Staying Safe in the Saddle
By Karen Sutton, MD and Lauren Wessel, MD
Date Posted: 3.9.2020
Approximately 30 million people ride horses annually in the United States. While popular, equestrian
sports carry a high risk of injury with a reported rate of 1 for every 350 to 1000 hours spent riding. The
risk of injury in riding may be attributable to the position of the rider, fall from height, and speed of
travel during sport. The range of orthopaedic injuries include spine and pelvis injuries, upper and lower
extremity long bone fractures, and joint dislocations.
Given the severity of trauma associated with equestrian sport, efforts should be taken to prevent undue
injuries. Falling off the horse is the most common cause of injury and efforts should be taken to ensure
the greatest ability for riders to maintain balance. A few specific cautions should be heeded by those
embarking on equestrian sport:
• Helmets: Prior literature demonstrates rates of use of protective equipment range from 6%-
66.7%. This variation in use persists in spite of literature that has shown that use of helmets
decreases hospitalization secondary to injury up to 5-fold. Both the incidence and severity of
skull fractures have decreased with the increased trend in helmet use, and all riders should be
aware of this safety precaution. When selecting a helmet, look for SEI (Safety Equipment
Institute) and ASTM (American Society of Testing and Materials) approved gear.
• Footwear: Proper footwear and appropriate riding position can help mitigate risk and afford
riders with the greatest control while mounted. Appropriately heeled boots aid riders in
maintenance of ankle dorsiflexion while mounted. Additionally, stronger riding boots may
decrease the risk of ankle injuries secondary to rotational loads.
• Additional protective equipment: Upper extremity fractures account for >50% of riding related
fractures. While upper extremity protective equipment has been noted to reduce fracture rate
in activities such as rollerblading, benefits have not been formally evaluated in riding. The
shoulder, elbow, and wrist are prone to high injury rates, and protective equipment may prove
beneficial in reducing injury occurrence.
Horseback riding remains a popular sport in the United States; however, with it comes a high risk of
injury. The combination of height and speed of travel during fall from a horse contribute the severity of
associated injuries, which include a high incidence of head and neck injuries as well as extremity
fractures. We advocate for the use of helmets as well as protective equipment for the upper and lower
limbs in order to stay safe in the saddle.