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Health & Exercise Forum

Horseback Riding: Part 2 of 2

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May 9, 2011

Dr. Mackarey's Health & Exercise ForumGuest Contributor: Erin Kane

Last Saturday May 7th was Kentucky Derby Day! This legendary event is followed by the Preakness Stakes on May 21 and the Belmont Stakes on June 11th to complete the famous U. S. Triple Crown of horseracing. No horse has won the crown since Affirmed in 1978.

Horseback riding is an exciting form of sport and exercise for many people in NEPA. This series is written in response to a mother’s request for information about the prevention and treatment of injuries for those involved in horseback riding.


Falls – are the cause of the most serious injuries in horseback riding. While sprains, strains, bruises, and contusions are common, they are usually not serious. However, fractures and head injuries may require emergency care.

Many falls and serious injuries can be prevented by following several rules.

  • First, always wear boots and an approved helmet.
  • Second, adjust stirrup size appropriately for each individual rider to prevent him or her from being dragged after a fall.
  • Third, always inspect the bridle, saddle and girth for structural and functional integrity.
  • Fourth, double check the tightness of the girth strap: if it is too tight, it will cause the horse to buck, and if it is too loose, it will allow the saddle to slip.
  • Finally, be smart! never ride a spirited horse without quieting it by lunging or chasing first. Never ride alone, and do not ride a horse beyond your ability. Never jump without a trainer. And if you do fall, let go of the reigns to prevent shoulder and rotator cuff injuries.


Neck and Lower Back Pain: can be caused by the spine absorbing the shock and motion of the canter gait or sitting trot. However, neck pain can also occur from a whiplash type injury sustained when the rider is “left behind” in midair over an obstacle.

To absorb shock on the neck and back, use a method called “posting.” Posting is rising up and down in the saddle in rhythm with a two-beat trot gait of the horse. In the canter gait, you can avert lower back ache by assuming a two-point position in the saddle. This is a slightly elevated and forward position, with the body supported by the heel and leg instead of the seat. Prevent whiplash by practicing with a good trainer, who can help you improve your timing and technique.

Hip/Knee Pain: It is not unusual to have achy, stiff hips and knees after long riding sessions. This is due to the fact that these joints are constantly in a flexed position. Dressage riders may be more vulnerable to hip pain due to the outward rotation of the hips in that particular riding style. Also, the prolonged leg separation may strain and overwork the hip muscles of the inner thigh, especially in the novice and occasional rider.

Ankle/Calf Pain: Ankle and calf results from the use of a “heels down” position, which helps maintain stability and balance in the saddle.

Good pre-riding warm-up, stretching and conditioning can help prevent problems in the knee and ankle (and will be discussed in more detail next week). A flexible stirrup, which has evolved over the last decade, can also help prevent ankle soreness.

Skin Chafing – most commonly found in the calf area due to friction. This is very preventable by using chaps or tall boots.


Kicked – may be inadvertent, due to a horse reacting to a fly or bee.

Bitten – inadvertently, while hand-feeding the horse.

Stepped on – inadvertently, while washing a horse or leading it from pasture.


Head Injuries – Concussions

Head injuries are serious and require immediate medical management. Riders who have experienced a concussion can display a wide variety of symptoms.

Symptoms: Classic symptoms of loss of consciousness, confusion, memory loss, dizziness and/or balance problems may be present in some people with mild concussion, while others may not show obvious signs that a concussion has occurred. Post-concussion symptoms can be subtle and may go unnoticed by the rider, trainer or family.

Prevention: Take lessons, ride with a trainer, and ride a proven horse. Always wear a helmet.

Bruises, Sprains and Strains

These are very common in horseback riding and are rarely serious.


Bruises: a bump or bruise can cause the skin to turn purple, brown or red in color.

Strains: are injuries to muscles or tendons from overuse or sudden overstretching.

Sprains: are injuries to the ligaments which connect the bones. It can be caused by a twist or fall or awkward sudden movement.

Treatment: RICE: Rest, Ice, Compression, Elevation

  • Rest – the first 24-48 hours
  • Ice – use ice or cold gel packs on the injury for 20-30 minutes several times per day
  • Compression – to the area with an elastic bandage
  • Elevation – elevate the injury on pillows, etc to limit swelling.

If the pain or swelling is not improved in 1-2 days, or if you cannot bear weight on the extremity, see your doctor.

Skin Friction Irritation

A & D Ointment – to prevent friction and promote healing of skin that is vulnerable to irritation. Chaps and Body Glide can help reduce friction.

Visit your doctor regularly, and listen to your body.

Keep moving, eat healthy foods, and exercise regularly.

Guest Contributor: Erin Kane, RN, MSN, is the owner of Sugar Mountain Farm in Dalton, PA

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   Next Week – Horseback Riding Part III: Exercise and Conditioning for Horseback Riding.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.