Recreational Injury Interventions
Equestrian activity can be dangerous. On average 16 horse riding
related deaths occurred between 1982 and 1992, Whitlock
1999. Numbers as high as 98 deaths from horse related
injuries have been reported during the 1982-1998 time period. Other studies have
further reported that of all sports-related injuries 4.3% are equestrian injuries,
Eventing, which is a horse riding competition that is known for
its relative high risk of injury, has increased in popularity recently. In 1997,
over 150 horse trials took place in England with more planned for the future, Whitlock 1999. Previous studies have highlighted the concern of head injuries among riders.
Yet, standards for helmets in eventing have been criticized and thought to be ineffective
in preventing severe head injuries. Additionally, fox hunting in cross country environments
is considered the most dangerous type of riding yet helmets are not often worn.
Despite the relative risk of head injuries to horse riders the use of helmets has
been inconsistent across and within events.
The article reviewed below provides a case control study of the
effectiveness of helmets and other protective equipment, such a shoulder and body
protectors. Standards for body protectors were implemented in 1991, but there has
been no evidence to support the effectiveness of current equipment in reducing soft
tissue injuries or rib fractures, Whitlock 1999.
Review of equestrian studies:
Study design and target population
|Case control study.
Population: injuries in equestrian eventing
in 54 days of cross country competition between 1992-1997.
16,940 pre-noivce to advanced horses
involved in study. Riders not exclusively assigned to 1 horse.
|Use of protective helmets and body
Cases were selected from hospital records if the rider required medical
assistance and was considered unfit to continue riding that day.
|Injury incidence, distribution of
injuries in eventing.
|193 injuries and 2 deaths occurred.
Overall injury rate 1.1%. Head and facial
injuries accounted for 31% of all injuries. 1/3 of these injuries required
All riders were wearing protective
helmets and BETA standard body protectors.
24 chest injuries occured, 1 of these
was fatal despite the use of chest protectors by all riders.
None of the riders who sustained a
shoulder injury were wearing shoulder protectors to any standard.
Of the 20 falls that could have resulted
in a potentially severe shoulder injury and the rider was wearing a class
3 standard CEN shoulder protector, all were able to continue with competition.
Study quality and conclusions
|Eventing is one of the most dangerous equestrian activities.
Improved protective equipment should reduce severity
of head and facial injuries.
Hospital records were obtained in relevant
cases, but no attempt was made to determine the final outcome.
Summary of equestrian studies
Results of this study suggest a high number of head and shoulder injuries during
equestrian eventing competition, further indicating a need for the use of protective
equipment. Improved protective equipment, which was made mandatory in 1999, should
reduce the severity of head and facial injuries in eventing.
Recommendations on equestrian
Current research indicates that the use of protective equipment
during equestrian competition may be effective in reducing the risk of certain injuries.
Based on the current results the class 3 standard CEN shoulder protector, BETA standard
body protectors, and helmets that meet current standards should be utilized by all
Recommendations for future
There is a definite need for
well-designed, large-scale randomized controlled trials (RCTs) to evaluate the effects
of protective equipment for equestrians participating in all activities, and in
particular in high risk eventing, fox hunting, and professional jockeying. Future
studies are needed to determine whether overall severity of head injuries can be
reduced by more rigid helmets that are designed to withstand crush injuries as compared
to the helmets designed to prevent rotational element of head injury. Research should
also focus on the development of more effective chest protector designs that consider
the energy absorption quality of the material used.