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Falls are an unavoidable part of horse riding. Even experienced riders occasionally come off, and while many falls result in only minor bruises, others can lead to injuries that require medical care and rehabilitation.

Horse riding is considered one of the higher-risk sports because riders sit several metres above the ground on an animal weighing hundreds of kilograms. Falls from the horse are responsible for around 45–80% of equestrian injuries, making them the most common cause of injury in the sport. 

The majority of injuries riders experience are soft tissue injuries, fractures and head injuries, with fractures accounting for a significant proportion of equestrian trauma. 

While some serious injuries require surgery, many riders experience injuries that can be managed with conservative treatment and physiotherapy. With the right rehabilitation, riders can safely return to the saddle and regain strength, balance and confidence.

At Flair Physiotherapy, we specialise in physiotherapy for horse riders, helping equestrians recover from falls and return to riding safely.

Falls can lead to a wide range of injuries depending on how the rider lands, the speed of the fall and whether the horse falls with the rider.

Common injuries following a fall include:

• concussion and traumatic brain injury
• sprains and ligament injuries
• muscle strains and soft tissue injuries
• minor fractures or breaks that do not require surgery
• major fracture or breaks that do require surgery (see post op care page)
• bruising and impact injuries
   

Many riders attempt to return to riding too quickly after a fall, especially if the injury initially seems minor. However, even relatively mild injuries can affect balance, reaction time, strength and coordination, which are essential for safe riding.

Physiotherapy can help guide recovery and ensure riders return to the saddle at the right time.

Head injuries are one of the most concerning consequences of a fall from a horse. Studies suggest that around 20% of equestrian injuries involve the head, and concussions are a common result of falls. 

A concussion is a type of mild traumatic brain injury that occurs when the brain is shaken by an impact or sudden movement of the head.

Symptoms may include:

• headache
• dizziness or balance problems
• nausea
• blurred vision
• difficulty concentrating
• sensitivity to light or noise
   

If a concussion is suspected, riders should stop riding immediately and seek medical advice. Guidance from equestrian governing bodies recommends that riders should not return to riding until symptoms have fully resolved and they have progressed through a gradual return-to-activity programme. 

Physiotherapy can support recovery from a concussion by addressing:

• neck stiffness following whiplash-type movements
• balance and vestibular dysfunction
• postural control and coordination
• gradual return to exercise and riding activity
   

A structured return-to-riding programme helps ensure that riders regain both physical stability and cognitive readiness before returning to the saddle.

Sprains are common injuries after a fall, particularly affecting the ankle, knee or wrist.

A sprain occurs when ligaments are stretched or partially torn during a sudden movement or impact. In riding accidents, this often happens when riders attempt to break a fall with their arms or when the foot becomes caught in the stirrup during dismount.

Symptoms of a sprain may include:

• joint pain
• swelling
• reduced movement
• difficulty bearing weight
   

Physiotherapy helps recovery by restoring joint stability, strength and mobility.

Rehabilitation often includes:

• progressive strengthening exercises
• balance and proprioception training
• gradual return to weight-bearing activity
• sport-specific rehabilitation for riding
   

These exercises help reduce the risk of re-injury and improve confidence when returning to the saddle.

Muscle strains and soft tissue injuries are among the most common injuries riders experience after a fall.

These injuries often affect the:

• lower back
• neck
• shoulders
• thighs or hip muscles
   

They may occur when the body absorbs impact during a fall or from sudden twisting movements.

Symptoms can include:

• muscle pain or tightness
• reduced movement
• weakness
• discomfort when riding or mounting
   

Physiotherapy treatment focuses on:

• restoring normal movement patterns
• reducing muscle tension and stiffness
• rebuilding strength and stability
• returning gradually to riding activity
   

Because riding requires coordinated movement through the hips, spine and core, proper rehabilitation is important before returning to regular riding.

Some falls result in fractures that do not require surgery but still require a period of rest or immobilisation.

Common fractures riders experience include:

• wrist fractures
• collarbone fractures
• rib fractures
• stable spinal fractures
• small fractures in the foot or ankle
   

Fractures account for a significant proportion of equestrian injuries, highlighting the forces involved in falls from height. 

Once the bone begins to heal and movement is allowed, physiotherapy helps restore:

• joint mobility after immobilisation
• muscle strength lost during recovery
• postural control and balance
• functional movement for mounting and riding
   

Without rehabilitation, stiffness and weakness can persist long after the fracture has healed.