Locking the Stable Door: Preventing Equestrian Injuries

Monash University Accident Research Centre - Report #103

Authors: C. Finch & G. Watt

Countermeasure Fact Sheets Full report in pdf format [780KB]

Abstract:

The medical and sports literature databases were searched for equestrian sports-related injury published in English since 1980, together with conference abstracts, and discussions with equestrian sporting bodies. This literature was critically reviewed, with emphasis on countermeasures. While there is considerable literature available on the epidemiology of injury incurred in most equestrian sports, there is little on the prevention of these injuries. Case-control or other studies evaluating the effectiveness of the countermeasures suggested by authors do not seem to exist. There is a good body of epidemiology that supports the proper use of approved helmets as a means of preventing injury in these sports. However, protective helmets do not always prevent injury as expected, and many riders do not choose to wear them because of perceived poor design. The search for the ideal equestrian helmet should continue. Ideally the effectiveness of helmets should be assessed scientifically. The use of rules and regulations for conduct of events, knowledge of horse behaviour, well-conducted lessons, contraindicated medical conditions, public education, rider education, appropriate equipment and clothing, the riding environment, rider experience, safety stirrups, body protectors, falling techniques, and first aid measures are among the other countermeasures discussed. Even though the injury rate for equestrians is relatively low by comparison with other sports, the injuries that are incurred are usually severe. In large part, prevention is difficult because the behaviour of the horse is unpredictable. Countermeasures used for prevention should be evaluated for effectiveness to reduce the frequency and severity of injuries to equestrians.

Executive Summary

While there is considerable literature available on the epidemiology of injury incurred in most equestrian sports, there is little on the prevention of these injuries. Case-control or other studies evaluating the effectiveness of the countermeasures suggested by authors do not seem to exist.

There is a good body of epidemiology that supports the proper use of approved helmets as a means of preventing injury in these sports. However, protective helmets do not always prevent injury as expected, and many riders do not choose to wear them because of perceived poor design. The search for the ideal equestrian helmet should continue. Ideally the effectiveness of helmets should be assessed scientifically.

The use of rules and regulations for conduct of events, knowledge of horse behaviour, well-conducted lessons, contraindicated medical conditions, public education, rider education, appropriate equipment and clothing, the riding environment, rider experience, safety stirrups, body protectors, falling techniques, and first aid measures are among the other countermeasures discussed.

Even though the injury rate for equestrians is relatively low by comparison with other sports, the injuries that are incurred are usually severe. In large part, prevention is difficult because the behaviour of the horse is unpredictable. Countermeasures used for prevention should be evaluated for effectiveness to reduce the frequency and severity of injuries to equestrians.

Ideally, the effectiveness of all equestrian injury countermeasures should be demonstrated before they are implemented or widely promoted. However, where there is good reason to believe that a particular countermeasure is highly effective, despite a lack of direct scientific evidence for its effectiveness, then the use of that countermeasure should continue, provided there are no known negative effects or disbenefits associated with the particular countermeasure. This would particularly apply to the use of protective helmets. Although there is evidence from the field and the laboratory that helmets may not be capable of preventing all head injuries, they have been shown to be effective in reducing injuries to bicyclists. With the emergence of new materials, the search continues to design the ideal helmet which will satisfy riders involved many equestrian sports.

There is ample epidemiology that demonstrates equestrian injuries, although relatively infrequent, are generally severe, disabling and too often, fatal. Information needs to be collected on the extent of the implementation of, and attitudinal barriers against the use of existing equestrian countermeasures to inform the development of new and improved countermeasures.

With a high injury frequency during lessons having been reported, it would seem that an assessment of the quality of rider education programs and facilities is needed. Standards and practices of riding schools should be subject to accreditation and inspection by an external body, where accreditation is not in place.

Where countermeasures are aimed at primarily preventing injury, such as modification of the environment, and increasing skills and knowledge, they should be evaluated and then fully implemented. Where countermeasures are aimed at reducing injury severity, but for which there are doubts concerning their effectiveness, such as the use of safety stirrups or body protectors, formal evaluation should be conducted, preferably by case-control studies. Little work seems to have been done on evaluating the teaching and use of falling techniques. These could present a cheap and effective avenue of reducing a wide range of injuries, including those to the head, neck and upper extremities.

Many equestrian sports bodies actively promote safety in their sport. Sometimes this promotion is formal, where internal or external official rules and regulations are applicable and enforced, at other times it consists of informal verbal advice and the supply of safety literature. There is scope for considerable variation in the advice and enforcement of safety issues, with a consequent possible variation in the frequency of injury to riders.

No single equestrian organisation would have sufficient funds nor the expertise to properly assess the effectiveness of countermeasures. It may require coalitions of umbrella sports bodies, equestrian sports groups and researchers to conduct appropriate investigations. However, while there is so little knowledge of the effectiveness of countermeasures, equestrian injuries will continue to occur. It is not sufficient to claim the injury rate amongst equestrians is low, when the severity of the injuries which do occur is so high.

The range of countermeasures considered in this review and the specific recommendations for further research, development and implementation are given below.

RULES AND REGULATIONS

Rules and regulations for rider safety in equestrian sports should continue to be enforced.
The extent to which these rules and regulations are actually enforced should be established. If found to be lacking, efforts should be made to improve their enforcement.
Equestrian sports without regulations for safety should consider developing these.
Guidelines for rider safety aimed at informal or unsupervised riding need to be prepared and disseminated to the general riding and farm communities.

RIDER EXPERIENCE AND KNOWLEDGE

Riders should develop their riding skills progressively and thoroughly and have a good knowledge of horse behaviour.
Over time, riders and horse handlers should develop a bond with their horse.
Handlers of horses should be aware of the significance of the horse's movements, safe ways to approach a horse and the relative position of the horse in relation to the surroundings and themselves.
Riders and handlers should exercise extreme caution when riding in the presence of objects or animals that could frighten the horse (eg other horses, dogs, vehicles). This is particularly applicable to children.
Extreme caution should be taken when riding in situations that could upset the horse and cause unexpected behaviour.
Small children should be separated from horses. Safety precautions around horses should be taught from an early age under close supervision.
Further research on identifying the injury risk factors amongst horse handlers (as distinct from horse riding) is needed.
Horse handlers should avoid the back legs of horses at all times.
The standards and practices of riding schools should be subject to mandatory accreditation and inspection by an external body.
Riding instructors should be certified, experienced and have a good knowledge of horses and horsemanship.
The choice of instructor should not be solely based on salesmanship or convenience (eg, the accessibility to the riding school or the availability of instructors).
Education of parents in the general principles of horse riding and handling safety should be included in public education programs.
The extent to which public education programs are effective in reaching their target groups, eg recreational riders, farmers, parents, etc should be determined.
The effectiveness of public education campaigns in reducing horse-related injuries should be evaluated. Results from such evaluation should be fed back to improve the education campaigns.
In rural areas, where much of the supervision of child riders is done by parents, training of parents in riding safety should be considered.
Educational programmes need to be targeted at recreational riders, encouraging them to have lessons with accredited instructors.
The teaching and use of appropriate falling techniques to prevent injury should be evaluated.

APPROPRIATE EQUIPMENT AND CLOTHING

Horse riders should conduct routine checks of their tack (or saddlery) before mounting. All equipment should be checked for signs of fatigue and correct adjustment of fit.
Regular maintenance checks of all equipment should be undertaken.
Riders should avoid wearing loose clothing that could catch on trees, etc.
Riders with long hair should ensure that it is tied back.
It is strongly recommended that stirrups are matched to the size of smooth heeled and soled boots with elastic sides.
Non-slip gloves may help to prevent friction burns associated with holding the rein.
Effective hand, particularly finger, protection for rope handling needs to be further investigated.
Sturdy boots should be worn when undertaking horse handling activities.

ENVIRONMENTAL FACTORS

Where possible, riders should avoid excessively soft/muddy ground and ditches, holes and uneven terrain with rocks and exercise caution if these surfaces are unavoidable.
Riding in outside paddocks should be limited to experienced riders.
During horse handling activities, the horse should be isolated from all other horses, if possible.

PROTECTIVE EQUIPMENT

All horse riders should wear a standards approved helmet.
Children in the vicinity of a horse should always wear a helmet, whether or not they are mounted.
There should be further standards development and improvement for helmets.
More developmental research needs to be undertaken to improve the design of helmets must be improved that are low cost and versatile.
Educational campaigns to increase helmet wearing rates need to be very well planned and implemented. Such campaigns should also be formally evaluated.
Attitudinal barriers towards helmet wearing need to be assessed and addressed in education campaigns.
Manufacturers should consider developing a helmet which meets both safety requirements and the aesthetics of different equestrian activities.
Consideration should be given to conducting formal evaluation of the effectiveness of equestrian helmets in the field.
The preventive effectiveness of the different types of safety stirrups needs to be formally evaluated.
The circumstances under which body padding is likely to be effective needs to be determined.
The effectiveness of such body padding needs to be formally evaluated in the field.

FIRST AID

Organisers of equestrian events should ensure that adequate first aid and medical services are provided.
Recommendations for the minium level of first aid equipment and personnel at all events should be prepared and disseminated to equestrian sports bodies.
All horse riders should receive basic training in first-aid principles as part of their rider education.

OTHER COUNTERMEASURES

Choose a horse of appropriate size, temperament, character and age for the rider's size and skill level, in conjunction with a trained and experienced hosreperson.
No beginner or child should have a horse aged less than five years. Older horses are better for beginners.
Inexperienced riders, especially children, should always be supervised when riding.
Alcohol use before riding should be avoided as this could impair coordination and judgement, lengthen reaction time, and reduce the ability to adjust to the movements of the horse

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