Sports and Health Sciences
Master's Degree Capstone Project December 2024
#Equestian Sport Safety; #Equestrian Training
#Equestrian Sport Preparticipation Exam
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   Current Equestrian Sport Injury Trends and A Proposed Unified Equestrian Safety Plan to Reduce the Risk of Injury

Zena A Medica-O’Hea

American Public University System SPHS 697: Capstone Brian Oddi December 01, 2024
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  Current Equestrian Sport Injury Trends and A Proposed Unified Equestrian Sport Safety Plan to Reduce the Risk of Injury Abstract

As a sport based on a working relationship between horse and rider, equestrian sports are some of the more challenging in terms of injury risk as the human with predator psychology is mounted upon a prey animal of a size of four to eight times the weight of the rider. In response to a perceived threat, the activation of the sympathetic system occurs resulting in the release of epinephrine, and norepinephrine from the adreno-medullary cortex of the renal system. To escape the perceived threat, horses are capable of rapid unpredictable changes in speed (aka bolting), horizontal and even vertical orientation changes (Peters & Black, 2011, p.63-65).

These reactions can unseat the rider with force resulting in injuries as the rider strikes an immobile object during or after the fall. While exploring equestrian sports safety, a literature review was conducted to discover current trends of equestrian; sport-related injuries, the use of preparticipation examinations, fitness/skills programs, and protective equipment.

Regarding equestrian safety, the information found readily available for study pertained to injury data and general riding instruction information. Less available, in this regard, was information in the areas of equestrian-specific fitness training, while nearly non-existent information sport-specific protective equipment efficacy and preparticipation exams was available.

During this project, to address these deficiencies, a proposed plan of unifying the above elements, with a very specific safety focus was developed into the ‘ Unified Equestrian Sport Safety Plan’ (EUS2).  EUS2 proposes a safety plan based on two key goals: 1 The ability to ‘sit’ a horse in a variety of circumstances and 2. Take a fall safely when it does occur thereby mitigating risk/ occurrence of injury.


 Equestrian sports activities are not only diverse like style and performance levels for horse and rider but also pairs of riders and horses, of various ages, and levels of training. It is estimated that in the United States of America (USA) 30 million people participate in equestrian sports (Mutore et al., 2021, p.1). Horses, able to travel up to 40 miles per hour and with an average weight of 1,000 pounds (Meyer et al., 2024, p.1), it is known and accepted within the sport that participation carries with it a certain level of risk of injury. To become a skilled horseman takes years of practice and training. Popular experts such as Dale Gibson (equestrian stunt rider and coordinator), express frustration that this aspect of equestrian sports is not well known (Lane, 2015, p.218). This is a common reoccurring observation as actors request to be trained to ride shortly before an audition. Mr. Gibson goes on to explain that just as a professional sportsman such as a football player begins a career in the sport at first high school, advances to the collegiate level eventually if able to advance far enough, becomes a professional level athlete. This is true for a horseman, it takes years of training to become proficient (Lane, 2015, p.218). Learning the skills to ride well will always entail time in the saddle experiencing dynamic forces to develop the strength, reflex, and specific skills to remain well-balanced upon a horse, that is ‘developing a seat’ or having a ‘good seat’ Introductory horsemanship instruction (aka ‘riding lessons’), and by convention involves one to two hours per week of instruction with a riding instructor while mounted on a ‘schooling’ horse (matched to the rider’s ability) at the instructor’s owned or contracted training facility. Basic posture, the use of subtle weight shifts, additionally cuing instruction help the novice equestrian build a foundation in horsemanship (Ritter, 2011, p.13). It is with consistent proficient riding (with or without an instructor) that the rider continues to develop the associated musculature, and neuro-muscular, flexibility to develop a sound seat (implies the rider’s balance, focus, and agility to remain in a mounted position while astride a horse) (Podhajsky, 1965, p. 210-221). As advancements in sports; physiology, biomechanics, and fitness science fields in general has occurred over the past 10 years, equestrian sport trends/changes were researched. This encompassed a look at equestrian-related sport injury (ERSI) data, use of preparticipation examinations, athletic personal fitness training, horsemanship instruction, and protective equipment keeping in mind finding a way forward to improved equestrian sport safety options. The resulting investigation not only provided the information needed but also set a unique approach to a way forward in a united manner. Literature Review The search to establish the foundation for the project involved multiple areas of literature search for insight. In the following discussions below it becomes clear that a consistent risk of injury as well despite available protective equipment, the widespread use of preparticipation physicals, and advancements in riding instruction standards. The topics included are: • Current trends of equestrian sport-related injuries o Cause of injuries o Injury patterns • Personal athletic fitness trainer professionals Current Trends Of Equestrian Sport-Related Injuries Beginning with a broad overview review of equestrian sport safety, a literature search was conducted. Employing the US National Medical Library public database for scientific the search string “equestrian sport related injury” with parameters set to the last 10 years and free access availiblity, a result of 46 studies returned. This was narrowed down to exclude solely pediatric studies, and to include US population-based investigations. The findings of the research revealed that over the past decade, equestrian sports injury incidence and type of injury (with the exception of a 2002 study result in which head injury rates slightly declined) has remained similar through the years (Young et al., 2015, p.6). Cause of Injury It is currently estimated that one in five equestrians will sustain a sport-related injury mainly due to a fall from a horse (Meyer et al., 2024, p.1). The following discussion of findings among the studies was quite similar establishing a pattern of injury and peristence. Publishing their results in 2024, Muir et al., conducted a retrospective study of the injury rates for equestrian related sport injuries from 2018 to 2022. The resource for the injury data was drawn from the one of the nation’s many medical data base systems connected to emergency service centers, the National Electronic Injury Survelliance System (NEISS). The NEISS gathers and sorts emergency room patient data by various data fields such as date, injury type and region of body (Muir et al., 2024, p.3). 4,760 patient cases qualified for inclusion in the study. The predominate cause of injury for 98% of the cases resulted from a rapid change of position unexpectedly from mounted to dismounted positions contacting the ground forcifully (Muir et al., 2024, p.5). Additional studies echoed similar findings. For instance, Gates and Lin published a 2020 review citing the finding that in 96% of the cases included in the study findings, it was an unexpected change from mounted to dismounted position striking the ground forcifully in an irregular manner that resulted in injury (Gates and Lin, 2024, p.19). This pattern of predominance of cause of injury was yet again noted by Young et.al., in the team’s 2015 literature review that likewise noted that it was the fall off a horse was the leading cause for injury in14 of the 19 studies reviewed (the remaining five studies did not specify the cause of injury) (Young et al., 2015, p.4). Injury Patterns Injury patterns among injured equestrian athletes have been noted in order of predominance as follows: 1. Extremity Fractures 2. Head/ Neck Injury 3. Thoracic/Abdominal Injury Extremity injuries such as fractures, dislocations, sprains and contustions were the most common injury patterns found in 1564 cases, while head injuries were the second highest cause resulting in 1,075 cases out of the total (Muir et al., 2024, p.6). Gates and Lin published a 2020 review of equestrian sport injury trends finding that extremity injuries were more predominant than head injuries and One study of note had a different pattern of injury prevalence. Mutore et al. researched the National Trauma Data Bank (NTDB) for head injury patterns of equestrian athletes cared for during 2007-2016. The findings revealed that of the 24,791 patients qualifying for inclusion, 37% sustained injury to the thoracic region, 26.46% involved extremity fractures, and 22% sustained a head trauma (Mutore et al., 2021, p.2-3). These studies of equine sport-related injury patterns reveal that the majority of incidents arise from the sudden unpredictable movement of a horse that unseats a rider who then contacts the ground with enough kinetic force to result in soft and osseous tissue injuries in nearly 96% to 98 % of the cases as above. This trend is despite, in general, sporting industries advancement in areas such as athletic physical fitness training science, use of pre-participation sports screening physicals, and protective equipment. This provides key insight into two areas in which the equestrian athlete can reduce the chances of injury; 1. Physical and mental fitness to help remain focused on the ride, maintain balance, adaptability to maneuver in the saddle to compensate for rapid position changes, and 2. Translate kinetic forces associated with the change from a seated position to contacting the ground more efficiently reducing the magnitude of the forces. An athlete’s performance and safety is directly associated to their overall health and medical conditions being as optimally managed to meet the demands of their chosen sport. Athlete’s in addition to general health physicials, will have a preparticipation sport examination (PPE) completed as required by a sporting authority and/or personal choice performed by a physician or under the supervision of a physician. The National Athletic Trainers Association most recent position statement stresses the importance of the regular completions of a PPE and provides guidance as to the components and reason for inclusion. The goal is to guide a clinician to potentially identify areas of medical safety concerns associated with the performance of the sport for that athlete (Conley et al., 2014, p.2) Pre-participation sport physicials have become common place over the past 40 years and are in use widely (Conley et al., 2014, p1) in general sports but not as prevelant in the equestrian culture. A literature review search of the US National Information of Biotechnologies: Library of Medicine database with the search string “Equestrian sport preparticipation physicals” resulted in no matched or associated studies with the topic. A Google search of the same search string, resulted in a link to the US Equestrian Foundation’s para-athlete’s PPE for competition and the Ohio based private university, University of Findlay’s equestrian studies program PPE form (University of Findlay, n.d.) Personal Fitness Athlete Trainers As sport sciences have advanced and become more incorporated into organized sports, athletes across many fields have benefited from a fundamental training program addressing their psychological, strengthening, agility and flexibility. In fact the American College of Sports Medicine (ACSM) published this year a special communication discussing the recent evidence of general fitness testing of adults to optimize training and performance (Vigh-Larsen et al., 2024). Personal fitness trainers (PFT) are uniquely educated and skilled in the current evidence based fitness testing, developing training plans and supervising the training of an athlete (McGill & Montel, 2019). Rising in popularity, PFT’s are common in many privately owned and chain operated gym facilities (some of which include PFT services as a benefity). It is important to note that while personal trainers are not required to be certified to provide services in the US many find that to be competitive in the market certification from one of many evidence-based exercise science training programs is a must. Within the general investigation into equestrian fitness concepts, it has been found that these fundamentals are making their way gradually within the equestrian culture. A Google search string performed on 25 November 2024 of “Equestrian personal trainers” yielded nine trainers offering this specialized focused personal training service either in-person and/or online video. Although the results were markedly lower than for many well-known sports (ie soccer, basketball, football etc.), this is an encouraging finding as a beginning of integration of personal training principles with a focus on rider-specific needs to perform their sport more healthily and safely. For a client with multiple medical disorders, or specialized physical needs (i.e. para-athletes) a personal trainer could then refer/recommend a client to a personal trainer with specialty training. For example, an American College of Sports Medicine (ACSM) trainer certified as an Exercise Physiologist has been trained in four sports medicine theoretical domains as noted below: • Health and Fitness physcial assessment. • Exercise prescription and implementation methods • Exercise counseling and approaches for modifying behavior- • Understanding of risk management/ responsibilities Equestrian Riding Discipline Specific Protective Equipment With the develop of more shock absorbing materials such as plastics, gels, foams, these agents have become integrated into protective sporting equipment in an effort to decrease kinetic energy made by forceful contact to improve safety of the athlete. A notable familiar area is the change in football (child-adult) athletic gear of vests, shoulder, anterior thigh contact regions and even includes flavored, stylized mouth guards made of advanced thermoplastics. In general, it is accepted that sport-related protective equipment that it does mitigate risk of injury occurrence and severity among contact sports. Logically, equestrian sports are classified as contact sports. The NATA more specifically identifies risk of contact/collusion as high for rodeo events, while on the other end of the spectrum, contact risk classification for recreational /general horseback riding categorized as a limited contact sport (Conley et al., 2014, p.113). Based on risk associated within a riding discipline, equestrian sporting organizations have begun to incorporte recommendations and rules of protective equipment to be worn during sponsored events. Rodeo Cowboy Disciplines An equestrian sport organization that sponsors bronc riding is the Professional Rodeo and Cowboy Association (PRCA) which holds competions in both saddle bronc riding and bareback bronc riding disciplines (Professional Rodeo and Cowboy Association, 2024). The PRCA, while not having specific rules according to the 2023 Professional Cowboys Rule Book regarding required wearable equestrian protective equipment for participation in its events, the responsbility as to the rider’s acceptance of the dangers of the sport and their responsibility for safety results in riders wearing helmets with faceshields, mouthguards, static vest with a neck collar; long sleeve shirts, jeans, chaps, gloves and boots (Professional Rodeo and Cowboy Association, 2024). Cross-Country Eventing Disciplines The equestrian organization sponsoring competitions in the discipline of Cross Country Eventing, US Equestrian Federation (USEF) has established rules of participataion to include protective equipment wear. With riders participating in a times and and performance point competition (aka cross country eventing) in which they traverse sequentially an outdoor course of obstacles of various size, shape and materials in which horse and rider jump over until all obstacles have been completed. The risk of injuries is notably higher due to the velocity, height of obstacles and terrain traversed. Likewise the US Eventers Association (USEA) is another national regulating authority sponsoring cross-country eventing competitions. USEA has also established strict guidelines for protective equipment to include rated helmets (ASTM F1163, SNELL E2016), and thoracic protection vests (ASTM F1937 or certified by the SEI) (United States Eventers Association, 2017). Riders participating in the eventing competitions will only be permitted to do so if wearing a static vest that meets the standardization or exceeds ASTM standard F1937 or is certified by the Safety Equipment Institute (SEI). If an AV is worn it is to be over the qualifying static vest (United States Equestrian Federation, 2024). Horse Racing Disciplines The preeminent US-based equestrian organization for the discipline of Horse Racing is it that of the US Jockey Association (USJA). The USJA mandates that in addition to being medically qualified and licensed by their authority to participate; wear of regulation helmets, vests, and boots be worn ( Ryan et al., 2020, p.375-377). Amature / recreational equestrian sport participation is not regulated and wearable safety equipment use is at the discretion of the rider. in general, is much less regulated. There are various equestrian sport riding clubs, associations, etc., however, few guidelines other than when participating in an organized competition for riders. Usually at this level, a helmet may be required, and boots as general custom with other protective equipment is the choice of the rider. Protective Gear for Equestrians by Region of Body Additionally, a rider’s mindset regarding safety equipment use, in particular helmets, is variable even despite the familiarity with the benefits. Theadom et al., in 2020 conducted a behavioral study survey investing equestrian knowledge of the purpose of a riding helmet and the possible benefits. The team found that despite having an understanding of and accepting the potential benefits to reduce the risk of head injuries, there was reluctance to wear a helmet (Theadom et al., 2020). Head and neck protection equipment specifics One of the most familiar of the wearable protective equipment used by equestrians is that of the riding helmet. Advances in safety analysis of use, ability to absorb kinetic energies with modern thermoplastics have led to standardized expectations of performance. The American Safies and Materials (ASTM) institute will assign a rating designation of ASTM F1937 for helmets manufacture to this specification. The Safety Equipment Institute (SEI) likewise has a specific safety standard and is an acceptable rating among many. Riding helmet mandates were introduced across nearly all equestrian disciplines in 2021 (Meyer et al., 2024, p.2). Although riders experience extremity injuries more commonly, head injuries tend to be more severe when they do occur and can result acute to chronic traumatic brain injuries (Gunter et al., 2018, p.3). Post-concussive recoveries are notably variable from rider to rider and it is recommended that return to riding protocals follow the six step plan of the International Conference on Concussion in Sports (Gunter et al., 2018, p.2-8). Although the USEF has mandated helmets for the equestrian discipline of show jumping in it’s competitions since 1967 (Gates and Lin, 2020, p.20), more broad multi-discipline mandates have been in effect since 2021 (Meyer et al, 2024, p.2). The efficacy of helmets to reduce skull fractures and mitigate exposure to concussive forces, there are but a few current studies which have examined the actual injury data of equestrian sport helmets to reduce head injury risk. In 2015, Young et al., performed a review of equestrian sport injury patterns noting that despite variances among research evaluated, that there was a reduction of skull fracture occurrence and severity (Young et al., 2015, p.6). While in 2017 Bier et al., performed a matched-pairs study in which 40 equestrians patients with sport related head injuries qualified for inclusion. The team found that of the 40 patients, six presented with skull fractures, only one of those six patients had been wearing a helmet (Bier et al., 2017, p.1). Additionally, Bier and team found that intracranial injuries were five-times higher in the unhelmeted patients. Of note in each of these studies other than self-disclosure by the patient/observers as to if the rider had a helmet on, no additional information such as brand, year of production etc was available. Helmet production and availability has matched the expanding equestrian equipment needs becoming a one-billion dollar industry in 2021 with projections to reach one point six billion dollars by 2031 ("Equestrian helmets market," 2024). This data shows that despite some limitations of use by equestrians based on preference, knowledge of function and risk of sport-related head injuries (Theadom et al., 2020), that there is a progressive demand and projections that this trend will continue. Thoracic/Abdominial Regional Protection for the Equestrian Transitioning to the thoracic and abdominal area of the equestrian, protective safety vests are available. Although there is a limited prevelance of thoracic injuries within equestrian sports when they do occur there is a notable risk for severe injury. In a restrospective analysis of equine sport related injury data, Muir et al found that rib fractures were sustained in 17% of the cases while internal organ injuries accounted for 15% of the 4,760 patients of the study (Muir et al., 2024, p.2). Despite thoracic/abdominal injuries occurring at releatively lower incident rates compared to extremity and head, thoracic /abdominal regional injuries make up the second (only to the head) leading cause of mortaility when they do occur (Mutore et al., 2021, p.3). Equestrian safety vests are currently being developed and used in attempt to lower the risk of injuries in various disciplines such as rodeo, bronc riding, hunter-jumper, eventing etc. Safety vests can be of a static nature, filled with foam and/or gel substances, or dynamic such as the CO2 cartige charged air-vests (AV) (Meyer et al., 2024, p3-5). Both AV and static safety vests are available readily for purchase. However, as of late, only static safety vests have safety standards (ASTM F2681, ASTM F1937) regulating a specific level of kinetic energy displacement and absorption capability (Meyer et al., 2024, p.2). Interestingly the efficacy of safety vests has been found to be contradictory. For instance, Meyer et al., found that while foam/static safety vests reduced injuries in riders of the show jumper discipline, another found that there was no reduction of injury to the thoracic /abdominal regions (Meyer et al., 2024, p.4-5). Meyer’s team additionally found that in the discipline of horseback racing, jockeys cited not only interference by position change with the vest causing the helmet to shift forward but also a hinderance of executing tuck and roll tumbling manuevers employed to mitigate forces when striking the ground from a sudden dismount. Although the pro and cons of safety vests had been found, there was no data that static safety vests caused injury. AV’s, on the other hand, have been found to be associated with increased risk of injury. Publishing in the 2024 Annals of Biomedical Engineering, Meyer et al., provided the results of a literature review of AV’s. AV’s did perform well in laboratory studies but the translation of ability in field use was not positive. Rather than reducing injury, it was found that the use of an AV was associated with nearly two times the risk of severe injury vs those riders who did not use AV’s (Meyer et al, 2024, p.3). AV and helmet combinations can also be problematic. A helmet’s protective action is in it’s ability to absorb some of the concussive kinetic energy force via absorption, deflect the contacting surface by not only is slick outer surface material but some even have a rotational component to translate the connecting kinetic energy forces. As the AV inflates rapidly and forcifully by the CO2 cartiage, it becomes firm around the head and neck of the rider in some case locking the helmet stationary (Meyer et al., 2024, p.5). Extremity protection gear There is a long tradition of riding boot wear to protect the lower leg, ankle and foot in the various equestrian disciplines. Not only are boots made with a heel specifically for horseback riding riding boots recommended to prevent kinetic energy forces from causing injury to the rider but also to help maintain the foot in the stirrup. The heel of the boot helps to keep the foot from traveling through the stirrup which would be extremly dangerous as the leg essentially locked in one position minimizing the rider’s ability to execute horsemanship techniques to communicate with the horse but also prevent tumbling escape manuevers if partially ejected from the horse. This scenerio can translate into a dragging of the rider and injury as they strike the ground repeatedly, are hit by a hoof, strike nearby objects such as fences, gates, vehicles etc. Equestrian Riding Instructor Qualification Standarization With multiple riding disciples existing within the equestrian sport, one rule book per say does not apply, hence riding instructors do not have a formalized standardization of training/qualifications that is required. That being said, currently there does exist of a variety of college and instituational certification programs that have been forming resulting in a general framework of compentency guidelines. An example of such an organization is the Certified Horsemanship Association (CHA). The CHA established basic riding instructor compentencies across more than 16 disciplines of equestrian sports that if met leads to certification According to the CHA’s riding instructor compentency guidelines, it is basically outlined that the instructor be familiar with human anatomy and physciology as it relates to coordinating motion while mounted, have knowledge of horsemanship techniques and skills within a discipline and develop safety plans to mitigate risk to horse and rider (Certified horsemanship association, n.d.). Customarily speaking, equestrian sport training is taught by an instructor at the beginning if not throughout a rider’s career. Traditionally a new rider will meet with a riding instructor (typically who has developed a reputation as a good rider during competitions, then decides at some point to become a self-recognized instructor) operating at an affiliated training facility which is arranged with minimal obstacles, sound distractors, visual stimulation working inside an fenced in area (the riding arena). This offers an environment to help focus the novice riding student and their horse (if the rider is not using a facility ‘lesson’ horse trained for student riders). Horsemanship foundation principles (which are basic across equestrian disciplines) are then taught in customarily one-hour lesson blocks. There are a variety of training programs for riding instructors in the United States, however, there are no standards of competencies that a riding instructor must achieve. The variability of riding instruction content, methods of instruction, advancement of a student, and recovery of an injured student persists. Although riding organizations such as the United States Equestrian Foundation (USEF), CHF, and United States Dressage Federation (USDF), are developing their respective certification programs, there is still much ground to be covered in such a diverse sport. Creative Project of a Proposed Solution: Introducing the Unified Equestrian Sports Safety Plan When considering the predominate risk of injury to the equestrian as being caused by a sudden movement by the horse (translating kinetic energy to the rider) resulting in an unexpected, ejection at various speeds, angles of flight, angles of contact to a surface a closer look at the basic physics principles at work is key. It is when the accumulated energy of the momentum contacts a surface, that the rider’s body translates the energy to that surface. The surface then either absorbs, dissipates, and/or reflects that energy back into the rider’s body. It is that reflected force back with the tissues absorbing the remaining kinetic forces which will determine the depth of disruption, magnitude of force, and direction of travel. It is that force returning to the body that causes injury. Considering these basics, a possible method of mitigation of those forces began to take shape. Physicians, personal trainers, riding instructors/coaches, protective equipment even gymnastic exercises/tumbling techniques are some of the components already available yet equitation sport injuries from contact with the ground in a rapid, unexpected manner are still occurring consistently over the past 10 years plus. What is missing? It is proposed that somehow these components are not unified to clearly work hand in hand with each other providing a substainal risk mitigating intervention. Developing plan of how to do this first required bringing the overarching two goals needed to be accomplish reducing rider sport injury and those are as follows: 1. The rider maintains their seat 2. The rider dampens the accumulated kinetic forces of a fall. Maintaining a Centered Riding Seat A skilled, fit rider can remain well seated despite a horse’s sudden change in speed, vertical or horizontal orientation. To do this a rider will need to be able to focus mindfully on the circumstance, aware of the horse’s concern with surrounding environmental stimuli (dogs suddenly barking or charging, a fluttering piece of plastic etc) noting if the horse is becoming more anxious. This awareness starts with the rider in a healthy mindset (Johnston, 2012, p.37). Pre-participation exams by a physician aware of the importance of this can fine-tune examinations of the associated systems such as psychology, psychiatric, metabolic, and the circulatory system which may affect this. A personal fitness athletic trainer would be quite instrumental in the performance of exercise testing with a focus on balance, core strength, flexibility and agility needed thereby instilling physical and mental preparedness to remain seated. focus on the development of strong horsemanship skills to safely combine a rider and horse both mentally and physically. a hard with that forceA possible solution that may mitigate risk of equestrian sport injuries could be to harness the advancements of sport science developments used by other sporting organisations. As the review has revealed, though various aspects of current sports sciences has made it’s way within the equestrian culture, the prevalence and consistency appears to be quite variable Building a basic framework gounded by the current science-based principles athletes are anticipated to have improved safety in general as well as sports performance. Mitigation of Accumulated Kinetic Energy Associated with a Unprepared Dismount. Mitigate the reflected kinetic energy forces reflected back to the rider resulting frequently associated with an increased speed, angular movement, and vertical orientation change upon striking a firm surface (Nylund, 2015, p.37). Various members in sports sciences practice such as clinical sports medicine professionals, personal trainers, registered dieticians, and sport-specific coaches currently apply the evidenced-based sports training and physiology concepts within familiar organized sports such as basketball, soccer, football, weight lifting, etc. Equestrian sports athletes, it is proposed, would benefit in the way of reduced injury if such services were to combine for equestrians built upon a unified approach from each in their respective professional fields to keep a rider mounted safely and in the event of a fall, reduce the kinetic force to which their bodies are exposed. UES2 Components and Framework Considering the above two safety goals for an equestrian, the following discussion proposes how professionals assisting the rider with their riding goals can approach the same two goals guiding them. An equestrian’s team of professionals could include in addition to the rider: • Physician • Personal Trainer • Riding Instructor Figure 1 illustrates a conceptual safety relationship among the team of professionals. The idea is that there is communication and a shared focused goal of the safety of the rider to minimize the risk of injury in a coordinated manner Figure 2, is similar as Figure 1, however, the center element specifically draws one’s attention to just what aspect of rider safety is emphasized in this proposal, that the rider’s ability to remain on the horse as well as mitigate forces associated with a fall is paramount to reduce ESRI ability to ‘sit a horse’ through many circumstances becoming safe skilled riders (Podhajsky, 1965, p.210). The rider must be supported to achieve and perform the skills necessary to do so. The following presents a proposed approach to decrease the risk of injury risks by routinely focusing on the rider remaining proficiently seated and yet being prepared to execute tumbling escape maneuvers when an unexpected dismount circumstance occurs. Physician Physicians whose primary training provides a broad knowledge of disease management principles across all age groups have specialized in Family Medicine and/or Internal Medicine. In the NATA position statement regarding PPE administration, it is discussed that a physician would be ideally suited to complete the exam. It is also mentioned that while other professionals such as a Nurse Practitioner or Physician Assistant who complete the physical, that the level at which a physician would perform the exam, sets the expected standard for any other professional completing the form (NATA, 2014, p.4). Although should perform a preparticipation sports physical to establish a an athlete focused health analysis of the patient. Timing for completion of the preparticipation physical can be completed before the beginning of sport participation, annually, after a medical incident/injury and/ or before return to play after a sporting injury. The physician’s role: Ensuring a rider’s ability to maintain a good seat. An equestrian sport-based supplement is proposed with an additional focus on rider safety to perform by maintaining their seat addressing: 1. Ocular-vestibular reflexes -metabolic influences that may decrease the speed of reflex. 2. Cognitive and Memory – Establish baseline measure; intrinsic or extrinsic influences. 3. Emotional regulation- An average or higher emotional intelligence. 4. Homeostatic Health/Injuries – Note prior injury, and current risks. 5. Balance-Coordination Systems: - Evaluate and consider confounding influences. 6. Open communication between rider, riding instructor, and personal fitness trainer Critical to riders maintaining their mounted position (aka “seat) The physician should address any other special considerations of the athlete that would potentially interfere with the rider’s ability to maintain a good seat. This includes but is not limited to nutritional health concerns such as eating disorders, and specific cultural dietary practices (periods of fasting etc). In fact, current nutritional science advancements and studies have not only recommended the use of registered dieticians to safely improve an athlete’s performance, but multiple professional sports medicine (include the Academy of Nutrition and Dietetics, Conditioning Coaches Association, American Medical Society for Sports Medicine and the National Athletic Trainers Association) agencies support a recently proposed consensus statement that nutritional services be integrated in athletic programs (Lambert et al., 2022, p 717). While a physician can provide basic and disease nutritional recommendations, in cases of more advanced needs they can provide a consult to a Registered Dietician Nutritionist (RDN) and/or a Certified Specialist in Sports Dietetics (CSSD) for proficient to expert level care of their patient’s needs (Lambert et al., 2022, p. 718-720). Physician’s role: Mitigating injury during the fall phase. Tumbling and gymnastic capabilities will need to be employed by the rider in the event of an unplanned dismount to manage the accumulated kinetic energy forces by the circumstances leading to the dismount. The following areas of clinical assessment could be of use when evaluating equestrian health and impairment influences by performing the tumbling techniques optimally: • Neuro-muscular coordination development; intrinsic or extrinsic influences • Agility- baseline musculoskeletal health; intrinsic or extrinsic influences Personal Fitness Trainer Personal fitness trainers typically have earned a sports science-related college degree and /or are certified by a sports performance training program. This education allows the personal fitness trainer in a position to provide a scientifically standardized method for creating and supervising an athletic training plan for a client (Waryasz et al., 2016, p.98). As not all athletes are equal, it is standard in the sporting science community that an initial fitness evaluation be completed to establish a baseline for both the client and the trainer to review and use as a template for an agreed-upon training plan. Periodic repeat assessments of the client’s progress are typically performed to assist with further training activities structure and incorporate additional techniques and equipment as the client progresses. Interestingly of note is that this is such a progressive area of sports science principles being explored that over the past ten years, the exponential study of methodologies to evaluate athletic ability in baseline and periodic assessments has occurred (Vigh-Larsen et al., 2024, p.1510). In a 2024 special communication, the Official Journal of the American College of Sports Medicine recommended a more tailored approach to fitness test selection for the athlete and one specific test in each relevant domain be used thereby reducing client overload from multiple tests in similar areas (Vigh-Larsen et al., 2024, p.1520). The CPT can provide navigate testing and planning, working in tandem with the client to develop a plan to meet fitness goals safely and efficiently. It stands to reason a horseman would benefit from this fundamental approach to fitness which is already widely employed in other sporting disciplines. With the key concept of minimizing injuries and maximizing performance, integrated sports training programs that include training in metabolic system balance, flexibility training, speed and agility, plyometrics, and balance would create a solid fitness foundation ( McGill and Montel eds, 2019, p.1-42) for a rider in general. Personal trainer’s role: Ensuring a rider’s ability to maintain a good seat. The rider’s and personal trainer’s eye is on developing the rider’s ability to maintain their seat in an explosive kinetic energy shift which requires the rider to rely on the neuromuscular strength and coordination systems. Listed below are proposed baseline personal training program elements to develop a rider’s ability to ‘maintain a good seat’ by focusing on developing the rider’s: • Core strength and endurance • Posture balance maintenance on static and dynamic motion platforms • Pelvic stabilization musculature and thigh muscular strengths and balance • Agility in explosive circumstances while in a seated position • Neuromuscular power associated with fatigue resistance. • Open communication with rider, physician and riding instructor Attention to the above elements in the training program is proposed to not only help the rider remain in the saddle effectively but also improves horsemanship skills, even if the rider is not able to train frequently on a horse. This thereby assists in safe advacement of the rider’s horsemanship capabilities. Personal trainer’s role: Minimize injury to a rider during the fall sequence. To assist the rider in a fall scenario, it is proposed that a fitness training plan that includes tumbling exercises will help to reduce the risk of injury by mitigating the kinetic energy consequent of fall/contact with the surface. Tumbling gymnastic skills employed to dissipate the kinetic forces of a fall have been introduced to reduce rider injury risks (Nylund, 2015, p.4). Fall training coaches who provide training clinics around the US and globally are becoming more prominent even providing specialized equipment to eject a rider onto sets of tumbling pads receiving further instruction as to form and considerations (Nylund, 2015, p.43). While this is beyond the pervue of the personal trainer in a local gym, providing tumbling training is not. This training should occur as early as possible as rider begins their career and be continued throughout the rider’s program. Responsive tumbling ablility and overall flexibility is needed to mitigate the kinetic energy force, angle of transmission through contact points and dissipation. Listed below are proposed training focus areas to help meet the client’s needs to excute escape tumbling procedures: • Tumbling training from static and dynamic platforms • Tumbling training with and without the wear of the rider’s protective gear. • Overall agility in a dynamic circumstance to transition into the tumble. Riding Instructors The key of a rider to remain mounted in a variety of equestrian sports demands is a fundamental pillar of horsemanship. Riding instructors play an instrumental role in integrating mounted horsemanship theory and the rider’s fitness to work in concert with the horse as a team. Horsemanship theory provides not only biomechanics of performance, and performance parameters, but also covers equine behavioral theory as well. As part of the horsemanship training, the riding coaches help to develop the understanding of the behavioral responses of a horse and how the rider's mood and /or reaction to a sudden change of the horse's demeanor can either de-escalate a situation and (thereby help the rider remain mounted) or draw attention to rider’s responses that escalated reaction by overstimulating the horse. Riding Instructor’s Role: Ensuring a rider’s ability to maintain a good seat. The cornerstone of safe effective horsemanship is the ability to remain atop a horse safely and in a communicative manner between horse and rider. A riding instructor can play an instrumental role by observing the rider and providing feedback as to the maintenance of the posture, leg, and hand aids. Guidance regarding the fit of riding equipment to horse and rider is another another benefit of working with a well-informed riding instructor. Of note, as the horse and rider’s physical conditioning evolves with training, periodic re-assessment is recommended. Riding Instructor’s role: Minimizing injury to a rider during the fall sequence. In the event of unexpected dismount, employing mitigating methods to reduce the kinetic energy reflected into the rider as the rider contacts a surface is absolutely fundamental to reducing the risk of injury and even preventing injury. Returning to the various rider’s sports team members, each will be discussed as to the role they can further play in reducing the rider’s risk. To mitigate the fall from the horse from injuring the rider the riding instructor can draw from the following: • Encourage rider fitness – require a PPE with an equestrian sport focus • Educate riders regarding the protective equipment available and use • Monitor the rider for behaviors that may indicate decreased concentration • Open communication between rider, physician and personal trainer • Rider is wearing prescribed hearing aids, glasses for the lesson • Ensure the saddle fits the rider and horse well In addition to coordination and communication between horse and rider; a riding instructor is in a unique position to educate riders as to the importance of tumbling skills and timing of use, but also the protective gear aspect. As part of the safety program, it is recommended that a riding instructor be knowledgeable about the types of protective equipment available, which is best suited for the demands/risks of a particular discipline but also the fit of protective equipment. Figure 5 is a proposed template guideline with considerations that can be used as a prompt for a riding instructor to develop their lesson plans. As with each of the other templates supplied, this can also be shared with the rider to discuss with their physician and/ or personal trainer. This approach should assist with not only a standardized approach to safety but also potentially improve communication between the rider’s other personal team members. Limitations The literature selected for a literature review project can tend to be biased inherently and at times unexpectantly. To minimize the inadvertent bias that can occur with resource selection, literature search strings, and Google search resources used were only of the top ten results. This inherently injects bias of the perceived safety risks of the study participants selected for inclusion in trend analysis. Studies in which non-emergency room visits such as urgent care clinics, local family or internal medicine practices, or home care that was delivered after injury were not found for inclusion in this project. Of note, for information gathered in the available studies was limited to what was entered into the electronic health record coding system when caring for the patient. A source of additional possible bias of resource use included textbook materials. Textbook resources were obtained from the author’s collection. This choice carried inherent bias, however, the information used for inclusion is represented broadly in similar texts as well. Conclusion As sports-related science fields continue to provide scientific-based theoretical and practical application guidance, athlete fitness and safety continue to improve. The prominent risk of injury to the equestrian has been identified, that is the translation of kinetic forces from the horse to the rider in an unexpectedly powerful manner. The kinetic forces that an equestrian is exposed to particularly when suddenly dismounted are unrefutable as the leading cause of injury, with the amount of absorption and/ or dissipation of the kinetic energy force reflected after contact with a surface that is the determining factor as to the severity of the injury. Current advances within the sports sciences and medicine industries provide the ability to mitigate accumulation and reflection of the forces into a rider. It is therefore recommended that current sports physiology and biomechanical principles become fundamentally integrated into the foundation for equestrian athletes as well. As equestrian sports fitness programs continue to emerge the author hopes that the proposed template, based on the safety principle focus, will offer a united way forward to decrease the risk of equestrian sports-related activities. 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