Prevalence of Lower Extremity Injuries in Rodeo Athletes: A Systematic Review with Meta-Analysis

Abstract

Rodeo, a non-traditional sport, may pose a higher risk of injury compared to other sports due to the intense forces exerted by livestock. The purpose of this study is to investigate the prevalence of lower extremity injuries and discuss potential strategies for injury reduction among rodeo athletes. A systematic review with meta-analysis, following PRISMA guidelines, was performed. A comprehensive search of three electronic databases was conducted, searching for studies assessing the epidemiological trends of lower extremity injuries in rodeo athletes. Studies were included if they were published in English, reported injury frequencies by body part, involved collegiate or professional rodeo athletes, and covered more than one rodeo event type. Among the seven identified studies on rodeo injury prevalence, six focused on Canadian and American professional rodeo athletes, while one studied collegiate athletes. The order of injury prevalence of the lower extremity was found to be thigh/knee (TK) > ankle (A) > lower leg (LL) > foot/toes (FT) across all rodeo athletes. Timed event athletes exhibited a nine-percent higher prevalence of thigh/knee and ankle injuries compared to rough stock athletes. Lower extremity injuries accounted for approximately twenty-eight percent of injuries among collegiate and professional rodeo athletes.

1. Introduction

Descriptions of horseback riding injuries date back to the time of Napoleon, when field surgeon Jacques Lisfranc documented injuries to the tarsometatarsal joint in riders who fell from their horses and had their foot caught up in the stirrup [1]. Rodeo is a sport with substantial injury potential due to the uniquely high forces and mechanisms that are seldom seen in other sports [2]. Rodeo events are divided into two categories: timed events and rough stock events. Timed events include tie-down roping, steer wrestling, team roping, breakaway roping, and barrel racing. Rough stock events include bull riding, saddle bronc riding, and bareback riding, and are scored based on a point system [3]. At the collegiate level, goat tying is an additional event sanctioned for female rodeo athletes [4].

Rodeo is a non-traditional sport that may carry a higher risk of injury than other sports due to the intense forces exerted by livestock weighing between 500 and 2000 pounds. The proximity between athletes and at times uncooperative livestock makes rodeo a dangerous sport with high injury potential. The two primary mechanisms of injury in rodeo events are (1) contact between competitor and livestock and (2) contact between competitor and the arena infrastructure, including the ground, chutes, walls, and gates. Other reported mechanisms of injuries include falls off livestock, mishaps during dismount, and getting “hung up” in the stirrups or rope. Reports of lower extremity injuries in rodeo athletes include fibular fractures with syndesmotic tears, metatarsophalangeal dislocations, metatarsal fractures, and turf toe injuries [2,5,6].

In a review of the literature, the earliest study to analyze rodeo injuries was published in 1983 [7]. A systematic review on all types of injuries and factors leading to injuries in rodeo athletes was published in 2024 by Box et al. [8]. While Box et al. provided a broad assessment of injuries sustained by rodeo athletes, the present study specifically focuses on lower extremity injuries and includes studies reporting sufficient anatomical data to characterize injury patterns affecting the thigh, knee, lower leg, ankle, foot and toes [8]. Consequently, the inclusion criteria differed from those of Box et al. to address a more focused research question [8]. Furthermore, the present study discussed several strategies aimed at reducing the frequency and severity of lower extremity injuries, providing practical considerations for injury prevention in rodeo athletes.

Rough stock events are associated with higher overall injury events and higher catastrophic injuries than timed events. Bull riding is the most dangerous of all rough stock events with central nervous system injuries and concussions among the severe injuries athletes have faced. While timed events are safer, catastrophic injuries including head trauma and thoracic compression fractures have been reported in barrel racing. Among general rodeo injuries, impact with ground, being stepped on by an animal, being kicked by an animal and other forms of animal contact are leading mechanisms of injury [9,10,11].

Despite the high prevalence of lower extremity injuries in rodeo athletes, a comprehensive review of the incidence and determinants of lower limb injuries in particular remains to be published. The purpose of this study is to explore the prevalence of lower extremity injuries in rodeo athletes which may help identify future opportunities for reduction in the frequency of these injuries in rodeo athletes. By characterizing lower extremity rodeo injuries, this study aims to identify opportunities to reduce injuries and to provide information about strategies—such as safety equipment improvements and arena maintenance—that may reduce both the frequency and severity of injuries in this high-risk sport.

2. Methods

2.1. Search: Strategy

The search strategy aimed to identify relevant studies on the prevalence of lower extremity injuries in rodeo athletes. The Office of Research and Sponsored Programs at Midwestern University’s Glendale Campus determined that this project did not meet the definition of human subjects research as defined in 95 CFR 46.102, and therefore required no further review by the IRB. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines (Table S1) [12], multiple electronic databases were systematically queried from inception to April 2025 by the primary author. The following databases were included in the search:

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Embase;

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Medline;

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PubMed;

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SPORTDiscus.

2.2. Search Terms

The search strategy employed a combination of relevant keywords to identify relevant studies. The primary search terms used were: rodeo AND injury(s). These terms were used in various combinations and adapted to each database’s specific search syntax to ensure a comprehensive search. Reference lists of identified articles were hand searched to identify additional relevant articles.

2.3. Inclusion and Exclusion Criteria

To refine the list of studies for inclusion in the review, specific inclusion and exclusion criteria were applied. Studies were included if they were published in English, reported injury frequencies by body part, involved collegiate or professional rodeo athletes, and covered more than one rodeo event type. Studies were excluded if they grouped injuries by broad body regions (e.g., upper or lower body), reported only injury prevalence, or focused on a single event type (e.g., bull riding).

2.4. Data Extraction

The total number of injuries, as well as the number of injuries for each lower extremity body part, was recorded. When available, injury data stratified by event type were also collected and summarized.

2.5. Statistical Analysis

This study analyzed the frequency and distribution of lower extremity injuries among rodeo athletes to identify common injury patterns and event-specific risks. Descriptive statistics were used to summarize the prevalence of injuries by body region and event type. Comparative analyses were performed to evaluate differences in injury rates between timed event and rough stock athletes, as well as between collegiate and professional rodeo athletes. All statistical analyses were conducted using R version 4.4.1 and the R package metafor version 4.2.0 [13].

3. Results

3.1. Identified Studies

The systematic search results are presented in a PRISMA flowchart (Figure 1). The initial search yielded 185 studies. After removing duplicates and screening titles and abstracts for eligibility, 18 studies were selected for full-text review. An additional three studies were identified through hand-searching reference lists of relevant articles. In total, seven studies met the inclusion and exclusion criteria. A risk-of-bias assessment was not performed because the included studies were primarily descriptive epidemiologic reports with variability in methodology and injury classification, limiting the applicability of standardized appraisal tools.

The seven studies included in the meta-analysis were published between 1983 and 2020, with the number of overall injuries ranging from 25 to 12,672. The included studies are as follows (study title, primary author, year published, number of overall injuries):

• Injuries in Professional Rodeo, Griffin, 1983, 25 injuries [7].
• Injuries in Professional Rodeo: An Update, Griffin, 1987, 61 injuries [14].
• Injuries in Intercollegiate Rodeo Athletes, Meyers, 1990, 138 injuries [15].
• Epidemiological Analysis of Injury in One Year of Canadian Professional Rodeo, Butterwick, 1996, 337 injuries [5].
• Epidemiological Analysis of Injury in Five Years of Canadian Professional Rodeo, Butterwick, 2002, 451 injuries [2].
• Rodeo Injury Report: 25 Years PRCA Injury Study, Justin Sportsmedicine Team, 2006, 12,672 injuries [16].
• Analysis of 4 Years of Injury in Professional Rodeo, Sinclair, 2020, 2305 injuries [11].

Figure 1 outlines the number of studies included in each statistical analysis. Among the seven identified studies on rodeo injury prevalence, six focused on Canadian and American professional rodeo athletes, while one studied collegiate athletes [

Table 1. Number of studies included in each statistical analysis.

Group	Thigh and Knee Injuries	Lower Leg Injuries	Ankle Injuries	Foot and Toe Injuries
All Rodeo Athletes	5	7	7	7
Professional Rodeo Athletes	4	6	6	6
Collegiate Rodeo Athletes	1	1	1	1
Rough Stock Athletes	2	3	3	3
Timed Event Athletes	2	3	3	3

]. Three of the seven studies provided a breakdown of the sample population by event type, distinguishing between rough stock and timed events [Table 1]. Timed events include tie-down roping, steer wrestling, team roping, breakaway roping, goat tying and barrel racing. Rough stock events include bull riding, saddle bronc riding, and bareback riding, and are scored based on a point system. Typically, female athletes compete in goat tying, barrel racing, breakaway roping, and team roping, while male athletes compete in tie-down roping, steer wrestling, team roping, bull riding, saddle bronc riding, and bareback riding. Two of the seven studies grouped thigh with pelvis or groin injuries which led to their exclusion from the thigh and knee injury prevalence statistical analysis [Table 1].

3.2. Injury Prevalence

The prevalence of lower extremity injuries was calculated by dividing the number of lower extremity injury cases by the total number of injuries across the body, as seen in

Table 2. Prevalence of lower extremity injuries among all body part injuries.

Group	Thigh and Knee Injuries	Lower Leg Injuries	Ankle Injuries	Foot and Toe Injuries
All Rodeo Athletes	0.15 (449/2980)	0.05 (815/15,989)	0.06 (978/15,989)	0.02 (282/15,989)
Professional Rodeo Athletes	0.15 (430/2842)	0.05 (804/15,851)	0.06 (970/15,851)	0.02 (281/15,851)
Collegiate Rodeo Athletes	0.14 (19/138)	0.08 (11/138)	0.06 (8/138)	0.01 (1/138)
Rough Stock Event	0.13 (270/2154)	0.05 (130/2436)	0.06 (111/2436)	0.02 (60/2436)
Timed Events	0.22 (69/289)	0.04 (13/316)	0.15 (42/344)	0.02 (6/316)

The first row in each cell represents the pooled prevalence estimated using a random effects model. The second row shows the total number of injuries for that body region divided by the total number of reported rodeo injuries within each group.

. Lower extremity injuries accounted for approximately 28% of all injuries across all body parts in the general rodeo athlete population [Table 2]. The order of injury prevalence of the lower extremity was found to be thigh/knee (TK) > ankle (A) > lower leg (LL) > foot/toes (FT) across all rodeo athletes [Table 2]. The largest difference between timed and rough stock athletes injury prevalence was a nine-percent higher prevalence of thigh/knee and ankle injuries among timed event athletes [Table 2].

The overall pooled estimate among all body part injuries for all rodeo athletes for prevalence of thigh and knee injury was 0.15 (95% CI: 0.11, 0.21) [Figure 2], for lower leg injury was 0.05 (95% CI: 0.05, 0.06) [Figure 3], for ankle injury was 0.06 (95% CI: 0.04, 0.09) [Figure 4], and for foot and toe injury was 0.02 (95% CI: 0.02, 0.03) [Figure 5]. There is high between-study heterogeneity for the prevalence estimates of thigh and knee injuries (I² = 82%) and ankle injuries (I² = 90%, τ² = 0.1914). There is substantial between-study heterogeneity for the prevalence estimates of foot and toe injuries (I² = 61%, τ² = 0.0756) and low between-study heterogeneity for the prevalence estimates of lower leg injuries (I² = 15%, τ² = 0.0039).

The overall pooled estimate among rough stock rodeo athletes for prevalence of thigh and knee injuries was 0.13 (95% CI: 0.11, 0.14), lower leg injuries was 0.05 (95% CI: 0.03, 0.10), ankle injuries was 0.06 (95% CI: 0.02, 0.15), and foot and toe injuries was 0.02 (95% CI: 0.02, 0.03). The overall pooled estimate among timed event rodeo athletes for prevalence of thigh and knee injuries was 0.22 (95% CI: 0.14, 0.33), lower leg injuries was 0.04 (95% CI: 0.02, 0.07), ankle injuries was 0.15 (95% CI: 0.06, 0.33), and foot and toe injuries was 0.02 (95% CI: 0.01, 0.04). There is high between-study heterogeneity for the prevalence estimates of rough stock lower leg injuries (I² = 77%, τ² = 0.2270), rough stock ankle injuries (I² = 95%, τ² = 0.7076), and timed event ankle injuries (I² = 87%, τ² = 0.7333). The between-study heterogeneity is moderate for the prevalence estimates of thigh and knee injuries (I² = 34%, τ² = 0.0806) for timed event rodeo athletes. There is low between-study heterogeneity for the prevalence estimates of rough stock thigh and knee injuries (I² = 0%, τ² = 0), rough stock foot and toe injuries (I² = 0%, τ² = 0), timed event lower leg injuries (I² = 0%, τ² = 0), and timed event foot and toe injuries (I² = 0%, τ² = 0).

The overall pooled estimate among professional rodeo athletes for prevalence of thigh and knee injuries was 0.15 (95% CI: 0.10, 0.22), lower leg injuries was 0.05 (95% CI: 0.05, 0.05), ankle injuries was 0.06 (95% CI: 0.04, 0.09), and foot and toe injuries was 0.02 (95% CI: 0.02, 0.03). Overall pooled estimates could not be calculated for collegiate athletes because only one study included exclusively collegiate rodeo athletes. The level of between-study heterogeneity is high for professional thigh and knee injuries (I² = 87%, τ² = 0.1431), low for professional lower leg injuries (I² = 0%, τ² = 0), high for professional ankle injuries (I² = 92%, τ² = 0.2037), and substantial for professional foot and toes injuries (I² = 65%, τ² = 0.0778).

4. Discussion

Our study found that 28% of rodeo injuries involve the lower extremities, with thigh/knee injuries being the most prevalent. This is consistent with a 2024 systematic review, which identified the knee as the most frequently injured body region among all rodeo athletes [8]. The study suggests that timed event athletes are at higher risk for thigh/knee and ankle injuries compared to their rough stock counterparts. This may be attributed to the increased risk of injury while throwing or tying their livestock [11].

Table 2 highlights the increased prevalence of lower extremity injuries in timed events versus rough stock events. The frequency of lower extremity injury is influenced by multiple factors, including the high exposure to injury from the leg positioning required during competition and the close proximity between athletes and, at times, uncooperative livestock [8]. Impact with the ground is the leading cause of overall injuries, followed by being stepped on by an animal [8]. Contusions have been found to be the most common type of lower extremity rodeo injury, followed by sprains, strains, and fractures [14]. Lower extremity injuries being more prevalent in timed events than rough stock events may be due to the mechanism of injury-exposure to collisions and high forces versus being a thrown rider with trauma to areas of the body more frequently than the lower extremities.

Given the substantial risk of lower extremity injury in rodeo athletes, several strategies have been proposed to reduce both the frequency and severity of injuries sustained during competition. Cowboy boots, designed specifically for riding, serve more than just a functional role in maintaining grip in the stirrups. These boots typically feature a higher heel to help keep the foot in place, a tapered toe box for easier entry and exit from the stirrup, and a tall shaft that extends up to the calf, offering protection. Beyond their role in comfort and performance, cowboy boots could play a significant role in preventing injuries, providing critical ankle and foot support during rodeo events. Ceroni et al. noted that the design of riding boots does not provide longitudinal support at the foot level [1]. The authors advocate for strengthening the medial and lateral borders of riding boots to prevent midfoot bending during trauma, a motion commonly associated with Lisfranc fracture-dislocations [1].

Lace-up western-style riding boots allow for a more customized fit, which could improve control over foot motion and potentially reduce injury risk [17]. In comparison to non-lace-up designs, lace-up ankle braces are more effective at improving dynamic postural control, particularly in athletes with unstable ankles [17]. Given the tighter fit that lace-up riding boots offer around the ankle joint, they may provide better ankle stability compared to classic cowboy boots, which lack laces. This added stability could be particularly important for athletes with poor ankle stability or a history of ankle injuries. Athletes recovering from lower leg injuries may find lace-up boots to be a more comfortable and secure option. Additionally, lace-up boots offer more flexibility for accommodating ankle braces, which are often restricted in traditional cowboy boots due to their narrower shaft. Research shows that athletes without a prior ankle injury who wear ankle braces have a 47% lower risk of sustaining an ankle injury compared with those who do not wear braces [18]. Similarly, athletes with a history of ankle injury experience a 63% lower risk of reinjury when wearing ankle braces [18].

In rodeo, the type of surface known as arena footing, as well as its maintenance, may play a role in injury prevalence among rodeo athletes. The condition of arena footing—comprising layers of sand and rock—may significantly impact the safety and performance of rodeo athletes. Arena surfaces with deeper, less compacted, and properly moistened cushion layers reduce key injury risk factors, such as force and deceleration [19]. Regular grading of the arena ensures a level surface, with the frequency of grading depending on the material quality and competition event type. Weather conditions can also impact footing, requiring more frequent maintenance. Despite its suspected role in athlete safety, the researchers were unable to find any studies examining how arena footing affects injury rates in rodeo, leaving a significant gap in understanding how variations in surface conditions may influence the frequency and severity of injuries among rodeo competitors. Poorly maintained or uneven footing may increase injury risks, especially in events where athletes dismount from horses or bulls, such as goat tying, steer wrestling, and bull riding.

Breakaway or quick-release stirrups have been developed to reduce the risk of lower extremity injury and dragging incidents following a rider’s fall [20]. In 2007, Ceroni described Peacock stirrups as the most commonly used type of safety stirrup [1]. The lateral side of these irons features a thick rubber band that releases under pressure, allowing the rider’s foot to disengage during a fall and reducing the risk of entrapment or dragging. Peacock stirrups are recommended primarily for young and lightweight riders. In older or heavier riders, however, there is a potential for the stirrup tread to bend downward and away from the horse’s body. For these individuals, Australian-pattern safety stirrups or models designed to function like ski-binding releases may offer a safer alternative. The rodeo literature has identified foot entrapment as a significant mechanism of equestrian injury; however, there is limited peer-reviewed research directly quantifying their effect of breakaway stirrups on injury reduction [1]. Further research is needed to determine their true effectiveness in preventing injury in rodeo athletes.

Many areas for future research are present when considering reducing the risk of injury for rodeo athletes. No formal studies evaluating the use of shoe inserts or orthotics in rodeo athletes were identified in our literature search. Although orthotics are unlikely to prevent the acute traumatic injuries commonly sustained during rodeo events, they may play an important role in the treatment and management of overuse injuries and biomechanical abnormalities. Studies in other athletic populations suggest that orthotics can be beneficial for treating these conditions, and in select circumstances, may also contribute to injury prevention [21,22].

This study has several limitations. Relatively few studies on lower extremity injuries sustained by rodeo athletes are published. The studies reviewed predominantly include data from the 1980s and 1990s, which may not reflect current trends. Variations in event types at different competition levels make direct comparisons difficult. Injuries sustained by rodeo athletes are likely significantly underreported due to several factors including personality characteristics [23].

By examining the prevalence of lower extremity injuries in rodeo athletes, this study provides insight into the patterns and mechanisms most commonly associated with these injuries. Understanding where and how such injuries occur supports the development of targeted risk mitigation and prevention strategies. Implementing these strategies has the potential to reduce injury rates, lessen injury severity, decrease medical costs, prevent lost income, and ultimately improve the quality of life and career longevity of rodeo athletes.