Equestrian sports can be enjoyed throughout a lifetime with athletes continuing in their sport well beyond when many athletes have given up their high school sports. For example, the oldest US Olympian that competed in the 2016 Rio Olympics was 52-year-old equestrian Phillip Dutton (Delzo, 2016). With older individuals choosing horseback riding as their hobby of choice some equestrian sports have the reputation of being low key, low risk sports. As a result, potential risk and safety considerations may be overlooked. This article provides an overview of some key statistics on horse-related injuries to humans.
On a total injury basis, horseback riding can be compared to other sports on an hours of participation basis (Table 1). Data on rodeo injuries were collected on a competitor exposures basis making it not directly comparable to other sports.
Table 1. Relative risk of horseback riding compared to selected sports
(per 1000 hrs of participation)
(per 1000 competitor exposures)
|Bronc riding (bareback)***||72|
|Bronc riding (saddle)***||63|
|Ladies barrel racing***||6|
Data from Parkkari et al. (2004) unless otherwise stated. Injury incidence determined by participant interview.
Compared to the American pastimes of football, basketball, and baseball, the injury rate for horse riding is relatively low. However, several studies have found that horse-related injuries presented at hospitals tend to be severe. A side by side comparison of horseback riding and hockey found that horseback riding related injuries were more likely to require hospitalization. Of common childhood injuries, only being struck by a car had a higher severity score than equestrian-related injuries. Additionally, studies have found that the average hospitalization for an equestrian related injury (including head injuries) is 5-6 days. Head injuries are of particular concern due to their severity. Approximately 10-30% of horse-related injuries are head injuries. In fact, of all sports in the US, equestrian sports are the most common cause of sports-related traumatic brain injury (TBI) in adults.
Statements such as “everyone falls off” and “you aren’t a real rider until you’ve fallen off” abound in the horse industry. While these statements are often used to encourage novice riders to not give up the first time they fall, the data shows that not just falls, but injuries are likely to happen. The data agrees that injuries are likely to happen at some point in a rider’s career. A survey of riders in Oregon, Washington, and Idaho states found that 81% were injured at some point in their riding career and that 21% were injured seriously (requiring hospitalization/surgery or causing long term disability).
Fortunately, horse-related fatalities are relatively few. For example, horses were involved with the deaths of 43 people in New Mexico between 1993 and 2004, a span of 11 years. For comparison, 298 fatalities were due to car crashes in New Mexico during 2015 alone. Over the decades approximately 60-70% of horse-related fatalities have been due to head injuries (Figure 1). Other factors involved in horse-related fatalities included spine injuries, crushing injuries, and the involvement of an automobile.
Figure 1. Summary of data collected in various studies on the percentage of horse-related fatalities due to head injuries. Data from Aronson & Tough, 1993; Sorli, 1999; Hammet, 1994; Malavase, 1994; Koephi, 2000; Lathrop, 2007; and Ghosh et al., 2000.
Experience & Risk of Injury
Researchers report conflicting evidence as to whether experience or number of years riding reduces injury rates. A study conducted in Oregon, Washington, and Idaho found that novice riders are the most likely to be injured (Mayberry et al., 2007). The same was true of a study completed in Hong Kong (Yim et al., 2007). Additionally, recreational riders had higher rates of injury than professional equestrians in Australia (Lim et al., 2003). These findings suggest that inexperienced riders are more at risk.
However, more experienced riders may take on more challenging mounts and activities which increases injury risk. The average years of riding experience for Canadian adults admitted to a trauma center for severe horse-related injuries was 27 yrs as determined from a 10 year study (Ball, Ball, Kirkpatrick, & Mulloy, 2007). Also, data collected in Austin, Texas, found that inexperienced dudes accounted for 38% of the livestock-injured patients, while ranchers and cowboys accounted for 43% of livestock-injured patients (Criddle, 2001). It is important to remember that accidents can happen to anyone, regardless of their level of experience.
Reducing Head Injuries
Sports and organizations that have adopted rules regarding helmet use have seen decreases in the number of head injuries and deaths. For example, the United States Pony Club, a youth organization, has documented a 60% decrease in head injuries after mandating that participants must have an ASTM (American Society for Testing and Materials) approved helmet with chinstrap fastened when mounted. Additionally, horse related deaths dropped from 4.9 per year (73% due to head injuries) to only one death caused by a vehicle collision in the three years after youth organizations and the New York State Horse Council mandated the use of ASTM/SEI (Safety Equipment Institute) certified helmets (Malavase, 1994). However, although helmet use has increased, it remains low in some parts of the country and world (Figure 2).
Mouth guard use, which is common at rodeos, may also protect against concussion through shock absorption (Butterwick et al., 2002). However, there is not nearly the body of evidence demonstrating the effectiveness of mouth guards in preventing concussions as there is with helmets.
Figure 2. Summary of data reported on helmet usage. Data is either percentage of injured patients that were wearing a helmet at the time of injury or percentage of survey respondents that reported helmet use. Data from Roe et al., 2003; Hughes et al., 1995; Lim et al., 2003; Condie et al., 1993; Frankel et al., 1998; Bond et al., 1995; Ball et al., 2007; Stafford, 1996; Ueeck et al., 2004; Newton & Nielsen, 2005; Carrillo et al., 2007; and Yim et al., 2007.
Take Home Message
As with any sport or activity, there is some risk involved in horseback riding and related sports. Head injuries make up a significant portion of the injuries incurred by equestrians and experience may not be protective against injury. Lastly, helmets have been shown to effectively protect against head injuries. With proper precautions and awareness of injury risk, riding careers can be both long and enjoyable.
- Abu-Zidan, F. M., & Rao, S. (2003). Factors affecting the severity of horse-related injuries. Injury, 34(12), 897-900.
- American Medical Association. (2006). Use of Protective Headgear During Equestrian Activities H-470.977 [Press release].
- Aronson, H., & Tough, S. C. (1993). Horse-related fatalities in the Province of Alberta, 1975-1990. American Journal of Forensic Medical Pathology, 14(1), 28-30.
- Ball, C. G., Ball, J. E., Kirkpatrick, A. W., & Mulloy, R. H. (2007). Equestrian injuries: Incidence, injury patterns, and risk factors for 10 years of major traumatic injuries. The American Journal of Surgery, 193(5), 636-640.
- Barone, G. W., & Rodgers, B. M. (1989). Pediatric equestrian injuries: A 14-year review. Journal of Trauma and Acute Care Surgery, 29(2), 245-247.
- Bond, G., Christoph, R., & Rodgers, B. (1996). Pediatric Equestrian Injuries Assessing the Impact of Helmet Use. Journal of Safety Research, 2(27), 133.
- Bond, G. R., Christoph, R. A., & Rodgers, B. M. (1995). Pediatric equestrian injuries: assessing the impact of helmet use. Pediatrics, 95(4), 487-489.
- Butterwick, D. J., Hagel, B., Nelson, D. S., LeFave, M. R., & Meeuwisse, W. H. (2002). Epidemiologic analysis of injury in five years of Canadian professional rodeo. American Journal of Sports Medicine, 30(2), 193-198.
- Carmichael, S. P., Davenport, D. L., Kearney, P. A., & Bernard, A. C. (2014). On and off the horse: Mechanisms and patterns of injury in mounted and unmounted equestrians. Injury, 45(9), 1479-1483.
- Carrillo, E. H., Varnagy, D., Bragg, S. M., Levy, J., & Riordan, K. (2007). Traumatic injuries associated with horseback riding. Scandinavian Journal of Surgery, 96(1), 79-82.
- Christey, G. L., Nelson, D. E., Rivara, F. P., Smith, S. M., & Condie, C. (1994). Horseback riding injuries among children and young adults. Journal of Family Practice, 39(2), 148-153.
- Condie, C., Rivara, F. P., & Bergman, A. B. (1993). Strategies of a successful campaign to promote the use of equestrian helmets. Public Health Reports, 108(1), 121.
- Criddle, L. M. (2001). Livestock trauma in central Texas: Cowboys, ranchers, and dudes. Journal of Emergency Nursing, 27(2), 132-140.
- Cripps, R. A. (2000). Horse-related injury in Australia: National Injury Surveillance Unit Canberra, Australia.
- Daneshvar, D. H., Baugh, C. M., Nowinski, C. J., McKee, A. C., Stern, R. A., & Cantu, R. C. (2011). Helmets and Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions. Clinical Sports Medicine, 30(1), 145-163.
- Danielsson, L. G., & Westlin, N. E. (1973). Riding accidents. Acta Orthopaedica Scandinavica, 44(6), 597-603.
- Delzo, J. (2016). The oldest and youngest Olympic athletes. Olympic Games 2016.
- Dick, R., Sauers, E. L., Agel, J., & Keuter, G. (2007). Descriptive epidemiology of collegiate men's baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. Journal of Athletic Training, 42(2), 183.
- Dvorak, J., & Junge, A. (2000). Football Injuries and Physical Symptoms: A Review of the Literature. American Journal of Sports Medicine, 28(suppl 5), S-3-S-9.
- Frankel, H. L., Haskell, R., Digiacomo, J. C., & Rotondo, M. (1998). Recidivism in equestrian trauma. The American Surgeon, 64(2), 151.
- Ghosh, A., DiScala, C., Drew, C., Lessin, M., & Feins, N. (2000). Horse-related injuries in pediatric patients. Journal of Pediatric Surgery, 35(12), 1766-1770.
- Hammett, D. B. (1993). Rider Survey Results. Equestrian Medical Safety Association Newsletter.
- Hammett, D. B. (1994). North Carolina Medical Examiner Reports 1983-1992: Horse Related Deaths. Equestrian Medical Safety Association Newsletter.
- Hammett, D. B. (1997). Justin Sportsmedicine Program 15-year PRCA study of rodeo injuries. Equestrian Medical Safety Association Newsletter, VIII.
- Hammett, D. B. (2000). Horse-related deaths in North Carolina, 1990-1999. Equestrian Medical Safety Association Newsletter, XI.
- Hammett, D. B. (2003). Dangers in Horseback Riding vs Hockey. Equestrian Medical Safety Association News, XV.
- Hasler, R. M., Gyssler, L., Benneker, L., Martinolli, L., Schötzau, A., Zimmermann, H., & Exadaktylos, A. K. (2011). Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case-control survey. Journal of Trauma Management & Outcomes, 5(1), 1.
- Hughes, K. M., Falcone, R. E., Price, J., & Witkoff, M. (1995). Equestrian-related trauma. The American Journal of Emergency Medicine, 13(4), 485-487.
- Jagodzinski, T., & DeMuri, G. P. (2005). Horse-related injuries in children: A review. Wisconsin Medical Journal, 104(2), 50-54.
- Koephi, G. H. (2000). Horse-related Fatalities in Ohio, 1990-1998. Equestrian Medical Safety Association Newsletter, XI.
- Lathrop, S. L. (2007). Animal-caused fatalities in New Mexico, 1993–2004. Wilderness & Environmental Medicine, 18(4), 288-292.
- Liestman, L. (1996). North American Horsemen's Association: Bodily Injury Damage Statistics Report January 1, 1992 through December 31, 1995. Equestrian Medical Safety Association Newsletter.
- Lim, J., Puttaswamy, V., Gizzi, M., Christie, L., Croker, W., & Crowe, P. (2003). Pattern of equestrian injuries presenting to a Sydney teaching hospital. ANZ Journal of Surgery, 73(8), 567-571.
- Malavase, D. (1994). Update on New York State Horse-Related Deaths. Equestrian Medical Safety Association Newsletter.
- Mayberry, J. C., Pearson, T. E., Wiger, K. J., Diggs, B. S., & Mullins, R. J. (2007). Equestrian injury prevention efforts need more attention to novice riders. Journal of Trauma and Acute Care Surgery, 62(3), 735-739.
- Newton, A. M., & Nielsen, A. M. (2005). A review of horse-related injuries in a rural Colorado hospital: implications for outreach education. Journal of Emergency Nursing, 31(5), 442-446.
- Parkkari, J., Kannus, P., Natri, A., Lapinleimu, I., Palvanen, M., Heiskanen, M., Vuori, I., & Järvinen, M. (2004). Active living and injury risk. International Journal Sports Medicine, 25(3), 209-216.
- Roe, J. P., Taylor, T. K., Edmunds, I. A., Cumming, R. G., Ruff, S. J., Plunkett‐Cole, M. D., Mikk, M., Jones, R. F. (2003). Spinal and spinal cord injuries in horse riding: The New South Wales experience 1976− 1996. ANZ Journal of Surgery, 73(5), 331-334.
- Sorli, J. (1999). Regional Variations in Equestrian Mortality in Canada. Equestrian Medical Safety Association Newsletter, X.
- Stafford, S. (1996). Horsepower Helmet Survey. Equestrian Medical Safety Association Newsletter, VI.
- Thomas, K. E., Annest, J. L., Gilchrist, J., & Bixby-Hammett, D. M. (2006). Non-fatal horse related injuries treated in emergency departments in the United States, 2001–2003. British Journal of Sports Medicine, 40(7), 619-626. doi:10.1136/bjsm.2006.025858
- Thompson, J. M., & von Hollen, B. (1996). Causes of horse-related injuries in a rural western community. Canadian Family Physician, 42, 1103-1109.
- Ueeck, B. A., Dierks, E. J., Homer, L. D., & Potter, B. (2004). Patterns of maxillofacial injuries related to interaction with horses. Journal of Oral and Maxillofacial Surgery, 62(6), 693-696.
- University of New Mexico Geospatial and Population Studies Traffic Research Unit (TRU). (2016). New Mexico Monthly Traffic Fatality Report, 2015.
- Waller, A. E., Daniels, J. L., Weaver, N. L., & Robinson, P. (2000). Jockey Injuries in the United States. Equestrian Medical Safety Association Newsletter, XI.
- Williams, F., & Ashby, K. (1995). Horse related injuries. Hazard: Victorian Injury Surveillance System, 23(93), ISSN-1320-0593.
- Winkler, E. A., Yue, J. K., Burke, J. F., Chan, A. K., Dhall, S. S., Berger, M. S., Manley, G. T., & Tarapore, P. E. (2016). Adult sports-related traumatic brain injury in United States trauma centers. Neurosurgical Focus, 40(4), E4.
- Yim, V. W., Yeung, J. H., Mak, P. S., Graham, C. A., Lai, P. B., & Rainer, T. H. (2007). Five year analysis of Jockey Club horse-related injuries presenting to a trauma centre in Hong Kong. Injury, 38(1), 98-103.