Mike Smith knows the feeling. A headache. Maybe some dizziness.
As a younger jockey he got concussions, felt better and went back to riding.
"I've had several," Smith said. "It's just like you hit your head playing any sport."
Smith is currently in the international spotlight as he goes for the Triple Crown on Saturday aboard Justify in the Belmont, but he's far from alone as a jockey who has dealt with concussions. U.S. horse racing remains years, if not decades, behind other pro sports — not to mention the sport in other countries — when it comes to concussion evaluation, diagnosis and return to racing protocol for jockeys.
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There's no national concussion program from state to state or racetrack to racetrack. There is also an ongoing debate on how to implement one and who should pay for it. That leaves jockeys like Smith facing different situations along the Triple Crown trail from the Kentucky Derby to the Preakness in Maryland and Belmont in New York.
The Jockeys' Guild last month voiced concern about the New York Racing Association's lack of a concussion protocol, but the problem isn't limited to one state.
Jockeys not as accomplished or famous as Smith are confronted daily with inconsistent care, especially in the area of brain injuries and head trauma. Not every track has an on-site athletic trainer or physician to diagnose concussions.
"The biggest thing is being able to pull a jockey if there is a suspected concussion, and a lot of racetracks don't even have that," said Dr. Kelly Ryan, who heads a pioneering concussion protocol program for the Maryland Jockey Club. "So a jockey could fall, hit his head, can feel dizzy, can feel nauseous, doesn't even understand that he has a concussion and then will get back on a horse with altered depth perception and reaction times and problems tracking and concentration."
Head injuries from a fall ended the career of jockey Ramon Dominguez in 2013. According to the British Journal of Sports Medicine, there were 36 reported concussions in U.S. racing from 2012-2016.
But it is unclear how many horse racing concussions have gone unreported. There is currently no official nationwide record-keeping system for jockey injuries and concussions.
A group including Ryan, MedStar, The Jockeys' Guild, University of Kentucky College of Health Sciences and New York Institute of Technology has come up with concussion guidelines, but they have not been widely implemented because of inequities from place to place.
The Association of Racing Commissioners International added guidelines for tracks to employ a medical professional trained in concussions, give jockeys baseline tests and institute a return-to-ride protocol, but that also must be adopted place to place.
"It's a long way to go," Jockeys' Guild national manager Terry Meyocks said. "We want to be treated like any other professional sports league, amateur or even high school girls' soccer teams. We just want to be treated the same way."
The NFL, NBA, NHL and Major League Baseball all have specific concussion policies that are mostly absent in U.S. thoroughbred racing, aside from places like Keeneland in Lexington, Kentucky, Pimlico and Laurel in Maryland and Gulfstream in Florida.
The National Thoroughbred Racing Association is trying to get a handle on the international issue.
"The NTRA Safety & Integrity Alliance regularly consults with racetracks to help establish the most effective protocols feasible in each jurisdiction," NTRA spokesman Jim Mulvihill said.
While the NTRA is doing the best it can, doctors with experience treating concussions among jockeys consider it a major issue. In a sport where there is significant attention paid to the health and well-being of horses, jockeys and exercise riders are often an afterthought.
"Everyone pays attention to the horses," Ryan said. "No one pays attention to the jockeys."
Paramedics and emergency medical technicians are available at tracks, following the field in an ambulance, but they're not concussion specialists and NYIT director of sports medicine Hallie Zwibel said roughly 25 percent of jockey injuries involve head or neck trauma.
"It's by nature a very dangerous sport," Zwibel said. "There's been more studies at the U.K., Ireland that show that there are fairly high rates of head injury and repetitive head injury and cognitive deficit in the long term from those repetitive hits."
Education has helped football, hockey, basketball and baseball players better understand concussions.
Kenneth Perrine, a neuropsychologist at Weill Cornell Medicine and NewYork-Presbyterian and a consultant for the NFL's Jets and NHL's Islanders, hopes that culture change trickles down to jockeys.
"I tried to drill it home that it is not in your best interest to hide it," Perrine said. "If you go and race in another race, either that same night on the same bill or a couple of days later at another track, you're at increased risk for another concussion and that second concussion is going to make you worse."
Victor Espinoza, who rode American Pharoah to the Triple Crown in 2015, said it is a big deal for him, and "actually for every jockey."
"It's the best thing ever done and hopefully it can improve more. We're in a very dangerous sport," Espinoza said. "Our life is basically race-by-race. Any race or any moment, we can get hurt."
Several organizations are taking steps to address jockeys' injury concerns.
— University of Kentucky's Carl Mattacola and his team headed up a pilot program at Keeneland to test a possible concussion protocol. A graduate student based at the track conducted baseline tests, treated and tracked injuries and concussions, and Mattacola said the results of the program showed a similar system could work at just about any track and be implemented quickly and economically.
— At the Maryland Jockey Club, Ryan has adapted a concussion protocol that includes evaluating jockeys who fall, doing baseline testing if they hit their head and take them off mounts if there's a suspected concussion.
— Zwibel, Dominguez and NYIT computer engineering scientist Milan Toma are engaged in a research project looking at different types of helmets to see if some are more effective than others at preventing head injuries. Meyocks said The Jockeys' Guild has been in contact with the NFL about helmet technology, too.
While the concern for jockey concussions has grown, there are still disagreements as to who should pay the costs associated with implementing a protocol.
"Everybody's worried about who's paying for it, who's liable for it, who's responsible for it," Meyocks said. "We need the industry to do more, and it's been very difficult, to say the least."