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Riding safety: helmets and injuries

Horseback riding injuries are common, and most happen to riders who are on the horse. The figures below come from Nationwide Children's Hospital and the American Academy of Orthopaedic Surgeons, and the advice also draws on Utah State University Extension and University of Kentucky equine programs. This page is not medical advice, and it is not veterinary advice.

How often injuries happen

Nationwide Children's Hospital reports that over 65,500 people per year are seen in US emergency departments for horse-related injuries. From 1990 through 2017, an estimated 1.8 million people went. The AAOS cites the National Electronic Injury Surveillance System, which shows more than 48,000 people treated in hospital emergency rooms for horseback riding injuries in 2017.

Most of these injuries, 89 percent, happened while the person was mounted. Overall, 67 percent came from falling or being thrown, and 12 percent from the horse bucking, rearing or spooking. Females made up 64 percent of injuries. The median age of those injured was 29.8 years.

What gets hurt

By body region, the hospital's data shows the upper extremity at 30 percent, the trunk at 29 percent, and the head and neck at 23 percent. The most common diagnoses were broken bones at 31 percent, soft tissue injuries at 28 percent, and concussion or closed head injury at 11 percent. Of those injured, 87 percent were treated and released and 12 percent were admitted.

The AAOS says arm injuries are common because riders try to break a fall. These include bruises, sprains, strains and fractures of the wrist, shoulder and elbow. It adds that the most serious injuries can damage the pelvis, spine and head, and may be life-threatening.

Helmets

Nationwide Children's Hospital says helmets reduce both the number and the severity of injuries, and that you should wear one every time you ride. It points to ASTM standard F1163, advises checking independent helmet rating websites before buying, notes that a more expensive helmet does not always protect better, and recommends replacement every 5 years or sooner if stored in a hot barn. Utah State Extension highly recommends a helmet certified by ASTM or the Safety Equipment Institute, and says bicycle and motorcycle helmets are not the same.

Boots, vests and equipment

The hospital recommends boots with a heel of at least 1 inch, a closed toe and a gripping sole, gloves for rein grip, and a safety vest to protect the chest, spine and internal organs in a fall. The University of Kentucky also calls vests a very good investment for all riders. The AAOS advises inspecting all riding equipment for damage, checking that the saddle and stirrups suit your size and are adjusted, and securing everything properly. Children and novices should consider safety stirrups that break away if the rider falls off.

Skill, terrain and condition

The AAOS says novice riders should take lessons from experienced instructors, and young riders should always be supervised. Amateurs should ride on open, flat terrain or in monitored arenas, and jumps and stunts need a higher level of skill and supervision. Do not ride when tired, when taking medications or under the influence of alcohol. If you fall, try to roll to the side, away from the horse.

Nationwide Children's Hospital also asks riders to match horse and rider: a nervous rider can pass that on to the horse, and a horse that is too energetic or distracted can be dangerous. It advises riding with someone in case the horse or rider needs help. The University of Kentucky says never to ride alone and to carry a phone.

Questions to ask before you ride

Use these to check the points above before you book or mount.

Also on this site: Your first trail ride · all horseback riding stables by state.

Sources

Read on November 9, 2026. Rules and advice change. If something here is out of date, the contact page is at the bottom.