Head First – Horse Riding Accidents and Concussions

Last Updated on March 2, 2022 by Allison Price

Head injuries are the leading cause of death or admission to hospital for riders. The shocking statistics show that there is a high rate of horse-related injuries resulting in traumatic brain injuries. Helmets have been shown to reduce the chance of this happening by up to 50%. Many riders don’t wear helmets.

Courtney King Dye, an Olympic dressage rider from Florida, was admitted to hospital with a fractured skull. Her horse fell while she was training at home. She was not wearing a helmet.

A horse that was unaccompanied returned to its Washington State boarding facility. A rider found the body of the missing horse a mile away, on a gravel road. She was a victim of head trauma, had fallen and was now dead. She was not wearing a helmet.

Patricia Moore, an Ontario barrel racer, died in 2005 from severe head injuries after her horse fell and stumbled outside the ring. Moore was not wearing helmet.

Elizabeth Hader, a ten-year-old girl from Ontario, was killed after being thrown from a horse which had spooked at a public trail riding area. The head injury was severe and she was not wearing any helmet.

Lara Dewees, a barrel racer and Florida rodeo queen, lost her reins in 2016 when her horse fell while competing. After the horse had recovered, she ran through the arena exit, but her reins were still missing. Dewees was then thrown to the ground, landing on her face. She died shortly after from a blood clot in her brain.

Horses can cause great damage because they are large animals. Contrary to popular belief, horses are not bombproof. A horse that is well-behaved and dependable can suddenly become a flight-driven, panicking animal in just a few seconds. People or riders can be hurt or crushed as it runs into or crosses people or horses. Horses can also stumble or trip and send a rider facefirst to the ground.

Head injuries are the leading cause of death or admission to hospital for riders. A fall of 60 cm (two feet), can cause permanent brain damage. However, a horse can raise a rider’s head to three metres (more that eight feet) above ground. Horses can travel at 60 km/h, while the skull of a human can be shattered by impact at speeds between seven and ten kilometres an hour. A rider with a head injury is at risk of sustaining a second. A second concussion can cause sudden death in children, teens, and young adults. Death can result from a catastrophic accident. However, people who survive traumatic brain injury (TBI), may experience epilepsy, memory impairment, speech problems and confusion, speech problems, mental and emotional disorders, personality changes, emotional changes and post-traumatic stress disorder. A head injury can change your life in a number of ways.

What is Traumatic Brain Injury or Concussion?

Parachute is dedicated to saving lives and preventing injuries. It explains that a concussion occurs when the brain shifts or shakes in the skull. Although the impact that causes the brain’s collision with the skull can be to the head, body or both, it is the force that does the most damage. You can bruise the brain or cause bleeding by rotating the brain. A shock can alter the brain’s chemical functions. There are no two brain injuries the same. The symptoms can vary greatly and last for days, months or even years.

According to the Northern Brain Injury Association, brain injuries are most likely to cause permanent disability or death. Brain injury is reported in British Columbia at a higher rate than any known cases of multiple sclerosis or spinal cord injury, HIV/AIDS and breast cancer. According to the NBIA website 452 Canadians suffer serious brain injuries each day.

Historical data, based upon a study by Janet Sorli on horse injuries and published in 2000 in Injury Prevention. Data from the BC Ministry of Health for 1991 to 1996 revealed that 1,950 hospital admissions were recorded, an average rate of 390 per day. 15 people were killed, 9 from head injuries. Sixty percent were women, ranging in age from four to seventy one years. No one who died from head injuries had ever worn a helmet.

Researchers from the Department of Neurological Surgery at the University of California, San Francisco and the Brain and Spinal Injury Centre, San Francisco General Hospital examined data from the National Trauma Data Bank. They found that the most common cause of sports-related TBI in adults was equestrian and horse-related. This figure accounted for over half of all TBIs in people older than 40. The report “Adult sports and traumatic brain injury in United States Trauma Centers” was published in Neurosurgical Flash in April 2016.

Horse Riding Accidents

Researchers wrote that this finding is consistent with previous reports which indicated higher rates of severe traumatic injuries in equestrian sports and related activities than in football, rugby and skiing. They also noted higher rates of hospitalizations than in other high-risk activities like motorcycle riding. The US Centers for Disease Control and Prevention states that while motorcycle riders sustain serious injuries every 7,000 hours, horses suffer one every 350 hours.

The UC San Francisco study found that helmet use rates are lower in equestrian sport than elsewhere, despite the fact helmets have been shown to reduce the absolute risk of TBI by as much as 40-50 percent.

It is alarming to see the number of head injuries sustained by equestrians compared to those suffered in contact sports and other activities. Research shows that 45.2 percent of all sports-related TBI occurred in equestrian or related sports. Falls and interpersonal contact accounted for 20.3 percent. Roller sports accounted for 19.0 percent, ski/snowboarding was 12.0 percent, while aquatic sports was 3.5%.

These findings are consistent in the report “Ten Years of major equestrian injuries: Are we addressing function outcomes?” published by the Journal of Trauma Management & Outcomes. They were written by Jill Ball, an occupational therapist, and a team of Calgary Health Region health professionals. Their focus was on severe and serious equestrian injuries.

They reviewed all trauma patients from 1995 to 2005 and found 151 injuries while horse riding. Ten people died from severe head injuries. All 141 of the injured had a mean injury severity (ISS) score of 20 (major trauma). Although 55 percent of the horses and riders were well-trained and experienced, only nine percent wore helmets.

Four categories often describe symptoms of TBI or concussion.

  1. It can be difficult to think clearly, remember things, or focus on specific topics.
  2. Headaches that don’t go away, nausea/vomiting balance problems, dizziness blurred vision, blurred vision and tiredness are some of the physical symptoms.
  3. These emotional changes can include sadness, irritability and depression.
  4. Problems with sleep include difficulty falling asleep, sleeping for longer periods or being awake for a longer time.

These symptoms can be present immediately, or they may not appear for several days or weeks. They may not be obvious to family members, friends or the doctor if they are subtle.

Brain cells and brain function are highly vulnerable after a concussion and they are at risk for a second injury. A rider who returns to equestrian activities after a concussion has fully healed is at greater risk for a slower recovery and worse outcomes, including post-concussion Syndrome, which can cause headaches and dizziness, and can take much longer to heal. They should not ride or engage in risky activities until their doctor has cleared them.

Accident Response

You should be aware that anything could happen when you’re at the barn riding or participating in a lesson. My facility hosted a riding clinic several years ago. The riders were both teenagers and juveniles. There were two groups with six riders each. One of the riders brought a horse that she wasn’t familiar with. She was testing it to make sure it was right for her. There were red flags. It is not a good idea to ride a horse in a riding clinic. The horse and rider didn’t know one another and they were in a foreign place. The horse panicked, bolted from the warm-up circle, and then bucked off his rider. The rider sustained a broken arm. This incident caused a stir among other riders and a “bombproof” pony, who was already nervous, also got involved. The young rider suffered a broken wrist.

These incidents are not meant to be a cause for concern, but serve to show that accidents and injuries can occur from any number of triggers. The injuries sustained by the riders were minor and all were wearing helmets.

Here’s a list of things to do if someone falls off a horse while riding in a riding circle.

  • All activity must be stopped
  • Call 911.
  • Don’t move the injured rider or allow him/her movement.
  • Do not take off the helmet.
  • Ask the conscious person where they feel pain.
  • To elicit a response, touch, rub, or pinch the skin of the patient if they are not responding. In the event of a spinal injury, do not shake the patient.
  • If you are not breathing, open your mouth to ensure that the airway remains open.
  • You should feel for a pulse at the wrist or neck. If there is no pulse, you should only start CPR if you have been trained.
  • Examine the area around your head and face for bleeding. Also, check for fluid draining from your nose or ears.
  • Keep the patient warm.
  • Apply pressure to a bleeding wound with a towel.
  • Notify the parent/guardian if the rider is under 18.
  • Secure the horse.
  • All other riders must leave the arena.
  • Make sure that paramedics have clear access to the patient.

Even if they jump up to claim that they are feeling good, ask them to sit down and rest. Do not allow them to excuse the accident. Accidents that aren’t obvious can be covered up with adrenaline. Internal bleeding could occur. You can suggest that they visit their doctor or the emergency room at their local hospital. Do not allow them to take chances.

All riders must immediately stop riding if they are involved in a riding accident. It is important to assess the condition of the rider who has fallen and to quietly capture the horse that has been left behind. The old saying that you can’t get back up after a fall is true, but only after the rider has been assessed and the cause of the accident. Photo: Shutterstock/Tanya Esser

Trail Riding

Trail riding, even on local trails, can make a medical emergency more difficult.

Ride with a friend to ensure safety. Inform someone at home about where you’re going and the trail(s) that you are following. Also, tell them when you expect to return. Make sure your phone is charged. You should have a first aid kit, one for you and one for your horse. You will need to bring bottled water, snacks, a whistle and lighter. Also, you’ll need waterproof matches or lighter. Before you leave, check the weather and dress accordingly. You will need a jacket or vest with zippers to store your phone, personal information (name, address and phone number), emergency contact, whistle, and medical information. If they are not in your saddle bag, they will cause you to be separated from your horse. Secure the shank with a halter and place the bridle underneath your horse. Your horse should learn to stop using dropped reins.

These are some additional guidelines:

  • Choose a horse that is suitable for your level of skill.
  • Ride with a friend if you are riding a green horse.
  • Keep one horse between the horses when riding in a group. This will ensure that, if a horse kicks or is thrown, no one behind it will be injured.
  • Do not race or ride too fast for the conditions. Use the least skilled companion or green horse to speed you along.
  • Learn how to fall and do an emergency dismount.
  • All safety equipment must be worn, including a helmet, safety vest, boots that have a heel, safety stirrups, or stirrups that come with cages.
  • Walk the last mile.

Avoid riding at night or in low lighting (not the best plan), and keep your pace at a walking pace. You should also consider wearing reflective gear.

Keep in mind that wildlife can be seen moving around at night and evening, so your horse may come across a bear or cougar. Horses will be able to see a deer in the dark, even if it is not visible. Your horse will be more at ease riding alongside a friend if you are riding together. You can both help one another if something happens. If you have a cellphone, you can also call for help.

Backcountry has a lot to offer. The lure of the backcountry is irresistible. Powerful views, iconic wildlife, camping under the stars, and the call of the loon from a lake at dawn make it an appealing option. There are risks and nature can be a tough taskmaster. Be familiar with the rules. Be prepared for any eventuality.

Make sure you have some safety precautions in place if you plan to take a long backcountry trip. Your route, planned campsites and estimated travel time are all important to your family so that they can calculate where you should go at any given moment in the time since your departure. Search & Rescue will need to know your details for any ride if something happens and you don’t return as planned. You should not alter the route unless there is an emergency, such as an avalanche, rockslide or other unplanned event. Make sure you have an emergency plan in place before you leave.

You know enough about your horse and yourself to recognize when you are losing your mind and should return. You could have fatigue, lameness, nagging injuries or overheating.

Memory loss, blurred vision and headaches are all possible signs of concussion. These signs may be subtle and not obvious immediately, or for several days or even weeks. Photo: Canstock/Bialasiewicz

You should always stop to greet other hikers or riders when you’re out of range of your cellphone. You could also give them your phone number so they can call your family.

Additional items that you will need for a local trail ride are a hydration pack, water purification tablets and pen flare kit with bear bangers or multi-coloured flares. You can also pack heavy-duty Ziplock(r), bags to protect your essentials, and a survival kit.

In the late summer of 2000, 30 kms from Banff National Park, I was filming bighorn sheep at a salt lake. My campsite was visited by a single rider. He was in his forties, riding a Quarter Horse and a reliable pack horse. He was riding a backcountry route from Banff and Jasper. He stopped, rested, and we spoke for a while. He was having some problems getting started in Banff, and was now behind schedule. He knew that his wife would be worried if he didn’t arrive in Jasper on time. He knew I was leaving for home in a few more days so I promised to call him and tell her everything was fine, where he was, that he would be late, and that I would be calling her. When I called her, she was so thankful.

The United States Pony Club tightened regulations regarding headgear. Concussions fell by 29 percent, and head injuries dropped by 26 percent.

Backcountry travelers have a common code of conduct: they look out for one another. There are enough things that can go wrong to make sharing information crucial.

Horses are amazing, but they can slip, spook and buck and fall. Their instinct to flee danger is just as strong today as it was for their ancestors. Be proactive. Be cautious. You can prevent an accident from happening by being alert to the dangers and taking proactive steps to reduce your risk.

Safety Gear and Equipment

Riding helmets

The most important piece of equipment for riding is the riding helmet. There are no excuses for not wearing a helmet. It should be securely fastened before being mounted.

A friend of mine had ridden her horse years ago and was about to put her helmet on. However, she forgot to fasten it when her horse reared. She fell backwards and landed on her head on concrete driveway. This caused permanent memory loss and functional problems.

A helmet should always be worn when you are working with horses or near them. Horses on the ground can cause serious injuries. Tied horses can jump and startle sideways, putting the handler at risk of being stepped upon.

Your helmet should be replaced every five years. It should also be replaced after one fall. Never share your helmet. Check the manufacture date and ensure that it conforms to ASTM standards.

Horse and rider must wear reflective gear while riding on roads and trails. Another way to reduce the risk is to wear high visibility clothing like this fly bonnet and helmet cover from Heads Up Clothing in Ontario. Heads Up Clothing.

Protective vest

The style, quality and type of riding will all play a role in the choice of vest that a rider chooses. Vests are designed to protect the rider’s vital organs and soft tissues from injury during a fall. While vests are not intended to save lives, they can be used to soften the blow. Vests that have been accredited by ASTM/SEI meet safety standards.


Boots with a heel protect your leg and foot (if you are wearing a long boot) while riding in the bush and prevent your foot from sliding through the stirrup.


For bush or trail riding, chaps are a great choice. They protect jeans and breeches from scratches and tears. They stop chaffing against saddles and pinching from stirrups leathers.


Gloves provide warmth and protection for hands. They also give you a better grip when holding the reins. They can be made from leather or in winter styles. It is important that you can comfortably hold the reins.

Toe Stoppers and Stirrups

There are many styles and sizes of stirrup irons, and their designs have changed over the years. There are traditional Fillis irons, breakaway stirrups that are used for emergency release, as well as those that ease joint pain and are specifically designed for competitions. You can add rubber inserts to improve boot grip or rubber-cushioned for endurance riding. The breakaway stirrups, made from stainless steel and featuring a thick rubber band on one side, are designed to reduce the chance of a foot being caught. Toe stoppers, or cages, prevent the toes from sliding through the stirrup. They can be attached to any existing stirrup iron.

Reflective equipment for horse and rider

Reflective equipment’s purpose is to make the horse visible. Equines can have reflective brow bands, nosebands, reins and quarter sheets. They also come with leg wraps, bell boots, tail plates, breast plates, tail wraps, leg wraps, leg wraps, belly boots, breastplates and bell boots. Riders have the option of wearing helmet covers, vests and jackets with reflective stripes.

Allison Price
Allison Price

I’m Allison, born and raised in San Diego California, the earliest memory I have with horses was at my grandfather’s farm. I used to sit at the stable as a kid and hang out with my Papa while he was training the horses. When I was invited to watch a horse riding competition, I got so fascinated with riding!