Head injuries and broken ribs are common injuries in equestrian sports, but they don’t have to be par for the course.

According to a new study looking at horse-related accidents in a primary (non-trauma) care centre, falls cause the most injuries, but ground-level mishaps lead to significant and often severe injuries as well.

Fortunately, helmets and other protective equipment likely keep injuries from being worse, medical researchers say.

If you’re headed from the saddle to the hospital after a fall, chances are you’ve got a concussion. In a recent five-year study in rural Scotland, researchers found that 86 percent of all equestrian-related admissions to a regional general hospital resulted from a fall, and 18 percent involved a head injury.

On the ground, though, people still incurred injuries, sometimes severe, and often from kicks, said Lachlan Dick, MBChB, MRCS(Ed), Clinical Development Fellow in the Department of General Surgery at Borders General Hospital in Melrose, Scotland.

“Unmounted injuries were less common; however, we found that being crushed or kicked resulted in far more significant injuries and need for intensive care admission,” Dick said. “I think there could be an argument for the use of helmets and other protective equipment  even when not riding a horse.”

In their study, Dick and his fellow researchers reviewed all case records of equestrians admitted to the general hospital following an accident involving a horse between 2014 and 2019.

They found that 75 percent were girls and women, making up two primary age brackets of either between ages 11 and 20 or between ages 51 and 60. Accidents ranged from falls to crushing with or without a fall, to kicks (with or without a fall), as well as getting a foot caught in a stirrup and/or getting dragged.

Nearly 18 percent had a head injury, but running a close second were rib fractures, representing 15 percent. Clavicle (collar bone) fractures accounted for 8 percent of the injuries.

Patients also fractured their arms and backs (upper and lower), and 8 percent had intestinal injuries.

More than a fourth had multiple injuries, and more than a third underwent surgery, the researchers reported recently in the Scottish Medical Journal.

Nearly 60 percent of the surgeries involved open reduction and internal fixation of a fracture. The average hospital stay was two days.

The death rate stood at 0.6 percent, Dick said. However, there may also have been long-term and potentially life-changing complications for some patients, although those details weren’t available in their data. And that’s unfortunate, he added, as it could be very useful to know to what extent equestrians have injuries that alter their lifestyles.

“Fixing a broken bone is only the first part of the patient’s recovery,” Dick said. “Do they have longer term problems? Are they restricted in any of their activities because of their previous injury? These are the sorts of questions that are often missed as they are harder to assess and require a long follow up.”

The results, coming from a general hospital compared to a critical care or referral center, provide a unique look at the kinds of everyday accidents that land riders in the hospital to start with, as opposed to the more frequently reported data focusing on specialized trauma centres, the researchers reported.

While riding accidents can be detrimental for humans, they could also spell health and welfare issues for their mounts, according to equine scientists. Injured riders can’t continue to care for their horses as they usually would, often resulting in dramatic life changes for the horse leading to loss of physical condition and sometimes neglect.

Worse, in certain cases horses might “pay the price” for their riders’ injuries, according to Rebecca Husted, PhD, owner of Technical Large Animal Emergency Rescue in Gray, Georgia.

“So many horses get sold or even shot when people get severely injured or killed after these incidents,” she said, adding that she’s known of threats towards horses by family members in the event of an accident in both the U.S. and Australia. “People don’t often talk about it, but it’s a problem that needs to be addressed.”

The good news is that, at least in this Scottish study, there’s been a major drop in equestrian-related accidents in recent years. By 2019, their hospital admitted 58 percent fewer patients annually compared to five years earlier, Dick reported. Whether that’s due to better riding, better-trained horses, or better use of protective equipment remains to be determined.

The study by Dick L, Yule M, Green J, Young J. titled ‘Patterns of injury following equine trauma: a non-trauma centre experience’ is published in the Scottish Medical Journal. 2021;66(2):73-76. The article summary is available here