Tim O’Connell has won three world championships in bareback bronc riding. Last week, he stepped into Dickies Arena at the beginning of this new season to try to claim another.

This was one of the dozens of rodeo events at the Fort Worth Stock Show and Rodeo, a three-week event that draws over a million people, with the evening bull riding, barrel racing, bucking broncs and calf roping — a major event.

In a black cowboy hat, and red, gold and white chaps and vest, O’Connell settles onto the back of a horse, digs his hand into a rigging made of leather and rawhide, and the gates burst open.

His horse bucks and jumps, all four hooves lifting off the ground. O’Connell holds tight, slapping back against the horse again and again, all the while keeping one hand in the air.

It’s a heart-pounding eight seconds before the buzzer sounds, and O’Connell ends the round with a top score and no injuries. But in rodeo, it’s not really a matter of if you’ll get injured, but when and how badly.

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Last year, a major shoulder injury that tore six of the eight tendons in his riding arm took him out of competition for several months. He was lucky to have won enough money to afford the time off, and to have a sponsor who covers his insurance so he could afford the surgery. A lot of rodeo riders aren’t insured.

It was the most severe injury he has sustained during his career, one of many.

“I tore my collarbone off my sternum,” O’Connell said. “I broke my riding hand – spiral fracture of my riding hand — didn’t require surgery or anything like that. Then there’s little things, like I’ve broken all my knuckles.”

Every cowboy and cowgirl who competes in professional rodeos carries a catalog of their injuries, says Sage Kimszey, a bull rider from Oklahoma who has won six world titles.

“Just in the last few years, I’ve got a totally torn UCL in my elbow, fractured my pelvis, broke some ribs, broken both arms before, broken feet — it’s a tough sport, for sure,” the 25-year-old said.

Rodeo athletes are basically independent contractors. Some of the best have sponsorships, but this is a sport where, for the most part, you don’t get paid if you’re not competing and winning. Unlike professional basketball or football players, rodeo athletes don’t have team doctors to help keep them healthy.

That’s where the Justin Sports Medicine Team comes in. At more than 125 professional rodeos across the U.S., the Justin Boot Company staffs clinics with hundreds of on-site doctors, physical therapists and athletic trainers – mostly volunteers – to take care of the athletes free of charge.

“We can put them in a boot, we can give them crutches, we can give them a prescription for pain medicine,” said medical director Tandy Freeman. “They don’t end up with a $1,000 [emergency room] bill.”

The Justin clinics treat upwards of 8,000 people a year, giving away 250 miles worth of athletic tape and more than $1.5 million worth of medical care. It’s care that Freeman said a lot of rodeo athletes wouldn’t be able to afford otherwise.

“There’s several thousand members of the professional cowboy rodeo association, and the reality is only about 300 of them are making a living,” he said.

Freeman, a former team physician for the Dallas Mavericks who runs an orthopedic medicine practice in Dallas, said there are some key differences in treating rodeo athletes.

Christopher Connelly / KERA News

For one, they’re on the road a lot, and many live in rural places, which can make continuity of care difficult. That means teaching the athletes how to do their own physical therapy, to apply braces and athletic tape to prevent or help injuries heal, and to know when they need to go to a hospital or see a doctor.

Because they’re moving targets, team doctors work to coordinate care for an individual athlete as they move on from rodeo to rodeo. A damaged elbow Freeman sees in Fort Worth might get an MRI taken by a doctor he knows in Lake Charles, Louisiana, because the athlete can’t take time in Texas to get the scan.

But overall, there are far more similarities than differences when it comes to sports injuries, says massage therapist and athletic trainer Benny Vaughn. He’s a volunteer on the Justin team who has worked with professional football, baseball and basketball teams, and went to four Olympics with the U.S. track and field team.

Christopher Connelly / Associated Press

“A muscle, is a muscle, is a muscle,” Vaughn said. “But the rodeo athlete in my experience of 45 years in the sports medicine world, they are some of the toughest and some of the most gracious athletes that I’ve ever worked with.”

Vaughn said the whole sports medicine team understands that the athletes will get back into the arena as quickly as they can, so the goal is to make sure they know when it’s safe to do it and the best ways to prevent further injury.

The program launched in 1981 with the idea of bringing professional sports medicine to professional rodeo. For Dr. Jason Mogonye, a sports medicine physician affiliated with Texas Christian University and John Peter Smith Hospital in Fort Worth, it’s a world of difference from when he grew up watching both of his parents compete in the 1970s.

“My dad had torn up his knee and he wore a brace, and my mom had a bad back and they just dealt with it,” he said. “Rub some dirt on it and hope for the best, that’s about how it went back then.”

Mogonye said he sees all kinds of issues as a volunteer for the Justin Sports Medicine Team, from bumps and bruises and strains and sprains, to the kind of damage that a fully grown bull can do to a human body.

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“Big cuts happen, blood and guts happen. But the bigger thing to me, are the ones who come in with fractures who were at a rodeo that didn't have medical coverage and they’re like, ‘what’s wrong with my arm?’ Well, it’s broken. ‘What’s wrong with my foot?’ Well, that’s definitely going to need surgery,” he said.

For bull rider Sage Kimzey, though, the most important service they provide is helping athletes like him understand how to prevent injuries.

“We’re all a bunch of ranch-raised kids for the most part. It’s not like we have a whole lot of extensive knowledge of how to stay healthy and how to stay at the top of our game,” he said. “So yeah, the knowledge is probably the biggest thing for me.”

That knowledge will help him next time he gets injured, so he can get back in the arena and back on the bull.