CNS and Thorax Injury and Associated Risks Factors in Equestrian Sports

Abstract

Context: Equestrian sports continue to gain popularity in the United States and are associated with a high injury rate, especially involving the central nervous system and thorax. Due to this high rate of injury and the potential for long-term consequences associated with participation, an understanding of the unique risks of this sport is needed. Objective: To describe severe injury in equestrian sports and review the role that protective gear plays in injury mitigation. Data Sources: The PubMed Database was searched using the search terms “equestrian” and “horse” combined with “spinal cord injury,” “head injury,” “traumatic brain injury,” “experience levels,” and “demographics.” Study Selection: A total of 53 papers were selected based on their relevance of epidemiology, risk factors, and management of injuries sustained during equestrian activities. Case studies, randomized controlled trials, prospective studies, and retrospective studies were all included for further review. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: None. Results: Injuries to the thorax, including fractures, pneumothoraces, internal organ contusions, and crush injuries, have been cited in multiple national and international trauma registries as the most prevalent injury location in equestrians; however, head and neck injuries, high cervical spine fractures, and closed head injuries are reported to be associated with the highest rates of mortality. Helmets provide protection against skull fracture and traumatic brain injury. Vests were not associated with diminished rates of spinal cord injuries; however, they may provide protection to the thorax. Riding experience also plays a role in reducing the prevalence of injury. Conclusion: Equestrian-related activities are associated with a high risk of injury despite protective measures. Protective gear can mitigate some injury risk but does not protect against spinal injury. Continued investigation into improving protective equipment, rider education, and preventative strategies to mitigate this risk is needed.