Many orthopaedic surgeons cover team sports such as football and basketball or individual sports such as skiing and track events. For Tandy R. Freeman, MD, FAAOS, however, sports medicine means covering a different kind of event—bull riding and rodeo.

On any given weekend, Dr. Freeman can be found in a Dallas rodeo arena not far from his athletes. They are a unique athletic group that requires a different approach to medical care. According to Dr. Freeman, “Rodeo athletes are different than athletes in other sports primarily because of the demands that are placed on them. You’re competing with or against, in many cases, an animal that may be 10 times your size in terms of weight. … Certainly, the forces that are involved are significantly different in rodeo than they are in other sports.”

Another point of differentiation is that rodeo athletes and bull riders rarely have a guaranteed contract, as these sports still largely require participants to pay an entry fee. “You’re placing your money up against other athletes, and you only get paid if you win,” Dr. Freeman noted. “That makes [rodeo athletes] oftentimes more willing to compete when they have injuries that you prefer they didn’t compete with.”

Rodeo culture
Dr. Freeman has taken care of athletes from other team sports, including football, hockey, and soccer, and he was the team physician for the Dallas Mavericks for 5 years. “There’s a different culture in rodeo than there is in other sports,” he acknowledged.

For instance, in bull riding, the bulls themselves are considered athletes. “They have a world champion bull at the end of each season that’s picked based on its athletic ability and how well he performs,” Dr. Freeman explained. “When a bull rider or a [bronco or ‘bronc’] rider is competing, half of their score is based on the performance of the animal athlete that they’re competing against—so you want a bull or bronc that’s going to perform [and] give you a challenge, because without that challenge you can’t win.” The rodeo athlete’s score is compared with the animal athlete’s score, so “the animal athlete’s really critical to how well you do,” he added.

Dr. Freeman began treating rodeo athletes almost by chance. During his orthopaedic residency, he completed a rotation with J. Pat Evans, MD, one of the first surgeons in Texas to specialize in sports medicine and the team physician for both the Dallas Mavericks and the Dallas Cowboys. One Cowboys player at the time, famed running back Walt Garrison, was also a rodeo cowboy who would bring his injured rodeo buddies to see Dr. Evans. Eventually, Dr. Evans started Justin Sports Medicine, the first organized sports medicine program for rodeo. As he was preparing to retire, Dr. Evans asked Dr. Freeman, who was coming out of training, to join him in taking care of rodeo athletes. Drs. Evans and Freeman and Walt Garrison are all in the Texas Cowboy Hall of Fame.

Caring for the rodeo athlete
Shoulder instability is a common problem in bull riding, along with core muscle and hip adductor injuries. However, “We also see the types of things you’d see in a motor vehicle accident or fall from a height. We see cervical spine fractures, lumbar spine fractures, abdominal and chest injuries,” Dr. Freeman said. “If there’s an injury to the human body that is the result of trauma, we see it in rodeo and bull riding.”

Dr. Freeman completed 3 years of general surgery training, which has been particularly helpful in evaluating blunt trauma. About one in 15 bull rides results in injury, with concussions among the most common. In many ways, evaluation and treatment of head injuries are similar between the Professional Bull Riders organization and the National Football League (NFL).

“We initiated a concussion protocol back in 2012, and part of what happens in bull riding and rodeo is that … there are events where guys have to get on more than one animal a night,” Dr. Freeman explained. “If you have an athlete who gets hurt early in the event, … you have to be able to evaluate him. We pretty much have a rule that if you sustain a concussion, you’re out. You don’t go back in.”

Pre-competition testing on all bull riders is also part of the program. Athletes undergo cognitive function testing, balance testing, and neurological examination to establish a baseline. “They have to retest after injury and have to get back to their baseline to be able to compete,” Dr. Freeman said. In addition to testing, “We spend a lot of time educating them to try to get them to understand the risks of trying to go back before they’ve had a chance to heal,” he added.

In other ways, evaluating bull riders for head injury is different than other athletes on a field competing in a team sport. “Where we have an advantage over, say, a football game is we have one athlete who’s competing at a time,” Dr. Freeman said. “We have folks [who] are at the arena, basically within feet of the athlete. And we can see what happens to them, and we can see their initial response to whatever’s going on in the arena. So when an athlete comes off of an animal, if there’s anything that looks like it may constitute a concussion, then we’re there to actually see it before the athlete can even get up off the ground or walk out of the arena.”

Building a sense of trust is important in caring for rodeo athletes, given that they pay to compete and are eager to get back in the arena. “The athletes have learned that our concern is about them, their health and well-being, and not about holding them out of competition,” Dr. Freeman said. “We’re there to make sure that when they do go back to competition, it’s the right time.”

He added, “In rodeo, you know, one of the things they talk about is this idea about ‘cowboy up.’ Basically, you don’t admit that you’re hurt. You just get up and dust yourself off, and you get right back on, and you don’t complain about it, and that’s something we had to overcome over time.”

As with NFL players, multiple head injuries in rodeo athletes can have long-term effects. “I have athletes that have come to me to say, you know, I’m having problems with anger. I’m having problems with depression. … And it’s clearly, in those cases, related to their history of head injuries,” Dr. Freeman said. His practice also consults with additional specialists to manage these injuries. “I’m fortunate in that I’ve got some folks [whose] primary specialty is taking care of athletes who’ve had head trauma,” he said.

Dr. Freeman grew up in Texas but did not start going to rodeos until high school—because there were dances afterward. “At that point, the dance was more important,” he recalled. However, he added, “Every now and then you just want to get in there and see what it’s actually like.” He has never ridden a bull himself but has been to steer wrestling school. At this point, he will not rope because of the high risk of thumb injuries.

His unique perspective allows him to give advice to parents of aspiring bull riders. To these parents, Dr. Freeman advises, “Make sure, one, they have the proper equipment, and two, they have somebody that teaches them how to do it. Then be sure that they’re doing it where they’ve got people there to take care of them if something happens.”

Dr. Freeman knows that his athletes are an unusual breed. “The thing about rodeo cowboys and about people [who] are involved in that lifestyle is that they are gonna do it because they love it.”

Stuart J. Fischer, MD, FAAOS, is an orthopaedic surgeon in private practice in Watchung, New Jersey. He also serves on the AAOS Membership Council, Board of Councilors, and Committee on Evidence-Based Quality and Value. Dr. Fischer is a member of the AAOS Now Editorial Board.