The medical and sports literature databases were searched for equestrian sports-related injury published in English since 1980, together with conference abstracts and discussions with equestrian sporting bodies. This literature was critically reviewed, with emphasis on measures to prevent or control injury i.e. countermeasures. While there is considerable literature available on the epidemiology of injury incurred in most equestrian sports, there is little on the prevention of these injuries. Case-control or other studies evaluating the effectiveness of the countermeasures suggested by authors do not seem to exist. There is a good body of epidemiology that supports the proper use of approved helmets as a means of preventing injury in these sports. However, protective helmets do not always prevent injury as expected, and many riders do not choose to wear them because of perceived poor design. The search for the ideal equestrian helmet should continue. Ideally the effectiveness of helmets should be assessed scientifically. Among the other countermeasures discussed are the use of rules and regulations for conduct of events, knowledge of horse behaviour, well-conducted lessons, contraindicated medical conditions, public education, rider education, appropriate equipment and clothing, the riding environment, rider experience, safety stirrups, body protectors, falling techniques, and first aid measures. Even though the injury rate for equestrians is relatively low when compared with other sports, the injuries that are incurred are usually severe. prevention is often difficult because the behaviour of the horse is unpredictable. Countermeasures used for prevention should be evaluated for the effectiveness to reduce the frequency and severity of injuries to equestrians.