Horseback riding is a leading cause of sports-related traumatic brain injury in the United States. A 2023 study of 210 equestrians found a higher incidence of concussion in equestrian sports than football or rugby. Handling, riding and driving horses have inherent risks. Horses are large prey animals with a well-developed
flight or fight instinct able to move quickly and unexpectedly. When mounted, the rider's head may be up to from the ground, and the horse may travel at a speed of up to . The injuries observed range from very minor injuries to fatalities. A study in
Germany reported that the
relative risk of injury from riding a horse, compared to riding a bicycle, was 9 times higher for
adolescents and 5.6 times higher for younger
children, but that riding a horse was less risky than riding a
moped. In
Victoria, Australia, a search of state records found that equestrian sports had the third highest incidence of serious injury, after
motor sports and
power boating. In
Greece, an analysis of a national registry estimated the incidence of equestrian injury to be 21 per 100,000 person-years for farming and equestrian sports combined, and 160 times higher for
horse racing personnel. Other findings noted that helmets likely prevent traumatic brain injuries. In the
United States each year an estimated 30 million people ride horses, resulting in 50,000
emergency department visits (1 visit per 600 riders per year). A survey of 679 equestrians in Oregon, Washington and Idaho estimated that at some time in their equestrian career one in five will be seriously injured, resulting in hospitalization, surgery or long-term disability. Among survey respondents, novice equestrians had an incidence of any injury that was threefold over intermediates, fivefold over advanced equestrians, and nearly eightfold over professionals. Approximately 100 hours of experience are required to achieve a substantial decline in the risk of injury. The survey authors conclude that efforts to prevent equestrian injury should focus on novice equestrians.
Mechanisms of injury The most common injury is falling from the horse, followed by being kicked, trampled and bitten. About 3 out of 4 injuries are due to falling, broadly defined. A broad definition of falling often includes being crushed and being thrown from the horse, but when reported separately each of these mechanisms may be more common than being kicked.
Types and severity of injury In
Canada, a 10-year study of trauma center patients injured while riding reported that although 48% had suffered head injuries, only 9% of these riders had been wearing helmets at the time of their accident. Other injuries involved the chest (54%), abdomen (22%) and extremities (17%). A German study reported that injuries in horse riding are rare compared to other sports, but when they occur they are severe. Specifically, they found that 40% of horse riding injuries were fractures, and only 15% were sprains. Furthermore, the study noted that in Germany, one quarter of all sport related fatalities are caused by horse riding. Most horse related injuries are a result of falling from a horse, which is the cause of 60–80% of all such reported injuries. include: • Arm fracture or dislocation (31%) • Head injury (21%) • Leg fracture or dislocation (15%) • Chest injury (33%) Among 36 members and employees of the
Hong Kong Jockey Club who were seen in a trauma center during a period of 5 years, 24 fell from horses and 11 were kicked by the horse. Injuries comprised: 18 torso; 11 head, face or neck; and 11 limb. The authors of this study recommend that helmets, face shields and body protectors be worn when riding or handling horses. In
New South Wales,
Australia, a study of equestrians seen at one hospital over a 6-year period found that helmet use both increased over time and was correlated with a lower rate of admission. However, 81% of admissions were wearing a helmet at the time of injury, In the second half of the study period, of the equestrians seen at a hospital, only 14% were admitted. In contrast, a study of child equestrians seen at a hospital emergency department in
Adelaide reported that 60% were admitted. In the United States, an analysis of
National Electronic Injury Surveillance System (NEISS) data performed by the Equestrian Medical Safety Association studied 78,279 horse-related injuries in 2007: "The most common injuries included fractures (28.5%); contusions/abrasions (28.3%); strain/sprain (14.5%); internal injury (8.1%); lacerations (5.7%); concussions (4.6%); dislocations (1.9%); and hematomas (1.2%). Most frequent injury sites are the lower trunk (19.6%); head (15.0%); upper trunk (13.4%); shoulder (8.2%); and wrist (6.8%). Within this study patients were treated and released (86.2%), were hospitalized (8.7%), were transferred (3.6%), left without being treated (0.8%), remained for observation (0.6%) and arrived at the hospital deceased (0.1%)."
Head injuries Horseback riding is one of the most dangerous sports, especially in relation to head injury. Statistics from the United States, for example, indicate that about 30 million people ride horses annually. On average, about 67,000 people are admitted to the hospital each year from injuries sustained while working with horses. 15,000 of those admittances are from traumatic brain injuries. Of those, about 60 die each year from their brain injuries. Studies have found horseback riding to be more dangerous than several sports, including skiing, auto racing and football. Falling from a horse without wearing a helmet is comparable to being struck by a car. Most falling deaths are caused by head injury. Once a helmet has sustained an impact from falling, that part of the helmet is structurally weakened, even if no visible damage is present. Helmet manufacturers recommend that a helmet that has undergone impact from a fall be replaced immediately. In addition, helmets should be replaced every three to five years; specific recommendations vary by manufacturer.
Rules on helmet use in competition Many organizations mandate helmet use in competition or on show grounds, and rules have continually moved in the direction of requiring helmet use. In 2011, the United States Equestrian Federation passed a rule making helmet use mandatory while mounted on competition grounds at U.S. nationally rated eventing competitions. Also in 2011, the United States Dressage Federation made helmet use in competition mandatory for all riders under 18 and all riders who are riding any test at Fourth Level and below. Riders competing at Prix St. Georges and above and also riding a test at Fourth Level or below, must also wear a helmet at all times while mounted.
Riding astride The idea that riding a horse astride could injure a woman's sex organs is a historic, but sometimes popular even today, misunderstanding or misconception, particularly that riding astride can damage the
hymen. Evidence of injury to any female sex organs is scant. In female high-level athletes, trauma to the
perineum is rare and is associated with certain sports (see Pelvic floor#Clinical significance). The type of trauma associated with
equestrian sports has been termed "horse riders' perineum". A
case series of 4 female mountain bike riders and 2 female horse riders found both patient-reported perineal pain and evidence of
sub-clinical changes in the
clitoris; the relevance of these findings to horse riding is unknown. In men, sports-related injuries are among the major causes of testicular trauma. In a small
controlled but
unblinded study of 52 men,
varicocele was significantly more common in equestrians than in non-equestrians. The difference between these two groups was small, however, compared to differences reported between extreme
mountain bike riders and non-riders, and also between mountain bike riders and on-road bicycle riders. Horse-riding injuries to the
scrotum (
contusions) and
testes (
blunt trauma) were well known to surgeons in the 19th century and early 20th century. Injuries from collision with the pommel of a saddle are mentioned specifically. ==See also==