Equestrianism is more dangerous than many sports including motorcycle riding, skiing, football, and rugby with one in five equestrians seriously injured during their riding career. Current research has focused on acute riding injuries but as seen in other sports over-use injuries, repetitive strain and lifestyle could aggravate symptoms causing chronic pain. An elite rider suffering from pain may still choose to compete with pain due to the pressures from sponsors and owners and the need for competition success. The aim of the study was to investigate the prevalence of riders at the elite level competing with pain, and whether they perceived this pain to have a negative effect on their performance. A quantitative approach was used due to the experimental nature of the study. Fifty questionnaires were distributed to elite dressage riders (British Dressage Group 3 and above) at the Festival of Dressage, Hartpury College to establish the prevalence of riders competing with pain. 74% of elite dressage riders competed while experiencing pain, 62% of this pain was classed as chronic and 76% of riders stated that this pain was in the low back. Over half (51%) relieved the symptoms of pain by using over the counter pain medication. There was a highly significant relationship between riders competing with pain and the perception that this pain affecting negatively on performance (χ²=16.216^a, df=1, P=0.001). This high incidence of elite dressage riders who compete with pain, particularly lower back pain (LBP), could be problematic given the longevity of a rider’s career which can span over four decades. This research reports rider’s perceptions and self-reported pain and management options, which may affect the data. Further research is needed to establish the causes of back pain and appropriate management strategies.