Objective: The objective of this study is to investigate the incidence of equestrian-concussion relative to other high impact sports (e.g., soccer, football, etc.) in Central Virginia. In addition, a supplement to the Zurich Return to Play (RTP) guidelines specific to equestrian activities is proposed. Method: Frequency data from 2010-2014 was obtained from The University of Virginia's Clinical Data Repository (UVA-CDR). Data pertaining to total incidence of concussion, along with sport-specific concussion (10 sports investigated), were extracted using the following ICD-9-CM diagnosis code search parameters: 850-850.9, E828.2, E007.5, E007.0, E003.1, E007.4, E007.6, E008.1, E008.0, E007.3, E005.4. Results: A total of 3,911 individuals were diagnosed with a concussion, with 230 of those secondary to the 10 high impact sports investigated. Of the sports-related concussion, equestrian and football activities had the highest incidence rate, at 25% and 26% respectively. Other high incidence rates included soccer (16%) and basketball (17%). In addition, concussion comprised 18% of all hospital visits associated with equestrian injury. Conclusion: Results were consistent with previous research exploring the national incidence of equestrian-concussion. The Zurich RTP protocol was modified by US Soccer to provide a more tailored approach to concussion recovery. Given that the incidence rate of equestrian-concussion is equivalent to, or exceeds, other high impact sports, a need for equestrian specific RTP guidelines is critical. As such, an equestrian-specific supplement to the existing Zurich RTP protocol was developed and will be presented to provide recovery guidelines to this high risk, and often overlooked, sport.