Q. I am an avid event rider and enjoyed watching the Defender Kentucky Three-Day Event. What kinds of nutritional support can you give horses competing in this level of competition to help them recover?

A. This is a great question. Any post-competition recovery effort starts with the base diet, which meet the horse’s daily requirements leading up to the competition. No long-term deficiency is going to get fixed in the short period during competition, so a balanced diet appropriate for the horse’s discipline and work level is crucial.

Part of that is ensuring the horse is getting the right kind of fuel to support the type of work that he’s asked to do. Event horses won’t only be utilizing stored carbohydrate on cross-country day but hopefully their reserves of fat stores, as well. Cross-country efforts will deplete glycogen stores (stored carbohydrates) in the horse’s muscles. The horse will need glycogen again for the show jumping phase, so restoring those stores is an important component of recovery.

Horses don’t restore muscle glycogen after heavy work particularly quickly, however—it can take up to 72 hours to fully replenish this important fuel source. The tactics human athletes use—such as “carb loading”—don’t work particularly well in horses. Not only has research found carb loading horses relatively ineffective at increasing muscle glycogen, loading with carbs such as starch could lead to colic.

Hydration

One thing that does help improve glycogen replenishment is making sure the horse is adequately hydrated. Muscle glycogen requires water for storage, so a dehydrated horse is less able to generate new muscle glycogen stores.

Hydration measures should begin well before cross-county day. Many horse travel long distances to events, and these long journeys cause surprisingly large amounts of sweat loss. Even when you can’t see the sweat, horses can lose very high levels of electrolytes during transportation. This puts them at a disadvantage before the competition even starts. Feeding salt every day and adding a well-formulated electrolyte while traveling will help horses remain hydrated. Consider arriving a day early if travel is particularly long, so your horse has time to fully rehydrate and recover from the journey before competition starts.

Horses that drink saline solution after exercise have been shown to consume more water in the subsequent hours than those that drink plain water. Consider acclimating your horse to drinking water after work with either salt or electrolytes so this is a normal practice at events.

Muscle Recovery

Hard-working horses might be muscle-sore after cross-country, and supporting recovering muscle might help your horse come out on Day Three with a little more spring in his step. Vitamin E is an extremely important antioxidant for muscle health. Oxidation of glycogen and fats to create energy for muscle contraction causes the formation of free radicals. These oxidizing compounds are unstable and damage cell walls if not removed. Vitamin E helps stabilize them by donating an electron so that a cascade of free radical damage is prevented.

Horses need to get adequate vitamin E every day and, because of individual variation, some horses—even when receiving enough vitamin E to meet the National Research Council guidelines—are vitamin E-deficient. The best way to know your horse is getting enough vitamin E is to ensure his base diet is meeting the stated requirement. Then have your veterinarian test his serum vitamin E levels. This will tell you whether you need to supplement additional vitamin E daily. Providing extra natural vitamin E after particularly heavy work such as cross-country day might aid in recovery.

During recovery from exercise, muscle protein synthesis increases in order to repair muscle tissue damaged during work. If adequate dietary amino acids are available in the 24 to 48 hours post work, a net protein gain might occur. The most important amino acid for this process is leucine, which is a branched chain amino acid (BCAA). For this reason, administering a supplement that provides BCAAs after especially heavy exercise might help shorten recovery.

Take-Home Message

In general, after strenuous exercise, ensure your horse has access to good-quality forage (this is a safe way to replenish carbohydrates and encourages water intake), increase electrolyte intake to replace losses and encourage water consumption, ensure adequate natural vitamin E, and provide BCAAs. Incorporating these into your program will help your horse be at his best for the third day as well as recover from the overall event as quickly as possible.

How a 21-year-old Hanoverian gelding stayed competitive at the Florida winter circuit

Many horse owners, riders, and trainers expect their horses’ athletic potential to diminish as they enter their later years; however, some horses remain healthy and happy in their work well past what many would consider their peak years. As horses age, they might experience more joint pain associated with osteoarthritis, digestive problems or a decline in gut health, or decreased performance. Fortunately, with advancements in equine medicine, veterinarians can work with horses’ trainers and care teams to help ensure long-term soundness.

The Crucial Equine Vet-Client-Patient Relationship

Successfully maintaining a horse in the top levels of competition throughout his later years requires a close relationship between the rider or trainer and veterinarian. “The rider is the person who spends the time on the horse’s back and feels differences in a gait transition or that a canter lead feels (different) one way versus the other,” says Kate Britton, DVM, of Atlantic Equine Services in Dover, New Hampshire, and Wellington, Florida.

These small details are crucial to the overall picture, especially when combined with information from the horse’s competition performance and a clinical exam. Meanwhile, don’t forget to keep the owner in the loop. “Keeping an open relationship with the owner is paramount to the health and success of the horse as they are the ones standing behind the horse with all parties involved on both good and bad days,” she adds. 

Maintaining Mindful at the Top Levels of Sport

Jennifer Hannan, rider and trainer, of Ocean Echo Farm in Wakefield, Rhode Island, and Wellington, has been training Mindful, a 21-year-old Hanoverian gelding owned by Selma Garber and Kensel LLC, since 2017. (Mindful started his US Equestrian-recognized showing career in 2013 with a different owner and riders.)

In their years together they have shown at the top venues around the country, such as Palm Beach International (now Wellington International), which Hannan says was the scene for their first international derby win as a pair. “He has since gone on to win seven international derbies at (Palm Beach/Wellington International). He has earned championships at every major horse show on the East Coast.”

Over the years Hannan and her veterinarian, Britton, have worked closely with one another to maintain Mindful’s physical and mental well-being at the highest levels of the sport.

Managing Mindful’s Joint Health

Britton regularly evaluates Mindful—typically monthly, she says, but twice monthly for performance evaluations during periods of intense competition. “Regarding maintenance care, we try to stay ahead of any issues, so (I see him) around four times per year for this.”

To manage any potential joint pain that could affect his performance, Britton treats him with intra-articular (IA) autologous protein solution and 2.5% polyacrylamide hydrogel (not at the same time) based on the results of her regular physical exams and soundness evaluations. “We try to stay ahead of any issues that may arise with his continued career, and we wanted to use the most beneficial treatments for his joints,” she says.

Equine Complementary Therapies and Nutrition

In addition to regular soundness examinations, Mindful also receives consistent veterinary chiropractic adjustments, acupuncture, and massage, which Britton says complement his medical treatments and play an important role in his longevity.

“He goes on a Theraplate daily and turns out as much as possible,” adds Hannan.

“His diet plays a role in his health as far as keeping him fit,” she continues. “We feed an all-natural diet, which is low in sugar, and I really feel like that has helped him in his career with me.” This consists of a forage-based diet (including alfalfa pellets and beet pulp) with non-GMO supplements to fill any nutritional gaps.

Utilizing Equine Fitness for Long-Term Soundness

Hannan works to keep Mindful physically fit year-round to help him maintain a healthy muscular condition and always stay comfortable in his work. “His overall fitness is our main goal,” she says. “We try to keep him fit and happy.”

Mindful stays in a consistent program with a balance of jumping and discipline-specific training days, along with relaxed trail riding and hacking days. “I think it’s important to keep him fit on many different types of surfaces,” says Hannan. “He works in the fields with hills as well as in the ring and even some harder surfaces.” However, Mindful only jumps once a week.

“That may include cavalletti exercises or just a few jumps, so he keeps his fitness,” Hannan adds, noting she rarely schools Mindful over show-height fences, but she might do so once before a show.

She adds that Mindful’s owner allows her to create a detailed training and competition plan for him, without ever pushing him past his physical or mental limits and while keeping his competition schedule light. “We have really been able to tailor his show schedule, physical fitness, and overall soundness (to his individual needs),” says Hannan. “I truly believe all of this has made a huge impact on his unbelievable career.”

Take-Home Message

Caring for horses that continue competing into their senior years demands a close relationship between the riders or trainers and veterinarians as well as careful daily monitoring of any minor changes in the horses’ behavior.

“Always listen to your horse and trust your feeling of them and what they are telling you,” says Britton. “Jenny has an exceptional ability to know minor changes in how her horses are feeling, which I feel helps keep them ahead of major issues.”

Trainers and veterinarians must maintain open communication regarding a horse’s health and performance to keep him sound and happy long-term.

This article is from the Older Horse 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Biologic, or regenerative, therapies have altered the way many equine veterinarians treat problematic joints. Some of the most mainstream and popular modalities they currently use to manage osteoarthritis (OA) in horses are autologous conditioned serum, autologous protein solution, platelet-rich plasma, and mesenchymal stem cells.

Most biologic therapies involve collecting and concentrating the horse’s natural anti-inflammatory and regenerative proteins or cells so they can be injected into an area of pathology (disease or damage) in the same horse.

Autologous Conditioned Serum (ACS)

Autologous conditioned serum is a cell-free extract of whole blood that has been processed to contain high concentrations of interleukin-1 receptor antagonist protein (IRAP), a naturally occurring anti-inflammatory protein within the body. It is marketed under the trade names IRAP and IRAP II.

When preparing ACS, veterinarians collect venous blood in a proprietary syringe system that encourages porous glass beads to bind with white blood cells. During an incubation process the bound white cells release high concentrations of IRAP. The veterinarian then draws the serum off into small portions and freezes it for future injection into arthritic joints. In clinical studies of ACS, researchers have reported improved synovial membrane (joint surface lining) health, stimulation of natural IRAP production, and improved lameness.

Platelet-Rich Plasma (PRP)

Platelet rich plasma is blood plasma that’s been centrifuged or filtrated to have a higher concentration of platelets than whole blood. Many horse owners are familiar with PRP and its use in tendon and ligament injuries; however, veterinarians are using it more regularly for treating joint disease.

One of platelets’ roles in the body is to modulate tissue healing. They do so by releasing growth factors and signaling molecules that initiate repair and promote anabolic (supporting tissue growth) effects. Veterinarians have capitalized on this ability by injecting high concentrations of platelets directly into damaged or inflamed regions. Because many PRP systems allow for stallside preparation, it is a convenient option for immediate treatment without the hassle of incubation or culturing in the lab, as is the case with ACS and stem cell preparation, respectively.

Historically, equine veterinarians have primarily used PRP to help treat soft tissue injuries. More recent work has led to intra-articular (in the joint) use with promising results. Although researchers have demonstrated how platelet-derived products work in vitro (in the lab) and veterinarians have seen promising anecdotal results in vivo (in the live horse), they’ve yet to produce evidence-based confirmation of its clinical efficacy.

Mark Revenaugh, DVM, owner of Northwest Equine Performance, in Mulino, Oregon, says the main factors standing between researchers’ ability to gather objective data and establish a consensus on PRP’s efficacy are the high variability among preparation systems, individual patient reactivity to the product, and an unknown ideal concentration of platelets for particular injuries.

“Most practitioners can’t always check how many platelets are being used,” he says. “Depending on the system, one veterinarian may be using 100,000 platelets/milliliter and another veterinarian may be using 1 billion platelets/milliliter. These are not the same treatments, even though both are called PRP. I would love to see an industry standard develop.”

Overall, PRP’s positive anecdotal results and relatively easy preparation make it a useful option for treating osteoarthritis (OA) in horses.

Autologous Protein Solution (APS)

Autologous protein solution (marketed under the trade name Pro-Stride) is essentially a hybrid of ACS and PRP. Its two-step stallside preparation process involves separating whole blood and sequestering white blood cells and platelets in a small fraction of plasma. The veterinarian then concentrates the separate blood components by filtration, leaving a solution of white blood cells, platelets, and serum proteins that provides the anti-inflammatory mediators of IRAP and the platelet-derived growth factors of PRP.

In a 2014 study out of The Ohio State University, researchers revealed that an intra-articular APS injection can significantly improve lameness, weight-bearing symmetry, and range of joint motion in horses that don’t have severe lameness or significant compromise to the joint structure.

Mesenchymal Stems Cells (MSCs)

Mesenchymal stems cells are adult stem cells that can direct regeneration and repair of damaged tissue. Veterinarians have used this type of stem cell as a treatment strategy for equine soft tissue injury for some time; it’s only recently that veterinarians have begun using them to treat OA, and it’s not fully clear how they work in this capacity. Researchers working on early stem cell studies hoped to establish evidence that stem cells injected into regions of injury would develop into the respective tissue. While this hypothesis proved to be incorrect, continued research has revealed that these cells might instead have anti-inflammatory effects and the ability to recruit other stem cells to the area that could, in fact, heal damaged tissue.

The two most common forms of mesenchymal stem cells are adipose (fat)-derived and bone-marrow-derived. Some study results have shown that bone marrow sources yield smaller concentrations than–but are superior to–adipose sources in their ability to differentiate into musculoskeletal tissue. Some encouraging data supporting the use of mesenchymal stem cells for treating OA exists, but researchers have only published a small number of studies with promising results. Equine veterinarians have used MSCs to treat intra-articular soft tissue injury (meniscal and cruciate damage—cartilaginous tissues and ligaments that support the stifle), with successful anecdotal results. They’ve reported more variable outcomes when using it for primary intra-articular injuries.

Carter Judy, DVM, Dipl. ACVS, staff surgeon at Alamo Pintado Equine Medical Center, in Los Olivos, California, says he currently prefers to use PRP and APS for OA treatment over MSCs. However, he admits there is much to be discovered. “What will be interesting to see is how manipulating the cells and providing them with different signals and markers can make their efficacy much more potent and focused,” he says.

Take-Home Message

When weighing treatment options for horses with OA, veterinarians should base their decision to use a certain biologic modality on its cost, availability, and how a horse has responded previously.

“Our knowledge base of how the biologics work is improving, but we are in the infancy of understanding,” Judy says. “Much of the use is based on the clinical response as much as is it on the scientific data.”

Veterinarians routinely perform suspensory ligament branch ultrasounds during prepurchase examinations of young Thoroughbred racehorses. However, they do not have much clear data on what constitutes a normal suspensory ligament branch. Frances Peat, BVSc, PhD, Dipl. ACVSMR, of the Orthopedic Research Center, C. Wayne McIlwraith Translational Medicine Institute at Colorado State University, in Fort Collins, Colorado, collected data from 969 ultrasound exams to establish reference ranges for forelimb suspensory ligament branches. She presented the results at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida.

Studying Thoroughbred Suspensory Ligament Branches

Peat said her goal was to define the normal appearance of suspensory ligament branches, identify common pathology, and determine any association between specific lesions and racing performance as well as association with radiographic changes in the sesamoid bones. This data could help veterinarians more accurately determine which horses are at risk of future injury or poor performance.

In total, she and her colleagues performed ultrasound exams on 593 sales yearlings and 376 sales 2-year-olds. During the exams, they assessed cross-sectional area of the medial and lateral (inside and outside) suspensory ligaments, width, periligamentous (around the ligament) tissue thickness, fibrillar pattern grade (0 to 3), hyperechoic foci (dark abnormality) grade, and sesamoid bone surface grade (yes or no).

They defined Grade 0 fibrillar pattern as a ligament with homogenous echogenicity (brightness) and uninterrupted fibrillar pattern. Grade 1 showed small areas of subtle irregularity, appearing as indistinct hypoechoic (darker) regions. Grades 2 and 3 showed moderate to severe hypoechogenicity and/or disrupted fibrillar pattern.

The researchers analyzed associations between ultrasonographic changes and racing performance from 2 to 4 years of age. Key findings relative to the fibrillar pattern were:

• The cross-sectional area of the medial branch of the suspensory ligament was consistently larger than that of the lateral branch;
• Cross-sectional area increased with fibrillar pattern grade, with Grade 3 lesions having the most enlarged branches;
• The prevalence of Grade 1 (mild) fibrillar pattern was 21% in yearlings and 29% in 2-year-olds;
• Grade 2 fibrillar pattern was seen in 8% of yearlings and 10% of 2-year-olds, and Grade 3 fibrillar pattern was seen in 1% of yearlings and 4% of 2-year-olds.

In some yearlings ultrasound data was available when they re-presented as 2-year-olds. Most of those horses (93%) either remained fibrillar pattern Grade 1 or improved to Grade 0 by the 2-year-old sale. However, one-third of yearlings with Grade 2 fibrillar pattern change progressed to a Grade 3 by the 2-year-old sale.

The Effects of Suspensory Changes on Horse Performance

Peat and colleagues also evaluated the effect of fibrillar pattern on racing performance, including eight measures of performance such as starting at least one race by 5 years of age, total number of starts, earnings per start, etc.

They only considered Grade 3 fibrillar pattern clinically important in reference to racing because those horses had a 0.8 probability of racing (i.e., an 80% chance they’d race), compared to 0.9-0.92 (a 90-90% chance) for horses with Grades 0-2 fibrillar pattern. They associated the presence of Grade 1 fibrillar pattern with significantly higher earnings per start compared to those with a higher grade.

The researchers concluded Grade 1 fibrillar pattern does not seem detrimental to racing performance—a key finding given its high prevalence in yearlings (20%) and 2-year-olds (30%). However, Grade 3 fibrillar pattern has a clinically important detrimental effect on racing.

Take-Home Message

Veterinarians frequently ultrasound suspensory ligament branches during Thoroughbred prepurchase exams but, until now, they’ve lacked clear agreement on what qualifies as normal. Researchers found Grade 1 fibrillar changes common and not linked to poor outcomes—in fact, they correlated with higher earnings per start. However, horses with severe changes had a significantly lower probability of racing. This research offers context for interpreting suspensory ultrasounds, helping veterinarians identify which horses are likely to stay sound—and which might be at risk for injury or poor performance.

People say good school horses are worth their weight in gold. Here’s what it takes to maintain the equine industry’s most valuable teachers.

How do you preserve your school horses’ health, soundness, and well-being long-term? This difficult question challenges every good horseman, says Jesslyn Bryk-Lucy, DVM, cAVCA, professor of equine studies and resident veterinarian at Centenary University, in Long Valley, New Jersey, where she manages the daily medical needs of the school’s approximately 85-horse herd.

Riding school owners like Nina Leeds, who runs Manor Hill Farm in Nicholson, Pennsylvania, constantly face the challenge of balancing their ponies’ and horses’ health and welfare with the financial pressures of their business. “You must do right by your equine employees,” she says.

Let’s take a closer look at the challenges and unique needs of riding school mounts.

School Horses’ Unique Challenges

Unlike a privately owned pleasure horse that’s not expected to pay for himself, school horses must earn their keep, generating enough income to cover their own care. But despite widespread stigma, a riding school job doesn’t necessarily equal subpar access to equine health care. In Bryk-Lucy’s collegiate program, where horses train and compete in the hunter/jumper and dressage disciplines, these equine professors have access to top-of-the-line care—a prime example being regular chiropractic and acupuncture treatments.

Nonetheless, these animals deal with stressors specific to their school horse status. “Inconsistency of riders is undoubtedly the biggest challenge,” Leeds admits. “These individuals must be forgiving and adaptable. Most of the time their student riders are still working on the basics and, as a result, may unintentionally sit crooked, add more pressure to one rein than another, etc.,” she says. “This can be habit-forming for the horses, causing them to travel incorrectly and creating compensatory pain over time.”

Adding to the challenge, she says, most ponies get ridden by children of varying skill levels because small, light, and experienced adult riders are hard to find.

Different Jobs, Similar Needs

Despite their occupational challenges, school horses have the same physiological needs as any other horse. “I manage the 85 school horses like any privately owned horse in my ambulatory practice,” says Bryk-Lucy, who also owns Leg Up Equine Veterinary Services in northern New Jersey. “The issues that I often have to manage—arthritis, sore backs, chronic soft tissue injuries, navicular syndrome, etc.—are the same pathologies (disease/damage) I see in private practice.”

Starting with the basics, school horses need suitable forage-based nutrition, sufficient turnout, proper grooming, regular dentistry and hoof care, and appropriate vaccination and deworming. In 2021 Bryk-Lucy’s then-student Abigail Reilly found that university horses turned out for at least 12 hours a day had a 25% lower incidence of soft tissue injuries than those turned out for less time¹. Researchers on a French study looking at 184 school horses found housing had the biggest impact on the animals’ emotionality level, a factor affecting their suitability to teach riders of varying levels². The data underscore the importance of species-appropriate care, including turnout and social contact for school horses.

Recognizing Signs of Pain in School Horses

Many school horses are hardy and stoic, making it easy to overlook signs of distress and discomfort. Pain can also manifest in subtle ways, which is why Bryk-Lucy relies on the staff and students to alert her to any potential issue with a university-owned horse. In her experience, early detection can have a significant positive effect on the horse’s recovery.

“Some common complaints that prompt an exam are an evasive response suggesting back soreness when being brushed, crabbiness when grooming and tacking, mounting block issues, reluctance to move forward, refusing jumps, favoring a lead, swapping (leads) before a jump, missing a lead change, running on the landing of a jump, tripping, etc.,” she says.

“In our lesson program we try to rule out pain as a cause of the behavior before classifying that behavior as a training issue,” she adds. In another study, the same French authors mentioned earlier found school horses were less likely to exhibit back disorders if managed by attentive caretakers who tend to overevaluate potential back pain³.

Essentially, scientists have shown attention to subtle changes in horses’ demeanors and getting the vet involved early pays off.

Limitations And Expectations

“Like most riding school programs, we have quite a few ponies that come to us as a step-down job from their competition careers with preexisting limitations,” Leeds says. She credits their long-term success to resisting the urge to push these schoolmasters when they are seemingly going so well.

“If our veterinarian has advised us that a pony should be used for flatwork only, not be longed, etc., there are no exceptions for us,” she adds. “It’s tempting when you are in a pinch, but ultimately pushing them past what is advisable, even as a once-in-a-while exception to the rule, can be detrimental to the goal of a long, productive career.”

Leeds says she’s found that teaching true horsemanship helps minimize wear on her ponies while still allowing her to run a large, successful program. Here again, setting expectations and prioritizing horse welfare remain key. “My students do not expect to jump every day, jump huge fences, or ride in extreme temperatures,” she says. “Our goal is to teach them that the animal must always come first. In turn, we can provide a more realistic workload for the lesson ponies.”

Further, Leeds emphasizes correct flatwork and small jumps with more technical exercises, and she turns to activities such as groundwork sessions and trail rides on extremely hot or cold days. For both their physical and mental well-being, she’s found it helpful to introduce variety in school horses’ work while limiting longe-line lessons because repeatedly traveling in circles adds strain to the musculoskeletal system.⁴

Money Matters

The stakes are high for the barn owner who depends on lesson income to feed and care for all her in-work, laid-up, and retired school horses and pay for and maintain the property. In France students often purchase an annual riding school pass with a fee to fund the school horses’ retirements. In the U.S. some establishments are switching from a no-commitment pay-per-lesson billing method to a semester-long subscription system, eliminating the sometimes devastating unpredictability of fluctuating monthly income. Some early adopters of the practice point out that school horses need to eat regardless of whether students attend their scheduled sessions.

We turned to Bryk-Lucy to describe the common physical limitations of school horses. “Beyond soft tissue and joint injuries, I see a lot of back soreness,” she says, pointing out that these animals typically carry different saddles and riders daily. Under her care university horses with chronic back pain get their own saddles. The rest get time off, non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone (Bute) or firocoxib, methocarbamol (a muscle relaxer), acupuncture, and chiropractic care. “These individuals usually return to work and are monitored and managed closely,” she says. However, if one needs shock wave therapy or regenerative therapies, she must refer to an outside practice, which she says isn’t always cost-effective for such a large herd.

Beyond her own expectations, Bryk-Lucy must also manage those of the faculty, staff, and students. “The reality is these donated horses are on their second or third career; they may come to us with a stiff hind end, good and bad days, etc.,” she says. As long as horses are comfortable and willing to work,and the slight gait abnormality (also called a mechanical lameness) does not worsen, she allows them to keep doing their job.

“I prepare the faculty, staff, and students to expect these individual variations in certain horses and educate them on what to look for to identify a new or worsening condition,” she says. There’s an upside, though. “Sometimes soundness issues in a low-level riding program are not as limiting as they once were on the show circuit because the horses are doing an easier job, and then I don’t have to manage anything!”

What Makes or Breaks School Horse Soundness

Bryk-Lucy says some of the big considerations that affect school horses’ ability to stay sound for the long haul include:

• Limiting rider weight to no more than 20% of the school horse’s body weight, because researchers have found exceeding this can temporarily cause lameness⁵.
• Maintaining fitness. Researchers have shown hippotherapy horses better tolerate heavier riders when fi tter⁶. “Fit horses are better able to handle their workload and less likely to sustain a soft tissue injury,” Bryk-Lucy says. “Some of our university horses are off for the summer and winter breaks. We are very careful and strategic with their return to work to ensure they are fi t enough for the first intercollegiate horse show, generally four to six weeks after the start of the semester.”
• Imposing limits on how often and how high horses jump. In a 2010 study of eight school horses, researchers in the Netherlands confirmed via blood tests what professionals already knew—jumping, even at a low level, significantly increases workload compared to cantering the same distance and speed without jumps⁷.
• Scheduling lessons so school horses have rest days and time off to recover. In 2023 researchers published data suggesting that following an increase in work hours, school horses show a greater degree of behaviors that can be interpreted as either fatigue or discomfort using the Horse Grimace Scale (HGS)⁸. Trainers must provide proper recuperation time to support career longevity.
• Choosing the appropriate level for use in a riding program, considering previous injuries, age, soundness, and suitability. “The horses that successfully work for a long time start at upper levels and slowly teach less experienced riders as they age (and need to step down),” Bryk-Lucy says. “These horses can continue to earn their keep as they age gracefully, fulfilling multiple roles as their career progresses.”
• Keeping up with maintenance as needed and addressing health and soundness issues early. At Manor Hill Leeds’ vet evaluates her ponies at least twice a year when it’s spring and fall vaccination time.

Leeds has found workload to be the most significant factor affecting a school horse’s career longevity. “Overloading an individual with a jampacked schedule risks leaving them physically sore and mentally burnt out,” she says. “Being realistic about how many students you can take with your current lesson stock is important,” she adds, tying back to the importance of keeping expectations in check.

“Pushing your lesson horses beyond reasonable risks harms both your animals and your means of making an income, potentially resulting in horses needing significant downtime and incurring vet bills,” she adds. To find the right balance, she grew her program gradually, accepting more students only as she could find more ponies to join her team.

Final Thoughts on School Horse Soundness

People say good school horses—reliable, adaptable, forgiving, and sure-footed—are worth their weight in gold. Our sources establish a few truths about the noble fourlegged teachers in riding schools: They need to earn their keep. They are athletes and should be treated accordingly, and they face unique challenges tied to their occupation. Ultimately, school horses form the foundation of our equestrian sport and deserve our commitment to a lifetime of care.

References

1. Reilly AC and Bryk-Lucy JA. Incidence of soft tissue injury and hours of daily paddock turnout in non-elite performance horses. 2021 Equine Science Society Virtual Symposium. tinyurl.com/6z75a9mw

2. Lesimple C, Fureix C, LeScolan N, Richard-Yris MA, Hausberger M. Housing conditions and breed are associated with emotionality and cognitive abilities in riding school horses. Appl Anim Behav Sci. 2011;129(2-4):92-99.

3. Lesimple C, Fureix C, Biquand V, et al. Comparison of clinical examinations of back disorders and humans’ evaluation of back pain in riding school horses. BMC Vet Res. 2013;9:209.

4. Logan AA, Nielsen BD, Robison CI, Hallock DB, Manfredi JM, Hiney KM, Buskirk DD, Popovich JM. Impact of gait and diameter during circular exercise on front hoof area, vertical force, and pressure in mature horses. Animals. 2021;11(12):3581.

5. Dyson S, Ellis AD, Mackechnie-Guire R, Douglas J, Bondi A, Harris P. The influence of rider: horse bodyweight ratio and rider-horse-saddle fit on equine gait and behaviour: a pilot study. Equine Vet Educ. 2020;32(10):527-539.

6. De Oliveira K, Clayton HM, Dos Santos Harada É. Gymnastic training of hippotherapy horses benefits gait quality when ridden by riders with different body weights. J Equine Vet Sci. 2020;94:103248.

7. Sloet Van Oldruitenborgh-Oosterbaan MM, Spierenburg AJ. The workload of ridingschool horses during jumping. Equine Vet J. 2006;38(S36):93-97.

8. Ijichi C, Wilkinson A, Riva MG, Sobrero L, Dalla Costa E. Work it out: investigating the effect of workload on discomfort and stress physiology of riding school horses. Appl Anim Behav Sci. 2023;267:106054.

This article is from the Older Horse 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Weighing Benefits Versus Risks

To boot or not to boot? The choice to cover a horse’s legs—and with what—­depends on many factors unique to each horse.

A main consideration is whether the horse has a specific need for protection, says Marlin, based on a previous injury, for example. Maybe he’s had issues with overreach and clips his forelimbs with his hind limbs. Or she’s got scrapes on the inner fetlocks where the opposite foot strikes. “If that shoe hits the inner fetlock just right, you can get a chip fracture,” he says.

Horses at high risk of colliding with structures other than their own feet—such as cross-country obstacles or show jumping fences taken at high speeds—also need protection. Horses hacking out through thick brush or on rocky paths need boots, at the very least to protect their skin from injury.

Hill believes it makes sense to follow the lead provided in human sports. “Human athletes use compression sleeves, tape, or braces to provide some support to areas that are unstable or a source of chronic issues, and I don’t recall those applications being shown to their detriment,” he says. Horses with chronic issues might still be able to have active careers with a bit of leg support, he says, and wrapping could help stabilize more recent injuries while they heal.

Warning Signs

Our sources agree: When used correctly, boots and wraps should only help, not harm. While researchers are still working on practical recommendations for their use, riders can take precautions to ensure these pieces of equipment aren’t causing new problems.

Polo wraps must be applied with just the right amount of tension—a skill riders can learn from experienced horse people, veterinarians, or physical therapists, says Hill. Any inflammation or swelling could suggest the wrap was too tight, he says.

Wet wraps might lose elasticity and trap moisture, putting the horse at risk of dermatitis (skin inflammation), Hill adds. Never apply a wet wrap. If the wrap gets wet during exercise, riders can complete the session, remove the wrap, and dry the leg.

As for boots, they shouldn’t slip, but they also shouldn’t be overtight, says Marlin. “Try putting an ankle bandage on, and make it really tight over your Achilles tendon,” Marlin says. “Then go for a run and see how that feels. You won’t do it to your horse again.”

Riders must also consider external factors, he adds. “The hotter the weather, the thicker the boot (especially foam or fleece types), the harder or longer the exercise, the hotter the tendons are going to get,” Marlin says.

Take-Home Message

Riders often apply boots and wraps to their horses’ legs for protection. But science still struggles to support manufacturers’ claims that boots and wraps help prevent certain injuries, and some researchers suggest they might increase the risk of tendon injury. Until evidence provides clearer guidelines, riders can aim to use properly applied boots and wraps wisely, recognizing their potential benefits and risks.

Editor’s note: This article was originally published in the Riding Horse 2023 issue.

Giving horses sufficient time to recover from athletic events could help them avoid acute injury and long-term health problems.

Training and conditioning sport horses helps prepare them both physically and mentally for competition, but the process can take a toll on their bodies. Without adequate rest, a horse’s body cannot fully recover, leading to overexertion and potentially acute injury or longterm soundness problems, increased risk of injury, and the horse becoming mentally burnt out.

Recovery activities and the amount of time a horse needs to recuperate depend on the individual horse and his workload. For example, a horse jumping a 1.60-meter (5.25-foot) course in competition needs a different recovery plan than a racehorse in training or a dressage horse competing second level.

“The recovery time (needed) is dictated by the individual horse, the type of work performed, the general health of the body, age of the horse, and so on,” says Tim Worden, PhD, an equestrian sports performance consultant based in Ontario, Canada. “In general, younger and healthier horses will recover faster than older horses or those struggling with health issues.”

How The Horse’s Body Recovers

“Following exercise, the body works to restore normal function, repair damaged structures, remove any by-products of exercise, and replenish resources such as energy,” says Worden. “Additionally, exercise stimulates different signaling pathways, which lead to proteins being assembled in the body to improve exercise tolerance (e.g., structures in muscle that can improve oxidative capacity or increase force output) for the next time the horse needs to perform a strenuous activity.”

He adds that these processes take time, and a lack of proper rest can cause overexertion in the short-term or overtraining—an imbalance between workload and recovery—in the long-term. “While allowing the horse to recover from a workout on Monday, you can still perform work on Tuesday, assuming you accommodate the fatigue level from the preceding day and steer clear of exercises that place similar demands on the body (for example, avoid doing two high-intensity jumping workouts on back-to-back days),” he says.

What Can a Horse’s Recovery Time Look Like?

Recovery can be divided into two categories: passive and active. Passive recovery involves no added physical activity, which for horses usually means spending a day turned out with no ridden exercise or groundwork, says Worden. “Active recovery is the deliberate prescription of low-to-moderate-intensity exercise to aid in the restoration of the horse’s body,” he explains. This could be going for a trail ride or a light walk, trot, and canter on a track or in a field to let the horse stretch his body.

“Recovery will vary with the type of exertion and the horse’s level of fitness,”says Steve Adair, MS, DVM, Dipl. ACVS, ACVSMR, associate professor at the University of Tennessee’s College of Veterinary Medicine, in Knoxville. “Recovery time may be a few hours between events up to a few days. Recovery time can be anything from a complete layoff to non-sport-specific exercise such as trail riding.”

“If I am building a training program, I may have one passive recovery day per week (assuming the horse can have extended turnout), but most of the time I prefer to use active recovery means,” says Worden. “Active recovery is helpful for pumping nutrients to the musculoskeletal system while simultaneously removing molecules and chemicals that accumulated during the preceding intense exercise.”

Active recovery can also give riders a chance to identify any potential soundness issues during less-intense training and provide horses with a mental break from typical ridden ring work.

“In my opinion, the No. 1 recovery method will always be active recovery,” says Worden. “Getting horses out of their normal environment and doing something fun. Some horses enjoy going for hacks, others enjoy controlled gallops on a track, and some will enjoy going to the beach. Figure out what allows your horse to mentally recharge and build that into your program as often as possible.”

Adair says the type of recovery time horses need varies tremendously depending on the sport. “For instance, a halter horse is not going to need much recovery between shows, whereas a 100-mile endurance horse may require several days to a couple of weeks for recovery,” he explains.

The Trainer’s Role in Planning Recovery Time

When building a program, trainers should tailor a horse’s recovery time to match his workload. “As trainers, we are essentially stress managers,” says Worden, applying stress in the form of exercise to stimulate the signaling pathways mentioned earlier. This “will ultimately result in improved aerobic performance, technique, power generation, and so on.”

Trainers should also ensure the horse’s recovery time is efficient and maximizes the training benefits. “A horse can perform a lot of quality work in training, but if there are issues with the recovery means chosen, then any potential gains will be lost or, in worst-case scenarios, lead to injury,” Worden adds.

Always consider fitness when planning recovery time. “The less fit an individual, the longer the recovery period that is needed,” says Adair. “The tissues (muscles, tendons, ligaments, cardiovascular system, etc.) of an unfit individual have not been conditioned to withstand heavy stress, thus they are more susceptible to injury.”

Riders and trainers can work with exercise physiologists and their horses’ veterinarians to perform multiday fitness tests designed to determine horses’ readiness to perform following a variety of recovery times, says Worden. Fitness wearables, which can collect information on the movement and health data (i.e., heart and respiration rates), can also give trainers and veterinarians more information about horses’ optimal recovery times, especially if used in daily training.

Do Long Periods of Rest From Exercise Benefit Horses?

In some cases trainers might choose to give horses several weeks of rest, especially during the winter in colder climates.

However, long periods of complete rest are often not favorable to a horse’s health; keeping horses at a minimal level of fitness is often more beneficial, says Adair. “Exercise and movement are important to prevent nagging issues from becoming a problem,” he explains. “For example, older horses with arthritis tend to fall apart if they are laid off for several weeks. It is better that they have some type of exercise, even if it is just trail riding.”

Happy and sound mature horses in a well-constructed training program often do not need extended periods of rest, adds Worden. “I would prefer to give a week or 10 days of passive and active recovery a few times throughout the year versus one or two months off at one time,” he says. “The hardest thing to do in sports programming is to build an athlete back up (from significant time off or an injury) so, for that reason, I tend to stay a bit further away from extended time off.”

He adds that longer rest periods can help horses that have been overtrained, because giving the body time to fully recover is often the best way to counteract overtraining. “Once a horse has reached the overtraining stage, you cannot continue to train through it,” Worden says. “If you do, you are likely to have an injury arise at some point.”

Longer periods of rest might also benefit younger horses because it gives them a break from the training environment, which can be mentally draining for them. Having downtime turned out with other horses can help them remain happy and sound in their work in the future.

Care During Recovery

“Proper foot care is very important,” says Adair. Correctly shoeing and trimming the foot to match the conformation of the leg and offer maximum weight-bearing support under the limbs can help horses maintain long-term soundness and reduce their risk of injury.

“Chiropractic evaluation and massage therapy can also be of benefit,” he adds, noting that while there are many anecdotal claims about the benefits of complementary therapies for recovery, more research is needed to confirm their efficacy.

Having a skilled team available to regularly evaluate the horse will help maximize recovery time. “Someone who can ‘listen’ with their hands is vital for both guiding therapy and training decisions,” explains Adair. “To know exactly where the horse is muscle sore following a workout and how the body responds to different types of exercises can tell you a lot about strengths and weaknesses.”

Take-Home Message

Appropriate recovery time is crucial to a horse’s long-term health and happiness in his work. Following exercise, a horse’s body needs to restore normal function, repair, and replenish energy supplies. The amount of time a horse needs to recover can vary greatly depending on the individual and the work he performs. Riders and trainers can use both active and passive recovery in their training programs and should find active recovery methods horses enjoy to help them recover mentally from challenging work.

Know the horse. “Ultimately, the most important thing for owners, riders, trainers, grooms, etc., to do is observe the horse and listen to what it is telling you,” says Worden. “If you know a horse well, then you will be able to detect slight personality and movement characteristics that indicate it is not yet fully recovered and may need an extra day before the next workout. It is always better to give an athlete an extra day off than to push them too soon and (risk) an injury or impact their confidence.”

This article is from the Older Horse 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

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Do we underestimate the impact of ill-fitting tack?

Some analogies compare the equine back to a violin. The horse’s spine is the wooden body of the instrument, and the muscles are the strings. When the horse’s muscles and other soft tissues move the spine, the structures must stretch and extend accordingly for the entire instrument—the back—to function. The horse’s ability to engage and use his back depends on well-­developed and healthy musculature. Underutilized, atrophied, or spasmodic or otherwise painful muscles disrupt the animal’s locomotion. Unfortunately, this kind of muscle damage often occurs due to a common, often-overlooked culprit: ill-fitting saddles. In this article we’ll tackle the process of recognizing and addressing saddle fit problems to help you be sure your equine partner has a pleasant experience in the tack.

The Importance of a Saddle That Fits

Imagine running a 5K with sneakers that are too small and tight for your feet, causing blistering pain with every footfall. Or picture a track-and-field athlete attempting to navigate a course of hurdles while wearing tightly buttoned jeans that dig into the skin and cause uncomfortable friction at the seams. These struggles are similar to those horses endure in the hands of well-­intentioned but ill-informed riders—and even trainers. Undoubtedly, pain, lameness, muscle atrophy, and behavioral resistance in the ridden horse can all be linked to an improperly fitting saddle. With so much potential for harm if fitted incorrectly, saddles deserve the attention of the professionals on your horse’s team—­veterinarian, bodyworker, and saddle fitter.

When it’s Time to Call a ­Pro

“It’s crucial to involve a saddle fitter when your horse’s body has changed for any number of reasons,” says Jenna Shipley, of Shipley Equine Services, a certified equine bodyworker and saddle fitter based in Carmel, New York. Like most independent professional saddle fitters, Shipley recommends a routine saddle checkup at least twice a year. She names a few scenarios that might affect this schedule and warrant dialing your saddle fitter’s number:

• Extreme weight gain or loss. This can include significant muscle loss from a period of inactivity, decreased nutrient intake, or even systemic illness.
• Starting (or restarting) a horse under saddle. Commencing training with properly fitted tack is better than fixing problems down the road.
• Rehabbing a horse after a period of stall rest due to injury. Shipley says the shape of the topline will change when transitioning from inactivity back to work and encourages horse owners to have saddle fit evaluated throughout the rehabilitation process.
• A change in riders. “Crooked riders make crooked horses,” says Shipley. Researchers have shown riders who are too large for the saddle, out of balance, or crooked create uneven force distribution across the tack (Bondi et al., 2019). “These unbalanced riders can actually change the quality of their tack, creating unbalanced, asymmetrical saddles,” she says.

Furthermore, ill-fitting saddles can create a “vicious cycle,” our sources say. “Horses with saddle-induced back pain can have the shape of their back change, often dramatically, in a short amount of time, from the associated muscle atrophy,” explains Shipley. “We have to remember how dynamic a horse’s musculoskeletal system is, how much it responds to its environment.”

Erin Contino, MS, DVM, Dipl. ACVSMR, associate professor of equine sports medicine and rehabilitation at Colorado State University, in Fort Collins, echoes these observations: “Whether from saddle fit issues or underlying back pathology (disease or damage), horses with back pain will often ‘turn off’ their stabilizing muscles, causing them to atrophy. Many horses with back pain will appear to have lost muscle mass over their topline rather quickly.”

As a general rule, Shipley recommends more frequent saddle fit checks for horses in a dynamic program—green horses that are still maturing, athletes rehabilitating from an injury, or horses experiencing a variable workload throughout the year—than those in a static program. This latter group is governed by consistency: These horses have a steady workload throughout the year, and their bodies are less likely to change rapidly.

Realistically, many horse owners look for more practical and cost-effective alternatives to having their saddles ­professionally ­evaluated and adjusted as frequently as every couple of months. Researchers’ findings suggest certain saddle pads can in some cases reduce pressure on the back (Kotschwar et al., 2010).

“I do see value in some half pads that come with the ability to have shims added and subtracted, as they can be particularly useful during these times when the horse’s body is changing a lot,” explains Shipley. “The reality is that although corrective saddle pads can temporarily improve the fit in certain cases, they can’t be a permanent solution.” And more padding isn’t necessarily harmless—layering on various pads to correct a gullet or tree that’s already too narrow will only make matters worse, similar to adding thick socks to your tight shoes.

How to Evaluate Saddle Fit

Our sources list eight elements to assess:

1. Saddle balance. The saddle must be balanced from front to back and from side to side to avoid putting excessive pressure on any portion of the horse’s back or shifting with movement. 
2. Panel contact. Both panels should make full, even contact with the horse’s back. Full panel contact prevents the saddle from rocking back and forth. It also helps distribute the rider’s weight evenly across the horse’s entire back, ending just before the last vertebrae (typically the 18th thoracic vertebrae—T17 in some horses—which is the point of junction for the last rib). If the panels are flocked with wool, they can be reflocked to address imbalances. Foam panels, on the other hand, do not offer that option.
3. Wither clearance. “Lack of wither clearance is one of the most common issues I see in performance horses,” says Shipley. It’s easy to see why a saddle that puts direct pressure on or around the horse’s sensitive, bony withers hinders range of motion and causes pain. A horse whose saddle pinches his withers might be reluctant to move forward and might show behavioral signs of pain such as kicking out and bucking.

4. Gullet width. How wide or narrow the gullet is dictates the weight distribution of the rider across both sides of the horse’s back. The width of the horse’s individual spine and musculature at the withers should dictate gullet width. Researchers have confirmed excessive padding can make an otherwise well-fitting gullet too small (Bondi et al., 2019).
5. Tree width. “The tree points located at the front of the saddle should mirror the angle of the horse, allowing the shoulders to rotate comfortably,” says Shipley. “If the tree is too narrow, it will restrict shoulder movement and likely cause pain. If the tree is too wide, the entire saddle will be unstable and have excess pressure at the front of the saddle. It may rock or slip from side to side, or the back half of the saddle may twist to one side or the other.” As their names indicate, saddles with adjustable trees can be modified, to some extent, to fit the horse. Traditional saddles—those without the built-in adjustable tree option—need to be replaced if the tree no longer fits the horse.
6. Billet alignment. The billets—the leather straps to which the girth connects on both sides of the saddle—should be perpendicular to the ground. Being pulled too far forward or too far back by the girth will alter the fit of the saddle and might also cause unnecessary pressure and movement at the front or back of the saddle. In Western saddles the same concept applies with the cinch strap or latigo.
7. Seat size. The pommel of the saddle must be at least 2 inches (or three fingers) behind the back of the scapula, providing enough freedom for the shoulder blades to move backward during extension. In both English and Western disciplines, the saddle panels should not extend farther back than the 18th thoracic vertebrae and last connecting rib into the lumbar spine region. A saddle of improper length, front to back, interferes with the balance of both horse and rider.
8. Tree integrity. This last one is easily overlooked. “If you buy a used saddle, or if your horse falls or rolls with the saddle on, have that piece of tack checked by a professional,” says Shipley. “Otherwise, a broken tree could go unnoticed for weeks or even months, causing damage to your horse’s back and risking the rider’s safety. On a related note, if a stirrup catches on something and pulls on the saddle, that stirrup bar can bend, putting sharp and uncomfortable pressure on the horse through the saddle.”

Addressing Back Pain: The Role of Therapeutic Modalities

To break the cycle of saddle-induced pain and dysfunction, rider and trainer must remedy the root cause of the problem—­saddle fit—before any treatments can provide lasting results. “No therapeutic modality can fix poorly fitted tack,” says Shipley. “Massage is just a Band-Aid if the fit is not being simultaneously addressed. From personal experience doing equine bodywork, I’ve worked on many sore backs that would improve by the end of the session, only to be braced, reactive, and sore after the very next ride in the ill-fitting tack.”

That’s not to say therapeutic modalities such as massage and pulsed electromagnetic field therapy (PEMF) don’t have value in detecting and mitigating ongoing problems, our sources say. “Oftentimes it’s actually these practitioners of therapeutic modalities who first discover the subtle signs of ill-fitting tack and can refer the client to a saddle fitter,” says Shipley. “By working on the horse, they can detect cues such as asymmetrical back pain, girth area sensitivity, or subtle changes of the hair over the back.”

Both Shipley and Contino encourage a holistic approach to rehabilitation from saddle-induced back pain. “In most cases the horse has muscle dysfunction all throughout the body as a result of compensating for their painful backs and not using their bodies properly,” Shipley explains.

Contino adds that even once you remove the “nidus” (in this case, a poorly fitted saddle), these back muscles that have switched off as a result of pain don’t switch back on automatically. Thus, the long-term physical consequences of ill-fitting saddles largely depend on what is done to reengage the back muscles. If you don’t act, the horse might end up in a downward spiral where he continues to lose muscle mass and strength. But if you do introduce interventions such as core strengthening exercises, the back muscles can return to normal function and strength, limiting long-term consequences. Shipley goes as far as recommending a full rehabilitation program for horses that have had poor saddle fit for a considerable amount of time. Some severe cases might even require giving the horse time off from riding before starting again in new or properly fitted tack, she says.

Looking Ahead: Long-Term Impact of Poor Saddle Fit

“The majority of horses with poorly fitted saddles have pain, or at least soreness, in the muscles on either side of the withers,” says Contino, naming specifically the spinalis muscle and part of the trapezius muscle. “Fortunately, once the saddle fit issue has been corrected the muscle soreness often resolves. However, in some instances, if a saddle or pad … is actually directly ­contacting the withers, a pressure wound can occur in which case, even when it is healed, scar tissue would remain. Scar tissue is less elastic than normal connective tissue and, thus, there may be limited gliding of the skin over the underlying tissue.”

Take-Home Message

Much like a pair of good shoes, good tack that fits your equine athlete properly makes all the difference in both comfort and performance. Learn to observe and advocate for your animal. “Feel his back regularly, and learn what’s normal for him,” says Shipley. “Reactivity over the back often indicates a tack fit issue.” Many horses are stoic and show no outward, behavioral signs of pain. “But a high pain tolerance does not mean they are not feeling pain,” she says. Attentive examination and early intervention by a professional are the keys to resolving saddle fitting problems before they cause bigger issues.

Joint pain and osteoarthritis (OA) represent one of the leading causes of performance loss in equine athletes, affecting around 60% of the overall population. Chronic inflammation may cause permanent changes in joint function, leading to long-term pain, swelling and decreased range of motion, among other debilitating symptoms.  

Many of the current OA treatments are management tools that prolong function, generally without modifying OA progression. The most common treatments include non-steroidal anti-inflammatory drugs (NSAIDs) and oral joint supplements that target cartilage repair or protective pathways, as well as joint injections with corticosteroids or newer orthobiologics, both of which are anti-inflammatory. Unfortunately, many of these treatments are associated with other adverse effects, especially when used long-term. 

Several novel treatments to reduce joint inflammation with minimal side effects have been proposed within the scientific community. One such treatment is cannabidiol (CBD), a non-psychoactive chemical compound found in Cannabis sativa (colloquially known as hemp). CBD is known to target the endocannabinoid system, a complex network of several biological systems that affects many physiological processes, including but not limited to, pain perception, appetite, mood, learning and immune function. Within the context of OA, CBD has been found to inhibit the production of substances that increase inflammation, decrease sensitivity of pain-associated receptors and modulate an overactive immune system. Anecdotally, many people claim the benefits of CBD, but more research is required to accurately quantify and qualify its potential benefits and risks. This is especially true within the equine community.  

Our work in the Page Laboratory is interested in understanding the potential anti-inflammatory effects of CBD in joints via the implementation of a three-phase project. We aim to improve a chemically induced joint inflammation model such that it will be repeatable and reversible, while still accurately mimicking the body’s physical and biochemical response to inflammation.  

Phase one involves refining the dosage of a proinflammatory compound which will be injected into one knee (carpal) joint, inducing temporary inflammation. Defining an appropriate dosage protocol and taking note of individual horse variability is an important step for developing a reliable experimental procedure.  

Following phase one, the aim of phase two is to identify an appropriate CBD formulation for oral administration. Due to its chemical composition, CBD is not well absorbed by the equine GI tract, with a bioavailability around 10% (e.g. horses will only absorb about 10% of the CBD administered to them). Previous research has found what a drug is dissolved in can make a large difference in systemic CBD levels, and the most effective candidates are usually composed of fats, such as sesame or canola oil. An optimized formulation is necessary to both maximize therapeutic benefit while keeping palatability in mind for horses.  

In phase three, we will combine the findings from the first two phases and analyze the effects of CBD on the drug-induced inflammatory response. A control group will receive no CBD, and the differences between the treated and untreated group will be evaluated. Horses will be evaluated for several parameters, including the presence of biomarkers associated with inflammation both within the joint and systemically throughout the body. The mild lameness that is induced will be quantified via an objective evaluation system that can better detect the subtleties of gait asymmetries when compared to the human eye.  

While other researchers have shown that CBD represents an exciting prospect for the treatment of chronic joint pain, our research should provide additional information on its efficacy for the horse. Our findings may find applications for human medicine given the mechanisms of OA and joint pain in humans often mimic those seen in horses, which is important given that approximately 45% of people will develop some form of OA within their lifetimes. In the end, we hope to provide a better research model for joint inflammation while simultaneously evaluating CBD as a way to manage joint pain in horses. 

Editor’s note: This is an excerpt from Equine Disease Quarterly, Vol. 34, Issue 1, funded by underwriters at Lloyd’s, London, brokers, and their Kentucky agents. It was written by Jenna McPeek, PhD Graduate Student at the University of Kentucky’s Gluck Equine Research Center, in Lexington and Allen Page, DVM, PhD, assistant professor and faculty advisor at the Gluck Equine Research Center. 

In recent years more equine practitioners have gained access to cross-sectional imaging, including MRI and computed tomography (CT). These modalities create “slice” images of structures, providing a three-dimensional view and giving veterinarians the ability to diagnose issues that aren’t always visible on standard radiographs. Practitioners often assess show jumping horses’ fetlocks using MRI and CT because this high-motion joint is a common source of pain in these athletes. Cross-sectional images can reveal various fetlock joint, but determining whether these lesions hold clinical significance or simply reflect normal adaptive changes can be challenging.

Annamaria Nagy, DVM, PhD, of the Equine Department and Clinic at the University of Veterinary Medicine, in Budapest, Hungary, and Sue Dyson, MA, VetMB, PhD, conducted a study to document findings on low-field MRI, fan-beam CT, and radiographs (X rays) in nonlame show jumpers in full work. None of the horses they included had a history of fetlock joint disease.

The researchers most frequently noted CT and MRI changes consistent with the densification of the highly porous bone trabecular bone located in the sagittal ridge and/or condyles of the third metacarpal (cannon) bone. Both the sagittal ridge and condyles are located at the bottom (distal) aspect of the cannon bone where it articulates with the long pastern.

They noted this particular change in 53 (85.5%) of the 62 limbs they studied.

“Densification of the trabecular bone of the medial condyles in the dorsal and palmar aspects was very common, and the densification of the lateral condyle was more pronounced in the palmar aspect,” said Nagy. “Usually, the densification was bilaterally symmetrical, affecting both forelimbs.” In other words, Nagy and Dyson commonly saw clear patterns where this bony densification occurred within the fetlock.

On MRI and CT they also found:

• A focal hypoattenuating lesion (dark abnormality on CT) in the dorsoproximal aspect of the medial condyle in three horses that they were not able to detect on radiographs;  
• A focal hypoattenuating lesion in the dorsodistal aspect of the condyle in one limb that they also could not detect on radiographs;
• A focal hypoattenuating lesion in the palmar aspect of the lateral condyle of one horse that they did not detect on either MRI or radiographs;
• Subchondral (found beneath the cartilage) bone plate thickening in the proximal phalanx—the long pastern bone—in 61 limbs, typically in just one limb per horse;
• Sagittal groove indentation in both limbs of one horse; and
• A focal hypointense signal (low-signal intensity on MRI) in the medial aspect of the sagittal groove in one horse.

“Periarticular (around the joint) remodeling was more evident on CT than MRI and radiographs, and no significant soft-tissue lesions were identified in this study,” said Nagy.

“Trabecular bone densification of the third metacarpal bone was common in nonlame show jumpers,” she added. “While the trabecular bone densification likely reflects adaptive changes to exercise, horses could experience pain in those areas due to increased intraosseous (in the bone) pressure.”

Take-Home Message

Although all horses included in this study were sound, some of the lesions in the cannon bone condyles or long pasterns could cause lameness and become clinically significant over time.

“Future studies collecting longitudinal data (from the same subjects repeatedly over a period of time) on these horses and objective comparison of imaging findings for specific abnormalities are needed,” said Nagy. Other research could include performing objective assessments of bone thickening in these horses, she added.

Professional human athletes experience strain from frequent, rigorous training and performance. They use various complementary therapies to accelerate their bodies’ natural healing process and ease the discomfort they experience so it doesn’t interrupt their performance. Equine athletes might also benefit from a variety of integrative therapies to help them feel and perform their best.

A significant advantage to using complementary therapies is that they are drug-free and most are allowed during competitions. Electroacupuncture, shock wave therapy, Class IV laser therapy, and cryotherapy are an exception because they are not permitted during FEI-sanctioned events. (Always check the rules governing your competition).

While many complementary therapies can be useful and incorporated into a horse’s wellness program, Tracy Turner, DVM, MS, Dipl. ACVS, ACVSMR, founder of Turner Equine Sports Medicine and Surgery, in Stillwater, Minnesota, says he considers the cost/benefit ratio when deciding which to recommend to a client.

“What does it cost to use it?” he asks. “How much benefit will the horse get? That changes based on the scenario and part of the decisions made by the horse’s health-care team, including the veterinarian, horse owner, and trainer.”

He adds that knowing the goal for using complementary therapies is also critical. If you’re trying to help the horse achieve relaxation (which has its benefits), that’s one thing, but if it is to heal an injury, these therapies on their own will not achieve the desired outcome.

“It’s important to have your veterinarian do a whole-horse evaluation,” he says. “I firmly believe there’s no such thing as a single injury. Diagnosing the underlying issues is essential to knowing how the horse might be compensating in other areas (and) to decide what the horse needs, and fitness comes into the equation, too.”

Picking a modality for your horse and your discipline can feel as overwhelming as restaurant menus with too many choices. Here’s a selection of popular treatments for keeping performance horses feeling their best. Use this article to start a conversation with your veterinarian about options that make the most sense for your horse.

Acupuncture

“Acupuncture is a useful, time-tested modality that has a lot of science and thousands of years of use,” says Andris J. Kaneps, DVM, PhD, Dipl. ACVS, ACVSMR. He owns Kaneps Equine Sports Medicine and Surgery LLC, in Beverly, Massachusetts. More of that science appears in the human literature than in equine studies, however. “It’s gradually becoming more widely recognized as a valid treatment in horses,” he adds. (Read about acupuncture and a review of existing research at TheHorse.com/181626.)

“It has very valid support scientifically and anecdotally,” he says. “A key difference between acupuncture and what we call Western veterinary medicine is that the approach is completely different.”

For example, as a Western-trained veterinarian, he palpates for swelling or increased joint fluid, looks for pain with hoof testers, and performs a lameness evaluation for signs of discomfort. In Chinese medicine those factors are important, but practitioners also evaluate the sensitivity of acupoints throughout the body, assess tongue color and moisture, and examine other factors that aren’t in the normal diagnostic approach for Western medicine, he explains.

Kaneps especially likes acupuncture for horses with back pain because of the equine research that supports its use for such cases, and he has seen multiple horses experience significant improvements after treatment.

“As with all complementary therapies, this does not mean I just treat a horse with acupuncture,” he says. “I may use some Western modalities as well as other complementary techniques to reduce back pain in a horse. Using one alone may not do it, but using several together can improve the outcome.”

Spinal Manipulative Therapy

Inflammation of the nerves and other tissues surrounding joints, especially in the spine, can lead to pain and reduced function, especially when the joints are stiff or immobile. Spinal manipulation (described at TheHorse.com/113280) could help restore the range of motion.

“Chiropractic adjustments keep the horse limber and moving to prevent areas of fixation through the neck, back, pelvis, etc.,” says Ed Boldt, DVM, owner of Performance Horse Complementary Medicine, PLLC, in Fort Collins, Colorado. “Like human athletes, when (horses) are in better shape, they are less likely to have an injury.”

In Boldt’s opinion, horses that are not performing optimally are candidates for spinal manipulative therapy. He uses the example of a barrel horse running to the wall (where the horse runs past the barrel and doesn’t slow down to turn) or going flat (leaning on his front end) around the barrel.

A horse that is three-legged lame is not one that would benefit from chiropractic therapy, he says. “Those horses need a diagnosis and treatment plan, and then integrative therapies might be added to help healing,” he explains.

Boldt also believes veterinarians trained in chiropractic care should make the adjustments. Some states allow chiropractors licensed to work on humans to have animals as patients after completing approved continuing education.

“To me, it’s important the vet is involved either doing the treatment or at least approving of the treatment,” he says.

Chiropractic care without an equine practitioner’s examination might worsen a situation. Boldt remembers being called to examine a horse treated by a nonveterinarian, and the horse was getting sorer rather than improving. By watching the horse move and using hoof testers, Boldt identified the horse had an abscess.

In another case an older horse had fallen on an icy hill and injured his neck. The owner brought it to Boldt, who refused to provide an adjustment without radiographs.

“Thankfully, I insisted,” he says. “The horse had a fractured neck, and if I’d just gone in and adjusted the horse there could have been severe consequences.”

Kaneps agrees that equine chiropractic adjustment is a well-tested modality, and those trained in it should perform treatment.

Vibration Plate Therapy

The next time you watch a sporting event, notice how the athletes “jump” around on the sidelines, readying themselves for play. Turner likens the benefits of vibration therapy in horses to those loosening routines.

The gentle motion is believed to increase blood flow, lessen joint pain and inflammation, and warm and loosen muscles, which reduces horses’ muscle tension before a ride. Research findings on the effects of whole-body vibration are mixed. One example is a Michigan State University study in which researchers subjectively found no difference in flexion, stride length, or heart rate after vibration therapy, but horses exhibited behavioral changes such as relaxation and less stress.

In another study, out of Peninsula Equine Medical Center, in California, a researcher found that hooves grew faster after two months of whole-body vibration. Further, this vet and colleagues plus one from Western University of Health Sciences College of Veterinary Medicine observed an increase in back muscle size and symmetry after twice-daily whole-body vibration treatments five days a week for 60 days (Halsberghe et al., 2017).

“In general, horses really like it,” says Gabrielle Solum, DVM, a resident at Equine Sports Medicine and Rehabilitation, in Whitesboro, Texas. “They yawn and relax on there, so it’s a nice therapy for them to have. The biggest thing is if you achieve benefits like increased hoof growth and larger back muscles, it must be used daily and (you need to) recognize that there is no prolonged effect if you stop using the modality.”

Pulsed Electromagnetic Field (PEMF) Therapy

This approach uses pulsating magnetic fields, made by pulsing a small electrical current through wire coils, to jump-start and accelerate normal biological cellular reactions. Most of the information on PEMF therapy is on bone healing. Proponents say PEMF increases circulation and decreases pain and inflammation to accelerate healing.

“It is really good for muscle relaxation … when an animal is relaxed, they hold themself differently, and we want a horse to bear its weight correctly,” Turner says.

Pulsed electromagnetic field therapy is just one type of electrical stimulation treatment. One of Turner’s go-to modalities that also falls into this category is functional electrostimulation (FES), which works to strengthen a muscle that is not being used and can provide pain relief. This mimics nerve patterns signaling the muscles to contract, and he has found it particularly beneficial when an area has been inactive following an injury.

“Functional electrostimulation has a lot of uses,” Turner says. “It can be particularly helpful for horses needing multiple spinal or skeletal adjustments. The electrostimulation helps fatigue the muscles so you can better work on an area.”

Ice/Cryotherapy

Since the dawn of human sports medicine, doctors and surgeons have recommended ice baths to decrease inflammation and reduce pain. Solum says this easy-to-use treatment is underutilized.

“Ice boots are great to use after exercise for 20-30 minutes to decrease inflammation,” she says. “There are a lot of ice boots on the market, but it’s also acceptable to use a bucket of ice if your horse will tolerate it.”

She often pairs ice with heat, especially for horses with back pain or those performing athletically.

“You can place a warm towel on the horse’s back or use one of the microwavable products for humans,” says Solum. “I probably wouldn’t use an electric heating pad, but there are benefits to using heat along the axial skeleton to give more mobility and prepare the horse to be athletic. Then I’d follow that up with ice after activity.”

Be cautious about the material’s temperature; you can damage tissue if it’s too hot. If you cannot tolerate the heat on your skin, it’s unlikely the horse can.

Be sure to discuss ice and heat therapy with your veterinarian before using them on your horse, because in some situations one is more beneficial (or could be detrimental).

Maintenance Begins with Fitness

Complementary therapies offer diverse options for enhancing performance and well-being. Boldt says collaboration with veterinarians and integration with conventional therapies are key factors in developing a holistic approach to maintaining performance horses.

“Integrative therapies are another tool in the toolbox—another therapy we can use with conventional therapies,” he says. “They can’t be used for everything, and I’m an advocate that they are done by a veterinarian.”

Although it can be argued that conditioning and exercise fall under rehabilitation, our sources here agree they are fundamental. Kaneps explains that people don’t run a 10K or a marathon without proper training. If they do, they are likely to sustain an injury. The same is true in equine athletes.

“Rehabilitation and conditioning exercise are the basis for having a good, strong equine athlete who is capable, and it hopefully helps prevent injury,” he adds. “When we see a horse with a sore back, we may use laser, shock wave, injection, or acupuncture, and the pain may be removed. But ultimately the horse needs to build core strength, topline strength, and flexibility and through exercise to build up that core.”

If you’ve ever managed a horse with back pain, then you’ve probably heard the term kissing spines floated around. But what exactly are kissing spines, and what does it mean if your horse is diagnosed with them?

Kissing spines, or overriding spinous processes, are reported to be one of the most common causes of back pain in horses. Though back pain was originally described in the 1960s, it wasn’t until recent years that veterinarians and researchers devoted more attention to it as a primary problem in horses as opposed to secondary to hind-limb lameness. As technology has progressed to produce higher-quality X rays and our knowledge of equine back anatomy’s complexity has expanded, we have a greater appreciation for and understanding of kissing spines.

A horse’s spine is composed of individual vertebrae connected by ligaments and surrounded by muscles. Each vertebra has a bony prominence that sticks up—the spinous process. In a normal horse, the spinous processes are spaced evenly, allowing a horse to both flex and extend his back. With kissing spines, the spinous processes are too close to each other or even touching. The lack of space between processes reduces back mobility and causes pain during movement as the spinous processes interfere with each other.

The underlying cause of kissing spines is still largely unknown. The condition can occur in any horse, but some breeds, such as Thoroughbreds and Warmbloods, seem to develop it more than others. Horses are most commonly diagnosed around 5 to 10 years of age, but younger and older horses can develop it, too. Kissing spines typically occur in the last few thoracic vertebrae—right where a saddle and rider would sit along the horse’s back.

Horses with kissing spines can demonstrate a variety of clinical signs. These can be subtle, such as poor performance or decreased range of motion when asked to flex or extend the back, all the way up to more noticeable behaviors, such as a painful reaction to back palpation, reluctance to be saddled or ridden, cross-­cantering, and bucking under saddle.

Veterinarians typically diagnose kissing spines using a combination of clinical signs and X rays of the horse’s back. X rays are the best way to assess the distance between spinous processes and to look for evidence of problems in the bones, such as increased density or ­cysticlike lesions. The tricky aspect of diagnosing kissing spines is that researchers have shown that 39% of horses have changes on their back X rays consistent with kissing spines, yet they show no signs of back pain. Similarly, the angle from which the veterinarian takes the X rays can influence the apparent spacing between processes and might result in overdiagnosis.

​Other diagnostic modalities your veterinarian might use include nuclear scintigraphy (bone scan), ­ultrasonography, and the injection of local anesthetic around the suspected painful spinous processes. Unfortunately, each of these modalities has its limitations. For example, injecting local anesthetic into the area does not produce reliable diagnostic results, meaning veterinarians cannot predict which horses will respond to treatment. Therefore, the most reliable way to diagnose kissing spines continues to be looking at changes on back X rays in conjunction with clinical signs of back pain.

Once a veterinarian diagnoses a horse with kissing spines, he or she can proceed with several treatment options. In mild cases horses might respond to conservative treatments such as muscle relaxants, chiropractic and acupuncture therapy, shock wave, or local corticosteroid injections. If a horse does not improve with conservative therapy or it’s a more advanced case, the veterinarian might recommend surgery. The surgical treatment might involve either cutting the ligament that runs between each spinous process at the affected sites to allow more space between them or removing part of the spinous process to create more space. The procedure the surgeon elects to perform mostly depends on the severity of the kissing spines. Surgery has been shown to produce more favorable long-term results than medical therapies in horses with this condition.

Back pain in horses can be complex. While kissing spines is the most common cause in horses, the diagnosis should not be made on X rays alone. Rather, the veterinarian should assess X rays in combination with clinical signs of back pain and only after ruling out other causes of lameness. Once your veterinarian makes a diagnosis, there are many treatment options that can help get your horse back on track and moving pain-free.

Pain in horses is a complex state. Laminitis exemplifies this complexity, involving multiple overlapping pain pathways that can be difficult to manage.

“It is so complex that we continue to struggle with keeping on top of it in cases of laminitis due to our lack of safe, efficacious protocols,” said Alonso Guedes, DVM, MS, PhD, Dipl. ACVAA, during his presentation at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida. Guedes is professor of anesthesia and pain medicine at the University of Minnesota’s College of Veterinary Medicine, in St. Paul.

“Our inability to manage the severe, debilitating pain is the single most common reason for electing euthanasia in cases of laminitis,” he added. Laminitis is a painful condition in which the sensitive tissues anchoring the coffin bone inside the hoof capsule—called the lamellae or laminae—become inflamed and compromised. In advanced cases this damage can cause the coffin bone to rotate or sink as the internal support fails. Guedes described the multiple mechanisms involved in the onset of pain in horses with laminitis, including:

• Mechanical disruption of the lamellar tissues that cause nociceptive pain (the traditional acute pain many of us think of);
• Inflammation of the lamellae that causes inflammatory pain;
• Systemic inflammation with the release of cytokines (proteins important in cell signaling), such as tumor necrosis factor-alpha (TNF-a). “This cytokine increases neuronal excitability, increasing the firing rate of sensory pain neurons,” Guedes said.

Laminitic horses also suffer from changes in peripheral neurons that transmit signals between the central nervous system and the rest of the body. Changes in those fibers, the A-delta (d) myelinated fibers, and C fibers likely contribute to neuropathic pain. “Neuropathic pain is difficult to treat, it’s not very responsive to NSAIDs (non-steroidal anti-inflammatory drugs) or opioids, and the changes to the nerve fibers start early in laminitis,” he explained. Indeed, the significant overlap between nociceptive, neuropathic, and inflammatory (both local and systemic) pain is what makes laminitic pain so complex.

Assessing Laminitic Pain in Horses

Laminitic horses often show telltale signs—weight-shifting, a sawhorse stance, and appearing depressed at the back of the stall—but Guedes said there aren’t any validated methods for assessing laminitis pain in horses.

Subjectively, veterinarians can use a visual analog scale (VAS), which is essentially a line extending from 0 (no pain) to 10 (could not be more lame/painful). This method is fairly reliable between laypeople and veterinarians; however, people spending time with the horse might adapt to the horse’s behavior and misassign the grade, said Guedes. In other words, chronic pain can become a horse’s “new normal.”

Analgesic Options for Laminitic Pain in Horses

Guedes said there is no doubt multimodal analgesia is more efficacious than a single modality. “A single modality can’t treat all the different types of pain,” he said.

But other than NSAIDs, what options do veterinarians have?

Tramadol

“(Tramadol) inhibits mu-opioid receptors as well as serotonin and norepinephrine reuptake in pain pathways, and it decreases levels of TNF-a,” said Guedes. “So, even by itself tramadol has multiple mechanisms of action.”

In one study, researchers examined the effect of 5 mg per kg of body weight of oral tramadol twice daily for seven days. Using force plates they measured the horses’ discomfort by how often horses off-loaded their limbs, shifting weight from foot to foot. The researchers noticed only a transient decrease in off-loading and, by Day 7 of treatment, the horses began off-loading again at baseline levels. In a second study using 10 mg/kg, however, scientists identified more sustained pain relief with no adverse effects.  

Ketamine

Ketamine blocks N-methyl-d-aspartate (NMDA, an amino acid derivative) receptors, which amplify pain signals. “Even with a stimulus that shouldn’t produce very much pain, NMDA receptors enhance it,” said Guedes. “Ketamine blocks the NMDA receptors located in peripheral nerve endings contacting the laminae and within the spinal cord, modulating pain signals.”

Ketamine might also suppress TNF-a production. Researchers on one study evaluated a combination of ketamine and tramadol in 15 chronic laminitis cases. They administered ketamine at a rate of 0.6 mg/kg intravenously every six hours for the first three days of the study. Again, using the force plates, the investigators found that the horses decreased their off-loading frequency for the entire seven-day treatment period and the first three days beyond cessation of tramadol.

Gabapentin

Guedes explained that gabapentin blocks voltage– gated calcium channels in nerve fibers transmitting pain signals toward the brain and from the brain to the spinal cord. Veterinarians typically treat horses with 20 mg/kg, which can be effective, but researchers on recent studies in horses use doses  as high as 120 mg/kg without producing adverse events.

Others

Researchers studying an oligofructose model of laminitis (not clinical cases) found that  delivering local anesthetics via continuous peripheral nerve block with dilute bupivacaine yielded positive results and reduced the animals’ off-loading frequency.

Alternatively, liposomal bupivacaine delivered via abaxial nerve block (placed at the base of the proximal sesamoid bones, which are located at the back of the fetlock, to numb the structures below the fetlock) provided 24 hours of analgesia in an experimental model of hoof pain.

Scientists are examining soluble epoxide hydrolase (sEH) inhibitors in human clinical trials for neuropathic pain. Guedes said some preliminary work conducted in horses with laminitis has yielded promising results.

Take-Home Message

Veterinarians should recognize the complexity of laminitic pain in horses—including the nociceptive, neuropathic, and inflammatory components—and take a multimodal approach to pain management.

A horse’s ridden or even competitive career doesn’t have to end just because of an OA diagnosis. It might just take a little more care and planning to keep him healthy, happy, and comfortable. Work with your veterinarian to provide appropriate support, plan workouts carefully, and implement management techniques to support healthy joints. In this excerpt from Ask TheHorse Live, Katie Ellis, DVM, MS, Dipl. ACVSMR, of the University of Georgia, weighs in on the importance of keeping horses with joint disease fit and active. 

This podcast is an excerpt of our Ask TheHorse Live Q&A, “What You Need to Know About Equine Degenerative Joint Disease.” Listen to the full recording here.

About the Expert

Katie Ellis, DVM, MS, Dipl. ACVSMR

Katie Ellis, DVM, MS, Dipl. ACVSMR, is a clinical assistant professor and section head of field services at the University of Georgia’s College of Veterinary Medicine, in Athens. Her research interests include equine rehabilitation and musculoskeletal imaging.

Degenerative suspensory ligament desmitis (DSLD) is a complex, progressive condition that causes pain and lameness in horses. Though researchers currently consider DSLD to be uncurable, they are working to better understand the degenerative changes that occur in the suspensory ligament and identify genes potentially involved in the development of DSLD. In this excerpt from Ask TheHorse Live, Katie Ellis, DVM, MS, Dipl. ACVSMR, of the University of Georgia, answers a reader’s question about how she can reduce her horse’s joint pain if he also has DSLD. 

This podcast is an excerpt of our Ask TheHorse Live Q&A, “What You Need to Know About Equine Degenerative Joint Disease.” Listen to the full recording here.

About the Expert

Katie Ellis, DVM, MS, Dipl. ACVSMR

Katie Ellis, DVM, MS, Dipl. ACVSMR, is a clinical assistant professor and section head of field services at the University of Georgia’s College of Veterinary Medicine, in Athens. Her research interests include equine rehabilitation and musculoskeletal imaging.

Researchers recently demonstrated that shoeing options can change the way a horse moves his back and neck, with potential consequences on his performance, health, and welfare.

Sébastien Caure, DVM, IPSAV, Dipl. ECVS, a veterinarian at the Livet Equine Veterinary Hospital Center, in Livarot-Pays-d’Auge, France; Renée Weller, PhD, of the University of Calgary, in Canada; and their colleagues placed reflective markers along the back and neck of six mixed-breed, sound, and barefoot riding horses who received regular trims. All the horses had been at rest at pasture for at least a year. The researchers filmed the horses walking and trotting in a straight line across a freshly dragged outdoor sand arena with seven types of hoof treatments each:

• Bare front and hind feet
• Bare front feet/shoes on hind feet
• Shoes on front feet/bare hind feet
• Shoes on front feet/shoes on hind feet
• Shoes on front feet/egg bar shoes on hind feet
• Shoes on front feet/wide-toe shoes on hind feet
• Shoes on front feet/reverse shoes on hind feet.

All shoes were composed of a lightweight metal (aluminum or steel) and weighed between 180 and 260 grams (6 to 9 ounces)—about half the weight of traditional steel shoes—to reflect real-life conditions in both equitation and racing. The horses rested in a stall for at least two hours between each treatment.

Shoeing’s Affect on Equine Neck and Back Flexion

Using computer analyses of the markers on the video footage, the team calculated joint angles along the spine from the poll to the lumbosacral area.

Compared to shod horses, they found barefoot horses displayed lower neck carriage with increased flexion along the lower neck and withers and a more horizontal thoracolumbar area (less flexion of the spine under the area at the back of the saddle), Caure said. The equine back has a limited range of motion from the saddle area to the tail, and some horses are naturally more flexible in the back than others. The neck, meanwhile, is highly flexible—which might be why two-thirds of sport horses experience instability and osteoarthritis of the lower neck, Caure said.

Wearing shoes only in the front led specifically to higher neck carriage and greater flexion in the thoracolumbar region at the back of the saddle area. That could be due to naturally greater weight-bearing on the forelimbs compared to hind limbs, or because the great mass of horses’ rumps dampens the effect of shoes, Caure explained. The fact the front feet are simply closer to the neck might also play a role, he added.

“You can really increase the expression of your horse’s head and neck and forelimb movements by shoeing him just in the front,” he said. While that might benefit upper-level dressage scores, it’s probably not ideal long-term due to excessive use of the joints, he added.

Likewise, the three types of orthopedic shoes used in the hind limbs triggered a higher neck carriage in both the walk and trot. That might be because the shoes have 200% of the surface area of standard shoes, the researchers reported.  

Wide-toe and reverse shoes increased flexion of the C3 joint (the third cervical vertebra) near the poll. Eggbar and reverse shoes—the two that cover the heel—on the hind limbs led to a flatter thoracic angle and increased dorsal/ventral flexion of the lumbosacral area. Eggbar shoes also increased thoracolumbar flexion as the hind feet touched the ground at a walk.

In addition, Caure said eggbar shoes on the hind feet helped horses push off with their hind limbs more symmetrically, which he said can be therapeutic in rehabilitating horses recovering from hind-limb lameness.

By contrast, having shoes on only the back feet had no significant effects on back and neck joint angles, he said.

Take-Home Message

Barefoot horses displayed a lower neck position than shod horses, and those shod on the front feet only carry their necks higher with greater flexion of the thoracolumbar area at the back of the saddle space. Orthopedic shoes on the hind limbs also led to higher necks and more thoracolumbar flexion. Veterinarians, farriers, coaches, and riders should keep these effects in mind when assessing, treating, and training horses, said Caure. “Lots of people—whether they’re riders, trainers, or surrey jockeys—say that their horses ‘feel’ different when the shoeing format changes,” he said. “Our study shows that they’re right. Shoeing significantly affects the way the upper body moves, a lot more than we ever thought.”

The study, “Effects of different shoeing conditions on equine cervical and back kinematics during walking and trotting on a soft surface,” appeared in the Journal of Equine Veterinary Science in November, 2024.

Typically, veterinarians use a thorough physical and lameness examination to localize pain to one area of the horse’s body. Then they use diagnostic imaging to find the pathology that’s causing pain. In this excerpt from Ask TheHorse Live, Katie Ellis, DVM, MS, Dipl. ACVSMR, of the University of Georgia, in Athens, and Howland Mansfield, DVM, CVA, CVMMP, of American Regent Animal Health, describe the common imaging modalities used to diagnose joint disease in horses. 

This podcast is an excerpt of our Ask TheHorse Live Q&A, “What You Need to Know About Equine Degenerative Joint Disease.” Listen to the full recording here.

About the Experts

Katie Ellis, DVM, MS, Dipl. ACVSMR

Katie Ellis, DVM, MS, Dipl. ACVSMR, is a clinical assistant professor and section head of field services at the University of Georgia’s College of Veterinary Medicine, in Athens. Her research interests include equine rehabilitation and musculoskeletal imaging.

Howland M. Mansfield, DVM, CVA, CVMMP

Howland M. Mansfield, DVM, CVA, CVMMP, of Summerville, South Carolina, received her DVM from Tuskegee University School of Veterinary Medicine, in Alabama, and completed internships in both general equine medicine and surgery and in advanced equine reproduction. She is certified in both veterinary acupuncture and veterinary medical manipulation. She has practiced along the East Coast over the course of 14 years, in addition to time in Germany providing veterinary care for some of the most elite show horses in Europe. In 2012 Mansfield was named by the South Carolina Horseman’s Council as the Horse Person of the Year for her efforts in equine rescue and in combating animal cruelty. She joined American Regent in 2023 as a technical services veterinarian where she can support the welfare of and improve health care for horses and small animals throughout the U.S.

Equine orthobiologics broadly defines an array of innovative medical therapies that can help a horse’s body repair, replace, restore, and regenerate cells and tissues that have been damaged by injuries and conditions such as osteoarthritis. In this excerpt from Ask TheHorse Live, Katie Ellis, DVM, MS, Dipl. ACVSMR, of the University of Georgia, in Athens, describes the pros and cons of using orthobiologics to manage joint disease in horses. 

This podcast is an excerpt of our Ask TheHorse Live Q&A, “What You Need to Know About Equine Degenerative Joint Disease.” Listen to the full recording here.

About the Experts

Katie Ellis, DVM, MS, Dipl. ACVSMR

Katie Ellis, DVM, MS, Dipl. ACVSMR, is a clinical assistant professor and section head of field services at the University of Georgia’s College of Veterinary Medicine, in Athens. Her research interests include equine rehabilitation and musculoskeletal imaging.

Skippy was almost aptly named. He didn’t skip, but he did hop and jump. And to his owner’s great regret, Skippy bucked.

“He was a horrible ride,” recalls Amber Cash of Newark, Delaware. “He kicked, he bucked, he bit, he would run and not stop. I thought I could train it out of him, but he always seemed angry.”

Skippy wasn’t always like that, though. Often—and especially when he didn’t have a rider—the big red gelding was delightful, which made Cash suspect his bucking was pain-related. “He was loving, funny, smart, and playful,” she says. “But when he hurt, he was a holy terror.”

Cash tried dozens of saddles, stretching techniques, and chiropractors, all to no avail. It wasn’t until she got his back radiographed that she discovered the tips of her horse’s backbone were running into each other—a condition known as kissing spines. After surgery to create more space between the vertebrae, Skippy was a changed horse. “He was so much happier and easy to ride,” says Cash.

Bucking Basics

The buck evolved in horses as a defense mechanism to literally throw off predators, says Sue Dyson, MA, VetMB, PhD, an independent consultant in the UK, who published a scientific review on bucking research in 2021.

A few other herbivores, such as sheep and antelope, have a certain kind of buck, she says. But the equine buck takes the skill to new heights: Their leaps into the air, with two or four legs off the ground, sometimes combined with either an arched-up or stretched-out back, the head low, and/or sudden stops and twists, could pitch off just about any animal—­including humans.

What Kind of Buck Is It?

Not all bucks are created equal, says Dyson. Some include little hops with the upper back—the thoracic spine, from the wither to the loin—in extension and the head up; some involve full flying leaps with the back up and the head down (“pronking” or “crow-hopping”); some propel rapidly forward in a series of pronks (“bronking”), often with lots of stops and twists.

“I always ask my clients, ‘Do you feel the horse is trying to buck you off?’ ” Dyson says. “If they say no, that’s a completely different situation from the horse that does the kind of rodeo act when its back is in flexion all the time.”

Our sources agree that most horses that buck consistently merit a visit from the veterinarian. Even if your horse isn’t throwing you off, his body language is likely telling you something’s wrong, and he needs help.

We’ve listed nine reasons horses buck—most of which are pain-related. Bucking seems to be a natural equine response to pain, although the biological reason for that remains unclear. “We can’t necessarily say it’s pain relief, but it’s definitely a reaction to pain,” says Dyson.

1. Kissing Spines

When the long points sticking up from the top of vertebrae—known as spinous processes—crowd each other, they’re said to be “kissing.” Bone hitting bone is painful, especially with added pressure from a rider, says Beau Whitaker, DVM, of the Brazos Valley Equine Hospital, in Salado, Texas. “The No. 1 thing I look for in bucking horses is kissing spines,” he says.

Kissing spines in the saddle area (the caudal thoracic and the lumbar spines) are the most likely to cause discomfort that can lead to bucking, he says. “When you get on the horse, it causes the back to drop and the spine to ventroflex (extend), and that pushes those bones even closer together, causing more pain, so the horse starts to buck.”

Not all horses with radiographic evidence of kissing spines, however, display signs of pain such as bucking.

2. Sacroiliac Joint Pain

The large, rigid sacroiliac joints lie between the ilium of the pelvis and the sacrum (the vertebral column from the loin to the tail—also considered a part of the pelvis) and are supported by ligaments above and below. Through wear or injury, horses can damage these joints and ligaments—and the result is often a very telltale kind of buck, says Dyson.

“They usually only buck when ridden, not on the longe,” she says. “They buck with their back extended, most commonly in canter, and may kick out backward or sideways. As a rider, you don’t feel like they’re trying to get you off.”

Her recent postmortem work for a soon-to-be-published study has shown that some of these horses even have a damaged obturator or sciatic nerve, which could lead to neuropathic pain (caused by damage to specific nervous system regions that perceive pain).

3. Gastric Ulcers

Bucking-related pain can also come from the stomach, says Whitaker. Sixty to 90% of adult performance horses have gastric ulcers, which develop when digestive acids break down the stomach lining, often due to stress, large amounts of concentrate feeds, and/or long breaks between meals.  

“Some horses get enough pain from gastric ulcers that when they’re moving, especially cantering, that acid starts to splash around and irritate them, making them buck,” he says. Gastroscopy is the only way to confirm a horse has ulcers, so it’s a useful procedure when other pain has been ruled out.

4. Poorly Fitting Tack

A saddle that’s incorrectly fitted or badly positioned on your horse’s back can concentrate high pressures in a small area or pinch, such as just behind the withers, Dyson says. Some horses have a “bucking spot” behind the saddle: Firm pressure to this area might trigger bucking.

A broken tree can also cause a horse to react, says Whitaker, as can a poorly fitted saddle pad or tack such as breastplates, bridles, and bits.

Girths can also be culprits, says Dyson, particularly those with elastic inserts. Some horses might find the moving elastic uncomfortable.

5. Other Sources of Pain

Bucking-associated pain can come from all over the body, our sources say. For example, they’ve found it in the pelvis, limbs (especially the hocks and stifles), and ribs. “Lameness may be the cause of bucking,” says Dyson.

Or it might come from the other end of the horse: “Sometimes they’ll have a hook or a fractured tooth,” says Whitaker. “This can hurt more when they get their heads in a certain position. Often those horses will throw their heads, but we do see some that manifest in ways you wouldn’t expect, like bucking.”

Dyson says she has seen bucking related to a torn ligament in the back, spondylosis (degenerative bone changes) of the spine under the saddle, and a broken sternum, among other orthopedic issues.

6. Fear

In some circumstances, the consequences of a horse’s buck—namely, the rider falling off—can scare them. “You see some horses, when they’ve bucked the rider off, they just stand there and act absolutely astonished and fearful,” Dyson says. “They are often terrified of being remounted, (and they may especially) not tolerate the rider sitting upright.”

This doesn’t mean the horse is afraid he’s “done something wrong,” which is too anthropomorphic, she says. Rather, the horse is fearful of having a mass projected over its head.

7. Accidental Buck Training

Whether they’re frightened or anticipating pain, or they just don’t like being ridden—maybe due to previous bad experiences—some horses learn that strong bucking gets rid of the rider and any related pain. That relief is a strong reward, and they learn to buck to get it.

Even after veterinarians perform therapy to relieve a bucking horse’s pain, he might continue to buck because he learned to when it hurt to be ridden. “Unless something changes, like an intervention from a behavioral management point of view, you may get into a situation which spirals out of control,” Dyson says.

Unskilled riders can start the spiral, she says. Riders with poor balance might bounce a lot (causing pain) and eventually fall with a simple buck. And some horses develop a tendency to buck early in a riding session, which could be the result of having quickly dislodged novice riders.

Learned bucking is often more difficult to resolve than pain-related bucking, our sources say. “Sometimes you have to try to work those horses through the mental aspect of it, once you get past the pain aspect,” Whitaker says. “And that’s not always easy to figure out.”

8. Intentional Buck Training

It’s worth mentioning, of course, that some horses are purposefully trained to buck. “Certain lines of horses, from a rodeo performance point of view, are apparently better at bucking,” Dyson says. Usually, when they don’t have cinches around their groin, they won’t buck, she adds. However, they might have a greater propensity for it.

Meanwhile, some high-level dressage horses, such as from the Spanish Riding School in Vienna, Austria, are taught bucklike movements such as the capriole.

9. Feeling Great!

Bucking can represent both negative and positive feelings. Horses buck out of exuberance when galloping and playing at pasture and sometimes under saddle, says Dyson. “They can feel fresh and exuberant, like when you take them out to the beach to gallop, and they give some happy bucks,” she says.

There’s a stark difference between the happy buck and the buck that says something’s wrong, however. Feel-good bucks are usually one-shots in specific situations of excitement, whereas bucks in a series or that happen every time you ride should raise a red flag.

Happy bucks aren’t usually an issue—unless you’re not skilled enough to ride them out, Dyson says. However, horses can be trained to not buck under a rider, even when they’re exuberantly happy.

Getting an Evaluation

If you’ve got a bucker, get your horse—and your tack—evaluated. Have a master saddler check your saddle and bridle, and ask your veterinarian to run a buck evaluation. That usually starts with palpating the back to check for reactions to pain, followed by radiographs and, if necessary, a gastroscopy, says Whitaker.

Veterinarians should also evaluate the horse in hand, while longeing, and under saddle (if he’s safe to ride), says Dyson. Local (temporary) nerve blocks can help find the part of the body that’s hurting.

Sometimes veterinarians perform an ultrasound of a painful area to see if the soft tissues have been affected. If those checks don’t lead them to the problem, practitioners might pursue bone scans (scintigraphy) to look for inflammation in the bones. Bone scans can help veterinarians track improvement once horses have started therapy, Whitaker says.

Treatment must be targeted depending on the diagnosis, says Dyson. Most horses also need behavioral retraining after they’ve recovered physically, to learn not to buck once the pain is gone. Seek the help of a certified behaviorist or a trainer versed in positive reinforcement methods.

Take-Home Message

Bucking might be what happy horses do in a field, but it can spell trouble when they’re doing it repeatedly under saddle. Veterinary treatment and behavior management can help resolve the issues behind the buck, our sources say. And when you identify the reason for the buck—like Cash did for Skippy—it can be a game-changer for both horse and owner.

“Bone is the only tissue in the body that can heal without a scar,” said Christopher Kawcak, DVM, PhD, Dipl. ACVS, ACVSMR, of Colorado State University’s College of Veterinary Medicine & Biomedical Sciences, in Fort Collins. Kawcak, who is professor of orthopedics and Iron Rose Ranch Chair at the Translational Medicine Institute, in the Department of Clinical Sciences, spoke at the 2025 IGNITE Sports Science for the Olympic Disciplines Seminar, held Jan. 12-13, in Ocala, Florida. He described bone remodeling in horses and how bone can heal back to its original strength or even come back stronger than before. 

Bone Remodeling in Horses 

When bone is damaged, it sends a signal that attracts osteoclasts (cells that break down bone tissue) to take away damaged, diseased bone. This cleaning process happens rapidly—beginning minutes after a horse suffers a fracture. However, it temporarily leaves a weakened spot in the bone. The bone-forming cells take a matter of months to repair the bone, requiring 60-90 days of downtime for the horse. Otherwise, the chances of reinjury go up. “The bone only needs to see low amounts of intensive load,” said Kawcak, to complete bone formation following injury.  

Understanding Bone Injuries in Horses 

Veterinarians see two types of bone injuries in horses: acute or traumatic injury, and repetitive-stress injury. When it comes to healing these injuries, there are two paths the bone can take, Kawcak said. 

Stall rest used to be the recommendation for healing bone injuries, but now veterinarians focus on active or athletic rest, including turn out if possible. The idea is to be more aggressive in rehabilitation to keep bone remodeling moving, said Kawcak. 

However, remodeling can induce (OA) in a joint if the bone continues to degenerate over time. The horse can experience pain isolated to that area or centralized in the nervous system. 

How can veterinarians determine exactly what happens with the horse’s bone? Kawcak says PET scans, thermography, and CT scans can reveal architectural changes in the bony tissue better than radiographs (X ray). A PET scan compliments and gives physiological information as well as shows high remodeling activity. In addition, wearable technology can help identify damage under saddle that doesn’t show up with an in-hand evaluation. 

Take-Home Message 

Bone remodeling is a key process that supports healing after injury or disease. Monitoring the fatigue process on imaging allows the opportunity to identify at-risk horses, and thoughtful rehabilitation can positively influence remodeling. This allows the bone to come back as good, or better, than ever, said Kawcak. 

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Ultrasonography has become one of the most versatile field imaging modalities for evaluating equine musculoskeletal injuries because it allows veterinarians to visualize almost any body tissue, most importantly soft tissues such as tendons and ligaments.

Ultrasound uses high-frequency sound waves to produce images in real time. The user holds a sound-wave-emitting probe against the skin toward the structure being evaluated. When the waves meet structures or interfaces between structures, they reflect back to the probe like a ship’s sonar. The more abrupt the interface or dense the structure, the more waves reflected. The more sound waves received, the brighter the structure looks on-screen. We describe brightness in terms of echogenicity. For example, bone appears bright (echogenic), normal fluid is dark (nonechogenic), and all other structures show up somewhere between.

With regard to lameness issues, your veterinarian is most likely to use ultrasound to assess tendons and ligaments, bone surfaces, synovial fluid, and cartilage. Think of tendons and ligaments as ropes made up of many strands or fibers. Tendons connect muscles to bones, while ligaments connect bones. When tendons or ligaments are strained, their fibers might tear. Veterinarians assess the extent of tendon or ligament damage by evaluating its size, echogenicity, and fiber pattern. Often, minor tendon or ligament injuries result in an increase in size, or cross-sectional area. In cases of significant disruption, veterinarians might notice changes in echogenicity and fiber pattern.

Normally, the “echotexture” or patterning of a tendon or ligament is homogenous (the same throughout); a perpendicular view of a normal tendon shows a round or ovoid structure with uniform shading. A damaged tendon might appear round and bright (normal fibers) with a dark area within it. Dark regions represent fiber disruption, or voids, where no sounds waves reflect. Larger, centrally located regions of fiber disruption are commonly referred to as core lesions.

Viewing this same region’s longitudinal axis, with the probe along the length of the tendon or ligament, the normally long, linear fibers might appear short and choppy or be missing altogether. Abnormalities are not always as overt, and true injuries could be as subtle as small, dark linear striations or mildly abnormal edges.

Ultrasound waves cannot penetrate bone, but veterinarians can use them to evaluate its surface. Due to bone’s density, it should look like a bright, white, smooth line on the screen. Bone surface changes at tendon or ligament insertion sites or around arthritic joints, fractures, or osteochondritis dissecans (OCD) lesions cause these lines to look disjointed and/or rough.

Evaluating characteristics within synovial structures (joints, tendon sheaths, and bursas) can be similarly useful. Normal structures have linings that produce a small amount of lubricating, nutrient-rich fluid. With inflammation from tendonitis, arthritis, direct trauma, or any other type of irritation, the lining produces excessive, poor-quality, and sometimes cell- and protein-rich fluid. Evaluating synovial fluid and lining can provide insight into inflammation severity. Additionally, veterinarians can examine joint cartilage for defects caused by traumatic injury or OCD.

Almost as important as making a diagnosis with ultrasound is treating and monitoring injuries with it. For tendon or ligament tears, for instance, veterinarians can administer regenerative products such as stem cells or platelet-rich plasma directly into the region of fiber disruption under ultrasound guidance. They insert a needle in the ultrasound beam so they can visualize penetration depth and see the therapeutic as it enters the space. Veterinarians can treat other areas, such as the sacroiliac, thoracolumbar and cervical facet joints of the spine, with anti-­inflammatory agents via ultrasound guidance, without which they’d be doing it blindly and potentially too distant from the pain site to be effective. Ultrasound guidance also ensures the needle doesn’t inadvertently penetrate other structures.

After injury or treatment, veterinarians perform follow-up clinical and ultrasound exams to assess healing. They look for decreases in cross-sectional area, increases in echogenicity, and improvements in fiber alignment in tendon and ligament injuries. Ultrasonographic improvement and clinical improvement together guide recommendations to increase the horse’s workload.

The portability, versatility, and accuracy of today’s machines make ultrasound an incredibly useful tool. With it vets can image any tissue to determine diagnosis, while helping owners save money and time. It can also help guide placement of therapeutic agents and allow monitoring of recovery. If your practitioner suggests using ultrasound on your horse, knowing its uses, mechanics, and limitations can help provide clarity during the process.

Lameness arising in the front feet accounts for most soundness issues in horses. However, it has been and continues to be difficult for veterinarians to diagnose a specific injury or source of pain within the foot because the structures can be tough to capture with imaging equipment. Over time, as medical knowledge has expanded, radiography has improved, and MRI has been incorporated into equine practice, we’ve learned a lot about the hoof capsule’s complex anatomy and physiology. The more we understand, the more injuries we can identify. This knowledge has opened doors to many treatment options in the veterinarian’s toolbox. With an accurate diagnosis, the veterinarian can formulate a proper treatment plan and provide an accurate forecast on the horse’s ­prognosis.

In spite of these advances, it’s still important for veterinarians to complete a thorough clinical exam. Visual and hands-on assessment of the horse can provide important clues as to the problem. This information often yields a wealth of knowledge that will help guide the need for diagnostic imaging.

History and Signalment

Knowing the horse’s age, breed, and use, as well as the duration of lameness and how quickly it came on, can help the veterinarian formulate a list of possible correlating problems. For example, a 6-year-old Warmblood show jumper coming up lame following a recent class might be dealing with a soft-tissue injury. Alternatively, a 17-year-old Quarter Horse used for team roping with intermittent forelimb lameness over several months might be dealing with a joint or bone-related injury.

Lameness Exam Findings

A veterinarian can learn much and narrow down possible problems simply by completing a thorough clinical exam. Clues that can help include:

• How the horse moves and travels on different surfaces (packed dirt vs. loose sand);
• How the foot lands and takes off from the ground during travel;
• The lead on which the lameness is most pronounced;
• Response to hoof testers; and
• Response to flexion tests.

Additionally, veterinarians can learn a lot by evaluating hoof capsule conformation and health. Distortions in growth, weakness of the hoof walls, contraction of the heels, and uneven wear of the wall or shoe can result from pain or injury in different parts of the foot, how the horse compensates, and predisposing factors to specific injuries.

Finally, they might be able to determine the cause of lameness with specific diagnostic nerve blocks. Using a local anesthetic drug, the veterinarian can desensitize different parts of the foot to detect the location of pain within the hoof capsule. For example, the commonly used palmar digital nerve block desensitizes the sole and back third of the foot, whereas a navicular bursa block generally targets that structure—which cushions the bone from the deep digital flexor ­tendon—alone. Following a nerve block, the vet assesses the horse to see if he travels differently.

Based on these exam findings, the veterinarian can use digital radiography to assess suspected bony problems, then pursue more advanced imaging if ­necessary.

High-Tech Diagnostics

Magnetic resonance imaging has been labeled the “gold standard” for veterinarians to image the horse’s foot. It can provide detailed information about soft tissue, bone, and fluid within the hoof capsule. It can often help veterinarians identify abnormalities they may not otherwise recognize using other diagnostics. Evaluating the horse’s foot using MRI is noninvasive, safe, and can be done with good accuracy either in a standing sedated horse or a horse lying down under general anesthesia. Though MRI is a great option, it does pose some limitations. It’s expensive, and in some parts of the country MRI unit availability is limited. Additionally, MRI imaging requires interpretation by a trained professional and often reveals more than one abnormality. For this reason veterinarians often look for other clues to help pinpoint a horse’s problem before pursuing an MRI exam or, later, to help determine the significance of the MRI findings.

Take-Home Message

In summary, front foot lameness is common and continues to frustrate horse owners and challenge veterinarians. Fortunately, owner-provided information and a thorough lameness exam can help practitioners start meaningful investigations. MRI has improved our understanding of the horse’s foot and serves as a valuable tool but is not an absolute necessity.

Type of fracture, diagnosis, and treatment dictate a horse’s chances of recovery

Finding a horse unable to bear weight on a limb can be a nightmare. And when your veterinarian says the word fracture, you might immediately anticipate the worst-case scenario: euthanasia. But don’t jump to conclusions.

With all the advancements in modern veterinary medicine, fractures are no longer death sentences for horses. Veterinarians can repair and rehab many limb fractures, and the horse might even be able to return to work.

Dean Richardson, DVM, Dipl. ACVS, former head of surgery at the George D. Widener Hospital for Large Animals at the University of Pennsylvania’s New Bolton Center, in Kennett Square, says the biggest horse owner misconception is that you can’t treat a fracture.

“You need to get every case evaluated separately,” says Richardson. “Just because somebody has experience with a fracture that couldn’t be repaired doesn’t mean that the one you’re looking at can’t be repaired. Some of them have a terrible prognosis, and some have an excellent prognosis. Also, not every fracture in the horse needs surgery.”

Let’s look at types of limb fractures and how to handle them.

Horse Limb Fracture Diagnosis

The first thing to understand about fractures is that they encompass a wide range of bone injuries, from small chips to large fragments called slab fractures. Common types include:

• Simple Only one crack in the bone.
• Comminuted Splintered or having many pieces of separated bone.
• Incomplete A fracture on only one side of the bone.
• Complete A full break that results in separated bone fragments.
• Displaced When bone fragments have moved out of their original position.
• Stress Small, incomplete fractures.
• Star Multiple cracks radiating from a central area.
• Articular A fracture involving a joint.
• Closed Without a wound.
• Open With a wound.

A fracture can produce localized heat, pain, and swelling—either alone or in combination with lameness. These are typically the first clinical signs you’ll notice, especially if you did not see the injury occur.

The presence of a wound can throw some owners off as to the underlying cause of a horse’s pain or lameness, says Laurie Goodrich, DVM, PhD, Dipl. ACVS, professor of surgery and lameness at Colorado State University’s Equine Hospital and Orthopaedic Research Center, in Fort Collins.

“Sometimes they assume that the wound is the primary scenario that is causing the soreness, but it’s important for them to be aware that the bone underneath it can be affected,” she says.

While lameness is the most relevant clinical finding, not every lame horse has a fracture. “You can imagine how many horses have come in over the years to any hospital with an owner convinced the horse has broken his leg, when in fact what it has is a hoof abscess,” says Richardson. “The thing we always teach veterinary students is that if you have a severely lame horse, there are two differentials (conditions to consider that cause similar clinical signs): a fracture or an infection.”

An accurate diagnosis is important so the veterinarian can stabilize the limb properly to prevent further damage. Diagnostics have come a long way due to most vets having digital radiograph (X ray) units, allowing them to detect fractures in the field, says Goodrich.

Because it can be more difficult to get a good radiograph as you move up the limb, due to the additional muscle tissue, Goodrich says some veterinarians might opt to perform an ultrasound.

Healing and Prognosis for Horse Limb Fractures

Bone healing in adult horses typically takes at least four months, whereas foals heal faster. Veterinarians might recommend rehabilitation exercises (e.g., mobilization, swimming, water treadmills) to restore mobility to joints and rebuild muscle function.

Some equine limb fractures have better outcomes than others. Prognosis can depend on many factors, says Richardson, including the horse’s expected use, age, size, whether the fracture restricts mobility, if the fracture is displaced, etc. One of the biggest factors affecting prognosis, however, is the fracture’s location.

Fractures that typically have good prognoses include:

• Those of the ulna’s olecranon process, which is the point of the elbow. Richardson estimates that 90% of horses survive this common fracture, with many returning to full athletic ­function.
• Chip fractures, which surgeons can remove arthroscopically. “You can have a very high expectation that the horse goes back to full athletic soundness for many, many types of those,” Richardson says.
• Fractures repaired surgically using lag screw fixation to compress fragments together. In most cases the hardware remains in the horse for his lifetime. These horses can return to full ­function.
• Simple fractures with simple repairs.

Fractures with poorer prognoses include:

• Displaced radius (the forearm bone extending down from the elbow) fractures, which Richardson says are expensive and very difficult to repair.
• Moderate or severe articular fractures requiring surgery to fuse the affected joint to reconstruct it. The horse can live a good life but might never return to full athletic function, says ­Richardson.
• Open fractures. “When you place implants to stabilize a fracture that’s contaminated, then the likelihood of having an infection is almost guaranteed,” says Goodrich.
• Complex fractures with complicated repairs.

One of Richardson’s most important reminders to owners is to get radiographs for any horse kicked above the knee that’s not sound. With a correct diagnosis and stall rest, horses with incomplete fractures of the radius can recover and go back to full work with no problems.

“But if you take that same horse and think, ‘Oh, that’s nothing,’ and turn it out, that’s a horse that can come in with its radius completely separated and displaced or catastrophically fractured, and then you’ve got a $15,000 to $20,000 (procedure) with a poor expectation of a good outcome,” he says.

Take-Home Message

Fracture repair in horses has come a long way. Having a veterinarian splint the injury properly in the field before transporting him to an emergency clinic is critical to success, our sources say. With advancements in treatment, many horses with fractures either return to partial or complete athletic function or can be used as breeding stock. This can provide horse owners with hope they can save their horses and give them functional, happy, and comfortable lives.

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Abscesses are a common lameness cause. What if your usual fix fails?

When your horse comes up three-legged lame, you’ll be forgiven for having a moment of panic. Chances are, it’s just an abscess. You’ll get it to rupture or drain, and your horse will be sound soon.

A hoof abscess typically consists of a pocket of infection located between the sole and underlying sensitive tissues in the hoof. Clinical signs include lameness (sometimes severe), heat in the affected hoof, and a strong or bounding digital pulse—as felt in the digital arteries at the back of the fetlock.

Why is it so painful? There are nerve endings in those sensitive tissues, of course. And everything is surrounded by a hard hoof wall. When the horse puts weight on the hoof, the infection has nowhere to go, and it hurts.

How Hoof Abscesses Form

The infection arrives by way of the hoof. Poor hoof quality is an abscess risk factor.

“If there’s a crack or crevices that bacteria can get up into, that’s a great way for abscesses to start,” says Craig Lesser, DVM, CF. Lesser, who trained as both a farrier and a veterinarian, completed a podiatry fellowship, and is a shareholder at Rood & Riddle Equine Hospital in Lexington, Kentucky.

Stone bruises, thin soles, or hot nails during shoeing are other known causes of abscesses. Hot or close nails are when a farrier drives a nail too close to sensitive tissues.

Often the infection occurs in the white line, where the hoof wall and sole meet, says Richard Mansmann, VMD, PhD, hon. Dipl. ACVIM-LA of Equine Podiatry & Rehab Consult Practice, in Chapel Hill, North Carolina.

Muddy, wet conditions can soften hooves and make them easier to penetrate. During abnormally wet summers, “we see a lot more abscesses,” notes Steve Kraus, BS, CJF, head of farrier services, senior lecturer, and section chief at Cornell University College of Veterinary Medicine, in Ithaca, New York.

“If we have a very dry summer, we see less of them because the feet are tougher,” Kraus says.

Conformation flaws such as toeing out can predispose a horse to abscesses because they place uneven forces on the hoof, he adds.

In this article we’ll focus on steps to take when faced with an abscess, especially one that lingers beyond typical treatment times.

Step 1: Treat the Initial Abscess

OPTION A: Manage It Yourself

When experienced horse owners know they’re dealing with an abscess, many choose to treat it themselves. They’ll soak the hoof in warm water containing Epsom salts and follow by wrapping the hoof.

Lesser suggests applying an Animalintex poultice pad to the sole, then a roll of Conform (absorbent stretch bandage), a cohesive bandage such as Vetrap, and duct tape.

After the abscess ruptures—and you’ll know when it does because it stinks, plus the lameness improves almost immediately—Lesser recommends a few days of non-steroidal anti-inflammatory (NSAID) drugs while continuing to soak and pack the foot. He says he continues to pack with an Animalintex pad until drainage stops, then switches to packing with povidone-iodine.

Lesser is adamant NSAIDs should come after the abscess ruptures, not before. “What these do is they shrink and consolidate the abscess and actually make it a lot harder to find,” he says. Though you might want to give your horse pain relief, he urges you to think of the big picture. “That anti-inflammatory actually will shrink the abscess and just make it slower to rupture.”

Your vet might advise you differently.

OPTION B: Get a Professional Out

Some horse owners prefer to have a vet or farrier look at the hoof before attempting to pack and soak it. Both will try to pin down the precise location of the abscess.

Kraus uses a thermal scanner to compare heat in the sound and unsound feet. During a visual inspection of the hoof, he’ll look for black spots or other obvious signs of where pathogens (disease-causing organisms) might have entered. Mansmann says he uses a wire brush or a hoof rasp to clean the hoof, making it easier to identify these spots.

Farriers and veterinarians often squeeze the hoof with hoof testers, which look like tongs, to see if the horse reacts. Kraus says he goes “around the clock” of the horse’s sole three times to see if the horse jerks his foot every time in the same place.

When they find a crack or entry point, professionals have various tools, including hoof knives, to open the abscess. Opening the abscess can get the drainage started. However, Mansmann and Lesser both discourage digging any further into the horse’s sole.

“I want to investigate that abscess up the wall because the wall is nonpainful,” Mansmann says.

After the vet or farrier gets the drainage started, it’s time to soak the foot and pack it for a few days to help it heal.

If your horse won’t leave his hoof in a bucket to soak, you might try Kraus’ trick: cutting off the top of a used IV bag, filling the bottom with an Epsom salts solution, putting the horse’s hoof into the solution, and then taping the bag around the leg to soak. The idea is to clean out the drainage site of pus and debris.

Step 2: Your Horse Is Still Lame. Now What? Call the Vet.

If you’re diligent about keeping the site clean and dry, abscesses typically heal quickly.

“You can see this thing heal up right before your eyes,” Kraus says. Relief can sometimes be immediate, though other horses might need a few days before they’re noticeably moving more soundly.

“(By) that three-day mark of not making consistent forward progress, I start worrying that maybe there’s something else going on,” Lesser explains. He defines progress as the horse being mostly sound at the walk within three days, with drainage being “minimal to none.”

The three-day deadline isn’t strict. “As long as every day we’re making progress in the right direction, I’m okay with giving us more time,” Lesser says.

If your horse isn’t improving and is still lame four or five days after the abscess first ruptures—or if the abscess never ruptures—our experts say you need to call your veterinarian and get some radiographs. Laminitis is the big fear. This happens when the lamellae (or laminae)—the Velcro-like tissues that hold the coffin bone in place within the hoof—become damaged and inflamed. In severe cases these tissues can separate, causing the coffin bone to rotate downward or sink.

Step 3: Hoof Radiographs

A horse that’s still lame even after a ruptured abscess needs radiographs. The images help the veterinarian ensure the problem isn’t something else, such as a coffin bone fracture, unilateral laminitis (in one foot of a pair), or another type of infection that can occur in the horse’s hoof, Lesser says (more on this in a moment).

If it’s not an abscess and you delay treatment, the problem can get very expensive, he adds, and some of the problems can be life-threatening.

For radiographs, he takes four views. This allows him to evaluate the entire coffin bone, checking for rotation and looking for subsolar abscess space beneath the coffin bone or going up the dorsal wall.

The X ray can show an abscess if bacteria within are producing gas. If it just contains pus, the abscess won’t show up because the fluid is the same density as the sole, Lesser says. If the X ray does show evidence of the abscess, that can guide treatment.

Step 4: Possible Post-Radiograph Diagnoses in the Horse’s Hoof

Radiographs allow the veterinarian to rule out other painful hoof conditions such as, again, laminitis; septic pedal osteitis, which is a coffin bone infection; keratomas, which are benign tumors; a sequestrum, where the body treats a dead, broken-off bone piece as a foreign object; or an actual foreign object in the horse’s hoof. Keep in mind that metal will show up on hoof radiographs but wood won’t.

Quittor, an infection in and around the collateral cartilage, found on either side of the coffin bone and believed to aid in hoof expansion and shock absorption, “often gets blamed on being a recurrent foot abscess as well.” It will show above the coronary band, Lesser says.

The most common nonabscess finding in situations like these is septic pedal osteitis. Radiographs will show a lucency—a dark spot—on the horse’s coffin bone.

The best news comes when the vet finds absolutely nothing.

“You know, 90% of the time the vet is going to take radiographs and say, ‘Hey, there are no changes on the bone, I think we’re okay,’ ” Lesser says.

Step 5: Treatments and Rehab for the Horse

Assuming your horse’s diagnosis didn’t change and the problem is still an abscess, you’re likely going to be soaking and packing again. At this point, Lesser switches the poultice he’s using.

“I reach for what we call an overnight poultice, which is a bran-mash-based poultice we can leave on the horse for 24 hours. That really helps us get drainage,” he says.

The overnight poultice helps get the horse’s foot extra wet so the abscess can rupture on its own—preferably not through the coronary band, Lesser says. But the important part is the abscess ruptures. If it happens in the coronary band, “you’re likely going to have a defect that’s going to have to grow out.”

It takes a year for the hoof to fully grow out, but the horse should be sound while that’s happening, Lesser says.

Your veterinarian or farrier might suggest shoes and/or pads while the horse recovers. “It’s just like a wound anywhere else, except it’s a place that’s very dirty,” Lesser says.

After the abscess stops draining, Lesser packs the site with povidone-iodine to dry out the tract and encourage the hoof to cornify (harden) quickly and prevent bacteria from entering. Some veterinarians prescribe antibiotics after the lingering abscess ruptures, though Lesser says he does that only with bone changes.

Step 6: Preventing Hoof Abscesses

Abscess prevention begins with good basic hoof care. “It starts with consistent trims,” says Lesser, who also suggests shortening the trim cycle could prevent hooves from cracking.

Mansmann agrees. “When in doubt, shorter is better on the cycle,” he says.

Shoes and pads might help protect the bottom of the foot.

Consider, too, how you might adjust the horse’s routine to help keep abscesses from developing in the first place. “In those wet, nasty environments, sometimes avoidance is the best thing,” Lesser says. That could mean “making sure horses’ hooves have a chance to dry out and also trying to avoid those deeper muddy areas.”

Take-Home Message

Any hoof abscess in horses can be frustrating to manage. One that won’t heal can be even more trying. Involve your vet and farrier to get an accurate diagnosis, and be prepared to treat the horse for as long as it takes. Time, patience, and dedication can all help resolve that aggravating abscess.

This article is from the Spring 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Hoof wall defects are common in sport horses presenting with lameness and loss of use. Successfully managing these horses requires an understanding of why the hoof wall cracks, said Stephen O’Grady, DVM, MRCVS, of Virginia Therapeutic Farriery, in Keswick, during his presentation at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida.

Why Do Quarter Cracks Occur in Horses’ Hooves?

Quarter cracks in the hoof arise from overloading one side of the horse’s foot, generally the inside—toward the midline. “You won’t see a quarter crack without hoof capsule distortion,” said O’Grady. “And that distortion is going to be caused by an asymmetrical landing, where the lateral (outside) side of the horse’s foot contacts the ground first, then overloading the medial (inside) aspect of the foot. Over time, when the hoof wall can no longer take the excessive loading, it cracks.”

Hoof capsule distortion means the capsule changes shape from what is considered normal or healthy. That distortion relates to the horse’s conformation and how the foot lands on the ground.

Most horses with hoof capsule distortion have a rotational deformity, which means the bone alignment is straight, but they have a narrow chest, and their limbs rotate laterally.

Corrective Shoeing for Quarter Cracks in Horses

“Again, if you have a quarter crack, you have a distorted foot,” said O’Grady. To manage this, take the shoes off for 10 to 14 days and trim the heels so the heels and frog are on the same plane.

“Once everything is on the same plane, there is load sharing by all the structures, and the heels drop down and relax,” O’Grady said. He typically puts a spider plate on these horses. This shoe type protects the heel and redistributes the load to the lateral aspect of the foot.

O’Grady also recommended moving the shoe laterally with an extension. “The shoe can be placed tight or flush on the medial side but then has a one-quarter- to three-eighths-inch extension on the lateral side,” he said. “This moves the center of pressure to the better side of the foot.”

Take-Home Message

Hoof wall defects, such as quarter cracks, can lead to lameness in horses, especially if left untreated. Quarter cracks occur when a horse unevenly loads one side of the hoof as he travels. Farriers can manage quarter cracks using corrective trimming and shoeing, which can help balance the pressures placed on the hoof.

Soft tissue injuries involving tendons and ligaments are common in sport horses and generally require six to 12 months to heal completely. A rehabilitation plan helps the horse heal and build strength over time and reduces the risk of reinjury, said Katie Ellis, DVM, MS, Dipl. ACVSMR, a clinical assistant professor and section head of field services at the University of Georgia’s College of Veterinary Medicine, in Athens. Ellis outlined how she rehabilitates sport horse soft tissue injuries at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida.  

The Ideal Rehabilitation Plan for Equine Soft Tissue Injuries

Ellis outlined her preferred rehabilitation plan for sport horses with soft tissue injuries as follows:

Months 1 and 2

• Stall rest with hand-walking.
• Physiotherapy (i.e., carrot stretches).
• Icing the affected limb once or twice daily.
• Administering topical and/or systemic anti-inflammatory drugs.
• Applying standing wraps to the affected limb and its opposing limb when the horse is stall-kept.
• High-power laser therapy applied by a veterinarian or supervised technician.

Months 3 and 4

• Stall rest with walking under saddle (”tack walking”).
• Walking over ground poles in hand.
• Continue all therapies and medications from the first two months.

Months 5 and 6

• Stall rest with walking under saddle and small amounts of trotting (depending on the type and severity of the injury)
• Walking over ground poles in hand.
• Icing the affected limb after riding.
• Continued physiotherapy.
• Standing wraps in the stall.

Months 7 and 8

• Stall rest with walking under saddle and trotting gradually included and interspersed throughout the ride (no trotting through turns).
• Walking over cavalletti (raised poles) under saddle.
• Physiotherapy.
• Icing the limb after work.
• Standing wraps in the stall.

Months 9 and 10

• Small paddock turnout added gradually (sedation provided by the veterinarian might be necessary).
• Canter work gradually included in under-saddle rehabilitation.
• Trotting and cantering through turns under saddle.
• Gradually adding cavalletti into under-saddle work.
• Physiotherapy.

Months 11 and 12

• Small-paddock turnout.
• Adding 20-meter circles and lateral movements (i.e., leg yielding) to ridden work.
• Physiotherapy.

Month 12 and Onward

• Normal turnout.
• Advanced/discipline specific maneuvers.

Rehabilitation for the Uncooperative Equine Patient

“Most patients will not follow the ideal example,” said Ellis. While some might not physically hold up to this plan, others might not be mentally capable of following it.

For horses not compliant with stall rest, Ellis typically recommends chemical intervention with a long-term sedation option such as trazadone or reserpine. Some horses do well in a stall with a small attached runout where they can walk outside without picking up any speed. Others might need to be turned out in a very small paddock next to other horses to remain calm during the rehabilitation process.

If a horse becomes dangerous to hand walk, Ellis sometimes recommends administering sedation before walking or, if the horse is cleared for it, starting to walk under saddle sooner than expected.

“If the horse is not compliant, I recommend adding more interesting exercises to keep them focused,” she said. “This might include ground poles, patterns, or even a walk around the property if the footing is safe.” In some situations she advises the owner pony the horse off a quiet horse in the early stages of rehab.

If the horse is too difficult to ride, Ellis might recommend increasing his turnout time sooner than planned and/or delaying ridden work. If safe for the individual horse and rider, she might choose to include light sedation for the early stages of ridden work.

Managing Client Expectations

“I find it can help the client to give them a time frame for total healing,” said Ellis. “My rule of thumb is six to 12 months for tendons and eight to 12 months for ligaments.” Having a timeline helps the owner stay on track with the rehabilitation plan and remain compliant throughout the process.

“Assure them the goal is to have the horse back in full work at the end of 12 months,” she said. For the clients that like to be very involved in their horse’s daily care, Ellis teaches them physiotherapy exercises to perform with them. She also has them use an electromagnetic blanket if they have access to it or balance pads as the horse progresses in his rehabilitation. “I find that giving them lots of other activities to do with the horse can help keep them busy and invested in the rehab.”

Repeat Imaging for Equine Soft Tissue Injuries

Ellis said she repeats imaging before increasing the horse’s workload and at every recheck, which she plans for every 30-45 days. “The imaging results rarely guide my rehab recommendations if the horse is improving clinically,” she said. “This just allows me to establish a new baseline.”

To check the horse’s clinical improvement Ellis watches the horse jog on a straight line but does not longe them in a circle. However, if the horse worsens during the rehabilitation process, she might perform a more extensive lameness examination or imaging to find the cause.

While diagnostic imaging technology and treatments for equine back pain have improved in recent years, the clinical examination remains a vital part of accurately diagnosing and treating spinal problems in horses. “Ninety-four percent of ridden horses experience back pain,” said Sandro Colla, DVM, MS, postdoctoral fellow at Colorado State University’s College of Veterinary Medicine & Biomedical Sciences, in Fort Collins. Colla explained the role of the clinical examination and functional assessment in diagnosing back problems in horses during his presentation at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida.

Equine Back Anatomy and Biomechanics

The horse’s back includes fascia, muscles, tendons, ligaments, and bones, which work together to support the horse as he moves and works. The fascia is a layer of connective tissue that surrounds muscles, providing support and structure. It contains nerve endings that can sense and send pain signals. Muscles and tendons work together to coordinate skeletal movement and provide stabilization at rest and during work, while bones protect the spinal cord and provide greater structural integrity, said Colla. Each piece of the horse’s back anatomy allows him to flex and extend both laterally (side-to-side) and longitudinally (dorsal-to-ventral) during forward and back global body movements—coordinated movements that utilize multiple muscle groups across the entire body to generate significant motion.

Dysfunction in the Equine Back

“Anything that impairs the physiological and biomechanical activities (of the spine) is considered dysfunction,” said Colla. Mechanical dysfunction renders tissues unable to execute their expected function and frequently has high clinical relevance, he added. Dysfunction caused by pain can be acute (conditions that develop suddenly and are often severe but short-lived), subacute (less sudden/severe), or chronic and observed in the horse’s posture, during palpation, and in spinal mobilizations.

“Horses can demonstrate normal, reduced, or increased spinal range of motion during examinations,” said Colla. This might be isolated to one joint or a whole segment due to bony changes, adhesions, abnormal muscle tone, or fascia pain, he added. “The clinical relevance of range of motion changes can vary but is usually associated with other dysfunctions.”

Veterinarians might also observe misalignments in the horse’s spine during examination, which can be isolated or evident throughout an entire segment of the spine. Misalignment can be congenital (present at birth) or acquired (developed after birth due to external factors) and generally has a variable clinical significance, said Colla.

Assessing Equine Back Pain

During a clinical examination, veterinarians should inspect the standing horse’s structure, noting any abnormalities or pathologies (disease or damage) found using palpation or imaging. However, the functional assessment allows practitioners to determine the clinical relevance of these findings and determine whether they affect the horse in his work, said Colla. “The functional assessment should be dynamic and include performance-related work.”

During an assessment Colla said veterinarians should ask clients to describe how long a horse has shown signs of back pain, characteristics of the horse’s pain, previous treatments and their successes, current athletic performance, and intended future use. They should inspect the horse both at rest and in motion and observe muscle development and any asymmetries. Then, using light palpation, they should locate any vertebral misalignment, increased temperature on any part of the back, or abnormal pain sensations.

“Gradually increase force applied to any structures of interest,” said Colla. “Find trigger points and put pressure on exactly that point to observe the horse’s reaction.”

Veterinarians can also observe how the horse moves during spinal mobilization exercises including sternal lifts, lateral bending/rotation, and lumbosacral flexions, said Colla.

Using objective measurement tools can help veterinarians accurately quantify abnormalities in a horse’s back. Colla said he often uses a flexible ruler to draw the contour of a horse’s spine to determine if his posture changes at any point during the rehabilitation, a pressure algometer to quantify pain, and a noncontact infrared thermometer to measure any areas of increased heat. He also takes pictures of the horse to refer to later if needed.

Diagnosing and Treating Equine Back Pain

“For horses with mechanical dysfunction, (veterinarians) can take radiographs, ultrasound, computed tomography, or bone scan (or a combination of several) to help determine the site of dysfunction,” said Colla.

In horses with dysfunction caused by pain, he uses these imaging modalities to locate any pathologies in the back. He also recommends manual therapies, systemic or local medications, acupuncture, extracorporeal shock wave therapy, and therapeutic exercises for rehabilitation.

Colla treats horses with range-of-motion restrictions using therapeutic exercises, manual therapies, and in cases of misalignment, chiropractic adjustment. The only way to treat misalignments is with chiropractic adjustments, he added.

Take-Home Message

Diagnostic technologies and treatments for equine back pain have improved in recent years, but clinical examination and functional assessment are still important for locating clinically relevant pathologies in a horse’s back. Veterinarians should approach each patient as an individual and develop a treatment plan based on the horse’s unique pain and the owner’s plans for the animal.

What joint therapy (if any!) is right for your horse?

With the summer show season just around the corner, now is the time to start preparing your horses for success. However, diving into intense training can take a toll on your horses’ joints, potentially leading to issues right when you need them performing their best.

In this article we’ll learn how common joint issues, primarily osteoarthritis (OA), concern owners of competitive horses. Then we’ll look at preventive and therapeutic approaches to manage this chronic, invariably progressive performance-limiting condition.

Why Focus on Equine Joint Health?

Results from several recent studies reveal that many horse owners view musculoskeletal conditions as a major health concern. For example, in one survey of 246 horse owners, researchers found that 29.2% of survey respondents listed stiffness and reduced leg/joint flexibility as a major concern (Herbst et al., 2024). Osteoarthritis was the most common owner-reported, veterinary-diagnosed medical condition, occurring in 32.6% of horses owned by survey respondents. That survey included horses 15 years or older actively involved in low-, medium-, and even high-level (international) competition.

Another research group conducted an online survey of 1,677 owners of British eventing horses about lameness and illness (Tranquille et al., 2024). Of those, 26% relayed having a lameness/musculoskeletal issue in the previous six months, with joints being the second most frequent source of the lameness (382 horses). The most commonly affected joints included the tarsus (hock), stifle, forelimb distal interphalangeal (coffin) joint, metacarpophalangeal (forelimb fetlock) joint, and the carpus (knee).

Joint issues disrupt training and competition. In the Tranquille et al. survey, owners reported that horses with fetlock and hock injuries were off work for about two weeks. Stifle and coffin joint problems often required layups of up to six months.

Preventing OA, Slowing Progression for Equine Joint Health

Osteoarthritis often begins with low- to medium-grade inflammation (i.e., synovitis or inflammation of the joint’s inner lining) where there might not be any cartilage or bone changes.

“But if left unchecked, this condition can progress, affecting other tissues in the joint, including the cartilage lining the ends of bones inside joints and the layer of bone directly under the cartilage called the subchondral bone,” explains Laurie Goodrich, DVM, PhD, Dipl. ACVS, professor of surgery and lameness at Colorado State University’s (CSU) Johnson Family Equine Hospital and director of the Orthopaedic Research Center, in Fort Collins. “As OA advances, the cartilage and subchondral bone lose their ability to support the necessary mechanical forces that are required of them.”

“Ultimately, OA permanently changes the joint environment where cartilage is thinned or lost, the bone underneath it becomes thickened (sclerotic), the joint capsule loses its pliability, and the joint becomes stiff. These are all characteristics of career-limiting OA,” says Goodrich.

No cure exists for OA, which means vets focus on prevention and slowing progression to maintain joint comfort and athleticism.

Potential ways of preventing OA include:

• Maintaining an appropriate body condition score (BCS). Excess condition and body weight can hasten the incidence of arthritis development, as has been observed in dogs and humans (Pratt-Phillips and Munjizun, 2023).

• Prophylactically administering joint supplements in healthy horses before joint trauma, inflammation, and evidence of OA (van de Water, 2016, and Leatherwood, 2016). However, not all joint supplements are backed by scientific evidence, so it’s best to discuss your options with your veterinarian.

• Focusing on proper training and conditioning while avoiding overtraining. “Muscles, tendons, and ligaments are critical for supporting joints and need to be conditioned to do the job that is expected of them—just like human athletes,” says Kyla Ortved, DVM, PhD, Dipl. ACVS, ACVSMR, associate professor of large animal surgery at the University of Pennsylvania’s New Bolton Center, in Kennett Square.

• Making sure athletes are shod to their conformation and properly supported.

Treating OA? Diagnostics First

When preventive measures can no longer maintain joint comfort, owners have various treatment options at their disposal. However, an accurate diagnosis of joint discomfort is needed; otherwise, the horse will not respond as expected to therapies, including intra-articular (IA) medications. In turn, this can delay return to work/competition or lead to continued poor performance.

In a standard lameness exam your veterinarian will watch the horse walk and trot and will perform flexion tests and diagnostic analgesia (joint blocks with a local anesthetic such as lidocaine) to try to identify the painful joint(s). Radiographs (X rays) can reveal pathology—disease or damage—including conditions such as osteochondritis dissecans (OCD) and intra-articular fractures that can lead to OA.

“Radiographic changes associated with OA can be seen in more advanced cases where bony reaction or loss of cartilage has already occurred,” explains Ortved.

In cases of early OA, however, advanced imaging, such as computed tomography, MRI, and positron emission tomography (PET) can be very useful, she adds.

After diagnosing OA and ruling out other issues, it’s time to consider treatment if preventive measures fall short.

Choosing the Right Intra-Articular Therapy for Equine Joint Health

The tried-and-true often first-line intra-articular medications that many owners would be familiar with for OA are corticosteroids, such as triamcinolone. Appealing features of corticosteroids include their low cost and widespread immediate availability. While these medications effectively reduce inflammation and discomfort, they do come with some drawbacks.

“First, depending on the corticosteroid and the frequency of usage, corticosteroids may negatively affect cartilage metabolism, ultimately hastening cartilage degeneration and worsening osteoarthritis over time,” says Goodrich.

Second, even corticosteroids administered within a joint can have systemic effects. Page et al. (2024) reported that a 9-milligram dose of intra-articular triamcinolone results in abnormal findings for the thyrotropin-releasing hormone test used for diagnosing pituitary pars intermedia dysfunction (PPID, aka equine Cushing’s disease) as well as the oral sugar test used for diagnosing insulin dysregulation. The IA triamcinolone also results in increased circulating levels of glucose and insulin, which could predispose horses to laminitis. Hallowell et al. (2024) also reported systemic effects of intrasynovial triamcinolone.

Third, corticosteroids simply control clinical signs associated with OA and do not play any role in modifying the course of disease/slowing disease progression. For this reason researchers such as Ortved and Goodrich direct their attention toward regenerative therapies, also called orthobiologics. These are treatments derived from biological substances to treat musculoskeletal conditions.

IA Corticosteroid Alternatives for Equine Joint Health

ACS

Autologous conditioned serum (ACS) is an orthobiologic created by collecting a blood sample from the patient and using a commercial kit to produce interleukin-1 receptor antagonist protein (IRAP, produced by incubating the blood with special beads) and other anti-inflammatory molecules. The IRAP blocks interleukin-1, a powerful and damaging pro-inflammatory mediator. The incubation process also stimulates the production of anti-inflammatory mediators and growth factors similar to those found in platelet-reduced plasma (PRP, more on this a moment). The vet then injects this “conditioned” serum into the target joint to inhibit inflammation.

In terms of efficacy, Tommasa et al. (2023) relayed in a systematic review of the literature that while most studies on ACS support this joint therapy for OA without significant adverse effects, some studies were poorly designed (e.g., lacked a control group). The researchers concluded that a “more rigorous approach to validate the efficacy of ACS in OA treatment” is needed.

Ortved did point out several studies, however, in which authors reported a good therapeutic effect, such as Frisbie et al. (2007) and Lasarzik et al. (2018).

APS

Like ACS, autologous protein solution (APS) is rich in growth factors and anti-inflammatory proteins.

In Ortved’s most recent study on APS (Usimaki et al., 2024), the research team created synovitis using interleukin-1β in one hock joint each of 18 horses. Twenty-four hours later they treated 12 joints with APS and left six untreated (control group). Although they did not report any changes in lameness or joint circumference (a measure of joint effusion/inflammation), they noted a significant improvement in gross joint appearance and the microscopic structure of joint synovial lining, suggesting APS has a disease-modifying effect on OA.

In Ortved’s hands, APS is more popular because it does not need to be incubated overnight like ACS does. Veterinarians also usually repeat ACS injections once weekly for a total of four doses, which in Ortved’s hospital setting is not easily accomplished.

Still, “I know many veterinarians that use ACS in the field and really like it,” she says.

At CSU, Goodrich and Erin Contino, DVM, Dipl. ACVSMR, are leading a large ongoing clinical trial to compare the therapeutic results of APS to those of corticosteroids in the stifle joint.

Platelet-Rich Plasma

Vets produce PRP by collecting and centrifuging a blood sample using a commercial system, then injecting platelets intra-articularly. The platelets, when activated, release growth factors and a number of other proteins.

In a recent review of five studies on PRP treatment for OA, researchers reported a “significant improvement in the PRP products treatment group compared with the control group.” Thus, Peng et al. (2024) concluded, “PRP products as intra-articular treatment are likely efficacious for treatment of equine OA,” but more blinded and randomized trials are needed.

Stem Cells

After collecting autologous (originating from the patient) or allogeneic (from another horse) stem cells from bone marrow or adipose tissue, the vet processes and injects these cells directly into joints, where they exert anti-inflammatory and immune-modulating properties and recruit other stem cells within the joint to facilitate healing.

Systemic, Other Therapies

Veterinarians still recommend nonorthobiologics such as intramuscular polysulfated glycosaminoglycan. This has been described to help restore the steady state between production and destruction of cartilage components, helping keep things on the right path in horses with early signs of joint inflammation or OA. They also prescribe hyaluronic acid (HA, the body’s natural joint lubricant) joint therapy, injecting hyaluronate sodium intravenously or IA to promote cartilage health and joint lubrication and reduce inflammation.

Polyacrylamide Hydrogels

Available commercially as 2.5% or 4% products, polyacrylamide hydrogels are the newest additions to the IA arthritis armamentarium. The Food and Drug Administration says hydrogels are not orthobiologics but, rather, “medical devices.” The suggested mechanism of action for the 2.5% product is that the hydrogel integrates into the joint’s synovial lining and changes the cellular properties with an increase in macrophages—white blood cells that surround and kill microorganisms, remove dead cells, and stimulate the action of other immune system cells—that can be anti-inflammatory (Lowe et al., 2024).

“It is also possible that the integration leads to changes in the elasticity of the synovial membrane, improving biomechanics in the joint. This property is currently being studied,” says Ortved.

In a study by McClure et al. (2024), the 4% hydrogel reportedly provided long-term joint lubrication with no adverse effects noted after serial injections once every 45 days for a total of four injections.

De Clifford and co-authors provided data supporting hydrogel use for lameness in 2021. That group reported the 2.5% hydrogel “led to statistically superior results compared to triamcinolone and HA in the management of selected middle carpal joint lameness in flat-racing Thoroughbreds, with therapeutic effects persisting up to 12 weeks.”

Take-Home Message

“In my opinion,” Ortved says, “orthobiologics should be used before corticosteroids if the situation is the right one … owners are willing to be a little patient to see an effect (i.e., several weeks) versus needing a change immediately, as can be seen with steroids.” Goodrich says she believes “the advantages of orthobiologics outweigh the increased cost (versus corticosteroids) because the approach is both anti-inflammatory as well as regenerative, and ultimately longevity of athletes’ joints is the goal.”

This article is from the Spring 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Veterinarians can use positron emission tomography (PET), computed tomography (CT), or magnetic resonance imaging (MRI) to help diagnose problems in equine patients, but how do they choose which to use? Timothy Manzi, VMD, Dipl. ACVR-EDI, clinical assistant professor of large animal diagnostic imaging at the University of Pennsylvania’s New Bolton Center, in Kennett Square, and Myra Barrett, MS, DVM, Dipl. ACVR-EDI, associate professor of equine diagnostic imaging at Colorado State University’s College of Veterinary Medicine, in Fort Collins addressed this nuanced question at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida.

Positron Emission Tomography in Horses

More veterinarians are using positron emission tomography for its unique capabilities. Paired with motion-correcting software, PET can tolerate minor movement, making the modality ideal for use under standing sedation, rather than anesthesia, they explained.

Used both for screening and follow-up evaluations, PET scans allow the veterinarian to assess all four feet in 20 minutes and structures as high as the proximal suspensory ligament and distal (lower) knee and hock in most horses. The veterinarians agreed the modality excels at detecting subtle issues such as impending sesamoid fractures, which veterinarians might miss on standard radiographs. Positron emission tomography is popular in both racehorse and sport horse practice because it allows practitioners to identify subchondral bone injuries early.

Computed Tomography in Horses

Significant advancements in CT technology have enhanced its use in equine medicine. Specifically, fan-beam CT produces high-resolution images and can be performed under standing sedation. The alternative, cone-beam CT systems, acquire volumetric data (used to display a 2D projection of a 3D sample) but the veterinarians agree these systems are more prone to artifacts (unintended distortions) and less effective for soft tissue evaluation compared to the fan-beam CT.

Small-animal practitioners use cone-beam CT for dental imaging. Manzi said it has more limited use in equine medicine but still offers some good utility.

Veterinarians can also use CT to diagnose vertebral pathologies (disease or damage). Used in combination with myelogram contrast, CT can reveal spinal cord compression undetectable by radiographs. For imaging of the equine pelvis, the modality offers better detail than some other imaging modalities, uncovering conditions such as sacroiliac lysis that were previously only diagnosed post-mortem.

Magnetic Resonance Imaging in Horses

Magnetic resonance imaging remains a cornerstone for diagnosing soft tissue injuries and bone-marrow lesions, including bone bruises with fluid and contusions. While Manzi and Barrett described low-field standing MRI as more accessible, they agreed it is prone to motion artifacts and offers less detail than high-field MRI conducted under general anesthesia.

Diagnostic Imaging in Equine Practice

Veterinarians often use a mixture of imaging techniques to assemble the puzzle pieces they need to reach a diagnosis. Combining MRI or CT with PET can create a comprehensive picture, compensating for the blind spots of each modality. For instance, contrast-enhanced CT outperforms standing MRI in cartilage evaluation, while ultrasound remains superior for some tendon and ligament injuries, the clinicians explained.

Cross-sectional imaging (MRI, CT, and PET, which show slices of the structure imaged) can be particularly valuable when radiographs fail to reveal the source of lameness—in the case of bone marrow lesions, for example, said Manzi. To avoid client disappointment and frustration with inconclusive scans, both veterinarians recommend preprocedural education about the capabilities and limitations of each technology.

The Role of Artificial Intelligence

Artificial intelligence advancements attempt to simplify image acquisition and provide motion control, but that’s where its usefulness currently ends. “Imaging interpretation fully remains in the hands of veterinarians,” Manzi said.

Take-Home Message

Advanced imaging modalities can provide precise answers for equine practitioners, contributing to more precise treatments and better prognoses. Evolving PET, CT, and MRI technologies improve veterinary diagnostic capabilities, offering precise insights into pathologies that were previously difficult to define, and refine the way veterinarians identify and manage lameness in horses.

Equestrian sports demand advanced skills and can involve extensive physical effort from both horses and riders. No horse is born with the capacity to perform at the highest level, which is where training comes into play. “We want the body to adapt to training,” said Tim Worden, PhD, an equestrian sport scientist located in Toronto, Ontario, during his presentation at the 2025 IGNITE Sports Science for the Olympic Disciplines Seminar, held Jan. 12-13, in Ocala.

But how do you prepare a horse to perform at the highest level of sport? What lessons can be taken from human athlete training and applied to horses?

Lessons for Training Equine Athletes

Lesson #1: Be flexible with planning. “Two steps forward one step back” is the traditional saying, and it’s typically true. Worden said it’s always good to have a plan, but you also need to remember it’s just a framework. Your horse needs daily monitoring. Watch the horse in the stall, during warmup, and during competition or training. Take notice of any changes (good or bad) and be ready to adjust your plan.

Lesson #2: If it matters, measure it. Are you and/or your horse getting better? You need to assess that somehow. Wearable sensors, smartphone applications, and software platforms might help, but it doesn’t have to be that elaborate. You can record your observations in notebooks or spreadsheets.

Lesson #3: Use exercises that must be solved in the desired way. The most effective training exercises mimic what you’ll be doing in competition and stimulate the same muscle patterns but are varied enough to keep routines fresh and engaging. Taking horses out of the arena and doing something faster (like a controlled gallop) than they typically go would be one way to do that, Worden said.

Lesson #4: Guide athletes along the safest possible path. Minimize injury and setbacks by managing risk factors. Worden explained that high-risk events include travel; issues with hoof trimming, shoeing, and conformation; psychological challenges; tack and equipment changes; and stress. The better you manage high-risk activities the more you can reduce the likelihood of injuries.

Take-Home Message

To help advance a horse’s training, observe his behavior daily, watch how he moves during work and around the barn, and understand what that is telling you about his strengths and weaknesses. Track your horse’s progress over time. Utilize exercises that naturally encourage the horse to move in the desired or correct way and, as your primary goal, avoid injuries.

Q: My horse came in from the field with what appears to be a puncture near his fetlock joint. His ankle is puffy and I can’t tell how deep the wound is, or if it goes into the joint. He does sometimes swell up over small scrapes. My veterinarian is coming to look at him tonight, but what should I do until then? Should I give him any medications, cold hose it, wrap it, or something else?

A:  First, it’s great that you have already contacted your veterinarian. Wounds near joints should always be treated as emergencies. Joints comprise smooth cartilage that covers the bony surfaces, a thick capsule that surrounds the joint, and viscous synovial fluid that lubricates the joint as it moves. If the joint capsule is penetrated, bacteria are introduced into the joint. When a joint becomes infected, it is imperative to initiate treatment quickly. Otherwise, the cartilage surfaces sustain long-term damage and severe arthritis will develop.

When your veterinarian arrives, he or she will perform an exam to determine the depth and direction of the puncture wound. Your veterinarian’s strong working knowledge of anatomy helps him or her determine the risk of joint involvement. Based on the exam, he or she will decide if further diagnostics, such as sampling the synovial fluid, are warranted.

While it is critical to rule out joint involvement, in many cases swelling seen around a wound is due to cellulitis—an infection of the deep layers of the skin. Cellulitis still requires prompt medical attention but has a much better prognosis than an infected joint. Additionally, we all know horses can choose some rather creative ways of injuring themselves, so some of the swelling might be due to trauma associated with the injury.

There are a few things you can do while you are waiting to see your vet. You can gently clean the area around the wound with soap and water. Betadine scrub is great to have on hand for these situations. Then you can apply an antiseptic ointment such as silver sulfadiazine cream, cover the wound with a nonstick pad, and apply a standing bandage. The horse should be left in a stall until the vet can examine him. Your proactive care will help your horse have the best possible outcome.

Horse inspections held prior to the start of a 3-day event and again prior to the competition’s show jumping phase are designed to ensure horses are sound to compete. Veterinary delegates and an inspection panel perform them. However, the final decision of a horse being accepted to compete lies with the ground jury. This can cause a variety of challenges, said Elin Hernlund, DVM, PhD, associate senior lecturer at the Swedish University of Agricultural Sciences, in Uppsala, during her presentation at the at the 2025 IGNITE Sports Science for the Olympic Disciplines Seminar, held Jan. 12-13, in Ocala, Florida.

Challenges During Horse Inspections

Horse inspections at events are brief, and varying standards even within disciplines make it particularly challenging for experts to agree on visual assessments of soundness. In cross-sectional studies of the inspections, researchers have found asymmetries in horses’ movements are prevalent, said Hernlund. Practitioners typically consider symmetric movers sound and severely asymmetric ones not sound. However, some asymmetries can make it difficult for veterinarians to determine if the horse is truly sound or lame, she said.

Although veterinarians have worked to establish threshold values for lameness, opinions vary widely on what qualifies as lame. “There are no threshold values we can use at the moment,” said Hernlund.

Study on Gait Analysis and Horse Inspections

Researchers have gathered data at seven FEI-level long-format eventing competitions from five countries, recording a total of 323 horse inspections. In preliminary results the investigators showed that measurements taken using a smartphone-based AI program largely support human decisions about soundness made at the inspections. Horses sent to the holding box (the area where horses go when the ground jury wants to reevaluate them for soundness) are more asymmetrical than those that do not go to the holding box, but there are exceptions, Hernlund said. Further results from the study will be forthcoming.

Take-Home Message

The goal of the horse inspection at every event is to ensure horses entered are sound and fit to compete. This is for the safety of horses and humans alike. Using data gathered by AI can help quantify what the veterinarians and ground jury see. While the idea is still in the early stages, Hernlund said it shows promise for the future.

With multiple rows of uniquely shaped bones, several distinct joint spaces, and a plethora of soft-tissue attachments, the horse’s hock (tarsus) plays a crucial role in equine locomotion. However, its complex anatomy can prove a diagnostic challenge for veterinarians.

“Unlike the forelimbs, lameness related to the distal extremity is less common in hind limbs, yet the hocks are a common source of pain/discomfort causing lameness,” says Pablo Espinosa-Mur, DVM, DVCs, Dipl. ACVSMR, assistant professor of diagnostic imaging at Ontario Veterinary College, in Canada. 

Horse Hock Anatomy

The hock joint is made up of three rows of bones and three distinct joints. The bulbous ends of the horse’s tibias, called the malleoli, come to rest on top of each talus, a uniquely shaped bone in the hock forming the tarsocrural joint. Each talus has two obliquely oriented (slanted or at an angle) ridges extending from the dorsal (towards the back) aspect of the bone that interlock with the malleoli and the distal (lower) intermediate ridge of the tibia.

The flat bottom of the talus articulates with the rectangular central tarsal bone, forming the talocalcaneal-centroquartal (or proximal intertarsal) joint. The bottom of the central tarsal bone overlies the small cuboidal bones, numbered one through four, forming the centrodistal joint. Finally, the small cuboidal bones articulate with the metatarsal bones (primarily the third metatarsal bone, which is the cannon bone) forming the tarsometatarsal joint.

Several soft-tissue structures such as muscles, ligaments, and tendons pass alongside the hock. This includes the digital flexor tendons coursing along the plantar aspect (toward the rear) of the joint, the extensor tendons running along the dorsal aspect, and the medial and lateral (located closer to and further away from the median plane of the horse, respectively) collateral ligaments extending from the lateral aspects of the tibia to the third metatarsal bones.

“However, there is sometimes communication between other joints as well, which means intra-articular (IA) anesthesia may not be specific,” adds Sue Dyson, MA, VetMB, PhD, an independent consultant based in the U.K. Joint communication refers to the interconnection between different joint compartments, which allows synovial fluid to flow between them.

“There are many attachments as well as deep and superficial parts both medially and laterally that have different orientations and attachments. These structures can get injured individually or together, complicating the workup,” Dyson explains.

Common Horse Hock Pathology

Dyson says common pathologies (disease or damage) causing lameness in the horse’s hock include:

1. Osteoarthritis (OA) in the distal hock joints, particularly the centrodistal (distal intertarsal) and/ or tarsometatarsal joints;
2. Osteochondrosis dissecans (loose cartilage or bone fragments in the joint) in the distal cranial (toward the horse’s head) aspect of the intermediate ridge of the tibia (DIRT lesions) or the trochleas of the talus, often combined with secondary osteoarthritis of the tarsocrural joint; and
3. Traumatic injury of the deep and superficial collateral ligaments.

“In some cases, osteoarthritis of the distal tarsal joints and desmitis (damage of a ligament and surrounding structures) of the proximal suspensory ligament (originates at the top of the cannon bone and supports the fetlock) can be seen in the same horse,” says Espinosa-Mur. “These conditions can be clinical while others can be subclinical (not visible to the eye) at the time of presentation.”

Diagnostic Analgesia in the Hock

Because the hock’s structures lie in such proximity to one another, performing nerve blocks to localize lameness to one location can be challenging for veterinarians, says Espinosa-Mur. Some of these structures share innervation or are close enough that diagnostic analgesic can diffuse and cause false results, he adds. For example, the anesthetic agent can diffuse from the tarsometatarsal joint into surrounding structures. This means the veterinarian unintentionally desensitizes the surrounding area, including the suspensory ligament.

“This is particularly true if too much local anesthetic solution is used as it will leak out from the tarsometatarsal joint and influence the suspensory ligament,” says Dyson. “Ideally, practitioners will cross-block, meaning they will block the suspensory ligament on one occasion and the tarsometatarsal joint on a separate visit.”

It is important for veterinarians to recognize that IA anesthesia will not remove bone pain, says Dyson. “So with OA that involves subchondral bone (beneath the cartilage) damage, an intra-articular block may be negative.”

Imaging the Horse’s Hock

Veterinarians can use X rays as a first-line method to evaluate the structures in the hock. When they cannot reach a clear answer using this imaging modality, advanced imaging is the next step.

To help home in on the specific source of hock lameness, Espinosa-Mur and colleagues recently published a study using ¹⁸F-sodium fluoride (¹⁸F-NaF, a radioisotope) PET for imaging the tarsus and proximal metatarsus (the upper aspect of the cannon bone near the hock). They took ¹⁸F-NaF PET images of 25 horses with lameness localized to these regions and compared them to computed tomography (CT) scans of those same 25 horses.

Espinosa-Mur says he and colleagues believe imaging modalities capable of distinguishing active injuries from chronic or incidental (found unexpectedly, typically without clinical signs or need for treatment) lesions would benefit equine practitioners, especially when evaluating the hock. In this case ¹⁸F-NaF PET provides an image that helps veterinarians detect active lesions by highlighting areas where the bone takes up the radioisotope—similar to a bone scan but in 3D.

In some cases the PET scan results correlated with those from the subjective and objective lameness evaluations. “Advanced imaging with PET could definitively help determine the (lesions) that display higher osseous (bony) turnover, which in some cases can be the ones that are causing lameness,” says Dyson.

Take-Home Message

The equine hock is a complex collection of joints, which makes diagnosing hock pain challenging. “With a good clinical examination, systematic use of nerve blocks, and good radiography and ultrasonography, many diagnoses of hock-related injury can be achieved,” says Dyson. Since the advent and wider availability of advanced imaging, including CT and PET, veterinarians can more easily diagnose hock problems and determine their clinical relevance, allowing targeted treatment options.

Patellar ligament injuries in the stifle are on the rise in horses, but researchers do not yet fully understand the ligament’s normal appearance on ultrasound and what they might see when the ligament is injured. Therefore, Ellen Law, DVM, ECVDI resident, a radiologist at the Diagnostic Imaging Unit at the Swedish University of Agricultural Sciences, in Uppsala, Sweden, and a research team studied the appearance of patellar ligaments in 111 riding and trotting (harness racing) horses on B-mode and color Doppler ultrasound.

“This study actually gained inspiration from human medicine, where a disease called jumper’s knee is a common orthopedic complaint in both recreational and professional athletes,” said Law. “We wanted to investigate whether a similar syndrome with chroinic pain from the patella apparatus also exists in horses.”

Objective Equine Hind-limb Gait Analysis

The horses included in the study were in training appropriate for their age—at least five days per week for mature horses—and the riders and trainers of each horse reported no impaired performance or lameness.

The researchers performed a full clinical examination and objective gait analysis on each horse within 24 hours of conducting ultrasonographic examinations. They recorded any abnormal findings during joint, tendon, and ligament palpation, or incorrect hoof conformation. They categorized each horse as hind-limb lame or sound based on the findings during the objective gait analysis.

None of the horses had effusion (swelling), increased heat in stifle joint compartments, or abnormal hoof conformation. However, one trotter horse had scar tissue in the skin over the attachment of the lateral (outer) patellar ligament.

The researchers noticed movement asymmetry in one or both hind limbs of 26 horses during the straight-line trotting gait analysis. Of these, six horses displayed push-off lameness in the left hind limb and four in the right hind limb, while three appeared to have an impact lameness in the left hindlimb and nine in the right. Two horses exhibited both impact and push-off lameness in the right  hind limb, and one experienced both in the left hind limb.

Equine Patellar Ligament Ultrasound Findings

A certified diagnostic imaging resident or veterinary radiologist examined the full length of each horse’s patellar ligaments using static and cine-loop B-mode and color Doppler ultrasound with the horse bearing weight.

The researchers commonly noted evenly distributed striations in the upper and/or lower portion of the intermediate patellar ligament, which they considered most likely to be normal. However, they considered unevenly distributed, hypoechoic (dark), wide, single, or multiple splits in the ligament to be abnormal and noted these changes in 21 horses.

Law and her colleagues described uninjured medial patellar ligaments as having a triangular shape throughout, and in 17 horses they noted a striated appearance. The lateral patellar ligament varied in shape amongst the horses but overall had an oval or triangular shape with indistinct margins. In 15 horses they noted abnormal bone formation at the origin or insertion of the lateral patellar ligament, but only four of these horses were lame in the affected limb.

“I think the most important point is that veterinarians have to be critical when they see changes on ultrasound in the patellar ligament in horses,” said Law. “Blocking to determine the clinical significance might be necessary in some cases.”

Law and her team plan to continue this research. “What has surprised us so far is the variable appearance of the patellar ligaments in horses. Dark (hypoechoic) regions don’t necessarily mean lesions as we had previously thought.”

Take-Home Message

Law and her fellow researchers did not find a strong association between hind-limb lameness and ultrasonographic findings in the patellar ligaments of the 111 horses participating in their study. She said in practice, veterinarians should perform further diagnostics to determine the clinical relevance of ultrasonographic and gait analysis findings if needed.

Equivalent to the human knee, the equine stifle is an intricate assembly of bone, joint, and soft tissues. Problems with the stifle commonly cause pain and lameness in equine athletes. Cathleen Mochal-King, DVM, MS, Dipl. ACVS-LA, associate clinical professor and service chief of equine surgery and medicine at Mississippi State University’s College of Veterinary Medicine, described how veterinarians diagnose and treat stifle-associated lameness at the 2025 Veterinary Meeting and Expo, held Jan. 25-29, in Orlando, Florida.

Diagnosing Stifle-Associated Lameness

Three joints make up the stifle, but no single joint compartment communicates with all articular (related to the joint) spaces; in other words, there is no continuous fluid connection among them. This means veterinarians need to perform multiple nerve blocks and joint injections, said Mochal-King. She added that veterinarians should be aware of the anatomy of the meniscus, the fibrocartilage found between the femur and the tibia. There are two menisci in each stifle: one medial (toward the horse’s center line) and one lateral. Both can tear, causing performance-limiting pain and lameness.

During soundness exams Mochal-King said she looks for a wider base stance in the hind limbs as an indicator of potential stifle issues in horses. She also observes how the height of the tuber coxae—a bony projection on the pelvis, located on the ilium and often called the point of the hip—varies between the left and right sides as the horse moves, which can help pinpoint the lame limb. After physical and gait examinations, Mochal-King performs flexion tests and nerve blocks to localize the lameness.

When she incorporates radiography into her diagnostic approach, Mochal-King said she likes to extrapolate as much information from the images as possible. “People aren’t reading X rays as well as they used to because we’ve got other diagnostics now, but there’s a lot that you can see on a radiograph,” she said, pointing to—for example—subtle changes such as flat condyles (the typically rounded articular surfaces of the femur or tibia become flattened) that can predispose a horse to medial meniscal tears.

Combining Ultrasound-Guided PRP Injections With Adjunct Therapies

Mochal-King said she treated 15 meniscal tears in 2024 and had success using ultrasound-guided platelet-rich plasma (PRP) injections in the standing patient. “In addition to its regenerative properties, PRP acts like tissue glue to help heal the tears,” she explained. She said she was particularly meticulous about injection site preparation and added amikacin (an antibiotic) to the injection to reduce the risk of septic arthritis.

She said she also used shock wave therapy for stifle lameness because it “really helps with the fiber pattern and in strengthening the collagen pattern throughout tendons and ligaments.” Out of the 15 meniscus tears she saw in the past year, all but one patient went back to work.

Surgically Managing Stifle Lameness

When a stifle injury warrants surgical intervention (i.e. it cannot be successfully managed with rest, rehabilitation, and/or medical treatment), Mochal-King said she prefers coupling arthroscopic debridement with PRP injection. She’s also had success with drilling and curetting (scraping to remove tissue) subchondral bone cysts from the outside rather than entering the joint. With this type of surgical procedure, she emphasized the importance of horses returning to controlled exercise following the procedure, typically 60 days post-surgery.

Successful Outcomes and Final Thoughts

Performing a thorough assessment can help veterinarians successfully diagnose stifle lameness in horses. Mochal-King said she prefers to treat common stifle-associated lameness problems, such as meniscal injuries, with PRP and shock wave, only turning to surgery as needed.