Abstract The use of trauma databases for epidemiological study of equestrian injuries is well established. However, such databases fail to capture minor injuries or injuries when medical attention is not sought. Additionally, concerns about chronic pain in equestrians have only been explored in small samples. The current study is the first nationwide survey of American equestrians 12 years and older participating in all equestrian disciplines. This study aimed to evaluate the patterns of self-reported acute injuries, behaviours of seeking medical attention for acute injuries, and chronic pain. A convenience sample of 2,573 American equestrians completed an anonymous online survey with questions on acute injury anatomical region, type, and if they sought medical attention. Additional questions identified frequency and location of chronic pain. In total, 2,049 survey responses were complete, with 96% female and representation from all regions of the United States. Participation status (PS) was categorised as professionals (19%), amateurs (43%), and recreational (38%). PS was associated with acute injury and chronic pain frequency. Only 3.9% had never experienced an acute injury from equestrian activity. Of all injuries, foot injuries were most reported (13% of all injuries; 52% of participants) with only 39% seeking medical attention. Professionals had higher odds of experiencing acute injuries in most anatomical regions. 42% indicated they had encountered a concussion; of those, 71% sought medical assistance due to a suspected concussion. Chronic back pain frequency was reported at 27.5%. This study is the first to evaluate self-reported injury in a large convenience sample of American equestrians. The current study found a higher rate of lower extremity injuries in equestrians than previously captured in trauma databases. Prior concussion and acute injury increased the odds of individuals experiencing regional chronic pain, suggesting that future studies and interventions should focus on improving preventative and rehabilitative care.