User:Twinzor/Equestrianism health concerns

Riding has some inherent risks, as when mounted, the rider's head may be up to 4 m from the ground, and the horse may travel at a speed of up to 65 km/h. The injuries observed range from very minor injuries, to fatalities.

Relative risk
A recent study in Germany reported that the relative risk of injury from riding a horse, compared to riding a bicycle, was 9 times higher for adolescents and 5.6 times higher for younger children, but that riding a horse was far less risky than riding a moped.

In Victoria, Australia, a search of state records found that equestrian sports had the third highest incidence of serious injury, after motor sports and power boating. In Greece, an analysis of a national registry estimated the incidence of equestrian injury to be 21 per 100,000 person-years for farming and equestrian sports combined, and 160 times higher for horse-racing personnel. Other findings were that use of spurs may contribute to ankle fractures and dislocations, and helmets likely contribute to prevention of traumatic brain injuries.

In the United States each year an estimated 30 million people ride horses, resulting in 50,000 emergency room visits (1 visit per 600 riders per year). A survey of 679 equestrians in Oregon, Washington, and Idaho estimated that at some time in their equestrian career one in five will be seriously injured, resulting in hospitalization, surgery, or long-term disability. Among survey respondents, novice equestrians had an incidence of any injury that was three-fold over intermediates, five-fold over advanced equestrians, and nearly eight-fold over professionals. Approximately 100 hours of experience are required to achieve a substantial decline in the risk of injury. The survey authors conclude that efforts to prevent equestrian injury should focus on novice equestrians.

Mechanisms of injury
The most common mechanism of injury is falling from the horse, followed by being kicked, trampled, and bit. About 3 out of 4 injuries are due to falling, broadly defined. A broad definition of falling often includes being crushed and being thrown from the horse, but when reported separately each of these mechanisms may be more common than being kicked.

Types and severity of injury
In Canada, a 10-year study of trauma center patients injured while riding reported that although 48% had suffered head injuries, only 9% of these riders had been wearing helmets at the time of their accident. Other injuries involved the chest (54%), abdomen (22%), and extremities (17%).

A German study reported that injuries in horse riding are rare compared to other sports, but when they occur they are severe. Specifically, they found that 40% of horse riding injuries were fractures, and only 15% were sprains. Furthermore the study noted that in Germany, one quarter of all sport related fatalities are caused by horse riding. Most horse related injuries are a result of falling from a horse, which is the cause of 60-80% of all such reported injuries. Another common cause of injury is being kicked by a horse, which may cause skull fractures or severe trauma to the internal organs. Any possible additional risks caused by riding during pregnancy is a matter of some debate, and not enough evidence is available to assess any such the risks accurately. Some possible injuries resulting from horseback riding, with the percent indicating the amounts in relation to all injuries as reported by a New Zealand study, include:
 * Arm fracture or dislocation (31%)
 * Head injury (21%)
 * Leg fracture or dislocation (15%)
 * Chest injury (??%)

Among 36 members and employees of the Hong Kong Jockey Club who were seen in a trauma center during a period of 5 years, 24 fell from horseback and 11 were kicked by the horse. Injuries comprised: 18 torso;  11 head, face, or neck;  and 11 limb. The authors of this study recommend that helmets, face shields, and body protectors be worn when riding or handling horses.

In New South Wales, Australia, a study of equestrians seen at one hospital over a 6 year period found that 81% were wearing a helmet at the time of injury, and that helmet use both increased over time and was correlated with a lower rate of admission. In the second half of the study period, of the equestrians seen only 14% were admitted. In contrast, a study of child equestrians seen at a hospital emergency room in Adelaide, South Australia reported that 60% were admitted.

Riding astride
The idea that riding a horse astride could injure a woman's sex organs is an historic bugaboo. This includes the popular idea that riding astride can damage the hymen. Evidence of injury to any female sex organs is scant.

In female high-level athletes, trauma to the perineum is rare and is associated with certain sports (see Pelvic floor). The type of trauma associated with equestrian sports has been termed "horse riders' perineum". A case series of 6 women, 4 mountain bike riders and 2 horse riders, found both patient-reported perineal pain and evidence of sub-clinical changes in the clitoris; the relevance of these findings to horse riding is unknown.

In men, sports-related injuries are among the major causes of testicular trauma. In a small controlled but unblinded study of 52 men, varicocele was significantly more common in equestrians than in non-equestrians. The difference between these two groups was small, however, compared to differences reported between extreme mountain bike riders and non-riders, and also between mountain bike riders and on-road bicycle riders. Horse-riding injuries to the scrotum (contusions) and testes (blunt trauma) were well known to surgeons in the 19th Century and early 20th Century. Injuries from collision with the pommel of a saddle are mentioned specifically.