Evaluating the Relationship Across Physical Activity Domains and Chronic Pain in Adult American Equestrians: A Secondary Analysis

Chronic pain (CP) in equestrians may disrupt rider–horse movement patterns, communication, and welfare. Physical activity (PA) is used to manage CP in other populations. Equestrians engage in high PA across equestrian (EqA), barn work (BW), and non-EqA domains, yet still report high CP rates. This study aims to explore risk and protective PA factors across domains associated with self-reported CP in American equestrians. Secondary analysis of a cross-sectional survey of adult American equestrians (n = 1,612). All variables were categorical (EqA, BW, and non-EqA volume; participation level; BW tasks). Chi-square tests informed forward binary logistic regression examining odds (ORs) of reporting CP across PA domains. The sample's participation level was 23.0% professionals, 44.5% amateurs, and 32.5% recreational equestrians, with 45% experiencing CP, most commonly in the back (27.8%). Recreational riders had lower odds of experiencing CP (OR = 0.6, P < 0.001), chronic lower-leg (OR = 0.47, P = 0.004), and neck (OR = 0.57, P = 0.01) pain than professionals. Regardless of participation level, equestrians engaging in categories ≤5 hours/week of EqA had lower odds (OR = 0.46–0.62, P = 0.001–0.04) of reporting chronic back pain compared with those spending ≥15.5 hours/week. Regular running was protective against reporting CP, particularly in the back (OR = 0.62, P = 0.007) and pelvic (OR = 0.50, P = 0.02) regions. Participation level emerged as the primary risk factor for CP, followed by EqA volume for chronic back pain. Higher EqA workloads may exceed adaptive capacity regarding chronic back pain, underscoring the need for context-specific prevention strategies addressing workload management, such as physical training programs scaled to participation level and consideration of equipment fit (i.e., saddle).