Equestrian Injury Statistics

AS-19
Date: 
01/24/2021
Sara L. Mastellar, PhD, Equine Faculty, Ohio State ATI

Equestrian sports are enjoyed throughout a lifetime. Many equestrian athletes continue in their sport well beyond when many athletes have given up their high school sports. For example, the oldest U.S. 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 can be overlooked. The purpose of this article is not to deter equestrians, but rather provide context for risk and potential injuries. Following is an overview of some key statistics on horse-related injuries to humans.

Relative Risk

On a total injury basis, horseback riding can be compared to other sports on an hours of participation basis (Table 1). Data on rodeo and racing injuries were collected on a competitor exposures basis making it not directly comparable to the other sports. 

Table 1. Relative risk of horseback riding compared to selected sports.
Sport Injuries per 1,000 Hours of Participation
American football* 10-35
Basketball 9.1
Ice hockey 7.5
Karate 6.7
Baseball** 1.6-5.8
Downhill skiing 4.1
Horse riding 3.7
Cycling 2.0
Swimming 1.0
Golf 0.3
Rodeo Event Injuries per 1,000 Competitor Exposures
Bull riding*** 141
Bronc riding (bareback)*** 72
Bronc riding (saddle)*** 63
Steer wrestling*** 50
Calf roping*** 8
Ladies barrel racing*** 6
Racing Type Injuries per 1,000 Rides
Jump racing**** 10
Flat racing**** 1

* Data from Dvorak and Junge (2000) which is a review of epidemiological studies.
** Data from Dick, Sauers, Agel, and Keuter (2007). Injury incidence data collected through a collegiate sport surveilance program.
*** Data from Butterwick, Hagel, Nelson, LeFave, Meeuwisse (2002). Injury incidence data collected through the Canadian Professional Rodeo Sport Medicine Team.
**** Data from O’Connor, Warrington, McGoldrick, & Cullen. (2017). Injury incidence data collected from the Irish racing industry.

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 the average hospitalization for an equestrian related injury (including head injuries) is 5-6 days. Head injuries are of concern due to their severity. Approximately 10%-30% of horse-related injuries are head injuries. In fact, of all sports in the U.S., 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 of 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 (University of New Mexico Geospatial and Population Studies Traffic Research Unit). 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 (Meredith, Ekman, & Brolin, 2018)

Horizontal Bar Chart with percentage of horse related fatalities due to head injuries in different U.S. states by the years of data collection on the vertical axis. Data ranges from the 1975 to 2004 and shows between 55 and 75 fatalities.
Figure 1. Summary of data collected in various studies on the percentage of horse-related fatalities due to head injuries. Data from [GM3][MSL4]Aronson & Tough, 1993 (Canada); Sorli, 1999 (Canada); Hammet, 1994 (North Carolina); Malavase, 1994 (New York); Koephi, 2000 (Ohio); Lathrop, 2007 (New Mexico); and Ghosh, Di Scala, Drew, Lessin, and Feins, 2000 (US).

 

Experience and 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, Pearson,Wiger, Diggs, & Mullins, 2007). The same was true of a study completed in Hong Kong (Yim et al., 2007) and a study United States Pony Club members (Andres, Bushau-Sprinkle, Brier, & Seger, 2018). Additionally, recreational riders had higher rates of injury than professional equestrians in Australia (Lim et al., 2003). These findings suggest inexperienced riders are more at risk.

However, more experienced riders can 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 years 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, an equestrian educational organization, has documented a 60% decrease in head injuries after mandating that when mounted participants must have an ASTM (American Society for Testing and Materials (astm.org)) approved helmet with chinstrap fastened. 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 (seinet.org)) certified helmets (Malavase, 1994). However, helmet use remains low in some parts of the country and world (Figure 2)

Horizontal bar graph showing % using helmets by country and states over years of data collection from 1976 to 2015.
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 [GM7][MSL8]Roe et al., 2003 (Australia); Hughes, Falcone, Price, & Wickoff, 1995 (U.S.); Lim et al., 2003 (Australia); Condie, Rivara, & Bergman, 1993 (Washington); Frankel, Haskell, Digiacomo, & Rotondo., 1998 (Pennsylvania); Bond, Christoph, & Rogers, 1995 (Virginia); Ball, Ball, Kirkpatrick, & Mulloy, 2007 (Canada); Stafford, 1996 (Canada); Ueeck, Dierks, Homer, & Potter, 2004 (Oregon); Newton & Nielsen, 2005 (Colorado); Carrillo, Varnagy, Bragg, Levy & Riordan, 2007 (Florida); Yim et al., 2007 (Oregon, Washington, & Idaho); and Ikinger, Baldamus, & Spiller, 2016 (Germany).

Protective Equipment Other Than Helmets 

A front and back view of a person wearing a secured blue padded vest.

Figure 3. An example of one style of protective vest. An inflatable version works similar to an airbag. Photo by Sara Mastellar.

Protective vests (Figure 3) were made mandatory for the cross-country phase of eventing in 1996 by the United States Equestrian Federation (USEF) and the United States Eventing Association (USEA) (Guyton, Houchen-Wisw, Peck, & Mayberry, 2013) and have since been shown to decrease risk of injury during cross-country riding (Andres et al., 2018). They are also used in racing (harness, flat, and steeplechase) (Gibson, Thai, Saxon, & Pollock, 2008), colt starting, and rodeo. Mouth guard use, common at rodeos, may also protect against concussion through shock absorption (Butterwick et al., 2002). 

In Closing

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.

Note: This article was originally peer reviewed and published through SDSU Extension (iGrow) in 2017. It was updated for an Ohio audience in 2020.

References

Andres, S. A., Bushau-Sprinkle, A. M., Brier, M. E., & Seger, Y. R. (2018). Effects of body protection vests and experience levels in prevention of equestrian injuries. BMJ open sport & exercise medicine, 4(1), e000426. doi.org/10.1136/bmjsem-2018-000426

Aronson, H., & Tough, S. C. (1993). Horse-related fatalities in the Province of Alberta, 1975–1990. The American Journal of Forensic Medicine and Pathology, 14(1), 28-30. doi.org/10.1097/00000433-199303000-00006

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. doi.org/10.1016/j.amjsurg.2007.01.016

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. org/10.1177/03635465020300020801

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. doi.org/10.1177/145749690709600115

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. doi.org/10.1067/men.2001.114583  

Delzo, J. (2016). The oldest and youngest Olympic athletes. Olympic Games 2016. Retrieved from cnn.com/2016/08/11/health/youngest-and-oldest-olympic-athletes/ 

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(5_suppl), 3-9. doi.org/10.1177/28.suppl_5.s-3

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. doi.org/10.1053/jpsu.2000.19247

Gibson, T., Thai, K., Saxon, J., & Pollock, R. (2008). The effectiveness of safety equipment in horse racing falls. Paper presented at the International Research Council on the Biomechanics of Injury Conference. doi.org/10.1016/S0021-9290(07)70129-X

Guyton, K., Houchen-Wise, E., Peck, E., & Mayberry, J. (2013). Equestrian injury is costly, disabling, and frequently preventable: The imperative for improved safety awareness. American Surgeon, 79(1), 76-83. doi.org/10.1177/000313481307900134

Hammett, D. B. (1994). North Carolina medical examiner reports 1983-1992: Horse related deaths. Equestrian Medical Safety Association Newsletter.

Hughes, K. M., Falcone, R. E., Price, J., & Witkoff, M. (1995). Equestrian-related trauma. The American Journal of Emergency Medicine, 13(4), 485-487. doi.org/10.1016/0735-6757(95)90148-5

Ikinger, C. M., Baldamus, J., & Spiller, A. (2016). Factors influencing the safety behavior of German equestrians: Attitudes towards protective equipment and peer behaviors. Animals, 6(2), 14. doi.org/10.3390/ani6020014

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. doi.org/10.1580/06-WEME-OR-089R.1

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. doi.org/10.1046/j.1445-2197.2003.02707.x

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. doi.org/10.1097/ta.0b013e318031b5d4

Meredith, L., Ekman, R., & Brolin, K. (2018). Epidemiology of equestrian accidents: A literature review. Internet Journal of Allied Health Sciences and Practice, 17(1), 9. 

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. doi.org/10.1016/j.jen.2005.08.009

O’Connor, S., Warrington, G., McGoldrick, A., & Cullen, S. (2017). Epidemiology of injury due to race-day jockey falls in professional flat and jump horse racing in Ireland, 2011–2015. Journal of Athletic Training, 52(12), 1140-1146. doi.org/10.4085/1062-6050-52.12.17

Parkkari, J., Kannus, P., Natri, A., Lapinleimu, I., Palvanen, M., Heiskanen, M., ..., & Järvinen, M. (2004). Active living and injury risk. International Journal of Sports Medicine, 25(3), 209-216. doi.org/10.1055/s-2004-819935

Roe, J. P., Taylor, T. K., Edmunds, I. A., Cumming, R. G., Ruff, S. J., Plunkett?Cole, M. D., ..., 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. doi.org/10.1046/j.1445-2197.2003.t01-1-02618.x

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.

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. doi.org/10.1016/j.joms.2003.12.010

University of New Mexico Geospatial and Population Studies Traffic Research Unit (TRU). (2016). New Mexico Monthly Traffic Fatality Report, 2015. Retrieved from gps.unm.edu/gps_assets/tru_data/Crash-Reports/Fatality-Reports/2015-fatalities.pdf 

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. doi.org/10.1016/j.injury.2006.08.026 


Additional Resources

Abu-Zidan, F. M., & Rao, S. (2003). Factors affecting the severity of horse-related injuries. Injury, 34(12), 897-900. doi.org/10.1016/S0020-1383(03)00054-8

American Medical Association. (2006). Use of protective headgear during equestrian activities H-470.977 [Press release]. Retrieved from searchpf.ama-assn.org/SearchML/searchDetails.action?uri=%2FAMADoc%2FHOD.xml-0-4293.xml 

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. doi.org/10.1097/00005373-198902000-00019

Bond, G. R., Christoph, R. A., & Rodgers, B. M. (1996). Pediatric equestrian injuries assessing the impact of helmet use. Journal of Safety Research, 2(27), 133. doi.org/10.1016/0022-4375(96)86979-9

Carmichael II, 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. doi.org/10.1016/j.injury.2014.03.016

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. 

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. doi.org/10.1016/j.csm.2010.09.006

Danielsson, L. G., & Westlin, N. E. (1973). Riding accidents. Acta Orthopaedica Scandinavica, 44(6), 597-603. doi.org/10.3109/17453677308989097

Gates, J. K., & Lin, C. Y. (2020). Head and spinal injuries in equestrian sports: update on epidemiology, clinical outcomes, and injury prevention. Current Sports Medicine Reports, 19(1), 17-23. doi.org/10.1249/JSR.0000000000000674

Hammett, D. B. (1993). Rider survey results. 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. doi.org/10.1186/1752-2897-5-4

Jagodzinski, T., & DeMuri, G. P. (2005). Horse-related injuries in children: A review. Wisconsin Medical Journal, 104(2), 50-54. 

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.

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.org/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. 

Waller, A. E., Daniels, J. L., Weaver, N. L., & Robinson, P. (2000). Jockey injuries in the United States. Equestrian Medical Safety Association Newsletter, XI. doi.org/10.1001/jama.283.10.1326

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., ..., & Tarapore, P. E. (2016). Adult sports-related traumatic brain injury in United States trauma centers. Neurosurgical Focus, 40(4), E4. doi: doi.org/10.3171/2016.1.FOCUS15613 

Program Area(s):