Dr. Naomi Betesh Launches Effort to Treat and Educate Riders - Saddle Up: A Focus On Equestrian Injury Rehabilitation

August 5, 2013
Dr. Naomi Betesh
Dr. Naomi Betesh
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Dr. Naomi Betesh Launches Effort to Treat and Educate Riders
Saddle Up: A Focus On Equestrian Injury Rehabilitation

One of the few things that precedes my love of medicine has always been my love for riding. As a teen, I spent weekends at my neighbor’s standardbred horse racing farm where I truly enjoyed the seemingly mundane chores of feeding the horses and cleaning the stalls. Occasionally, if I was really lucky, I would be allowed to ride the one horse on the property that could be ridden. I hacked in a Western saddle and was the happiest girl in the world.
Many years later, on vacation, I took my children horseback riding in Colorado. My youngest daughter immediately fell in love, just as I did at her age, and when we returned home riding became her weekend activity. The barn was only 20 minutes from our home and every weekend I sat through every lesson watching enviously. After watching only a few of her lessons, I decided to take lessons too. That was almost 2 years ago. Since then I have been schooling in hunter/ jumper lessons since and recently started dressage.
On January 15, 2013, our life was changed forever when we acquired a horse we fell in love with that was abandoned at the barn by another family. I was surprised and elated to find out that her show name was Jersey Girl. My mother reminded me of the times when I was younger and begged her for a horse. I now fulfilled every little girl’s dream and my own. I also convinced my husband to take a few lessons by telling him it was silly to tell people you owned a horse but did not know how to ride. He has been hooked since.
Many times around the barn, other riders complained of chronic aches and pains. Other times, I would not see the familiar faces for weeks at a time. When I would ask them where they had been, they would tell me that their back, shoulder or hip pain prevented them from riding for a while. I too, during my riding irritated an old shoulder injury and had to take a little time off. In my office I have treated many equestrians and often no matter how severe the injury, the first question they asked was when can I ride again? I decided that as a clinician I should make an effort to educate and help these fellow riders. From here, Saddle Up: A Focus On Equestrian Injury Rehabilitation, was developed with the goal of getting equestrians back in the saddle after injury and trying to prevent injury.
Common Injuries
Back pain is one of the most common complaints among riders and studies have shown a high incidence of back pain in riders. In fact, 30% of all riding related injuries were to the lumbar spine. One of the most important structures in the rider’s body is the spine. While riding, the spine is responsible for absorbing the compressive forces generated by the horse.
The incidence of lumbar spine injuries can most often be attributed to improper posture coupled with unstable core muscles. When the core muscles are weak or not functioning optimally the rider tends to hunch forward causing the spine to be in a flexed position. While in this position, the normal forces absorbed the intervertebral discs becomes exaggerated and can lead to disc injuries. For riders, herniated discs often occur over time as a result of the repetitive concussive forces generated by the horse are absorbed by the discs.
The cervical spine is also another common area of injury due to repetitive strain and overuse. This is usually a result of forces transmitted from contact with the horse’s mouth. Repetitive strain can also lead to tendonitis in various muscles such as the biceps or injuries such as carpal tunnel.
Another common injury I see in my practice among riders is Sacral dysfunction. The sacroiliac joint is responsible for connecting the spine to the pelvis and allows it to remain stable. It is common for riders to have one side that is stronger than the other and this difference in strength can lead to Sacral dysfunction, which can cause one leg to seem longer than the other. If the stirrups are not adjusted for a leg length discrepancy, the rider may tend to shift more weight to the side of the shorter leg causing an unbalanced seat. This lack of balance often can cause accelerated wear on the hips and sacroiliac joint. Since pelvic alignment is a crucial component of balance in the saddle, it is important for riders to address side to side strength differences and any limitation in pelvic mobility.
A key element in avoiding many musculoskeletal injuries is proper core stabilization and training. Most often, this type of training can be done with a physical therapist with knowledge of riding. The therapist will most often set a regimen of workouts designed to strengthen the core muscles thus leading to a reduced risk of injury. For those who are already experiencing pain or other symptoms, it is important to speak to a medical professional as these injuries can worsen if ignored.
As we know, riding is an activity not relegated to one singular age group and many continue to ride into the 60’s and 70’s. With the aging rider, there are several factors unrelated to riding that can lead to injury. Osteoarthritis of the hip, knee and shoulder joints and spinal stenosis are prevalent injuries among this age group. The risk of fracture from any kind of fall, whether on the ground or while on the horse, also increases. Fortunately, with advances in modern medicine, surgical techniques and focused rehabilitation therapy under the supervision of a physician who understands riding can prevent the aging rider from spending extended time away from riding.
Avoiding Medical Care
Sadly, it is all too common for riders to forego seeking medical advice at the onset of pain as most fear the diagnosis will force them to spend time away from doing what they love. This is an all too ironic mindset considering what great care we take of our horses but often not ourselves.
This was exemplified by renowned Grand Prix Dressage Rider, Pam Goodrich. Pam underwent a hip replacement surgery as a result of degenerative arthritis. Pam had been suffering this pain for 15 years but had attempted to stave off any form of surgery as long as possible. It was only when her pain began affecting her ability to compete that she decided to undergo surgery. However, after surgery Pam returned to competition with no weakness or deficits and went on to win another Grand Prix, this time without being in pain. Pam often said she wished she had not waited so long to have this injury properly addressed.
Saddle Up: A Focus on Equestrian Injury Rehabilitation
My goal with this Saddle Up is not only to treat riders suffering from chronic injuries, but to educate them as well. It is also to help people return to riding after an injury or surgery. Whether you are a weekend rider or an avid competitor there is always the opportunity to improve your riding and avoid injury. With this program I want to be able to afford riders the opportunity to continue doing what they love without sacrificing their physical health.
For those who are experiencing pain that is preventing them from enjoying riding, education is key. Finding a physician who is familiar with your needs and lifestyle is one of the most important factors when seeking care. I have been fortunate enough to treat many talented riders and there is no greater satisfaction for me than seeing them get back on the horse after an injury.
Dr. Naomi Betesh is board certified in Pain Management and Physical Medicine and Rehabilitation and is part of the team of specialists at Union County Orthopedic Group. Dr Betesh completed her residency training in Physical Medicine and Rehabilitation at Mount Sinai School of Medicine where she was elected and served as Chief Resident. She then, completed a fellowship in Pain Management in the department of Anesthesiology at Mount Sinai School of Medicine. Dr Betesh’s practice focuses on a multidisciplinary approach to pain including interventional procedures and rehabilitation medicine.
If you, or someone you love, is suffering from pain that is preventing them from riding, or to contact her about this program please call 732.388.1761 or visit