Managing chronic injuries for horse riders

Common Issues

Horse Riders/Trainers with Sarah Ankersmit


At first mention of sports, most people think of football, soccer, tennis, running, or any other myriad of widely televised events. Rarely, however, is the equestrian world mentioned within that context. Make no mistake about it, reigning in a mammal of pure muscle weighing in around a thousand pounds requires no small amount of athleticism. As a result, equestrian competitors experience unique pain patterns and injuries. I sat down with Sarah Ankersmit to talk about her experiences working with such athletes. Early in our conversation, we realized that my experiences in this corner have been almost exclusively with horse trainers while hers focused on riders. For those unfamiliar, the trainers are for the horse: they teach, prepare, and prime the animals to be ridden. Though both riders and trainers spend a lot of time in the saddle, the injuries they sustain divert at unexpected locations.

According to Ankersmit, her riders often present with hip pain and injuries to the knee, shoulder, and arm. These are largely due to managing their horse with small leg movements and handling the reigns. Oftentimes their pain will radiate down from the shoulder to the hands and involve chest pains as well. As to the hip and leg issues, those can present with a variety of different symptoms from pseudo-sciatica (sciatic nerve compressed through the piriformis muscle) and pain localized to the hip or knee. That’s not to speak toward injuries sustained from a fall.

By contrast, the unifying pain symptom with horse trainers is disc dysfunction in the lumbar spine from repetitive compression through riding and training horses. Most notably, it is not primary movers of the appendages that suffer the most injury, as it would in other sports like soccer. Both riders and trainers are less likely to injure muscle groups such as the quadratus femoris (quads) or gastrocnemius (calves) since the sport requires more fine control overall.

Because the larger problems reside with smaller, more delicate stabilization and initiation muscles like obturator, piriformis, adductors magnus, iliopsoas, the treatment protocols for both riders and trainers follow similar paths. Sarah spends a large portion of treatment sessions addressing the deep hip rotators, which requires deep tissue modalities. Her riders report greater levels of sensitivity to excessive force however, so the act of balancing depth, pressure, and response mirrors the precise control and movements that injured the tissue in the first place.

Contrasted by my experiences with horse trainers, the aforementioned disc dysfunction leads to pain localized to the lingering scar tissue accompanied by a lack of mobility from discectomy or fusion in their spine. I spend less time working on the small movement muscles and more time applying deep friction to break up scar tissue and unlock the cascading patterns of tension and guarding associated with spine surgery. From there, I will travel through the posterior chain to address the same deep hip flexor muscles, adductors, and hamstrings.

When dealing with acute injuries sustained from falls—be it spinal, shoulder, back, rib injuries or whiplash—Sarah and I agree that our first order of business is to refer out to a doctor. Once having been cleared for receiving massage, we proceed with other protocols to address those specific injuries.

After receiving treatment, our patients report feeling immediate pain relief that lasts up to a week on average. These results vary and can last far longer depending on training schedules: Sarah and I have seen results last up to two weeks. Sarah does note that with shoulder injuries, be it from a fall or repetitive stress, the results will always be temporary. My experiences echo her observations. Because the shoulder is a highly mobile joint reliant almost entirely on soft tissue strength for its stability, an injury with any of those structures nearly universally requires regular maintenance to ensure the hypertonicities, scar tissues, and guarding patterns do not exacerbate old injuries and to keep it mobile, stable, and strong.

With regards to hip and leg issues—thanks to the innate nature of long bones, ilium, and sacral structures within the lower body—the muscles, tendons, and ligaments require just as much attention because they’re utilized so often by both riders and trainers. Equestrian athletes benefit from regular massage in their recovery from injury, maintenance, and ability to ride comfortably.

To manage pain from regular riding, Sarah suggests receiving massage no more than bi-weekly, where I have found that trainers fare best with weekly sessions for three weeks followed by a re-evaluation of progress. Do you know a rider who’s struggling with a myriad of pain issues? Our sports massage team are ready to help the get back on the saddle.