I wear a helmet when I ride. I'm in my 50s, wear bifocals, am a bit overweight and look like a dork because I'm an awkward rider. I'm not much worried about how I look, being cool or social acceptance. That said, lots of the helmet threads are kind of thin on facts. So below you'll find some stuff I found on the Internet about the risks of riding. I only found one study addressing how helmets impact safety and I underlined it.
While head injuries comprise about 18 percent of all horseback riding injuries, they are the number one reason for hospital admission. A 2007 study by the Centers for Disease Control and Prevention found that horseback riding resulted in 11.7 percent of all traumatic brain injuries in recreational sports from 2001 to 2005, the highest of any athletic activity. Of the estimated 14,446 horseback-related head injuries treated in 2009, 3,798 were serious enough to require hospitalization. There were an estimated 4,958 concussions and 97 skull fractures. Subdural hematomas and brain hemorrhages comprised many of the serious injuries. According to the Equestrian Medical Safety Association, head injuries account for an estimated 60 percent of deaths resulting from equestrian accidents.
There are factors that may increase the risk of falling, such as a green horse, slippery footing, or bareback riding, but it is the height from which the rider falls that most significantly impacts the severity of the injury. According to the Ontario Equestrian Federation, a rider sitting on a horse is elevated eight feet or more above the ground, and a fall from just two feet can cause permanent brain damage. Riders ages 10-14 are most likely to be involved in an accident with a horse.
While serious head injury can occur while wearing a helmet, the data very clearly shows that the severity of the head injury can be decreased through helmet wear. While helmets are required in equestrian sports that involve jumping, including eventing and show jumping, in high level dressage competitions, the riders generally wear top hats, which provide no protection. Accidents are less common in competitive dressage, but accidents can occur. While most dressage riders do not wear helmets even when practicing, they are allowed both during practice and competition.
AANS - Sports-Related Head Injury
Horse riding carries a high participant morbidity and mortality. Whereas a motor-cyclist can expect a serious incident at the rate of 1 per 7000 h, the horse-rider can expect a serious accident once in every 350 h, ie 20 times as dangerous as motor cycling.4 This depends on the type of riding. A Cambridge University study of 1000 riding accident hospital admissions has shown:5
* One injury for 100 h of leisure riding
* One injury for 5 h for amateur racing over jumps
* One injury for 1 h of cross-country eventing
Recent surveys have shown that 20% of injured riders attending hospital are admitted and approximately 60% of these have head injuries...
...The first paper from the Radcliffe Infirmary Accident Department, Oxford8 was a retrospective study of people who sustained injuries as a result of horse riding related accidents, who attended the Accident Department and were admitted to hospital. This was followed up by a comparison 20 years later by Chitnavis et al 9 who undertook a prospective study of attendance at the Accident Department in 1991. They found a reduction in total admissions of 46% because of a fall in head injuries most likely due to the use of riding helmets. Of 177 patients seen with 236 injuries, 42 (24%) were admitted to hospital. There were four spinal fractures....
...In an overall review of horse riding injuries,10 head injuries outnumbered spinal injuries at about 5 : 1 which would indicate that the force required to cause a head injury is rather less than that required to fracture the spine (Figure 1).
With regard to admission to spinal units for horse riding accidents, there are far more lumbar and thoracic injuries than cervical in contrast to all other sporting injuries (Table 12) which are almost entirely cervical injuries, indicating that there are different mechanisms involved.17 In all other sporting injuries where the head leads it is almost inevitable that the cervical spine, which is more vulnerable, will be fractured rather than the lumbar or thoracic spine. The only rugby injury in which the thoracic spine was involved was when a drunken rugby player fell downstairs after a game. This would be in keeping with the speculation that in horse riding accidents there are two methods of riding: either jockey style (cross country position) with the head forward, where the rider would be more likely to sustain a cervical injury accompanied inevitably by a head injury, and classical style where the head is held high and the rider would be likely to fall on to the buttocks.8
Jumping is the most dangerous horse riding activity.13,14,15,16,18 In Australia, injury rates were found to be especially high among event riders14 (Figure 2) and in the USA cross country schooling accounted for 22.5% of accidents at pony clubs.15 USCTA statistics16 show that most serious injuries occurred in a jumping phase (Figure 3). There were 12 back injuries in 1993 and seven in 1995, all occurring in cross country....
...The speed of falling is thought by many to be relevant to the likelihood of serious injury as slow falls are sometimes the worst in this respect. The proximity of other horses seems to be the major problem for jockeys as their tuck and roll technique seems to ameliorate quite a lot of injuries. Recent fatalities in eventing have nearly always been when the horse has fallen on the prone rider....
Horse riding is a dangerous sport. There has been an increase in spinal cord injury admissions due to horse riding. Women riders are more likely to be admitted with serious injury but there are more women riding and the number of accidents to female riders is probably in proportion to the total number of women riders. Lumbar and thoracic fractures are much more common than cervical fractures, the likelihood being that this is due to fall on the buttocks or being thrown against obstructions. The injuries are more likely to occur in point to point and jumping than in flat racing or in social riding. Figures about hunting are not available and are pure speculation.
Spinal injuries resulting from horse riding accidents
The place where most accidents occurred was on cross country. Cross country involves jumping fixed obstacles at speed. If a hors hits one of these obstacles, either the rider or horse and rider will fall. The second most common area was either stadium or other unspecified. Warmup areas for the jumping phases were the next most likely place for an injury. It comes as no surprise the jumping phases accounted for 86% of the injuries. Dressage accounted for only 1% and the stable area and other accounted for 12%, again indicating the surprisingly large number of unmounted injuries.
American Medical Equestrian Associaton
Here is my interpretation, taken it FWIW:
Helmets reduce the risk of a head injury by roughly 50%. That is good enough for me. However, the type of riding done has far greater impact on safety. This comment "One injury for 100 h of leisure riding / One injury for 5 h for amateur racing over jumps / One injury for 1 h of cross-country eventing" would indicate that jumping raises the risk of injury at least ten fold.
It is echoed by this comment: "This would be in keeping with the speculation that in horse riding accidents there are two methods of riding: either jockey style (cross country position) with the head forward, where the rider would be more likely to sustain a cervical injury accompanied inevitably by a head injury, and classical style where the head is held high and the rider would be likely to fall on to the buttocks." and by this one:
"It comes as no surprise the jumping phases accounted for 86% of the injuries. Dressage accounted for only 1% and the stable area and other accounted for 12%, again indicating the surprisingly large number of unmounted injuries."
If riding without a helmet doubles the risk, but jumping increases it over 10-fold, then the single best thing you can do to reduce the risk of head injury is not jump. This may explain why many western riders don't feel a need for wearing helmets - the saddle is darn hard to jump in, and they ride closer to a dressage style seat (more upright, longer leg). Add in that most jumpers in these studies were probably wearing helmets already, and I don't see how one can avoid concluding that someone riding flats in a ball cap is safer than someone jumping with a helmet.
I'm not arguing against jumping. I think it is a great sport. I support steeplechases, and think eventing is arguably the pinnacle of the riding sports - although I'll never do it. With regrets, but I've concluded the mid-50s isn't the right time to take up jumping. Injuries just take too long to heal at my age.
I still wear a helmet and insist that my daughters wear them. I don't see much downside to wearing them.
Does anyone know of studies, however, showing that the riding activity doesn't outweigh the use of helmets in the risk of injury?