University of Vermont AAHS

September 1999, Vol. X, Number 3

 Table of Contents

Nutrition Advice for Your Riding Patients
Eating to Compete
How Safe Is Riding?
Horse Riding Establishment Bylaw
Letters and Comments on Bylaw Enactment
Compensable Horse Related Injuries in Professionals
Approved vs. Non-Approved Riding Helmets in Competition Disciplines
The Importance of Protective Equipment
Editorial Comment
Irish Horse Riders Accidents
News Items

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Riders are 50% of an athletic partnership. Do they pay as much attention to their own nutrition as they do to their horse's?


Nutrition is not a consideration only for show days. It is about developing healthy eating habits for every day of your life. This makes particular sense for riders. The very business of caring for a horse is tough physical work -- from mucking stalls to pushing wheelbarrows, lugging sacks of grain, stacking hay bales, slogging water buckets. Even grooming the horse for an hour has been estimated to burn as many calories as a session of low-to-medium impact aerobics.

Yet riders are frequently so busy running after their four-legged partners, and catering to their every need, that they neglect their own. They skip meals, eat whatever is at hand (often junk food like cola and burgers), gulp food on the run, and at horse shows, they throw every principle of good nutrition out the window and subsist on nachos and curly fries from the catering truck! Or even worse, they rely on adrenaline and caffeine to get them through a day that demands peak performance. Figuring out a better way to fuel their performance will not only make show days run more smoothly, it will help them cope with all the day-to-day chores of horsekeeping.


Like any other kind of athlete (including the equine kind), riders perform best when fueled by a diet that is high in carbohydrates. Carbohydrates are the most ergogenic nutrient known -- meaning that they support or stimulate athletic performance.

Carbohydrates come in two basic varieties, simple (sugars, such as glucose, sucrose, and fructose) and complex (sometimes called starches). Both are converted by the body into glycogen, a molecule which is stored in the muscles and the liver and is available to be converted back into glucose whenever there's a need for energy. Carbohydrates can fuel both aerobic activities (those requiring slow, steady effort over a long period of time) and anaerobic (high-intensity, short-duration bursts of energy). They also help maintain the body's blood sugar levels; a healthy blood-sugar level is linked to brain function and ability to focus on a task, among other things.

Complex carbohydrates are the most valuable kind of food to include in the rider's diet, because they are stored more efficiently; simple carbohydrates, or sugars, are easier for the body to break down, so tend to supply a quick, but not lasting, energy burst. Good sources of complex carbohydrates include pasta, cereals, breads, whole grains (such as rice), and legumes (beans), while simple carbohydrates are found in fruits and vegetables as well as sugary foods like cookies and candy bars. Fruits and vegetables are the better choice, because they are also excellent sources of vitamins and minerals, including the trace minerals and electrolytes which are so important for athletes to replenish after they perspire.

All athletes, riders included, should aim to make carbohydrates (both simple and complex) a full 55 to 65% of their daily diet. That is six to 11 servings per day of pasta, beans, bread or grain, two to four servings of fruit, and three to five of vegetables in all. A diet too low in carbohydrates will tend to leave the athlete feeling wrung-out and exhausted prematurely -- because his or her energy stores are depleted.


The primary role of protein in the diet is to help the body grow new tissue and to repair tissues which have been damaged by day-to-day wear and tear. A young, growing human has quite a high protein requirement, but adult athletes need to make protein only about 15 to 18% of their daily diet (two to three servings).

Protein requirements do not increase that much even when a mature athlete is exerting him or herself to the maximum. Most humans eat far more protein than their bodies could ever need or use -- so adding more protein to the diet, over and above what is normally consumed, is almost never necessary. Instead, it is best to concentrate on finding good sources of protein that are also low in fat. Turkey, fish, chicken, beans, nuts, tofu, and low-fat dairy products are all quality protein choices; also good, but higher in fat, are many cheeses, red meats like beef or pork, and spreads like peanut butter. Though everyone needs "some" protein, the best rule of thumb is this: when you put together a meal, consider high-protein foods an "accompaniment", not the main focus on your plate.


Americans know that we eat far too much fat. But fat isn't "all" bad. It is a dense energy source that can be used to fuel performance; it supplies the body with essential fatty acids, which are crucial for healthy skin and many other organic functions; and it carries the fat-soluble vitamins, A, D, E, and K, without which our immune functions, our eyesight, and our blood-clotting ability (to name only a few functions) would be compromised.

The main reason fat tends to do so much damage is that it is more than twice as energy-dense as other nutrients. One gram of fat contributes nine kilocalories of energy, while a gram or protein or carbohydrates contains only four kilocalories.

The aim is not to eliminate fat from the diet, but to regulate it. At most, riders should aim for fat to make up 20 to 25% of their daily diets. A lower fat intake has a number of benefits, including a lower risk of heart disease and some forms of cancer. Not only that, but the less fat riders are storing in their tissues, the more athletic they are likely to be on their horses.

Much has been written about the relative evils of saturated vs. unsaturated fats, 'good' vs. 'bad' cholesterol. Suffice to say that animal fat sources, which are 'saturated' and are generally solid at room temperature, are considered less healthful, on the whole, than vegetable sources of fat, which are for the most part unsaturated and are liquid at room temperature.

Since finding sources of fat is rarely a problem, here are some recommendations for limiting fat in your patients' diets:

· Avoid fatty, marbled cuts of meat, choosing the leanest cuts instead and trimming most or all of the visible fat before cooking.

· Remove the skin from chicken and turkey before you cook it.

· Boil, grill, steam, broil, bake, or stir-fry foods instead of frying them.

· Instead of using butter or oil for cooking, try water, or a quick spritz with an aerosol cooking spray such as Pam (yes, it's oil, but you'll apply much less). Non-stick pans will also cut down on the amount of fat needed.

· Substitute chicken, turkey, or fish for high-fat meats such as sausages, burgers, or bacon.

· Limit consumption of butter, margarine, mayonnaise, and high-fat salad dressings.

· Wherever possible, choose 'low-fat' food products, including skim or 1% milk rather than cream in coffee.

· For snacks, choose baked products like pretzels, air-popped popcorn, or some kinds of crackers, rather than greasy chips, buttered popcorn, nuts, or chocolate bars.



Of all of the nutrients, none is more crucial to health and athletic performance than plain water. Water accomplishes a wide array of functions in riders' bodies -- including helping them regulate their internal temperatures, helping to carry nutrients through the body, and acting as a coolant for working muscles. Riders get rid of wastes by mixing them with water and expelling them from their system as urine and sweat; when sweat evaporates on the skin, it also helps cool them in hot weather. Without sufficient water, riders become dehydrated, a state which affects almost every body system. Most importantly, a dehydrated rider does not think straight -- and that can be a dangerous scenario.

All too often, riders forget to keep their bodies hydrated, especially in adverse, high-stress situations such as horse shows. By the time a rider registers that she/he is thirsty, chances are she/he is already dehydrated; a headache is another sign. To ward off dehydration, riders should get in the habit of carrying bottled water wherever they go, especially to the barn and to horse shows. They should keep those fluids coming throughout the day, even when they're not feeling thirsty; this advice goes double in hot, humid conditions.

In a horse-show situation, especially in the summer months, riders should avoid coffee and tea, both of which contain caffeine and thus act as diuretics (substances which encourage the body to lose fluids). Alcoholic beverages are also diuretic in nature and a no-no for successful athletic performance. And riders should also avoid sugary, carbonated beverages -- especially caffeinated colas, which may be the worst of all worlds! Women who are feeling premenstrual may also want to avoid high-sodium beverages such as some vegetable juices, (ie tomato and V-8); the high salt content may increase fluid retention.

If riders are well-hydrated and urinating every two to four hours, the color of the urine should be light to clear; darker urine means they need to increase their fluid intake.



Though a well-balanced diet should supply riders with all the vitamins and minerals they need, even the best of them sometimes fall off the wagon and eat less well than they should. Riders should pay particular attention to three minerals which tend to be lost in sweat: sodium (usually found in sodium chloride form, which is salt), calcium, and potassium.

Getting enough sodium in a rider's diet is rarely a problem, but most dietitians recommend that athletes NOT make any heroic efforts to cut down on salt; riders need to replace the sodium lost in order to help their bodies absorb water, maintain fluid balance, and help stimulate the thirst reflex.

Calcium is needed not only for strong bones and teeth, but may also help protect against muscle cramps during athletic performance. Dairy products are the best calcium source, of course, but if a rider isn't a big milk drinker, consider adding more broccoli, kale, and collard greens to the diet. Supplementation in pill form may also be a good idea for many people, especially those with a family history of osteoporosis or brittle bones.

Potassium is an electrolyte which sometimes gets depleted over a long period of exertion (such as an endurance rider on a 100-mile ride might experience). Bananas and orange juice are excellent sources of this mineral.



Between the impractical attire required by horse shows and all the other stresses of a show day, both physical and mental, the last thing a rider needs is to feel faint and pass out in the horse trailer because she neglected to give his or her body the fuel it needs to cope. This is where a good nutritional program will stand a rider in good stead -- when performance really counts.

Part of the science of nutrition is finding out what riders' systems will tolerate as fuel when their adrenaline level is high and their intestines are tying themselves in knots! Sports psychologist Geri Agrey, of Seneca College in Toronto, worked extensively with Canada's three-day event riders in preparation for the 1996 Atlanta Olympics, and had the chance to observe many of the Team rider's nutritional habits in the months leading up to those Games. Skipping meals was a big problem, she says -- and so, she notes wryly, was persuading riders to avoid alcohol! She recommended to the Canadian athletes that they concentrate on putting something in their bodies every four hours, that they cut back on caffeinated beverages, and that they bring their own healthy food to competitions so that they didn't have to depend on the standard horse show fare of nachos and hot dogs.

Agrey also suggests that if riders make changes to their diet, that they do them gradually and well before the Big Event. "People should eat what they're familiar with," she says. "Don't suddenly change your diet just before (a show) and become a health-food nut. You might find that you spend the day on the toilet instead of in the show ring!"

A day before competition, riders should eat carbohydrate-rich meals and drink lots of extra fluids. On the day of the show, they should eat a light, easily digestible breakfast -- and here each may have to experiment to see what sits easily in the stomach when jitters may take over. Riders should avoid high protein or high fat foods, which not only tend to trigger unhappy digestive tracts, but may leave them with an energy deficit just when they need it most.

If riders are riding early, they should eat light, but if their turn in the ring isn't until later in the day, they should eat a full-sized meal to fuel them through to the afternoon. Leave time for digestion; most high-carb snacks can be processed and absorbed in under an hour, but a full meal may take as much as four hours.

During the show, riders should keep downing water, and snacking on carbohydrate-rich snacks every couple of hours. It is also a good idea for them to have a re-energizing snack within an hour after any strenuous exercise (such as the cross-country phase of a one-day-event); that's when their muscles will be most receptive to replacing lost nutrients. Riders should pack a cooler full of low-fat, high-carbohydrate foods, so they will be able to avoid the concession-truck foods. If they're forced to scavenge something at the show, they should eat smart as much as they can. Riders should try to re-fuel at least every four hours, and save something for the long drive home with the horse trailer.

Riders who pay attention to their own nutritional needs report that life takes less out of them. They have the energy they need when it counts, and that's a sign that their bodies are receiving the right fuel. Regardless of your age or physical condition, you owe yourself the same courtesy. You will thank yourself, and your horse will thank you too.

Based on material prepared for HORSE ILLUSTRATED.Copyright 1999 Karen Briggs

freelance journalist, specializing in equine subjects
1998 American Horse Publications award winner
Author of "Understanding Equine Nutrition", RR #1, Box 182, Mount Albert, Ontario L0G 1M0
phone (905) 473-9161 / fax (905) 473-5073

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Day before the show:

· Low-fat, high-carbohydrate meals such as pasta with a tomato or primavera (vegetable) sauce (rather than a cream sauce), baked potatoes, or skinless grilled chicken and rice.

· Lots of fluids.

· If a rider knows she won't be able to eat much of a breakfast, she should have a late-night carbohydrate snack before going to bed.

Morning of the show:

Something light, such as

· Fruit 'smoothie' shakes, made with yogurt or low-fat ice cream.

· Soft cooked cereals such as Cream of Wheat.

· Bagels or toast.

· Fruit (grapefruit, oranges, bananas) or fruit juice.

Avoid traditional, greasy breakfast foods like fried eggs, bacon, sausage, doughnuts, danishes, and hash browns.

During the show:

Pack a cooler with low-fat, high-carbohydrate items such as:

· Turkey or tuna sandwiches (hold the mayo), fruits (frozen seedless grapes are great on hot days), bagels, dry cereal, Melba toast, string cheese, or soup.

· Lots of cold water and juices.

· Save the caffeine for the drive home, if you need it!

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A report from
The Netherlands


The number of riding accidents is rising. Moreover, the injuries suffered tend to be relatively serious. With a view to prevention, the Consumer Safety Institute (CSI) of The Netherlands circulated a questionnaire to nearly 400 riding accident victims treated at Accident and Emergency (A&E) departments. Its objective was to discover the background to such accidents.


Horses and accidents

There are an estimated half a million horse riders in The Netherlands. They include approximately 72,000 competition riders and roughly 400,000 recreational riders. Only about 10% belong to an equestrian association. The majority of recreational riders (about 300,000) attend a riding school. Between 1992 and 1996 the number of riders increased by about 16% and the number of rides by about 28%-

Horse riders in The Netherlands sustain some 74,500 injuries annually of which about 45% require medical treatment. Each year about 9,100 riders are treated at A&E departments, about 720 are admitted to the hospital and about five riding accidents prove fatal. The number of both riding injury related A&E treatments and hospital admissions increased between 1990 and 1995 by 30% and 41% respectively. The rise in the number of injuries is thus not entirely attributable to the increase in the number of horse riders.


Restless mounts

We analyzed questionnaires from 189 victims, a response rate of 48%. Nearly half of the accidents occurred at riding schools, one third on private property, 12% on public roads and 10% on the countryside. Of the injured, 69% were riding the horse, 26% were not riding, and 5% were mounting/dismounting from the horse.

At riding schools many accidents take place during group instruction. Victims of riding school accidents are more likely to blame the horse than themselves. They tend to be less familiar with the horse and to ride less frequently than average horse riders. Many other respondents reported having been bothered by other horses, their mounts being restless and that the measures taken following the accident were inadequate. Such accidents often proved more serious than others in riding schools.


Public roads and countryside

In about a third of the accidents on a public road or on the countryside, a "third party" was involved (eg. another rider, a pedestrian or a car). The third party may have moved in an unexpected manner, made a noise or allowed insufficient room to pass. In accidents on public roads or in the countryside, victims tend to fall onto hard surfaces and to sustain relatively serious injuries. These victims are likely to blame themselves, to know their horse better and to ride more frequently than the average rider in this survey.


Unmounted accidents

One third of the accidents were on private property, of which 40% happened while riding with the remaining injuries taking place while tending the horse. These ground injuries often resulted from being kicked or trodden on by the horse. The consequences tended to be quite serious. These victims are more likely to blame themselves and to know their horse relatively well. They tend to be experienced horsemen and women.



The common injuries were bruises (40%) and fractures (35%); 5% of victims suffered concussion. Over half the injuries resulted from falls, and these tended to be relatively serious. Nearly 70% of the victims had another accident within the previous five years.



Among the victims, 57% were wearing a helmet at the time of the accident., of which more than half (54%) wore a standard classical helmet and 45% the more protective helmet. The safety helmet, which features a chinstrap, clearly fits more firmly than the standard one, but can still fall off. The protective safety helmet must neet a European standard set in 1996 (EN 1384). Wearing a helmet , particularly a safety helmet, appears to reduce the likelihood of brain and skull injuries. Only 9% of all helmet-wering victims had brain and skull injuries compared to 15% non-helmet-wearing victims.


Safety at Riding Schools

Organizations measures cater largely to riding schools and their managers and instructors. Direct contact with riders enables these schools to assure and enhance safety. Schools should encourage riders to wear helmets, limit group sizes, provide adequate medical facilities, inform instructors of their safety role and establish safer external riding routes, especially with inexperienced riders. Schools need to emphasize training and falling techniques and the increased risk of riding in public places and in horse care. An accreditation procedure for riding schools, coaches, and instructors should be established. Included in the accreditation should be their safety procedures, education content, reporting and follow-up on riding accidents.


Future actions

Riding schools and organizations could offer information kits giving recommendations for riding attire, equipment and the types of additional risks of riding in public places, on the country side and horse management on private property. Protective helmets could certainly be improved. If they were more comfortable, they would be worn more often.

Several organizations could implement these recommendations.

* Intermediary organizations like CSI could oversee safety standards and the design of information kits.

* Industry association such as riding organizations and clubs could promote the implementation of safety standards and study of training programs, and

* riding schools managers and private instructors should influence riders by the content of their teaching and by personally providing role models.

Hidde Toet
The Netherlands
Consumer Safety Institute
BOX 75169, 1070 AD
Amsterdam, The Netherlands

Editorial Comment

Following our study, several steps leading to preventive actions were made. In association with the Dutch Olympic Commitee, Dutch Sports Foundation and the Dutch Equestrian Association, we wrote a strategic plan in horse-riding accidents.The first action was pointed at horse riding schools, because they were easy accessible with prevention programs. A pilot study for safety guidelines at riding schools was further conducted in association with all possible participants. Implementation is expected to be followed by an evaluation within the near future.

Hidde Toet

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Editorial: Canada


Admission data from British Columbia reveals 11.8/1000 riders admission rate while Holland has 1.5/1000 riders admitted to hospital.  The admission rate for Dutch riders treated in the ER is 8% while the Canadian Injury Reporting and Prevention Program (CHIRPP) reveals 14.3% of Canadian riders require admission once they have arrived at ER (usual admission rate is 5%  for all other ER patients with injuries).  In BC 1/10,0000 riders per year have a fatality while the Dutch have 1/100,000.

This may be because 43.3% of CAnada accidents occur in outdoor recreation areas while the Dutch only spend 10% of their riding in the country.   Half of Dutch accidents occur in riding schools while only 19.8% of Caanadian riders are injured at a riding school.  ONly 2.7% of CAnadian accidents occurred on the raod while the Dutch had 12%.

Injury type seems similar with concussions 5%, contusions 40% and the rest are fractures.  The Canadian injuries also showed similar percentage of accidents while on the ground (37.9%).

Certainly, rdiers in BC's wilderness do not comply with helmet rcommendations as well as the controlled environment of the Dutch riding school and this may account for some of the increase in both admission rates and mortality.  The recommendations at the end of the article are universally necessary.

References:  Equstrian Injuries -- a Five Year Review of Hospital Admissions in 1995 CHIRPP Injury Report.


Janet Sorli, MD
Surrey, BC, Canada

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Ontario, Canada

The Township of Aurora, Ontario, passed a Horse Riding Establishment By-law on July 21, 1999, that is much more than a helmet by-law. This by-law sets a benchmark for future rules and by-laws in this area. They have addressed the issues of safety standards to include the unique requirements of equestrian activities. Not only do they address the issues of safety equipment but also instructor training and experience, first aid requirements and the horse’s training and experience.

All horse-riding establishments (where horses are let out on hire for riding or used in providing instruction for riding) require a license, which is revoked if there is a failure to comply with the by-law. The first section addresses mandatory approved helmet use by persons under the age of eighteen. They specify properly fitted helmets, fastened securely by a harness. They insist on boots with a heel or hooded or breakaway stirrups.

They have specific requirements for instructor training. Methods of communication are required i.e. two-way radios and cellular phones for trail rides. Riding double is forbidden. The horse must be considered safe, at least 5 years old, not a stallion, sound and schooled for the activity expected. A person must hold the horse by the bridle on the ground while the rider mounts or dismounts. There is a zero tolerance for drug or alcohol consumption among riders and instructors. Tack must be well fitted and in good condition.

The rider must have basic instruction in emergency dismount and rein techniques. There are a maximum 6 riders for each guide. No one under the age of 10 is permitted to ride unless they are ponied and at least 6 years old. Obstructions must be removed from the grounds. A sign must be posted stating the risk of the sport as well as the helmet and boot requirements.

The definition of instructor is that they are 18 or more years old and have 5 consecutive years experience riding horses in the previous 7 years or they are certified by the CEF, OEF, CHA, CanTRA , or the British Horse Society. The assistants must be at least 16 years old and have 3 consecutive years’ horse riding in the previous 5 years. Instructors must all have current CPR and First Aid training. The riding establishments must have insurance to cover two million dollars in liability per claim.

Chris Alexander
By-Law Service Coordinator
100 John West Way
Box 1000, Aurora, Ontario, L4G 6J1

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Letters and Comments on Bylaw Enactment



Chris Alexander
By-Law Service Coordinator
100 John West Way
Box 1000, Aurora, Ontario, L4G 6J1

Dear Chris:

Thank you and the city of Aurora for your concern for horseback riding safety and your leadership and courage in passing the recent by-law for your city.

As an individual, I would recommend a change in the by-law to you and your board. Your ordinance states: "No one under the age of 10 is permitted to ride unless they are ponied and at least 6 years old."  The United States Pony Clubs, an organization for youth under the age of 22, does not give a chronological age. The Safety Committee has suggested that the recommendations of the American Medical Equestrian Association be followed which includes:

Muscle Strength to hold the proper position in the saddle.
The balance to remain on the horse.
The ability of understand instructions and follow directions.
Sufficient attention span for instruction.
Neck Muscles strong enough to support fitted, approved protective headger.
No child should ride a horse without appropriate skills and level of development for riding.
A child must NEVER be mounted o a horse without a secured, ASTM standard SEI certified helmet.

The safety committee felt that this level of proficiency will be reached at different ages for individual children. At no time does the USPC require a child be ponied, led or on the longe line.  Under special circumstances a child under 6 years of age is allowed to participate. For the purposes of the Aurora By-Law, I would retain the requirement that the child be 6 years of age, but omit the requirement that a child be ponied under the age of 10 years.

Thank you and your governing board for your concern.

Doris Bixby Hammett, MD
American Medical Equestrian Association, Secretary
United States Pony Clubs, Inc., Safety Committee



I am not in favor of government regulation to address matters of individual behavior. I believe that adults must make their own decisions regarding such matters as wearing a helmet -- or riding a horse at all for that matter. A responsible adult must make such decisions for their children. Government regulation tends to incite an opposing response in many people, especially Americans. Government regulation also can not be tailored to an individual situation: there is one set of regulations for all. This is germaine, for example, to the question of how old a child must be before she/he can ride. Furthermore, I do not believe, in general, that it is the role of government to play "big brother" and try to protect each and every one of us from life and from our own mistakes. We must all be responsible for our actions. It is a slippery slope to engage government entities to try to force fully capable adults to behave in "desirable" ways.

Based on the above, I believe that education is ultimately better way to change behavior. One must accept that not eveyone you try to educate will care to be educated. In addition, I recognize that it is faster to pass a law than to try to reach large numbers of (possibly) unreceptive people. Difficult though it ay be, I believe that education is to be preferred over regulation.

Maureane Hoffman, MD
AMEA Board of Directors
5408 Sunny Ridge Drive, Durham, NC 27705

Editorial Comment:

When I compare these requirements with the AMEA recommendations I believe the Township should be congratulated on covering so many safety issues. I commend their consultants for not stopping at a simple mandatory helmet rule but insisting on addressing many of the contributing factors in riding accidents. As a former trail guide myself, I have seen where accidents were the direct result of such simple things as faulty tack or failure of an inexperienced guide to check the cinch. The helmet can decrease the risk of death from head injury but prevention of the wreck in the first place will save much suffering from other types of injuries and allow riders to experience the joys of the sport without the sorrows. I believe this is a gold standard for other horse riding safety recommendations. I wish the Township every success in making this by-law a Regional by-law and hope to see every riding establishment in Canada required to comply with these standards. I put it also to the insurance companies to encourage, by way of premium reduction, all riding establishments to comply with these standards where no by-law is in force.

Janet Sorli, MD
1575 12th Street
South Surrey, BC V4A CV2

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Compensible Horse Related Injuries in Professionals

A Comparison of Race Course versus Other Workers


Introduction: Horses are 500 kilograms of unpredictability even for experienced professionals. In British Columbia, Canada, the Workers Compensation Board insures most workers. In the horse industry many workers have no insurance whatsoever but racetracks and ranches must provide insurance for full-time staff. In 1987, Whitlock et al, compared injuries to professional jockeys versus amateurs and found that jockeys were less likely to sustain injuries than amateurs. Literature review has failed to reveal any comparison of jockeys versus other professional horse workers.

Method: Data from 1992 - 1996 inclusive was obtained from the Worker's Compensation Board of British Columbia. The data was coded as falls from mammals and contained the number of claims, (There are more uncoded claims in the current year than in other years. When the uncoded claims have been coded, the number of claims in the specific categories will increase as the number of uncoded claims decreases), benefits charged in dollars. ( The costs do not include health care and rehabilitation costs. The claim count includes claims accepted in the year regardless of year of injury. Health care only claims are not included in the count and days lost ( The days lost include all days lost in the year regardless of the year of injury). The information came under two headings; Race Course or Ranching, Horse Boarding or Training, etc.

The claims in each category were then compared by person years of employment. (The person-years of employment for an employer are estimated by dividing the employer's payroll by the average wage rate for the industry in which the employer opeates. The assumption being made is that wage rates are the same for all employers in the industry.)

Results: Among race course workers there were 1.75 injuries per year over the 5 years studied. Since there were 304.6 person-years of employment per year the rate of injury for race course workers is 5.7/1000 person-years of employment. The cost, on average, per claim for race course workers was $26,659 and the average days lost per year was 109 or 62.3 days per claim. Other professionals in the industry averaged 12.2 injuries per year in 3144.4 person-years of employment or an incidence of 3.9/1000 person-years employment per year. The average cost for other professionals was $4,782. Other professionals lost 905.6 days per year (74.2 per claim).

Discussion: Clearly the risk of injury for a race course worker could be predicted to be higher than others due to the type of horse used and the nature of racing. The Thoroughbred race horse is young (2 - 6 years old) and untrained for other activities than all out speed, reaching 65 kph. Why does a claim for a race course worker cost 5 times as much as for another horse industry professional, even when the length of claim is shorter on average? Clearly, further investigation is required.

Janet Sorli, MD
15321 16 Avenue
Surrey, BC, V4A 1R6

References: 1.Whitlock, MR., Whitlock, J, and Johnston, B Equestrian Injuries: A Comparison of Professional and Amateur Injuries in Berkshire Brit J Sports Med 21(1) March 1987 p25-26

2. Waller,A, Daniels,J,Weaver, N and Robinson,P Jockey Injuries in the United States Presented at the AMEA Annual Meeting Duke Univ. November 6, 1999

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Approved vs. Non-Approved Riding Helmets in Competition Disciplines

Sarah A. Neal


Introduction: Approved helmets are certainly safer when participating in mounted activities. It was a parental requirement that I always wear an approved helmet when riding. It was my opinion, however, that I was being discounted in the show ring by wearing an approved helmet. This was due to the helmets bulky and unattractive appearance. My concern was also due to approved helmets being uncomfortable and having a poor fit.

Method: I conducted an internet survey consisting of a twenty question query. The survey asked discipline, age, preference of helmets, use of approved and non-approved helmets. (See Figure 1) Over a 2-week period one hundred responses were gathered. The data was then tabulated into percentages based on the survey results. Three AHSA rated judges were kind enough to offer their honest opinions on the issues.

Survey: Approved vs. Non-Approved Riding Helmets

1. Do you wear an approved or non-approved to school?

2. Do you wear an approved or non-approved to show?

3. In response to the last 2 questions: What is your preference to the type of helmet based on?

4. What makes one helmet more appealing than another?

5. What brands are your helmets now?

6. What color harness/chin strap is on your helmet?

7. How long have you been riding in equine sports?

8. What # of people do you know that ride in approved helmets to show?

9. What # of people do you know that ride in approved helmets to school?

10. What # of people do you know that ride in non-approved to show?

11 What # of people do you know that ride in non-approved to school?

12. What relationships are most of the people that ride in approved helmets to you?

13. What relationship are most of the people that ride in non-approved helmets to you?

14. If you show what divisions and types of shows do you do?

15. If you do not wear an approved helmet now what would change your mind to wear one?

16. Rate the helmets on the following: 1 best- 8 worst:

                           Approved           Non-Approved

a. comfort                 _________             ________

b. fit                     _________             ________

c. how long they last     _________             ________

d. appearance              _________             ________

e. cost                    _________             ________

f. chin strap             

    -comfort               _________             ________

    -color                 _________             ________

g. harness   

    -comfort               _________             ________

    -color                 _________             ________

h. selection               _________             ________

i. styles                  _________             ________

17. What is your age and gender?

18. What would you change about an approved helmet?

19. Would you support the AHSA on the law to make certified helmets mandatory to show? Why or Why not?


Results: One hundred responses were received. These included 93 Hunter/Jumpers, 5 Eventers, and 2 Western riders. The data is presented below.


Survey Responses

Total Responses:

Hunter/Jumpers 93
Eventers        5
Western         2

People who show/school in Approved Helmets:

Hunter/Jumper    8/93 (9%)
Eventers         5/5  (100% are required)
Western          0 0

People who show/school in Non-Approved:

Hunter/Jumper   85/93 (91%)
Eventers         0 0
Western          1 (50%

People who do not wear a helmet:

Hunter/Jumper    1/93 (1%)
Eventers         0 0
Western          1 (50%)

Ages of people who responded:

Under 12 Years-   6 (6%)
13-17-Years      75 (75%)
18-24- Years     13 (13%)
Over 24- Years    6 (6%)

Reasons for wearing  Approved    Non-Approved

Comfort:              3 (16%)         13(30%)
Fit                   1 (6%)          7(16%)
Appearance           2 (11%)         19(43%)
Safety                9 (50%)         2 (4%)
Parents              2 (11%)
Brand                 1 (6%)          3 (7%)

Years in Equestrian sports:

Under 5          5 (5%)
5-9             78 (78%)
10-15           14 (14%)
Over 15          3 (3%)

AHSA Rated Judges: (N=3)

Certification Level:                 A3       A's     B/C

Prefer to see non-approved to show: Yes      Yes     Yes
(Higher Levels)

Prefer to see approved to show:     Yes      Yes     Yes
(Younger Ages)

Would penalize for an approved:     Yes      Yes      No


Conclusions: Despite the safety benefits of approved helmets the majority of respondents in this study who are hunter/jumper riders do not wear them. This is due to the uncomfortable fit and unattractive appearance. All of the Event riders wore approved helmets because it is a requirement. A small percentage of people wore no helmet at all. The reason for this was undetermined. Three American Horse Show Association Judges confirmed my beliefs that they would prefer to see competitors wearing non-approved helmets in higher levels. If approved helmets are to be worn, helmet manufacturers will have to consider improving the appearance and fit of the helmet.

Sarah Neal
356 Shanelly Drive
Port Matilda, PA 16870


Editorial Comment

My daughter has recently completed an internet survey regarding approved and   non-approved helmets. As a pediatric and emergency medicine physician, I have insisted on use of an approved helmet. Her findings are concerning in that almost 100% of a large pool of respondents do not use approved helmets as they find them not only uncomfortable/cosmetically non-appealing, but also feel they will be discounted by the judges for the appearance. I assured my daughter that this was unfounded until 2 judges confirmed her concerns in writing, that they would indeed discount a rider based on an approved helmet.

My daughter is a very serious competition english rider (equitation and hunter/jumper) and I now find myself with mixed thoughts as to where to proceed with this. I am (much to my dismay) considering allowing a non-approved helmet only during her competition (not schooling or training). I have two questions:

1. Why is there no requirement for junior riders in AHSA to wear approved helmets (so judges can't discount a rider on common sense).

2. I assume there is some literature on injury comparision with approved and non-approved equestrian helmets, but I have not found any on research (there is a wealth of information on motorcycle and bike helmets). I am contacting several manufacturers regarding specifications on their products.

Any help you could offer would be appreciated. I am also interested in more information on your group as I frequently volunteer coverage for shows.


Cliff Neal, D.O.
386 Shanelly Drive
Port Matilda, PA 16870

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Michael R. Whitlock


Abstract: Objectives: To determine the distribution of injuries in the eventing discipline of equestrian sports and the effectiveness of the protective equipment worn.


Methods: Data on all injuries sustained in the cross country phase over fixed obstacles were collected from 54 days of competition from 1992 to 1997. This involved 16940 rides.


Results: Data on a total of 193 injuries were collected, which included two deaths. This represents an injury rate of 1.1%. Head and facial injuries represented the largest group (31%), with one third of these requiring treatment in the hospital. All riders were wearing protective helmets and body protectors.


Conclusions: Eventing is one of the most dangerous equestrian sports. Improved protective equipment, which is mandatory for 1999 (European Committee for Standardization CEN), should reduce the severity of these injuries.

Figure I

Anatomical Distribution of Eventing Injuries

Head & Face                 60
Shoulder Girdle            40
Upper Limb                  40
Chest                       24
Lower Limb                  19
Pelvis                       8
Spine                        2

Total                      193

MR Whitlock
Wellhouse NHS
Barnet General Hospital
Barnet, Herts EN5 3DJ, United Kingdom.
Br J Sports Med 1999;33:212-214.

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Congratulations to Dr. Michael Whitlock for his work in collecting accident statistics in eventing. Only with continued observation and reflection will we be able to increase safety in an exciting but potentially dangerous sport. The last USCTA Statistics were published by me in 1996 with analysis of the years 1990, 1991, 1993, and 1995.

These can be found on-line at

Dr. Whitlock's study included 16,940 riders. The number of competitors surveyed in our studies was between 25,000 and 30,000 per year. This was the number of entries and not the number of actual riders as a rider would likely ride at multiple events per year and might also ride more than one horse per competition. The accident rate for the USCTA remained remarkably constant at 0.36 to 0.39% per competitor over the four years surveyed. This is lower than the 1.1% rate in Dr. Whitlock's study. However, Dr. Whitlock's study probably included only BHS recognized shows which are intermediate and advanced. The injury rate in USCTA competitions was 0.84% per competitor for intermediate and 0.83% for advanced. This is comparable to the l.l% rate in Dr. Whitlock's study.

In our study we differentiated between head and facial injuries. The rate of head injuries was 16% in 1990, 21% in 1991, 20% in 1993, but dropped to 10% in 1995. This compares favorably to the 30% rate in Dr. Whitlock's study. However, Dr. Whitlock's rate includes facial injuries which were usually in the top 5 types of injuries in our studies. It is therefore difficult to make a direct comparison

My opinion for the reason for the drop in head injuries in the USCTA studies was the increased availability and use of ASTM/SEI helmets. As more tack shops and mail order catalogs stock only ASTM helmets, more riders will be wearing them.

The high rate of head injuries in the UK may be from the resistance to an improved helmet standard and the continued use of the British Jockey helmets. It should be noted that while concussions dropped from 10% of the total injuries in the USCTA in 1993 to 4% in 1995, they were still fairly common. In 1993 we recorded 12 back injuries and in 1995 recorded 7 back injuries, 3 kidney injuries, and 2 punctured lungs. From the data we received it was impossible to tell if any of these riders were wearing a protective vest. Protective vests were mandated by the USCTA and AHSA commencing in 1996.

The new USCTA Incident Reports to be completed by show officials in the event of an accident have just been approved by the USCTA and the AHSA after several years of development and lobbying. They will help the USCTA Safety Committee to obtain better data on injuries. It will be up to my replacement, Dr. Julie Ballard, to continue the data analysis. Perhaps with further data analysis we can see what role, if any, the protective vests are having in preventing injury.

David A. McLain, M.D.
Birmingham, Alabama

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From recent research into injuries to horse riders certain facts are available. There are approximate 600 accidents involving horse riders in Ireland annually, which require hospitalization. Of these accidents 28% to 30% result in brain damage and/or concussion. Riders under twenty years of age account for 45% to 50% of the accidents.

Research into accidents to jockeys riding over fences (Point to Point and Racing) show that concussions account for approximately 40% of the more serious injuries to jockeys.

Injury rate per fall seems to be related to speed. For every 10 falls jump racing a jockey is injured once. Point to Point (amateur) tend to be run at a slower pace. Injuries per fall are less.

Injury rates per fall for flat racing (fastest) vary between 30 - 60%. The accident occurs less often but such falls are far more serious. In a flat jockey gets two falls, one at least will be serious.

Overall the practice of wearing a riding helmet is well established in Ireland. Nearly all riding organizations insist on or recommend that all riders wear a safety helmet. The practice of steeplechase jockeys (who wear the most up to date standards) wearing helmets has been established for thirty years or more, and is insisted on and policed by their authorities.

                1993   1994  1995  1996  1997  1998  Total   Average    

TOTAL ACCIDENTS    508   493   549   624    615   474   3263   544
Brain & Concussion  137    162   164   181   169   120     933   156
% Total Concussion  27%   33%   30%   29%    28%   25%    29%   29%

AGE Total           508    493   549   624   625   474    3263
5-9 years            22     26    31    37    43     21    180    5.5%
10-14 years         124    98    146   141   122    99     730   22.4%
15-19 years          85    94     99   120   118   104     620   19.0%
Subtotal <20 yrs    231   218   276   298    283   224   1530   46.9%
% under 20 yrs      46%   44%   50%    48%   46%   47%    47%   47.0%
Ages 25 & below     292   288   346    361   363   272   1922   58.9%
  Percent          57.5% 58.4% 63.0% 58.0% 59.0% 57.0%
Ages 45 & above      36    54     41    25    65    67     298    9.1%
  Percent           9.0% 11.0%   7.5% 12.0% 10.5% 14.1%

(Steeple Chase)
TOTAL                 41     25    27    41    35    38     207    35
CONCUSSIONS          17    12     15    17    12   14       87    15    42%
FRACTURES            24     13    12    24    23    24     120    20    58%
% CONCUSSIONS       41%   48%   56%    41%   34%  37%     42%   43%
% INJURIES/FALL    13.5%  10%   12%   12%    13%  20%

TOTAL ACCIDENTS      36    51    34     58    54    52    285     48
CONCUSSION           11     22    13    26    23     18    113    19   39.6%
FRACTURES            25     29    21    32    31     34    172    29   60.4%
% CONCUSSION        31%   43%   38%    45%   43%   35%   39.6%  39%
% INJURIES/FALL     8.2%  8.8%  8.2%  8.8%  11%    10%


Peter Downes
Russellstown Mullingar
Co. Westmeath
Republic of Ireland

Note: The figures for 1998 seem to show less injuries but we will need for this trend to continue be confirm that these figures are not variations.


Editor's Note:

Dr. Peter Downes' study in Irish horse riding accidents shows 29% of thoese injured had a concussion or brain injury.  This is running higher than most studies in the states, where 20% is considered the overall figure for concussion and head injury.

Our NEISS figures in the states show for the years 1992-1996 43.3% of horse related injuries were to children and young adults below 25 years of age.  This gives a lower percent of injuries to this age group than the Irish study.  NEISS is showing that the ages below 45 years of age are having less percent of the accidents and the fastest growing sector is those riders over 44 years of age.  This age group had 22.9% of the accidents in 1997.  Dr. Downes's figures show the same trend in Ireland.

We do not have figures from point to point racing so these figures cannot be compared.  The Irish figures appear to show that the professional experienced jockeys have a greater number of concussions and the amateur jockeys have a greater percent of fractures although the figures are remarkably similar.

Dr. Downes is to be commended for his study of Irish horse riders accidents.

Doris Bixby Hammett, MD

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News Items


Mike Nolan has resigned as Executive Secretary of the AMEA effective September 1. Nolan expressed his appreciation for the efforts of the Board and membership over the past two years, but found there were certainly recent policy decisions which he could not accept. "Since an executive must either carry out Board policy with enthusiasm or remove himself from office, I have submitted my immediate resignation to President Lee and the Board," Nolan stated.

Nolan had expressed strong opposition to the recent AMEA endorsement of a local ordinance which imposed burdensome requirements on commercial stables. "I have always been an advocate for improved rider safety, but this governmental imposition of mandatory safety rules goes too far. I oppose many of the specific rules in the Aurora, Ontario ordinance," Nolan wrote in explaining his decision to step down, "and I fear the AMEA will lose credibility with a large segment of the horse industry as a result of its endorsement."

Starting January 1, 2000

The American Medical Equestrian Association seeks applications for the position of Executive Director beginning January 2000. This person needs to be knowledgeable of both the medical and horse community and be confident in communication with persons from both. This position is a part time activity which can be done from either home or office at hours convenient to the director. E-mail access and skills are required. There is a small stipend and expenses related to AMEA business.

If you are or know someone who might be interested, have them contact Doris Hammett, MD, for a job description, application form and more information. Include in the request, his/her curriculum vitae, and the proposed salary that is requested. The completed application needs to be in before November 1 for presentation at the annual meeting November 6-7 in Vancouver, BC, Canada.

Doris Bixby Hammett, MD
Secretary, AMEA,
103 Surrey Road
Waynesville, NC, 28786
Phone/FAX 828/456-3392


The annual meeting of the American Medical Equestrian Association and Equestrian Medicine Symposium, November 6 and 7, has an excellent program (AMEA NEWS June 1999) for participants. The brochure will be sent to AMEA members and to those who request a copy.. For registration contact Dr. Janet M. Sorli, #140 - 15321 16th Avenue, Surrey, BC, Canada V4A 1R6. For hotel reservations contact Delta Vancouver Airport Hotel & Marina, 3500 Cessna Drive, Richmond, BC (604)276-1989 or 1-800-268-1133. The Board of Directors will meet Thursday prior to the annual meeting.


Nominations for Members of the AMEA Board of Directors

The American Medical Equestrian Association will replace four of the members of the Board of Directors at the annual meeting. The directors must be a physician. If you or someone you know would be interested in serving, please send the name, a curriculum vitae, a picture of the nominee (preferably with a horse) to Doris Bixby Hammett, Secretary AMEA

Robert L. Faulkner, MD, 4186 Mill Street, Convington, GA, 30209

Since 1984 Dr. Faulkner has owned and operated Falconwood Farms, a hunter-jumper facility near Atlanta, GA, and has been a member of the American Medical Equestrian Association since 1995. Dr. Faulkner has been a speaker on medical and safety issues at two national equestrian meetings and has written supporting articles for their publicaitons. He has been active in medical and safety programs with local pony clubs and has provided medical support at numerous horse shows and events.

Currently he serves on the Board of Directors for Horse Time, a very active pioneering program of service, training and research in the area of equine facilitated mental health that involves psychology, nursing, and animal science students of three universities. (AMEA NEWS June 1999)

He feels the AMEA would be an excellent vehicle for promoting research in equine related safety issues, for distributing the knowledge gained, and for encouraging the use of this information. Her feels further that the AMEA should be able to supply technical support and coordination for the various organizations and communities concerned with safety in equestrian sports.

George H. Koepke, MD, 2222 S. Main, Findlay, OH 45840

Dr. George Koepke is a founding member of the American Medical Equestrian Association and has been a continuous member since that date. He has attended most of the annual meetings of the AMEA over the ensuing years contributing to the program every year..

Dr. Koepke has served in multiple positions at the University of Michigan, retiring as Chairman and Professor of Physical Medicine and Rehabilitation in 1976. He is certified by the American Board of Physical Medicine and Rehabilitation. He is an Associate Member of the American Academy of Orthopaedic Surgeons, a member of the American Academy of the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. He is a member of the United States Horsemanship Safety Association. Dr. Koepke will be a speaker at the AMEA annual meeting in Vancouver in November.

Dr. Koepke will bring his experience in the equestrian sports and academic medicine to the Board of the American Medical Equestrian Association.

Timothy J. Nice, MD, 6770 Mayfield Road #426, Mayfield Hits, OH 44l24

Dr. Nice is a team physician for the United States Polo Association and has made an extensive study of the injuries in polo. He is chairman of the USPA Safety Committee and has recently completed a study of polo helmets. (AMEA NEWS June 1999). He is a 1999 Nominee Board of Governors United States Polo Association. He serves on the Board of Therapeutic Riding for the Handicapped.

Dr. Nice is medical director of Northeast Ohio Novacare Outpatient Rehabilitation Services and a member of the Meridia Board of Rehabilitation. He is certified by the American Board of Orthopedic Surgery and is a Fellow of the American College of Surgeons. He is head of the Total Joint Arthroplasty Section of Meridia Hillcrest Hospital.

Dr. Nice will bring his medical knowledge, experience and work for safety in polo and the equestrian activities to the Board of Directors of the American Medical Equestrian Association.



The USCTA Safety Committee has completed a comprehensive manual designed to assist anyone who assumes the role of Safety Coordinator at a USCTA event. The manual is designed as a workbook with pages available for handout to medical volunteers at events. When publication is complete the manual will be available through the USCTA.

Julie Ballard, MD
Chairman, USCTA Safety Committee
1891 Ardmore Road
Atlanta GA 30309

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