Debbie Stanitski’s life changed in an instant March 14, 1999. “I was riding and went to jump a fence. That’s the last thing I remember.” She was thrown from her horse, smashing her head on a rock.

Stanitski had recently accepted a faculty position as a pediatric orthopedic surgeon at the Medical University of South Carolina. She had continued training for equestrian competitions despite a surgical career and family. Now she was fighting for her life. After emergency brain surgery, she endured months of rehab just to “walk, talk and swallow.” She required a feeding tube for two months and worked with physical and occupational therapists for a year.

As the current president of the Equestrian Medical Safety Association, Dr. Stanitski fights passionately to prevent equestrian injuries.

Wear a helmet to prevent brain injuries in equestrian sports.

Brain injuries in equestrian activities

Approximately 7 million Americans ride horses each year. Whether they ride competitively or for recreational enjoyment, serious injuries can occur. Horses can weigh up to 1100 pounds and travel up to 40 mph. When one considers that a rider’s head can be 13 feet off the ground when sitting in the saddle, it makes sense that brain injuries can occur.

In fact, brain injuries are the most common cause of death and serious injury in equestrian activities. They also make up a large portion of sport-related traumatic brain injuries. A 2013 study presented data from a statewide surveillance system from all hospitals and emergency departments in South Carolina. Equestrian activities accounted for over 9% of all sport-related traumatic brain injuries.

In terms of brain injuries, studies have shown that equestrian sports can be as dangerous as motorcycle racing.

Also read:
Traumatic brain injuries in sports are on the rise
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Mandating helmet use in competition

Only in recent years has the United States Equestrian Federation mandated that riders wear helmets. Starting in 2013, all dressage riders competing at any level in a nationally recognized competition must wear protective headgear. Still, riders competing in Fédération Equestre Internationale (FEI) sanctioned classes are not required to wear them.

“Part of the problem is a cultural one. It’s not the way we’ve done it forever,” Dr. Stanitski says, pointing out the conventional argument some riders had opposing helmets. When asked what it will take to make helmets mandatory for all competitors in all disciplines, she quickly replied, “It’s going to take someone having a serious injury.”

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Could Sarah Burke’s fatal injury happen to you?
Suicide and mental health concerns exist after concussions in young athletes

The brain injury of Olympian Courtney King-Dye

In dressage, that injury occurred March 3, 2010. Courtney King-Dye, an equestrian competitor in the 2008 Beijing Olympics, was training a show horse when the horse tripped. King-Dye landed under the horse. Not wearing a helmet, she suffered a skull fracture. The traumatic brain injury kept her in a coma for almost a month and led her to years of rehabilitation.

Her accident inspired other riders and supporters to create the Riders4Helmets campaign. Riders4Helmets aims to educate the equestrian community about the benefits of wearing a helmet.

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Education about concussions and helmet safety

Stanitski, who spoke at the first Riders4Helmets symposium, believes that this message must reach the grass roots level. “There is education about concussions (at the national level), but we need to reach the parents.”

On Saturday, July 12, 2014, parents and young riders have an opportunity to learn about helmet safety. Riders4Helmets will host the International Helmet Awareness Day 2014, partnering with numerous helmet manufacturers. Riders can learn more about helmets and purchase them at a discount. Plus, Riders4Helmets will offer educational webinars featuring concussion experts, psychologists and helmet testing groups.

Also read:
Recognize that concussions occur in sports other than football
How can we encourage athletes to report concussions?

Tips for parents and young athletes who ride horses

Dr. Stanitski advocates some simple helmet recommendations for parents and their children. Wear a helmet approved by the American Society for Testing and Materials (ASTM) and the Safety Equipment Institute (SEI) during any equestrian activity. Wear one that is designed to fit the individual rider. Inspect its condition regularly and replace it at least every five years. Plus make sure to wear a helmet specifically designed for equestrian events and not other activities, like a bicycle helmet.

Despite wearing an ASTM/SEI-approved helmet, Stanitski suffered a serious injury. She has battled to return to compete in both regular and para equestrian dressage. Her message for anyone involved in the sport is simple. “We have to create a culture where you don’t get on a horse without a helmet.”

Note: A modified version of this post appears as my sports medicine column in the July 10, 2014 issue of The Post and Courier.

Selassie AW, Wilson DA, Pickelsimer EE, Voronca DC, Williams NR, Jonathan C. Edwards JC. Incidence of sport-related traumatic brain injury and risk factors of severity: a population-based epidemiologic study. Annals of Epidemiology. 23 (2013) 750-756.

Equestrian Safety Fact Sheet. Available online at

Statistics & Facts. Available online at