While the importance of improving horse-related safety seems self-evident, no comprehensive study into understanding or reducing horse-related risk has been undertaken. In this paper, we discuss four dimensions of horse-related risk: the risk itself, the horse, the rider and the culture in which equestrian activities takes place. We identify how the ways in which risk is constructed in each dimension affects the applicability of four basic risk management options of avoidance, transference, mitigation and acceptance. We find the acceptance and avoidance of horse-related risk is generally high, most likely due to a common construction of horses as irrevocably unpredictable, fearful and dangerous. The transference of risk management is also high, especially in the use of protective technologies such as helmets. Of concern, the strategy least utilised is risk mitigation. We highlight the potential benefit in developing mitigation strategies directed at: (a) improving the predictability of horses (to and by humans), and (b) improving riders’ competence in the physical skills that make them more resilient to injury and falls. We conclude with the presentation of a multidisciplinary agenda for research that could reduce accident, injury and death to horse-riders around the world.