed.

The BESS test is a common protocol used in most athletics because it’s quick and easy to conduct on the sidelines. But for many jockeys, who spend so much time crouching and straddling a horse, these positions feel unnatural, and they can struggle to maintain balance while perfectly healthy.

“So we thought if a jockey is doing poorly on the BESS before a concussion, how will it accurately diagnose a concussion when they fall or get hit by a horse in the gates?” Keener said.

Essentially, the BESS test and other existing concussion protocols aren’t one-size-fits-all, and most concussions in the jockey community go undiagnosed.

Keener, who is also a rehabilitation and health sciences doctoral student at the UK College of Health Sciences, and Kimberly Tumlin, Ph.D., assistant professor in the UK College of Public Health and research director of the Equestrian Athlete Initiative, have been around horses all their lives. Keener and Tumlin, who were both brought to Kentucky because of their love of horses and research, have developed a groundbreaking jockey-specific concussion test to close the gap and fulfill some of these needs in the jockey community.

They call it “the Graham Test,” affectionately named after the aforementioned jockey James Graham. The test involves asking the jockeys to perform a reaction-time test while balancing on an upside-down BOSU ball and then again on a stable surface while in their riding position.

The two researchers have been working day-in, in and day out with Graham, Gilligan and other jockeys here in Lexington, collecting data and asking them for their feedback during the past five meets at Keeneland.

In the SMRI, researchers use a large reaction time testing machine called the Dynavision for various sports research. The Dynavision is an interactive light board used by athletes worldwide to assess performance factors such as awareness, balance and motor skills — which can also serve as a test for concussions. However, when Keener and Tumlin wanted to add the reaction-time component to their test and took the machine out to the track, they realized that this piece of equipment, while helpful for many other athletes, wasn’t suitable for jockeys.

“We found that the Dynavision just isn’t applicable out in the field,” Tumlin said. “First, our jockey population travels a lot, and we can’t move this big machine track to track.  And the machine is designed for users to look up, which isn’t natural for jockeys while in their racing position. So, we worked closely with the jockeys who gave us some valuable feedback on what else is working for them and what isn’t, in terms of actually using the device.”

Keener and Tumlin needed to create a new setup to fit the jockeys’ needs. And they wanted to do it in a way that included the jockey community in the conversation. That’s what brought them to create this unique set-up for the Graham Test.

“We got a lot of great feedback from the jockeys when using the Dynavision,” Keener said. “When we asked them to use it while in their riding position balancing on the BOSU ball, we were able to see which lights they didn’t need and where to place lights to be relevant to their occupational demands.”

They found that the Graham Test can assess the jockeys accurately and in a way that takes advantage of their specific physical strengths.

“We actually found that the jockeys, when in their racing position on the BOSU ball, have a faster reaction time,” Keener said. “Their accuracy goes down a small amount, but this shows us that their riding position is where they are most comfortable and where we should assess them for head injuries.”

In the spring of 2022, Keener and Tumlin brought the first model of the Graham Test to Keeneland. After working closely with the jockeys to refine it, they’ve now created a more definitive version of the device, which they collected data on during this year’s fall meet.

For jockeys, a lot is at stake if they cannot ride.

“Unlike the NFL, or other professional sports, jockeys aren’t on a salary — they work for themselves, and they don’t get paid if they don’t ride,” Keener said. “So, we want to protect their health and get them back to riding as safely and quickly as we can. And, hopefully, we will be able to set an example and the Graham Test could become the popular protocol for testing concussions in this industry that will let them do so.”

Tumlin says without Keener, none of this would have been possible.

“The development of this groundbreaking test was really with the help of Michaela’s efforts and her background in biomechanics,” Tumlin said. “She is so passionate about what she does, working with her is incredible, as are our undergraduate student researchers. We have had many great helpers who helped develop this test and collect data with us; many of us come from very different research backgrounds, making us a great, cohesive team.”

Graham says the new test is much better and more comfortable than other standard concussion tests he has tried during his 30-year horse racing career.

*****

Inspiring jockeys to become advocates for their health has been one of the most rewarding parts of this project for Tumlin, who is looking at this from a public health background.

“Because the horse racing world has been behind other sports in enforcing adequate jockey safety protocols, many jockeys weren’t able to advocate for their own health,” Tumlin said. “So, I can help them advocate for their own health and safety, which they deserve as much as other athletes do. And so if I can do this, I know I’m doing a good job in my research.”

One of the key factors in developing this research is the symbiotic relationship that the University of Kentucky and Keeneland have created.

“Our extended partnership with Keeneland has been vital to promoting rider safety,” Tumlin said. “We are very lucky to get to come back each meet and further develop this research, and so thankful for Keeneland’s eagerness to invite us back each meet — this allows us to continue doing what we love and to continue helping the jockey community.”

Keener said that conducting this kind of research for a living has been a dream come true, but it’s become about more than just research. They have developed a unique relationship that will support their work for years to come.

“The jockeys have really welcomed us into their family,” Keener said. “What we do at the meet twice a year is exhausting, but every time Keeneland asks us to come back for the next meet, all of us get so excited to reunite and see each other again, catch up and continue working toward our goals together.”

Graham hopes that his namesake will continue to help jockeys for generations to come.

“The work they are doing here is incredibly important,” Graham said. “I’ve seen so many injuries during my career — some of us are literally pieced together after all our injuries. But this is one huge step in the right direction to ensuring my community is safer and healthier than ever, and I’m so grateful to see it come to fruition for the sake of jockeys here in Kentucky and beyond.”

Click here for more Kentucky business news.