When Rajiv Maragh mounts Irish War Cry at the Kentucky Derby on Saturday, he will cap a comeback from a spill that left him with broken ribs, a broken back and a collapsed lung, injuries that kept him out of racing for 16 months.
Maragh was riding Yourcreditisgood at Belmont Park on July 2015 when another horse veered in his path. The two horses' heels clipped and Yourcreditisgood fell on top of Maragh.
“I knew I was pretty badly injured. When I fell, the horse fell on top of my back,” said Maragh, 31. “I was in a lot of pain, I couldn’t breathe. Afterwards, I found out it was because I had a collapsed lung. I felt like I was fighting for my life.”
Maragh gained prominence when he swept four Breeders’ Cup races from 2011-2013, but his 13-year racing career has been marred by severe injuries. Before the 2015 accident, he fractured his spine twice, broke his arm, fractured his pelvis and collarbone and had a severe concussion that resulted in a 2-week memory loss.
“It was a rollercoaster, the last few years. I feel like I got everything out of the way,” Maragh said of his injuries.
Falling off a horse that’s running at 40 mph is a gamble jockeys take every race. Perched on top of a large, heavy and fast-moving animal, jockeys are completely exposed, with very little equipment to cushion a collision or a fall. Jockeys' Guild, the union that represents the riders, has been working to make the sport safer by collecting information about injuries and spearheading a concussion management protocol.
In 2012, the Jockey’s Guild launched a Jockey Injury Database aimed at collecting where, when and how injuries occurred; what type of equipment riders were wearing; and the nature and severity of the injuries.
The data will be analyzed for trends and used to help choose rider safety equipment and racetrack surface types and address other safety concerns. There is no cost to tracks to participate in the project and the data entry is not mandatory. Not all tracks are on board, so the guild still does the bulk of data collection.
“Any time there’s a horse that doesn’t finish, we get an alert, we look at the race chart and contact the rider and see what happened,” said Jeff Johnston, the guild's regional manager. “I think all racetracks appreciate we’re doing this. We’re still progressing, but it certainly has been a lot more work on us and we hope to get more industry support.”
In the U.S., there is no single governing body that oversees racing, and that’s been an obstacle to achieving progress in the area of jockey safety, experts say. It’s especially evident in how jockeys' concussions are handled, they said.
Concussions typically cause a headache, mental fuzziness, memory loss, some confusion, lightheadedness and balance problems. Many symptoms are short lived, but often a rider may not know they had a concussion and they get back on a horse to run another race.
“From my experience having a concussion, you don’t really know you have a concussion — when you have a concussion, you think you’re in a fine shape,” Maragh said. “Even football players or anyone at the moment think they’re fine; they don’t know what happened.
"If you feel like you’re fine and you’re a jockey you’re going to ride a race," he continued. "One way you’re going to make money is ride a race, you’re not going to stop."
Unlike the major U.S. sports leagues or international horse racing authorities in the U.K. or Ireland, U.S. racing has yet to implement a standard for diagnosing and managing concussions in jockeys.
According to the Jockey Injury Database, 14 percent of injuries in riders from 2012 to 2017 were concussions. The database, however, isn’t comprehensive and there is also no way to know how many retired jockeys could be suffering the effects of repeated concussions.
But with a recent spotlight on sports-related concussions and the deaths of high-profile athletes who developed chronic traumatic encephalopathy, a brain disease caused by repeated head trauma, the guild recognized that the concussion management plan has been missing from horse racing.
In June 2016, the guild started a three-year pilot study designed to evolve into the first comprehensive concussion management protocol for jockeys in the U.S. The union worked in partnership with the University of Kentucky College of Health Sciences, thoroughbred tracks in Kentucky, National Thoroughbred Racing Association and other organizations.
As part of the study, a specially trained health care provider assesses a jockey’s physical and cognitive function using the Sports Concussion Assessment Tool test. The baseline score from the test — which looks at coordination and memory and orientation — can then be used to compare against a jockey's responses after a fall to determine whether he sustained a concussion.
“You can’t fix it and you can’t prevent [concussions], but what you can do is to try to manage it better,” said Carl Mattacola, associate dean of academic and faculty affairs at the College of Health Sciences at the University of Kentucky who oversees the pilot study at all of Kentucky’s thoroughbred racetracks, including Keeneland, Churchill Downs, Turfway Park and Kentucky Downs. “What we’re trying to do is provide health care that is at a similar level as the other professional sports.”
"HOOF PRINT ON MY SKULL"
A jockey who races with a concussion risks multiplying its severity and its long-term consequences. Riding with a concussion also endangers the other jockeys in the race and the horses because the rider's decision-making and reaction time can be compromised.
When Maragh had a severe concussion about a decade ago while racing at Belmont Park in New York, he lost consciousness for about five minutes after he fell and a horse stepped on his head. He woke up in excruciating pain when paramedics were loading him into an ambulance.
“At first, I thought my legs were broken; both legs felt like the femur had snapped. I was telling the paramedic, my legs are snapped in two, they are hanging off,” Maragh said. “That was the message from the brain, they felt like they were snapped in two. I passed out and when I got to the hospital, I woke up with the worst headache, I was telling them to check my brain, do a CT scan. There was a hoof print on my skull on the scan.”
Maragh spent several days in the hospital and his then-girlfriend came from Florida to take care of him.
“I had bad headaches for two weeks. Two weeks went by and I only remember two hours of the two weeks after I left the hospital,” Maragh said. “Im sure I had to get cleared to ride again after but I don’t remember anything."
Maragh said it was his only diagnosed concussion during his professional career. His first concussion happened when he was 12 years old in his native Jamaica.
That's when he snuck into a racetrack where his dad was a jockey and pretended he was an apprentice rider, wearing his dad’s gear. But when he got on the track, the horse threw him off and Maragh hit his head. When he got home he began vomiting and passing out. He spent two days in the hospital and had amnesia.
U.S. RACING PLAYING CATCH-UP
Since 2004, all jockeys riding on British Horse Racing Authority tracks have been required to undergo baseline neuropsychological testing annually in order to be licensed. While the concussion protocol is not mandatory for jockeys in the U.S., tracks like Keeneland are moving to change that.
Dr. Barry Schumer, Keeneland’s medical director, has been advocating for a standarized approach to jockeys' medical care. Starting in October, he said, all jockeys have to have their baseline concussion testing performed before they compete at the track. He hopes that move, as well as sharing information from the concussion pilot study at industry meetings and conferences, will get other tracks to follow along.
Schumer said smaller racetracks may be more reluctant to get on board because of costs associated with having a medical professional conduct the baseline for concussions. Other tracks simply want to do things their way, he said. He’s hopeful, however, that more tracks and more jockeys continue to recognize the danger of untreated concussions.
“Each jockey is an independent contractor… their job is as risky as in any sport, if not riskier,” Schumer said. “When they get injured, they can’t ride and when they can’t ride they can’t get paid. They are resistant to health mandates because they would rather get back on the horse with a headache than miss a paycheck. Part of this whole process is educating the riders about the importance of all this.”
Mattacola said he’s made presentations to jockeys about the concussion protocol, explaining that most high schools and colleges in Kentucky have medical staff that includes a physician and an athletic trainer who provide care if someone should get injured, including concussions, so that they don’t suffer long-term complications.
“We told jockeys, our role is not to hold you out, our role is to to protect you if we think there’s something serious going on,” Mattacola said. “The role of the physician or health care provider is to get you out there to race safely."
Racing this spring, with his sights fixed on the top prize at Churchill Downs, Maragh said he tries not to dwell on the 2015 spill that left him wearing a body brace and bedridden for weeks, or on the potential health effects down the line from his injuries or undiagnosed concussions he may have had.
"I choose to be a jockey and there's a always a risk of danger and injury and you can't let that blur your vision or riding," said Maragh, who has won more than 70 races since November. "If that's going to be the case, better off not riding. Anything that happens to me on the racetrack I take it as it comes. I'm just happy to be out there, I don't have any fear at all."