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

LEXINGTON, Ky. (Nov. 4, 2022) — This weekend, Keeneland is hosting the Breeders’ Cup World Championships for the third time in the race’s 38-year history. While the races are an exciting time for many, onlookers in Kentucky and around the world don’t often consider how much risk jockeys face in their profession every day, all year around.

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 there are any jockeys who 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 a lot 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, and that sometimes forces us out of the saddle for extended periods of time when those injuries accumulate.”

Jockeys ride 12 months out of the year, and these “forced vacations” present a number of physical, 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 absolutely crucial for athletes of all kinds — including jockeys — to have access to 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.

“Unfortunately, the horse racing world has fallen behind in terms of creating and enforcing policy that protects the health of jockeys,” said Michaela Keener, research administrative coordinator with the Equestrian Athlete Initiative through the SMRI. “The Horseracing Integrity and Safety Act just went into effect on July 1 of this year — and part of that includes a basic requirement for jockeys to receive yearly concussion tests and tests as-needed so that they are able to return to riding safely. This is already an enforced practice in other sports, so it has been a critical need in this community prior to this act.”

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

In most sports, athletic trainers assess concussions by 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 consists of asking 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 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 prior to a concussion, how is it going to 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 a one-size-fits-all, and the majority of concussions in the jockey community go undiagnosed.

Keener, who is also a rehabilitation and health sciences doctoral student in 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 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, both while in their riding position.

“We named the test after James because he has been a huge help in developing this with us,” Tumlin said. “We can always count on him to be upfront and honest with us about what is working and what isn’t — so this test really is named in honor of James’ contribution to our protocol. We truly couldn’t have developed this without him.”

The two researchers have been working day-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.

“Back in 2020, Keeneland welcomed us to come work at the meet, which is when we began collecting data,” Keener said. “We asked jockeys to squat in their position and hold it for two minutes while balancing on a BOSU ball pre- and post-race day to see how their balance and position changes across the workday. Then, a year later, we added the reaction time component, which was suggested by the jockeys to simulate how they have to make quick decisions during a race.”

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, isn’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 found that they needed to create a new setup all together 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 creating 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 is able to 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 truly shows us that their riding position is where they are most comfortable, and where we should be assessing them for head injuries.”

In 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.

“We are truly at the forefront of developing an affordable, portable and engaging test where the jockeys actually want to come and test with us,” Keener said. “Because underreporting is a huge issue in many sports — not just horse racing.”

For jockeys, a lot is at stake if they’re unable to 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, yes, but also 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 so many great helpers who have helped develop this test and collect data with us; many of us come from very different research backgrounds which makes us a great, cohesive team.”

One undergraduate research assistant, Gavin Vice, a student in UK College of Engineering, has been a huge part of the process in developing the Graham Test and assisting in data collection.

“One of the coolest things about the Graham Test is that it really will quantify a jockey’s reaction time and balance,” Vice said. “With the BESS test, it is completely subjective — a human is telling you whether you are performing at the standard. With the Graham Test, you must break the barrier or hit the lights a certain number of times in order to pass and maintain your balance, and the technology will tell you whether or not you’re passing. So, it’s more standardized and specific — hopefully allowing for more precise and accurate concussion diagnoses.”

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.

“This test is going to be able to tell us when something is wrong, and it’s going to stop us from heading out and potentially making that injury worse,” Graham said. “It will ultimately help us prolong our careers, which is huge. Bottom line is, I love this test. And I am so grateful that Kim and Michaela come out here each meet to help us jockeys.”

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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’m able to help them advocate for their own health and safety, which they completely deserve as much as other athletes do. And so if I’m able to 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 which 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.”