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Learn to Recognise the Subtle Signs of Pain

February 2019 by Lena Clifford, DVM, PhD, EOB, MIVCA
Trained as a veterinarian in Germany, where she completed a PhD, Dr Clifford is based in Queensland and now specialises in animal acupuncture, Chinese herbal medicine and animal biomechanics. She is a Member of the International Veterinary Chiropractic Association (IVCA).

Horses are instinctively ‘stoic’, they do their best to mask all signs of pain in an effort to keep-up and blend-in with the rest of their herd. By the time your horse shows clear signs of lameness or injury, it is likely a lot of damage has already been done. Although they may not scream it loud and clear, horses do display subtle signs they are in pain and/or discomfort. As horse lovers, it is our responsibility to learn to recognise these earlier signs and intervene as soon as possible.  

In this article, Dr Lena Clifford, a trained veterinarian with a special interest in animal biomechanical medicine, animal acupuncture, Chinese herbal medicine and advanced neurological release techniques lists and explains some of the subtle hints to watch out for - not just in your own horse, but every horse.

What is pain?

Pain in horses is a topic that is very close to my heart. In my everyday work I see too many horses that have been misdiagnosed and have been given all sorts of labels – pushy, hard-mouthed, stubborn, dangerous, head-shy, spooky, cold backed, lazy… you get the idea.

In my life and work with horses I have come to appreciate one thing. Horses don’t wake up one day to make your life hard. They don’t want to be difficult. Horses want to have an easy life. They are flight animals that try and preserve energy as much as possible.

Horses will exhibit high energy behaviour for a few reasons: mating, fight, flight and play. If a horse uses too much energy other than for survival it might get eaten by the next predator. The same thing is true for showing pain.

According to the Oxford Dictionary, pain is defined as “Highly unpleasant physical sensation caused by illness or injury“.

The International Association for the Study of Pain states: “Pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.”
Pain is a sensation that motivates us to protect the body from physical harm.

Being a flight animal, the horse has, over its evolution, learnt to hide pain very well. This does not mean it feels pain less, it just does not show it as obviously. This is because a wild horse showing lameness or other signs of being unwell is going to get targeted first by predators.

By the time a horse shows clear signs of pain such as lameness, it is often too late and the physical damage is done. A horse in pain will change his/her gait and behaviour to try and avoid physical damage before going obviously lame.

Don’t get me wrong, there are horses that do have behaviour issues. Usually, they are caused by stress, environmental factors, nutrition or training issues. So, how can you tell that the horse you are dealing with is in pain?

Here are a few hints to watch out for in your horse and every horse in the future.

Sudden behaviour changes

When a horse changes his/her behaviour suddenly and nothing much has changed in everyday life it is worth investigating to see if the behaviour change is caused by pain. A horse that is sore might show new behaviour like, for example:

  • The horse doesn’t want to flex when you ask because that movement hurts, rather than ‘being stubborn’.
  • The horse doesn’t want to go forward or faster because the muscles in his/her shoulders are sore, rather than because he/she is ‘lazy’.
  • The horse with a bridle that is pressing on a sore poll may become head-shy rather than trying to ‘avoid being ridden’.

This subject gets really interesting when it comes to spookiness or oversensitivity in horses. Often, these horses are actually neurologically challenged.

In human neurology there is a term called “noisy brain” an overloaded brain that is getting too many signals from the body constantly. Consciously or unconsciously, we have the brain (and other parts of the nervous system) tell our body what to do. At the same time, we have every part of our body send signals to the brain so the brain knows what is going on in the body and how to react to it.

For example, when we want to stand upright we need the brain to know where in space we are. This is called proprioception.

When a horse has a noisy brain, the brain gets too much information from its body – this could be due to soreness or stress – and the brain gets overloaded with information. This horse might get spooky because it cannot process  all the information in its own body, let alone what is coming in as information from the outside world.

High head carriage

A horse that is sore will change head carriage (head and neck posture) and tends to hold it higher than usual. This causes tightness and tension through the neck muscles and puts pressure on the temporomandibular joint (TMJ) and the poll. In turn, this can lead to dental problems as a tight TMJ changes the way of chewing. It might also make the horse head shy, as he/she tries to stop you from touching that sore poll. The higher head carriage can also affect vision and make your horse more spooky.

Tight jaw

A tight jaw can be caused by a high head carriage and it can also be caused by teeth problems and other issues in the mouth area.

A horse with a tight TMJ might start playing with the bit more, put the tongue over the bit or become ‘hard-mouthed’ or heavy in the bridle. Also, a horse with a TMJ issue might refuse to accept any contact with the bit or be inconsistent in their contact.

Worried eyes

When a horse is in pain he or she changes the muscles around its eyes and gets a worried look. This can, of course, also happen when a horse is worried about something in its environment in a situation that he/she is not happy about, but in this case, the eyes should relax once the horse settles down again. 

Inverted or u-neck

A change in the neck muscles can be caused by incorrect training or pain often coming from the front end of the horse. So, front feet, legs, shoulders or neck can all cause the horse to change the muscles of the neck.
Often, we see horses develop a u-neck and the riders complain that the horse will not stretch out anymore or accept a contact with the bit.

Muscle wastage/tightness

If your horse changes his/her top line and develops, for example, a big wither dip it is often due to a change in the way the horse is ‘holding itself’. In other cases you may see muscles wasting away in the hind end and you are not sure why. Another scenario could be that the horses gets very tight in their muscles.

All of these are a result of them trying to  protect a sore area by bracing themselves against the painful movement.

Uneven shoulders

Uneven shoulders are a big red flag. If your saddle slips to one side all the time or you feel like you are riding longer in one stirrup than the other despite them being the same length, have a good look at your horse’s shoulders.

An unevenness is caused by the horse getting off one leg and overloading the other. This could be caused by a so-called high heel-low heel syndrome (this is when the horse has one upright foot and one flat foot) or by other pain issues in the front limbs or feet.

Laying down more often

Have you noticed your horse laying down more often than it used to? This might also be a sign that the horse is uncomfortable standing up or too sore standing up. A good reason to get your horse checked out for some underlying pain issues.

Fascia lines

Fascia lines are a sign that the horse is overworking the area where the line is showing. This might be due to soreness in a different area - whether it is a fair way away from the fascia line or close to it. Fascia lines will go away once you fix the underlying issues.  

Pelvis angle

A horse needs a functional pelvis area to be able to develop propulsion no matter if they are a dressage horse, a campdrafter a show jumper or a trail pony. If a horse is sore he/she can sometimes change the angle of the pelvis, either making it steeper or flatter depending on the way they are compensating or bracing against the pain.

This angle change leads to a reduced mobility in the pelvis which changes the way the horse can use himself and causes a lot of sacroiliac (SI) joint problems.

However, it is not always a problem in the hindend that causes the horse to change pelvis angle, more often than not it is actually coming from a pain issue in the front of the horse and the change in pelvis angle is the way the horse is compensating for that.

Uneven pelvis

When you look at your horse from behind and the horse is standing square but the rump appears uneven, this is another sign that your horse might be sore, even if he or she is not visibly lame.

Tucked tail

Can’t lift your horses tail easily? This happens often in combination with a change in pelvis angle and can be a sign of soreness in your horse.

Roached lumbar spine

If your horse gets very tight over the lumbar spine (this is the part between where your last ribs and where the pelvis begins) or the spine roaches up in that area, it is likely that your horse is dealing with some pain issues.

Stance

Is your horse always putting the same foot out the front when it is grazing? Does it always stand the same way when you tack up? Can your horse never stand square when you halt? Getting to know how your horse stands normally and noticing small changes in stance down the track is a good way to know if your horse is sore.

Feet

Your horse is standing on his/her feet almost 24 hrs a day. If the feet are sore, your horse will have to compensate for that. Are the horse’s feet changing shape? Are they showing signs of bruising? Brittle hoof horn or wall separation? Flares or cracks? Get an expert to check for soreness in the feet.

Coat colour

Sudden changes in coat colour like white spots or washed out appearance can be a sign for soreness in your horse. This can be caused by changes in blood flow due to restrictions in the fascia and pressure on blood vessels.

Weight

Struggling to keep weight on your horse? If a horse is sore the muscle work very hard to try and avoid the painful movement and to compensate for the weakness in one area. Your horse is tired before it starts work and you can not feed your horse enough to gain weight. Once the soreness is dealt with and your horse is comfortable, you might have to cut the feed down so your horse does not get too fat.

So, what next?

As with everything, these few hints are guidelines for you as a horse owner to help you understand when things go wrong in your horse.

The conditions listed here are the more common ones we see in our everyday work, but there are many other conditions that could cause your horse to show these changes.

The first, most immediate thing you can do is ensure that all the gear is fitted correctly and not causing your horse any discomfort or undue pressure.

Every horse compensates differently, but if something changes behaviour wise or body wise please get your horse checked by a registered biomechanical professional (the ABPA in Australia) or other qualified professionals that understand and can help your horse with the issues it is dealing with.

If one thing is not working you might need more people on board to help your horse. One person cannot know everything, but the pain can also come from different areas and you might need your vet, your farrier and other therapists working together for a good outcome.

Do not be afraid to ask questions and insist on getting them answered. You are your horse’s advocate - your horse relies on you to get the help he/she deserves.