Prevalence of Low Back Pain in Competitive Dressage Riders: A Cross-Sectional Study.

Researchers surveyed 100 competitive dressage riders in South Africa to find out how common low back pain is and whether aspects of riding are linked to it. Many riders reported current back pain, and riders who believed their pain was riding-related also tended to experience and worsen pain during riding, while time spent in specific gaits showed no clear link.

What the study set out to answer

• Estimate how common low back pain (LBP) is among competitive dressage riders (point and lifetime prevalence).
• Identify riding-related factors (for example, time in specific gaits) that might be associated with LBP.

How the study was done

• Design: Cross-sectional, exploratory, quantitative survey using an online questionnaire.
• Setting: Riders recruited at South African Equestrian Federation–registered dressage shows.
• Analyses: Frequencies/descriptive statistics and cross-tabulations; associations assessed with Spearman’s rho correlations.

Who participated

• Sample: 100 dressage riders competing at preliminary level and higher.
• Age range: 18 to 66 years.

Key findings

• Point prevalence of LBP: 71% of riders reported having LBP at the time of the survey.
• Lifetime prevalence of LBP: 56% reported ever having had LBP.
• Belief pain is riding-related correlated with:
  • How often riders experienced LBP while competing/riding: r = 0.46, P ≈ 0.00 (likely P < .001), indicating a moderate positive association.
  • How often pain worsened with competing/riding: r = 0.49, P ≈ 0.00 (likely P < .001), indicating a moderate-to-strong positive association.
• Time in specific gaits showed no clear association with increased LBP:
  • Hours in sitting trot vs increase in LBP: r = -0.13, P = .28 (small, non-significant negative correlation).
  • Hours cantering vs increase in LBP: r = -0.19, P = .94 (small, non-significant negative correlation; P-value suggests no evidence of association).
• Overall conclusion: LBP is common in competitive South African dressage riders; riders’ pain experiences are linked to riding itself, while measured time spent in certain gaits did not show a significant relationship with increased pain in this sample.

How to interpret these results

• Prevalence patterns:
  • The reported point prevalence (71%) is very high compared with many general-population estimates for current LBP.
  • The reported lifetime prevalence (56%) is unexpectedly lower than the point prevalence and lower than typical lifetime estimates in the general population; this may reflect wording, recall, sampling, or classification issues in the questionnaire.
• Correlations about riding and pain:
  • Moderate positive correlations indicate that riders who more strongly believe their pain is riding-related also report more frequent pain during riding and more frequent worsening with riding.
  • These associations reflect riders’ experiences and beliefs rather than proving that riding causes LBP.
• Gait-specific exposure:
  • The non-significant, slightly negative correlations suggest that simply spending more hours in sitting trot or canter was not associated with increased LBP in this dataset.
  • This does not rule out biomechanical contributions of specific gaits; it indicates that, as measured here, gait-duration exposure alone did not predict pain increases.

What this means for riders, coaches, and clinicians

• Screen and monitor:
  • Routinely screen competitive riders for LBP and monitor symptoms around training and competition blocks.
  • Track symptom fluctuations relative to riding intensity, horse type, and surface conditions.
• Training load management:
  • Progressively periodize riding volume and intensity; avoid abrupt increases before shows.
  • Use microbreaks and vary tasks within sessions to reduce continuous spinal loading.
• Technique and equipment:
  • Assess rider posture, pelvic control, and shock attenuation, especially during sitting trot.
  • Check saddle fit for both horse and rider and consider stirrup length and saddle geometry that influence spinal loading.
  • Match horse movement characteristics (back motion, impulsion) to rider tolerance and skill.
• Conditioning:
  • Incorporate trunk endurance, hip mobility, and neuromuscular control exercises tailored to riding demands.
  • Address off-horse contributory factors (sedentary work, lifting, non-riding training) that may sensitize the low back.
• Symptom management:
  • Implement early, active management strategies for LBP and consider graded exposure to aggravating riding tasks.
  • Coordinate care among physios, coaches, and saddle fitters for an integrated approach.

Strengths and limitations

• Strengths:
  • Focus on a specific, under-studied athletic population (competitive dressage riders).
  • Practical insights into when pain is experienced (during competition/riding).
• Limitations:
  • Cross-sectional design cannot establish causality between riding and LBP.
  • Self-reported data are subject to recall and belief biases.
  • Sample size is modest; some analyses appear to include fewer respondents (e.g., r[75] suggests item-level missing data).
  • Unexpected prevalence pattern (point > lifetime) raises questions about measurement or reporting.
  • Limited exposure metrics (hours in gaits) may not capture key biomechanical loads (e.g., horse kinematics, rider asymmetries, transitions).

How this fits with broader evidence

• LBP is common in equestrian sports; sitting trot is often cited as mechanically demanding due to vertical accelerations transmitted through the spine.
• However, duration alone may be a poor proxy for mechanical load; rider technique, horse motion, saddle fit, and transitions likely modulate spinal forces.
• The high current pain reports align with the notion that competition contexts and training intensification can exacerbate symptoms.

Future research directions

• Prospective cohort studies to track incidence and exacerbations relative to training load and competition schedules.
• Biomechanical analyses (motion capture, inertial sensors, saddle pressure mapping, surface EMG) across gaits and transitions.
• More granular exposure metrics (number of transitions, intensity, horse gait quality, rider asymmetry) beyond hours.
• Intervention trials testing coaching cues, equipment adjustments, and conditioning programs on pain and performance outcomes.
• Clarify and standardize prevalence questions to resolve point vs lifetime inconsistencies.

Bottom line

• Low back pain appears very common among competitive dressage riders in this sample, and riders frequently experience or worsen pain during riding.
• Simple measures of time spent in sitting trot or canter did not predict pain increases here, suggesting that technique, equipment, horse–rider interaction, and load management deserve closer attention.