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, Whitlock 1999.

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:


Whitlock, 1999

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 protectors.

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 hospital treatment.

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 interventions

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 riders.

Recommendations for future research

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.