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Horses & Health: Riding Safety and Therapeutic Riding

Horses can build balance, confidence and joy — and they can also hurt you. Learn how riding injuries happen and how to prevent them, what therapeutic riding and hippotherapy can and cannot do, and the germs, allergies and vaccines every horse person should know about.

After a fall from a horse or a kick, call 911 or go to the emergency department right away if the person has any of these warning signs:

  • Head injury danger signs: a headache that gets worse and does not go away; weakness, numbness, decreased coordination, convulsions or seizures; repeated vomiting; slurred speech or unusual behavior; one pupil larger than the other; confusion, restlessness or agitation, or not recognizing people or places; or passing out, looking very drowsy or not waking up (CDC). See our Head Trauma guide.
  • Neck or back pain with numbness, weakness or tingling, inability to move the neck, or loss of control of the arms, legs, bladder or bowels. Do not move the person until emergency services arrive; if you must open their airway, gently lift the jaw without moving the neck (NHS 111 Wales). Back pain that starts after a serious accident also needs emergency care (NHS).
  • A kick to the chest or abdomen, or any injury with uncontrolled bleeding, extreme pain, bone showing or an inability to move (CDC). Internal injuries from a kick can look minor at first and then get worse (case report, 2019).

Some concussion symptoms don’t appear for hours or days, so keep watching a rider who hit their head (CDC).

Horses and your health

Close to 2 million U.S. households own a horse, and riding and working around horses have been shown to increase balance, self-confidence and self-esteem (CDC). This guide covers three sides of that relationship: riding injuries and how to prevent them, therapy that uses horses, and illnesses people can catch around horses.

How common are riding injuries?

  • A CDC-led study estimated that about 102,904 people a year were treated in U.S. emergency departments for horse-related injuries from 2001 to 2003. About two-thirds (66.1%) were hurt while mounted, usually by falling or being thrown; on the ground, being kicked was the most common cause. The head and neck were injured most often (23.2%), about 11,502 people a year had a traumatic brain injury, and more than 11% were admitted to the hospital (Thomas et al., 2006).
  • From 1990 to 2017, an estimated 1,836,536 people went to U.S. emergency departments with horse-related injuries. Most mounted injuries came from a fall or being thrown (73.9%), and most unmounted injuries from a kick (42.1%). Mounted injuries were about twice as likely as unmounted ones to need a hospital stay. Diagnoses of concussion and closed head injury rose 337.2% from 1990 to 2009, and the injury rate among adults over 60 rose 139.6% (Acton et al., 2020).
  • Girls and young women aged 15 to 19 made up the highest share of emergency visits for riding injuries in a 2010–2014 national sample (Asa et al., 2019).
  • For children, horse-related injuries ranked second in severity only to being hit by a car as a pedestrian, and kicks to children on the ground made up about 30% of horse-related injuries (review, 2005).

Head injuries and helmets

Head injuries, including concussion, are more common in riders than spinal injuries, and both most often follow a fall from a horse (review, 2020). Head injury is the injury most likely to lead to a hospital stay or death in children (review, 2005). CDC advises wearing a helmet when you ride a horse (CDC). No helmet is concussion-proof, but a helmet can help protect against a serious brain or head injury if it fits, is certified for the activity, is well maintained and is worn every time (CDC HEADS UP).

Spine, kicks and bites

An estimated 54,830 people went to U.S. emergency departments with equestrian spine injuries from 2000 to 2023, most often in the low back. About half were not sent home from the emergency department, and about three in four with a neck (cervical) injury were admitted. Nerve injury was rare (1.8%) (Loder et al., 2025).

On the ground, kicks matter most. In one trauma center, people injured while unmounted more often had face and abdominal injuries, and two of three deaths were from severe head injuries caused by a kick (Carmichael et al., 2014). Bites and kicks can also spread germs, even if the wound doesn’t look deep (CDC). A foot trapped in the stirrup when a horse falls on its rider can cause serious foot fractures (Ceroni et al., 2007) or a dragging injury (review, 2005).

Barn and handling safety

CDC’s advice for working around horses (CDC):

  • Know where the horse is at all times, and approach its head from the side, where it can see you — not from the front or the rear.
  • Don’t stand directly behind a horse. Flattened ears can mean a horse may bite.
  • Don’t leave young children unsupervised around horses, and choose a horse that suits the rider: young or untrained horses may not suit children or beginners.
  • If you are hurt, wash the wound with warm, soapy water right away.

Injury rates are rising among riders over 60 (Acton et al., 2020); our Balance guide covers ways to stay steady on your feet.

Health risks from horses

Allergies

Horse allergy is talked about less than cat or dog allergy, but many people are sensitized to horses, even city dwellers with no direct contact (review, 2012). In an Italian study of 2,097 outpatients with a positive allergy skin test, 5.38% were sensitized to horse dander, and some had never been near a horse (Liccardi et al., 2011). Horse allergy can cause severe reactions, including anaphylaxis, especially with heavy exposure in a barn or after a bite (Gawlik et al., 2009). See our Allergies guide.

Germs: ringworm, Salmonella and more

Horses can carry germs that make people sick even when they look healthy and clean; CDC lists ringworm, Salmonella, MRSA, rabies, leptospirosis and other infections among those horses can spread to people. Common chores such as cleaning stalls and grooming can expose you (CDC).

  • Ringworm is a fungus, not a worm. It causes an itchy, scaly, often ring-shaped rash and spreads by skin contact with infected people or animals. Don’t put steroid creams on a rash that could be ringworm — they can make it worse (CDC). Athlete’s foot is a form of ringworm; see our Athlete’s Foot guide.
  • Salmonella lives in the intestines of people and animals. You can swallow it after touching animals, their poop or the places they live. Children under 5 and adults 50 and older with health problems such as heart disease are among those more likely to get seriously ill (CDC).

Tetanus

Tetanus bacteria live in the environment and enter through broken skin; deep wounds or wounds with dirt carry more risk, and about 1 in 10 U.S. cases is fatal (CDC). Adults need a tetanus booster every 10 years (CDC). After a horse bite or injury, see a doctor if your last tetanus shot was more than 5 years ago (CDC).

West Nile virus and EEE

West Nile virus and eastern equine encephalitis (EEE) are spread by mosquitoes, not by horses. Horses and people are “dead-end” hosts: they can get sick but do not pass the virus on to mosquitoes (CDC, CDC). West Nile is the leading mosquito-borne disease in the contiguous United States; most infected people have no symptoms, but more than 1,300 a year become severely ill (CDC). EEE is rare but very serious: about 30% of people with severe EEE die (CDC). There is no vaccine for either virus in people, so prevent mosquito bites (CDC, CDC). Horse owners should ask their veterinarian about vaccines for West Nile and equine encephalitis (CDC).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Emergency and injury care after falls, kicks and bites (imaging, fracture and wound care, concussion care, tetanus shots); allergy testing and treatment; and physical, occupational or speech therapy that may use horse movement (hippotherapy). Emergency care and hippotherapy: cost estimate being researched. Medicare Part B covers medically necessary outpatient physical therapy; you pay 20% after the deductible. Most riding injuries are treated and released, but head, neck and abdominal injuries can be serious. Hippotherapy shows benefits for walking and balance in cerebral palsy, with mixed evidence elsewhere; insurance coverage varies.
Chiropractic Spinal manipulation for riders’ low back pain, as one of several options for back pain in general. About $55–$100 for a self-pay follow-up visit and $90–$200 for a first visit (The Pricer). Small benefits for low back pain in general; we found little research in riders. Never after a fall with neck pain until a doctor has ruled out a fracture.
Acupuncture Acupuncture for low back pain in general. About $90–$185 for a private follow-up visit (The Pricer). Modest benefit for acute and moderate benefit for chronic low back pain in a 2017 evaluation; little research in riders. Complications are uncommon when sterile, single-use needles are used properly.
Herbal medicine No role. No herb prevents riding injuries, horse allergy or infections, and none replaces a tetanus shot. Not applicable. Allergy and asthma treatment is conventional: avoidance, medicines and allergy shots. Herbs can interact with medicines.
Massage therapy Massage for sore muscles after riding. One national chain’s membership: about $70–$90 a month for one session (The Pricer). Small improvements in muscle soreness and flexibility in sports research; limited evidence for riders. Low risk.
MBHA Wellness Coach Helmets every ride, sturdy riding boots and safety stirrups, lessons and a suitable horse, barn safety, handwashing, tetanus boosters, mosquito protection, and help choosing a therapeutic riding program. Cost estimate being researched. Supports — never replaces — your medical and therapy team.

Approach 1 of 6

Conventional medicine (AMA)

We name treatments but never doses — your care team tailors them.

Injury care

Most people treated in emergency departments for riding injuries are treated and released (Asa et al., 2019). Bruises and scrapes, then fractures, are the most common diagnoses, and more than 11% are admitted (Thomas et al., 2006). Concussion care follows CDC’s guidance — see our Head Trauma guide. For back injuries and lasting back pain, see our Back Problems guide. After a bite or a dirty wound, your provider may give a tetanus vaccine or tetanus immune globulin, depending on your vaccination history (CDC).

Physical, occupational and speech therapy using horse movement (hippotherapy)

Hippotherapy is the use of a horse’s movement by a physical therapist, occupational therapist or speech-language pathologist as one tool in a plan of care (Pham & Bitonte, 2016). It is used most often by physical and occupational therapists for children (Peters et al., 2020). The research is described in the therapeutic riding section below.

Allergy care

Allergies are diagnosed with skin and blood tests and treated with medicines, allergy shots and avoiding the trigger (MedlinePlus). Horse allergy may be treated with allergen immunotherapy (Gawlik et al., 2009), though research on horse allergy shots is limited (review, 2012).

What it costs

  • Emergency care, imaging and hippotherapy sessions: cost estimate being researched.
  • Physical therapy: Medicare Part B covers medically necessary outpatient therapy; after the Part B deductible you pay 20% of the Medicare-approved amount (Medicare.gov). Whether a plan pays for therapy that uses horse movement varies; in a Southern California survey, only 7 of 40 rehabilitation centers offered hippotherapy, mainly because of payment problems (Pham & Bitonte, 2016). Ask your insurer before you start.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Low back pain is common in riders: more than half of 100 competitive dressage riders surveyed in South Africa reported it (Landman et al., 2025). In a small study without a comparison group, 9 riders with chronic low back pain had less pain after an 8-week exercise program (Weeks et al., 2024). We found little research on chiropractic care for riders specifically. For low back pain in general, spinal manipulation may lead to small improvements in pain and function (NCCIH).

Mild side effects such as soreness, stiffness or headache are common and usually pass within 24 hours. Serious problems are very rare, but manipulation of the neck has been linked to tears in neck arteries that can lead to a stroke (NCCIH).

Never after a fall with neck pain until a doctor has checked you. About three in four riders seen in the emergency department with a neck (cervical spine) injury were admitted to the hospital (Loder et al., 2025), and anyone who may have a spinal injury should not be moved until emergency services arrive (NHS 111 Wales). Get medical evaluation and any imaging your doctor orders first.

Cost: about $55–$100 for a self-pay follow-up visit and $90–$200 for a first visit (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

We found little research on acupuncture in riders. For low back pain in general, a 2017 evaluation of 49 studies found a modest benefit for acute and a moderate benefit for chronic low back pain, and the American College of Physicians lists acupuncture as an option (NCCIH). Complications are uncommon, but improperly delivered acupuncture can cause infections or injure organs or nerves (NCCIH). A private follow-up visit costs about $90–$185 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Herbs have no role here. No herb prevents falls, heals a head or spine injury, protects against horse-borne germs or replaces a tetanus shot — CDC calls vaccination the best way to prevent tetanus (CDC).

If horses make you sneeze or wheeze, treatment is conventional: avoiding the trigger, medicines and allergy shots (MedlinePlus). For seasonal allergies, NCCIH notes hints that butterbur may help but raises safety concerns about it (NCCIH). Herbs can interact with medicines (NCCIH), so check with your doctor or pharmacist. We don’t list doses.

Approach 5 of 6

Massage therapy

A review of 29 studies found that sports massage did not improve strength, sprinting or endurance, but was linked to small improvements in flexibility and delayed muscle soreness (systematic review, 2020). We found little research in riders. For low back pain, the evidence for massage is low quality and mainly short-term (NCCIH). The risk is low, though rare serious problems have been reported, some with vigorous deep tissue massage (NCCIH). Wait until injuries have been checked. One national chain’s membership costs about $70–$90 a month for one session (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help riders, horse owners and families build safe habits — alongside, never instead of, your medical and therapy team.

Another approach

Therapeutic riding and hippotherapy

What they are

Programs that use horses are easy to confuse. A national consensus group recommends naming the actual therapy first — for example, “physical therapy using equine movement” — and separates therapy (counseling, occupational therapy, physical therapy, psychotherapy and speech-language pathology) from non-therapy services such as adaptive or therapeutic riding. It suggests dropping vague terms like “equine therapy” and “horse therapy” (Wood et al., 2021).

  • Hippotherapy is treatment by a physical or occupational therapist or speech-language pathologist who uses the horse’s movement (Pham & Bitonte, 2016).
  • Adaptive or therapeutic riding is a recreational activity: riding lessons adapted to the rider’s abilities, usually in a group, taught by a therapeutic riding instructor. It is used by people with autism or cerebral palsy, veterans with PTSD and older adults with dementia, among others (Hanson et al., 2023).

What the research shows

Safety and cost

In a U.S. survey of therapists who use hippotherapy, incidents needing basic first aid happened in 0.05% of sessions and incidents needing off-site care in 0.01%, and recommended safety practices were widely used (Peters et al., 2020). Ask your doctor whether riding is safe for you or your child. Cost estimate being researched; insurance coverage varies (Pham & Bitonte, 2016).

Choosing a program

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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