Evaluating the Relationship Across Physical Activity Domains and Chronic Pain in Adult American Equestrians: A Secondary Analysis

Elisabeth A. Ohrnberger; Kimberly I. Tumlin; Michaela M. Keener

doi:10.64292/ijes.185

Authors

Elisabeth A. Ohrnberger Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, 40506, KY, USA https://orcid.org/0000-0002-4950-2285
Kimberly I. Tumlin Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, 40506, KY, USA https://orcid.org/0000-0001-7319-8175
Michaela M. Keener Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, 40506, KY, USA https://orcid.org/0000-0001-6525-8238

DOI:

https://doi.org/10.64292/ijes.185

Keywords:

Horseback riding, risk factors, protective factors, pain prevalence, human–animal interactions

Abstract

Chronic pain (CP) in equestrians may disrupt rider–horse movement patterns, communication, and welfare. Physical activity (PA) is used to manage CP in other populations. Equestrians engage in high PA across equestrian (EqA), barn work (BW), and non-EqA domains, yet still report high CP rates. This study aims to explore risk and protective PA factors across domains associated with self-reported CP in American equestrians. Secondary analysis of a cross-sectional survey of adult American equestrians (n = 1,612). All variables were categorical (EqA, BW, and non-EqA volume; participation level; BW tasks). Chi-square tests informed forward binary logistic regression examining odds (ORs) of reporting CP across PA domains. The sample's participation level was 23.0% professionals, 44.5% amateurs, and 32.5% recreational equestrians, with 45% experiencing CP, most commonly in the back (27.8%). Recreational riders had lower odds of experiencing CP (OR = 0.6, P < 0.001), chronic lower-leg (OR = 0.47, P = 0.004), and neck (OR = 0.57, P = 0.01) pain than professionals. Regardless of participation level, equestrians engaging in categories ≤5 hours/week of EqA had lower odds (OR = 0.46–0.62, P = 0.001–0.04) of reporting chronic back pain compared with those spending ≥15.5 hours/week. Regular running was protective against reporting CP, particularly in the back (OR = 0.62, P = 0.007) and pelvic (OR = 0.50, P = 0.02) regions. Participation level emerged as the primary risk factor for CP, followed by EqA volume for chronic back pain. Higher EqA workloads may exceed adaptive capacity regarding chronic back pain, underscoring the need for context-specific prevention strategies addressing workload management, such as physical training programs scaled to participation level and consideration of equipment fit (i.e., saddle).

References

Kang Y, Trewern L, Jackman J, McCartney D, Soni A. Chronic pain: definitions and diagnosis. BMJ 2023;381:e076036. https://doi.org/10.1136/bmj-2023-076036.

Kraft CN, Pennekamp PH, Becker U, Young M, Diedrich O, Lüring C, et al. Magnetic resonance imaging findings of the lumbar spine in elite horseback riders: correlations with back pain, body mass index, trunk/leg-length coefficient, and riding discipline. The American Journal of Sports Medicine 2009;37:2205–13. https://doi.org/10.1177/0363546509336927.

Kraft CN, Urban N, Ilg A, Wallny T, Scharfstädt A, Jäger M, et al. [Influence of the riding discipline and riding intensity on the incidence of back pain in competitive horseback riders]. Sportverletz Sportschaden 2007;21:29–33. https://doi.org/10.1055/s-2007-963038.

Duarte CR, Raimundo A, Sousa JP, Fernandes O, Santos R. Prevalence of lower back pain and risk factors in equestrians: a systematic review. Sports 2024;12:355. https://doi.org/10.3390/sports12120355.

Lewis V, Kennerley R. A preliminary study to investigate the prevalence of pain in elite dressage riders during competition in the United Kingdom. Comparative Exercise Physiology 2017;13:259–64. https://doi.org/10.3920/cep170016.

Lewis V, Baldwin K. A preliminary study to investigate the prevalence of pain in international event riders during competition, in the United Kingdom. Comparative Exercise Physiology 2018;14:173–82. https://doi.org/10.3920/cep180006.

Lewis V, Dumbell L, Magnoni F. A preliminary study to investigate the prevalence of pain in competitive showjumping equestrian athletes. Journal of Physical Fitness, Medicine & Treatment in Sports 2018;4:555637. https://doi.org/10.19080/JPFMTS.2018.04.555637.

Lewis V, Nicol Z, Dumbell L, Cameron L. A study investigating prevalence of pain in horse riders over thirty-five years old. International Journal of Equine Science 2023;2:9–18. https://doi.org/10.64292/ijes.63.

Keener MM, Tumlin KI. Self-reported acute injury and chronic pain in American equestrian athletes. Comparative Exercise Physiology 2023;19:279–92. https://doi.org/10.1163/17552559-20230021.

Smith E, Hoy DG, Cross M, Vos T, Naghavi M, Buchbinder R, et al. The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases 2014;73:1462–9. https://doi.org/10.1136/annrheumdis-2013-204680.

Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. The Cochrane Database of Systematic Reviews 2017;4:CD011279. https://doi.org/10.1002/14651858.CD011279.pub3.

Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine 2020;54:79–86. https://doi.org/10.1136/bjsports-2018-099878.

2023 economic impact study of the US Horse industry. American Horse Council Foundation; 2024.

Douglas J-L, Price M, Peters DM. A systematic review of physical fitness, physiological demands and biomechanical performance in equestrian athletes. Comparative Exercise Physiology 2012;8:53–62. https://doi.org/10.3920/cep12003.

Schneider IE, Earing J, Martinson K. Revealing motivations for and conflicts associated with recreational horseback trail riding. Journal of Forestry 2013;111:282–6. https://doi.org/10.5849/jof.12-056.

Bye TL, Chadwick G. Physical fitness habits and perceptions of equestrian riders. Comparative Exercise Physiology 2018;14:183–8. https://doi.org/10.3920/cep180012.

Collado-Mateo D, Lavín-Pérez AM, Fuentes García JP, García-Gordillo MÁ, Villafaina S. Effects of equine-assisted therapies or horse-riding simulators on chronic pain: a systematic review and meta-analysis. Medicina 2020;56:444. https://doi.org/10.3390/medicina56090444.

Malchrowicz-Mośko E, Wieliński D, Adamczewska K. Perceived benefits for mental and physical health and barriers to horseback riding participation. The analysis among professional and amateur athletes. International Journal of Environmental Research and Public Health 2020;17:3736. https://doi.org/10.3390/ijerph17103736.

Garcia-Peña IM, Gómez AG, Guerrero-Barona E, Moreno-Manso JM, Barrios-Fernandez S. Physical activity and sleep improvements in a group of equestrian therapy volunteers: a pilot study. Evidence-Based Complementary and Alternative Medicine 2022;2022:1–8. https://doi.org/10.1155/2022/5364491.

Sáez I, León-Guereño P, Malchrowicz-Mośko E, Balerdi E, Río X, Lavín B, et al. Health benefits and participation barriers of different level horseback riders age-wise. Frontiers in Psychology 2022;13. https://doi.org/10.3389/fpsyg.2022.889605.

Ball CG, Ball JE, Kirkpatrick AW, Mulloy RH. Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries. The American Journal of Surgery 2007;193:636–40. https://doi.org/10.1016/j.amjsurg.2007.01.016.

Mayberry JC, Pearson TE, Wiger KJ, Diggs BS, Mullins RJ. Equestrian injury prevention efforts need more attention to novice riders. Journal of Trauma: Injury, Infection & Critical Care 2007;62:735–9. https://doi.org/10.1097/ta.0b013e318031b5d4.

Sorli JM. Equestrian injuries: a five year review of hospital admissions in British Columbia, Canada. Injury Prevention 2000;6:59–61. https://doi.org/10.1136/ip.6.1.59.

Neville EK, Hicks H, Neville CC. Epidemiology of horse trauma: a literature review. European Journal of Trauma and Emergency Surgery 2024;50:741–54. https://doi.org/10.1007/s00068-023-02436-0.

Ball JE, Ball CG, Mulloy RH, Datta I, Kirkpatrick AW. Ten years of major equestrian injury: are we addressing functional outcomes? Journal of Trauma Management & Outcomes 2009;3. https://doi.org/10.1186/1752-2897-3-2.

Ekberg J, Timpka T, Ramel H, Valter L. Injury rates and risk-factors associated with eventing: a total cohort study of injury events among adult Swedish eventing athletes. International Journal of Injury Control and Safety Promotion 2011;18:261–7. https://doi.org/10.1080/17457300.2010.545129.

Hobbs SJ, Baxter J, Broom L, Rossell L-A, Sinclair J, Clayton HM. Posture, flexibility and grip strength in horse riders. Journal of Human Kinetics 2014;42:113–25. https://doi.org/10.2478/hukin-2014-0066.

Lewis V. The impact of yard work and stable duties on the perception of pain in United Kingdom recreational and amateur competitive horse riders. Journal of Physical Fitness, Medicine & Treatment in Sports 2025;11:555802. https://doi.org/10.19080/JPFMTS.2025.11.555802.

Cejudo A, Ginés-Díaz A, Sainz de Baranda P. Asymmetry and tightness of lower limb muscles in equestrian athletes: are they predictors for back pain? Symmetry 2020;12:1679. https://doi.org/10.3390/sym12101679.

Greve L, Dyson S. Saddle fit and management: An investigation of the association with equine thoracolumbar asymmetries, horse and rider health. Equine Veterinary Journal 2015;47:415–21. https://doi.org/10.1111/evj.12304.

Dyson S, Carson S, Fisher M. Saddle fitting, recognising an ill-fitting saddle and the consequences of an ill-fitting saddle to horse and rider. Equine Veterinary Education 2015;27:533–43. https://doi.org/10.1111/eve.12436.

Gunst S, Dittmann MT, Arpagaus S, Roepstorff C, Latif SN, Klaassen B, et al. Influence of functional rider and horse asymmetries on Saddle force distribution during stance and in sitting trot. Journal of Equine Veterinary Science 2019;78:20–8. https://doi.org/10.1016/j.jevs.2019.03.215.

Meyers M, Bourgeois A, Leunes A, Murray N. Mood and psychological skills of elite and sub-elite equestrian athletes. Journal of Sport Behavior 1999;22:399–409.

Salma CL, Meyers MC. Athletic and pain coping skills of competitive female equestrian athletes. Journal of Sport Behavior 2019;42:91–108.

Ginés-Díaz A, Martínez-Romero MT, Cejudo A, Aparicio-Sarmiento A, Sainz de Baranda P. Sagittal spinal morphotype assessment in dressage and show jumping riders. Journal of Sport Rehabilitation 2019;29:533–40. https://doi.org/10.1123/jsr.2018-0247.

Quinn S, Bird S. Influence of saddle type upon the incidence of lower back pain in equestrian riders. British Journal of Sports Medicine 1996;30:140–4. https://doi.org/10.1136/bjsm.30.2.140.

Deckers I, De Bruyne C, Roussel NA, Truijen S, Minguet P, Lewis V, et al. Assessing the sport-specific and functional characteristics of back pain in horse riders. Comparative Exercise Physiology 2021;17:7–16. https://doi.org/10.3920/cep190075.

Keener MM, Tumlin KI, Dlugonski D. Self-reported physical activity and perception of athleticism in American equestrian athletes. Journal of Physical Activity and Health 2023;20:169–79. https://doi.org/10.1123/jpah.2022-0398.

O'Reilly C, Zoller J, Sigler D, Vogelsang M, Sawyer J, Fluckey J. Rider energy expenditure during high intensity horse activity. Journal of Equine Veterinary Science 2021;102:103463. https://doi.org/10.1016/j.jevs.2021.103463.

Meyer H-L, Scheidgen P, Polan C, Beck P, Mester B, Kauther MD, et al. Injuries and overuse injuries in show jumping—a retrospective epidemiological cross-sectional study of show jumpers in Germany. International Journal of Environmental Research and Public Health 2022;19:2305. https://doi.org/10.3390/ijerph19042305.

Caparrós T, Alentorn-Geli E, Myer GD, Capdevila L, Samuelsson K, Hamilton B, et al. The relationship of practice exposure and injury rate on game performance and season success in professional male basketball. Journal of Sports Science & Medicine 2016;15:397–402.

Williams J, Tabor G. Rider impacts on equitation. Applied Animal Behaviour Science 2017;190:28–42. https://doi.org/10.1016/j.applanim.2017.02.019.

Keener MM, Tumlin KI. The Triple-E model: advancing equestrian research with perspectives from one health. Animals 2023;13:2642. https://doi.org/10.3390/ani13162642.

Pugh TJ, Bolin D. Overuse injuries in equestrian athletes. Current Sports Medicine Reports 2004;3:297–303. https://doi.org/10.1007/s11932-996-0003-6.

Pilato M, Henry T, Malavase D. Injury history in the Collegiate Equestrian athlete: Part I: mechanism of injury, demographic data and spinal injury. Journal of Sports Medicine and Allied Health Sciences 2017;2:3. https://doi.org/10.25035/jsmahs.02.03.03.

Burbage J, Cameron LJ. An investigation of bra concerns and barriers to participation in horse riding. Comparative Exercise Physiology 2018;14:1–10. https://doi.org/10.3920/cep170030.

Ropa A. Sustainability of equestrian physical activities during COVID-19 pandemic, University of Latvia Press; 2022, p. 1084–94. https://doi.org/10.22364/htqe.2022.78.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics 2009;42:377–81. https://doi.org/10.1016/j.jbi.2008.08.010.

Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208.

Keener MM, Tumlin KI. Corrigendum on: Self-reported acute injury and chronic pain in American equestrian athletes. Comparative Exercise Physiology 2024;20:97–9. https://doi.org/10.1163/17552559-2024x001.

Lopes AD, Costa LOP, Saragiotto BT, Yamato TP, Adami F, Verhagen E. Musculoskeletal pain is prevalent among recreational runners who are about to compete: an observational study of 1049 runners. Journal of Physiotherapy 2011;57:179–82. https://doi.org/10.1016/s1836-9553(11)70039-x.

Duarte C, Santos R, Fernandes O, Raimundo A. Prevalence of lower back pain in Portuguese equestrian riders. Sports 2024;12:207. https://doi.org/10.3390/sports12080207.

Krueger K, Schwarz S, Marr I, Farmer K. Laterality in horse training: psychological and physical balance and coordination and strength rather than straightness. Animals 2022;12:1042. https://doi.org/10.3390/ani12081042.

Gaughan EM. Skeletal Origins of Exercise Intolerance in Horses. Veterinary Clinics of North America: Equine Practice 1996;12:517–35. https://doi.org/10.1016/s0749-0739(17)30270-5.

Castejon-Riber C, Riber C, Rubio MD, Agüera E, Muñoz A. Objectives, principles, and methods of strength training for horses. Journal of Equine Veterinary Science 2017;56:93–103. https://doi.org/10.1016/j.jevs.2017.04.011.

Keener MM, Critchley ML, Layer JS, Johnson EC, Barrett SF, Dai B. The effect of stirrup length on impact attenuation and its association with muscle strength. Journal of Strength & Conditioning Research 2021;35:3056–62. https://doi.org/10.1519/jsc.0000000000003278.

Engell MT, Clayton HM, Egenvall A, Weishaupt MA, Roepstorff L. Postural changes and their effects in elite riders when actively influencing the horse versus sitting passively at trot. Comparative Exercise Physiology 2016;12:27–33. https://doi.org/10.3920/cep150035.

Peham C, Licka T, Schobesberger H, Meschan E. Influence of the rider on the variability of the equine gait. Human Movement Science 2004;23:663–71. https://doi.org/10.1016/j.humov.2004.10.006.

Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 2005;30:346–53. https://doi.org/10.1097/01.brs.0000152379.54463.65.

Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. Journal of Electromyography and Kinesiology 2004;14:13–23. https://doi.org/10.1016/j.jelekin.2003.09.015.

Kenny LB, Westendorf M, Williams C. Managing manure, erosion, and water quality in and around horse pastures. Horse Pasture Management, Academic Press; 2025, p. 277–95.

Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The Physical Activity Guidelines for Americans. JAMA 2018;320:2020. https://doi.org/10.1001/jama.2018.14854.

Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. The Lancet 2021;397:2082–97. https://doi.org/10.1016/s0140-6736(21)00393-7.

El-Tallawy SN, Nalamasu R, Salem GI, LeQuang JAK, Pergolizzi JV, Christo PJ. Management of musculoskeletal pain: an update with emphasis on chronic musculoskeletal pain. Pain and Therapy 2021;10:181–209. https://doi.org/10.1007/s40122-021-00235-2.

Tan L, Cicuttini FM, Fairley J, Romero L, Estee M, Hussain SM, et al. Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review. BMC Musculoskeletal Disorders 2022;23. https://doi.org/10.1186/s12891-022-05047-9.

García-Correa HR, Sánchez-Montoya LJ, Daza-Arana JE, Ordoñez-Mora LT. Aerobic physical exercise for pain intensity, aerobic capacity, and quality of life in patients with chronic pain: a systematic review and meta-analysis. Journal of Physical Activity and Health 2021;18:1126–42. https://doi.org/10.1123/jpah.2020-0806.