Equestrian Sports: Trends, Injuries and Prevention

Equestrian sports were introduced to the Olympic Games in Paris in 1900 and it remains one of the few events in which women and men compete on equal terms.

As the 2024 Paris Summer Olympics approach the focus sharpens on not just the competition but on the health and safety of equestrian athletes. Equine sports come with a distinct injury profile owing in part to the inherent risks of working with a potentially unpredictable animal weighing approximately 1500 pounds and traveling at speeds up to 40 mph. As one in five riders will sustain a serious injury during their riding career it is important for Sports Medicine providers to understand mechanisms of injury, risk factors, and prevention strategies in this popular sport enjoyed by more than 30 million Americans and many more worldwide.^1,2

Equestrian sports encompass a broad range of activities from Western reining and trail riding to Olympic sports including dressage, cross-country and jumping. Although some injury patterns are shared across disciplines, differences in safety equipment, environment, and type of activity result in distinct injury profiles. The majority of injuries occur during noncompetitive riding, with a fall from the horse remaining the most common mechanism (42.7-82%) versus being kicked or otherwise injured while handling an animal on the ground.^1-3

Traumatic Brain Injury (TBI)

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.⁴ Traumatic brain injury (TBI) is the most prevalent serious injury pattern in equestrians despite modern advances in helmet technology which may reduce the likelihood of severe head injury by approximately 40-70%.^1,3,4,5 Sadly, in some studies as few as 6% of riders were helmeted at the time of injury, which likely contributes to the sobering statistic that almost half of riders sustain one or more concussions during their riding career.^2,5 It was not until 2021 the international governing body for dressage (FEI) mandated use of a helmet during competition in place of the traditional top hat, and Paris will mark the first Olympics where all riders will be helmeted during dressage competition.⁶ Other disciplines like Saddle Seat and Western riding continue to forgo helmets for a traditional look in competition. Sports medicine providers should continue to strongly encourage athletes to wear a helmet any time they are mounted, and ideally even when unmounted when directly working around animals.

Thoracic and Abdominal Injury

Cross-country eventing carries one of the highest injury rates for serious thoracic injury. The Olympic sport involves galloping over ditches, streams, and solid immobile objects which can result in high-speed rotational type falls in which a horse falls on top of the rider. A protective vest lowers but does not eliminate the risk of severe chest injury^7,8Air jackets which inflate upon detachment from the saddle are a newer vest design and an alternative to a rigid vest. A body protector is required in cross-country, racing, and rodeo competitions. A safety vest should always be worn by all riders when practicing these events. Safety vests can be considered for riders in other disciplines, however clear benefit outside of those events has not been proven.

Upper Extremity Injury

Appendicular fractures such as the clavicle, wrist, and humerus are common injuries due to the natural reflex to brace in event of a fall. Soft tissue sprains, strains and contusions can range in severity, with Morel Lavallee type lesions being observed from high-speed falls. Lower-extremity injuries have a lower incidence than other injury patterns but can be seen in high energy accidents and when proper riding attire is not worn. Pants and boots with an appropriate heel provide some protection against injury both while mounted and handling the horse on the ground. The heel of the boot is designed to prevent a foot becoming stuck in the stirrup iron in case a rider was to fall and be dragged. A reinforced toe provides some resistance against a horse stepping on a handler’s foot, which can occur inadvertently even with a well-behaved horse. More serious femur and pelvic fractures can be encountered in any discipline if a horse falls on to a rider, but they can also occur if a handler is struck or crushed. Cranial injuries such as orbital and midface fractures are most commonly the result of a kick but can also occur from a rotational fall.⁹

Conclusion

It is important for medical providers to understand the unique injury risks associated with equestrians sports and to advocate for use of safety equipment in practice as well as competition. Sports Medicine providers should strongly encourage riders to wear appropriate attire and use well-fitting protective equipment including a helmet as well as a safety vest where appropriate. Athletes and coaches should be aware of the risk of TBI and be educated on signs and symptoms indicating need for evaluation and treatment. Preventative measures and continued awareness can ensure participants enjoy the many diverse varieties of equestrian sports while minimizing risk of serious injury.

References:

1. Havlik, Heather S.. Equestrian Sport-Related Injuries: A Review of Current Literature. Current Sports Medicine Reports 9(5):p 299-302, September 2010. | DOI: 10.1249/JSR.0b013e3181f32056

1. Carmichael, Samuel P 2nd et al. “On and off the horse: mechanisms and patterns of injury in mounted and unmounted equestrians.” Injury vol. 45,9 (2014): 1479-83. doi:10.1016/j.injury.2014.03.016. PMID 24767580
2. Meredith L, Ekman R, Brolin K. Epidemiology of Equestrian Accidents: a Literature Review. The Internet Journal of Allied Health Sciences and Practice. 2019 Jan 01;17(1), Article 9.
3. Glace, Beth W et al. “Incidence of concussions and helmet use in equestrians.” Journal of science and medicine in sport vol. 26,2 (2023): 93-97. doi:10.1016/j.jsams.2022.12.004
4. Kuhl HN, Ritchie D, Taveira-Dick AC, Hoefling KA, Russo SA. Concussion History and Knowledge Base in Competitive Equestrian Athletes. Sports Health. 2014;6(2):136-138. doi:10.1177/1941738113508073
5. Fédération Équestre Internationale, FEI General Regulations, 24th edition (2020), https://inside.fei.org/sites/d... General Regulations effective 1 January 2020 – Final Version for Website – Clean.pdf.
6. Hynd D, Muirhead M, Carroll J, Barr A, Clissold J. Evaluation of the Effectiveness of an Exemplar Equestrian Air Jacket against Crush Injuries. 2016 International Council on the Biomechanics of Injury (IRCOBI) Conference, September 2016.
7. Andres SA, Bushau-Sprinkle AM, Brier ME, et al Effects of body protection vests and experience levels in prevention of equestrian injuries. BMJ Open Sport & Exercise Medicine 2018;4:e000426. doi: 10.1136/bmjsem-2018-000426
8. Weber CD, Nguyen AR, Lefering R, Hofman M, Hildebrand F, Pape H-C. Blunt injuries related to equestrian sports: results from an international prospective trauma database analysis. Int Orthop. 2017:10-7. [PMID: 28801837]