Horse riding is a dangerous pastime with more accidents occurring per hour than during motor-cycling. Since a prospective survey of horse-related injuries conducted at a major centre in 1971-1972, equestrian groups and the medical profession have encouraged improvements in training and protective riding wear. By conducting a similar study at the same centre 20 years later we hoped to assess the effects of these measures on the pattern of injuries resulting from contact with horses. Patient and injury details were recorded prospectively for all those presenting to the Accident Service at Oxford during the whole of 1991. Total admissions fell by 46 per cent on average. Most of the decrease was due to a near fivefold fall in those admitted with head injuries (P < 0.001). A reduction in the severity of such injuries was associated with an increased use of riding helmets. However, the most commonly injured group remained amateur young female riders suggesting the need for increasing awareness and training of this group. In seven cases, severe digital injuries were caused by the habit of entwining reins around the fingers. This practice should be discouraged. Up to 12 per cent of all injuries might have been prevented if adequate footwear had been worn.