Harmonious Horsemanship by Sue Dyson and Sue Palmer

Title: Harmonious Horsemanship: use of the ridden horse ethogram to optimise potential, partnership and performance

Authors: Sue Dyson and Sue Palmer

Published: 2023

Available as paperback or Kindle edition

In the UK? View now at amazon.co.uk

About Harmonious Horsemanship

In Harmonious Horsemanship: use of the ridden horse ethogram to optimise potential, partnership and performance, Sue Dyson and Sue Palmer share their professional knowledge and experience to teach the reader how to use the list of 24 behaviours to check for musculoskeletal pain in ridden horses.

The book includes research studies and contributions from industry experts, alongside real-life case studies. The book is full of practical tools to teach everyone from amateur owners to experienced equestrian professionals how to use ridden behaviour to recognise the signs of pain, even in horses that appear sound.

Review: Harmonious Horsemanship by Sue Dyson and Sue Palmer

Too often horses are labelled “bad” or “naughty” when they are actually in pain. Dr Sue Dyson’s ridden horse pain ethogram – also known as the ridden horse performance checklist – is a list of 24 behaviours that can be used to recognise musculoskeletal pain in horses which are not obviously lame.

As well as covering the background of how and why the ethogram came about, this book focuses on educating equestrians in how to apply the checklist to their own horses, and includes many real-life case studies. It also contains numerous photos showing multiple examples of each of the 24 behaviours being shown by horses, to help equestrians visualise the signs.

The book poses important questions to the reader though out, promoting us to reconsider some long-held assumptions and beliefs we may have about our horses. It also offers advice on where to go next if you find your horse is showing signs of pain when you apply the ridden horse performance checklist, and includes a useful set of FAQs covering a wide range of questions that may cross your mind along the way.

Numerous experts – from vets to farriers to physical therapists to saddle fitters – have contributed their thoughts on ridden horse behaviour to the book, providing additional insight through the lens of their professional speciality.

For an educational reference book, I found the language easy to follow as it doesn’t get bogged down in too much veterinary terminology. That said, there is a lot of information on take on board so I did need to take breaks from reading to give my brain time to process the information being imparted.

I think this is a book that I will return to time and again. It will help me to be become a more informed owner and rider who can advocate clearly on my horse’s behalf when speaking to equine professional about my horse’s well-being.

Verdict

If everyone involved with ridden horses, whether as a rider, trainer or carer, would read this book, the world would be a better place for horses in all situations.

In the UK? View now at amazon.co.uk

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Horses’ behaviour is their trying to communicate with us, and we have to listen and try to understand.

This was the message from welfare, veterinary and behavioural experts, at a World Horse Welfare webinar titled “Myth-busting: is my horse being a pain or in pain?”

Sue Dyson, former head of clinical orthopaedics at the Animal Health Trust, gave the main presentation, in which she tried to bust common myths about undesirable equine behaviour.

H&H has reported on Dr Dyson’s ridden horse pain ethogram, RHpE, which comprises 24 behaviours, the presence of eight or more of which is likely to indicate that the horse has pain.

“We have lots of myths, which I believe are not based on evidence,” she said. “They’re misleading concepts that don’t ask the question ‘Why?’ Have we lost sight of what normal should look like? To me, that’s harmony, willingness, cooperation and partnership, and I don’t think we necessarily see that all the time.”

Dr Dyson said her focus is to promote ethical and harmonious horse-human partnerships, and she believes it is important riders are familiar with how horses learn, that the “horse-rider-tack triad” is considered, and that horses are kept as naturally as possible, with friends, turnout and suitable management.

In considering some myths she has heard, she cited riders’ being told a horse drags one of both hind toes and that the horse is “lazy”, or that the rider needs to create more impulsion.

“Are we making excuses for a horse that’s actually lame?” she asked.

Dr Dyson looked at other myths including spooky horses described as “of a nervous disposition”, who could need more training or be reacting to rider anticipation but who could also be showing underlying pain; spooking is one of the 24 RHpE behaviours.

“Grumpy” horses, even if “that’s just how she is” could be communicating that they do not want to be tacked up, in anticipation of discomfort.

“In my experience, pain-free horses aren’t grumpy,” Dr Dyson said, adding that horses who do not want to go forward are also often reacting to pain or discomfort rather than being “lazy”.

Another issue is recurring gastric ulcers. If a horse has been treated for them, and is managed appropriately but is still suffering, Dr Dyson said, “they’re usually secondary to a stressor, and the most common one is musculoskeletal pain”.

Horses who “lean” on one or both hands when ridden, those who are reluctant to jump steps or downhill and those who do not want to stand at the mounting block could all be trying to tell us they are uncomfortable,” Dr Dyson said.

“Don’t always blame the horse or rider,” she added. “Be sure you know what’s normal, recognise abnormal behaviour and ask why.”

Equine behaviour specialist Rosa Verwijs joined Dr Dyson to answer questions; she said probably half the horses she is asked to see are showing pain-related behavioural issues, or their behaviour has been exacerbated by pain.

“Lots of things building up can result in the end behaviour you see,” she said. “Often behaviourists are the last port of call, and by the time we’re called out, the behaviour is quite serious, and it might be more likely it’s a pain issue.”

One question asked was about terminology used; horses do not have the ability to intentionally “be naughty”, and the experts were asked if language should be reconsidered.

“There are certainly challenging horses,” Dr Dyson said, citing one she had who reared, was retrained and went on to be an advanced eventer.

“He was challenging, but I had to understand what the problem was and resolve it. It’s unfortunate to label horses ‘naughty’ as that has bad connotations. I prefer ‘challenging’ or ‘difficult’ but it’s important to understand that multiple challenging behaviours mean it’s highly likely the horse has pain, and we need to investigate.”

Ms Verwijs said the terms owners use to describe horses reveal how they feel about certain behaviours.

“By giving horses labels, we might assume the horse feels a certain way, which might not reflect how it is actually feeling,” she said. “If we use human terms, like ‘My horse is an idiot’, it gives us an excuse, that it’s the horse’s fault and not ours, and it removes the responsibility to us to look at the problem and what it stems from.”

In terms of key messages, Ms Verwijs said: “Please listen to your horse. Behaviour is their way of communicating with us and we need to listen, and if we don’t understand, try to find the answers and learn from them. It’s really important to advocate for your horses, to look out for them, and try to give them the best life possible.”

Dr Dyson agreed, adding: “Look. See. Think about what you see, and ask why.”

You might also be interested in:

‘Pain-free horses don’t react like that’: film aims to help riders hear what their horses are saying

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Research has found it is possible for untrained observers to assess pain and lameness in ridden horses using an ethogram

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The creators of a new documentary on the ridden horse pain ethogram (RHpE) hope it will improve horse welfare and performance, as well as horse sport’s future.

The RHpE comprises 24 behaviours including tail-swishing and an open mouth, the presence of eight or more of which may indicate that the horse has musculoskeletal pain, even if it is not overtly lame. Sue Dyson, former head of clinical orthopaedics at the Animal Health Trust, developed the ethogram through research including assessing lame and non-lame horses.

She has since expanded its application, and has this year been involved in the creation of the 35-minute documentary, with Kathryn Lauritzen of Padma Video, which was released on 30 September, “aimed at everyone involved in the equine industry”.

The film has already been shown at a conference in the US, and Dr Dyson said the response was “tremendous”.

“We developed a course [on the RHpE] with US charity Equitopia; a paid-for course, but the person who did all the video and photography was Kathryn,” Dr Dyson said. “She’s very much a horse person and she was blown away by the subject area. She came to me this year and said ‘Let’s make a documentary, and make it free to watch, so we can transmit the message’. I said ‘Good idea’.”

The video follows the story of showjumper Galina, owned by Lauren McMahon, who had started refusing jumps and becoming less willing to work on the flat, but was not overtly lame. Dr Dyson, with Gold Coast Equine vet Jim Myers, examine the mare, apply the ethogram; their findings shown on the footage, and diagnose the issue.

Dr Dyson said the aim is to “raise more awareness that so many of these behaviours that people accept as normal for horses are not normal; they’re a clue that something’s wrong,” she said. “And to encourage early investigation of problems rather than letting them linger, then when they are investigated, they’re more of a challenge.”

Dr Dyson said the equestrian industry can be very traditional, and many riders will have learned on ponies with low-grade lameness issues, who may be reluctant to go forward, often have their ears back or swish their tails when ridden, and “we become kind of accustomed to that being how horses behave, but it’s not”. She hopes using the ethogram will help maintain horse sport’s social licence to operate, or public acceptance of the use of horses in sport.

“Pain-free horses don’t react like that,” she said. “I hear time and again trainers saying ‘Kick harder’, or ‘Go to the gym and build your core strength’, ‘make your horse take an even contact’, but they’re all the ways horses try to communicate with us, and we need to listen.”

World Horse Welfare is among the promotional partners for global distribution of the documentary.

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Subscribe to Horse & Hound magazine today – and enjoy unlimited website access all year round

Horse & Hound magazine, out every Thursday, is packed with all the latest news and reports, as well as interviews, specials, nostalgia, vet and training advice. Find how you can enjoy the magazine delivered to your door every week, plus options to upgrade your subscription to access our online service that brings you breaking news and reports as well as other benefits.

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A study looking into the behaviours of a group of 60 ridden horses, considered sound by their owners, identified that 73% had low-grade lameness in one or more legs, using Dr Sue Dyson’s ridden horse pain ethogram. H&H finds out more about the research and its implications for the future...

More education is needed to better understand how horse behaviour can reflect underlying pain, a study indicates.

In the research, led by veterinary orthopaedic specialist Sue Dyson, 60 sports and riding school horses, considered sound by their owners, were assessed using a ridden horse pain ethogram (RHpE). The RHpE comprises 24 behaviours more likely to be seen in lame than sound horses; the presence of eight or more of these behaviours is likely to reflect pain.

Of the 60, 73% were found to be suffering with low-grade lameness on one or more legs, 47% had gait abnormalities in canter, and 47% had ill-fitting saddles with potential to adversely influence performance. Lame horses had higher RHpE scores than non-lame horses. The study was an extension of previous work that had shown that specific facial expressions and other behaviours are a reliable indicator of musculoskeletal pain.

Dr Dyson told H&H while she expected to find at least 50% of the horses to show lameness, a figure previously demonstrated by research, she was disappointed by the larger proportion – but added this work reinforced the value of the RHpE as a “signpost“ towards the presence of pain.

“Clearly there is ignorance about the fact behaviour can reflect underlying pain,” she said. “Education is required so owners, riders and trainers recognise behaviour, such as ears back and tail swishing, can reflect musculoskeletal pain, and vets know how best to investigate such horses.

“When an owner says, ‘My horse doesn’t like dressage,’ it may be because the horse is uncomfortable, and if the underlying problem was recognised and treated, the horse may be able to perform dressage quite well.”

The study found a larger proportion of the riding school horses compared with the sports horses showed lameness or gait abnormalities in canter.

“I think back to the riding school where I grew up and remember there being some grumpy or not very willing horses, and retrospectively they probably had some degree of musculoskeletal discomfort,” said Dr Dyson. “Horses are trying to communicate; we need to learn how to listen.”

Lucy Grieve, chair of the British Equestrian Veterinary Association’s ethics and welfare committee told H&H the study shows science can be applied to give riders, trainers and vets a framework to more reliably identify horses who need help and enable early detection.

“Horses are frequently presented to vets far too late after the injury started. Early detection not only means the horse should suffer for less time, but it can keep costs and recovery time down,” she said.

“A horse with a mild, short-lived injury is much more likely to return to full health than one with an injury that has grumbled on unnoticed and potentially resulted in a domino effect, leading to the development of further secondary injuries.”

Veterinary behaviour specialist Gemma Pearson told H&H this is an important study demonstrating the association between facial expressions and pain and lameness.

“Many people fail to recognise subtle signs of pain or stress in horses and assume any unwanted behaviours are due to the horse being naughty,” she said.

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Animal behaviourists have come to appreciate that horses can display a range of subtle facial expressions that indicate mood and pain. Vets routinely assess pain in conditions such as colic or laminitis by reference to pulse rate, sweating, posture or restlessness, but even low-grade discomfort can affect the expression on a horse’s face. So can facial expressions identify dental pain in horses?

A team at the veterinary school in Utrecht developed a system called the equine Utrecht University scale for the facial expression of pain (EQUUS-FAP), which showed how horses with colic can be scored, while behavioural scientists at the universities of Portsmouth and Brighton developed the equine facial action coding system (EquiFACS) to map and catalogue the complete range of possible facial expressions.

Vets and behaviourists in Germany and Italy have been working on a scoring system they call the horse grimace scale, to narrow down the changes in expression that specifically indicate pain. Studies showed that this was accurate in revealing pain after castration.

Different breeds and even individuals may be more stoical and less reactive to pain but, nonetheless, these facial expressions appear to be reliable.

Signs of dental pain in horses

A Brazilian team used the horse grimace scale to assess possible dental pain in horses used in rodeo work or cattle ranching. None of the horses had any particular dental problems, as far as the owners or riders were aware, and none had received dental treatment for at least six months.

The scientists scored the horses using the established grimace scale, with its six key indicators: ears held stiffly backwards, tension above the eye area, tightening around the eye, prominently strained chewing muscle, mouth strained with pronounced chin and strained nostrils with flattening of the profile.

The scores were made by trained assessors looking at the horses in the flesh, and photographs were taken for other trained assessors to score the horses. Photos were also given to equine vets – who were not trained in the use of the scale – to score the pictures for signs of pain using their professional experience alone.

The horses, 33 in total, then underwent full dental and oral examination, under sedation. Any sharp tooth edges, ulcers and hooks or other abnormalities were treated.

Two weeks later, the assessment process was repeated by all groups. None of the vets or scientists knew which horses had been found to have dental problems.

Settling scores

There was surprising correlation between high scores for pain on the horse grimace scale and significant dental disorders found in the dental exams.

All the trained assessors using the six key indicators – those who saw and scored the horses in their stables, and those who looked at the photographs – could tell which horses were in pain. But the horse vets who were not trained in the use of the established scale could only guess, based on overall appearance, and were only randomly correct in line with general probability.

This research reveals that dental problems and associated pain are common yet are frequently overlooked or unappreciated by owners and riders. Trained assessors can detect dental pain in horses by reference to facial expressions. Yet even experienced horse vets cannot accurately determine pain just by looking at the faces of their patients, unless they have been trained in the use of an objective scale.

Further reading…

● Facial expressions: Applied Animal Behaviour Science 225, 104970-76

Ref Horse & Hound; 7 May 2020

Desensitising part of a limb with anaesthetic may be necessary to localise the source of pain, as Dr Liz Barr explains

When there is no obvious swelling, heat or discomfort in the leg of a lame horse, the best option to localise the pain causing the lameness is to use diagnostic analgesia — which are commonly described as nerve blocks in horses. Blocking is also useful when a horse has multiple areas of swelling, some of which may be old, to confirm whether a particular finding on clinical examination is significant.

A nerve block involves injecting local anaesthetic around nerves at specific points on the limb, to desensitise various regions.

Local anaesthetic stops nerve signals to the brain; while the horse cannot feel pain after a nerve is successfully blocked, he can feel some pressure or movement.

The aim is to deposit the anaesthetic solution without touching the nerve itself with the needle, as this can result in a very quick and dangerous reflex kick. The anaesthetic can also be injected directly into joints or tendon sheaths to abolish pain associated with these structures.

How nerve blocks in horses work

The procedure takes place under veterinary guidance, at home or at a clinic. The horse is first watched in action to determine the baseline level of lameness. Some horses may not be obviously lame when trotted up in hand, or may have more general poor performance issues or problems that affect certain movements only. These patients will also need to be seen working under saddle.

The predominantly lame leg is then identified, but bear in mind that some horses will be lame in multiple legs. Others may merely appear so as a result of compensatory lameness, which arises from altered loading of limbs due to pain in one of them.

Blocking generally starts with an injection at the bottom of the affected limb, after which the horse is viewed in motion again.

Sequential nerve blocks are performed, working upwards, until the horse becomes sound or shows a significant improvement in the level of lameness — indicating the origin of the pain.

The exact cause can then be identified by appropriate imaging such as X-ray, ultrasound, MRI or CT, to reach an accurate diagnosis and formulate a treatment plan.

A more targeted approach may be preferable when blocking a hind limb to avoid the need for excessive injections, particularly in a sharp horse or known kicker.

The bottom hock joints are a common site of pain and lameness, so I often start by blocking these in a middle-aged or older horse with no palpable abnormalities. If the lameness does not improve, I go back and start at the bottom of the limb. If it does improve, however, I’ve managed to avoid up to four of these lower blocks.

Risks and limitations of nerve blocks in horses

Putting a needle into a horse’s leg, particularly a hindleg, is risky for a vet. There’s the added danger that a sudden kick or a quick move can result in the needle breaking off under the horse’s skin. Experienced handling can reduce risk, along with measures such as fitting the horse with a twitch, lifting another of his limbs, distracting him with food or using short-acting sedation.

If there is any suspicion that lameness is caused by a non-displaced fracture of a limb, blocking should be avoided. Removing the pain and repeatedly trotting and lungeing the horse can result in a catastrophic displaced fracture.

Vet and owner must recognise the limitations of nerve and joint blocks, and confusing information that may be thrown up.

Joint blocks can abolish pain in adjacent areas, creating misleading results. A common occurrence is a “cross-over block”, such as an injection into the bottom hock joint that also removes pain from the proximal suspensory ligament region. For this reason, it is routine to scan the proximal suspensory ligaments as well as X-raying the hocks of horses that go sound after this block.

Another shortcoming is that joint blocks may not abolish all the pain, although the joint is the problem. An example is persistent lameness in the subchondral bone, directly below the cartilage surface of the joint, where the anaesthetic solution is inadequately absorbed. There can also be issues within complex joints such as the stifle, where various joint compartments may not “communicate” to let the anaesthetic permeate the whole area.

Nerves can also be blocked incompletely, resulting in continued transmission of some pain and a response that is not as expected. Conversely, the anaesthetic sometimes diffuses up the limb — it may appear from the results of the blocking pattern that the pain is coming from the foot, but the anaesthetic has risen and blocked out fetlock joint pain.

Procedure prep

An additional risk is infection, usually of a synovial structure (a fluid-filled joint cavity). This can be minimised by first scrubbing the injection site with an antiseptic solution before applying surgical spirit. Clipping hair or feathers will enable easier palpation of the anatomy and more accurate needle placement, although this can still be difficult in very thick-skinned cob types and heavy breeds.

No other preparation should be necessary. Where a leg has been subject to multiple injections, applying a stable bandage overnight is a good precaution against swelling.

How much do nerve blocks in horses cost?

A number of nerve or joint blocks may be needed to abolish lameness, each costing £45-90 depending upon on the level of complexity (price correct as of early 2019). Once the service fee for lameness evaluation is added, plus local anaesthetic solution costs of around £12 per 10ml bottle (with 5ml being required to block a foot and 60ml for a stifle joint), costs can soon escalate.

Despite the expense and the inherent risks, diagnostic analgesia is of utmost importance in lameness diagnosis. Without obvious clinical findings, it is the only way to identify the source of pain categorically, and accurately diagnose and treat the issue.

Nerve block case study: ‘it was worth persevering’

Dutch dressage mare Peaches first attended the Bell Equine Vet Clinic in May 2016, with right forelimb lameness. Nerve blocks of the lowest parts of the limb failed to alter the lameness, but she came sound after a below-the-knee nerve block.

Subsequent ultrasound scans revealed damage to the proximal suspensory ligament, so Peaches was rehabilitated accordingly and regained soundness. Repeat ultrasound scans looked encouraging, but the lameness returned when she started full work the following spring and the ultrasound appearance seemed to have deteriorated. After trying unsuccessfully to put her in foal, her owners gave her the rest of the year off.

Last April, Peaches was reassessed to see if she would be capable of some light hacking. She remained lame on the right fore, although ultrasound scans of the proximal suspensory ligament showed no real reason for this. However, the 14.2hh mare came sound after an abaxial sesamoid nerve block — an injection of local anaesthetic above the fetlock joint. This indicated that the previous suspensory injury was not the reason for the residual lameness.

More specific blocks were then performed. Diagnostic imaging of the lower limb then enabled diagnosis of a synovial ganglion cyst (a fluid-filled lesion) of the digital flexor tendon sheath, along with mild arthropathy (joint disease) of the distal interphalangeal (coffin) joint. Once the digital flexor tendon sheath was medicated with hyaluronic acid, Peaches, now 15, regained soundness.

“It was worth persevering,” says her owner Rosemarie Lovegrove. “My daughter Bryony is now at university, so Peaches is my ‘happy hacker’, which is all we really wanted.”

First published in Horse & Hound; 14 February 2019

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Even without training, it is possible for onlookers to assess pain and lameness in ridden horses using an ethogram, research has shown.

Dr Sue Dyson, head of clinical orthopaedics at the Centre for Equine Studies at the Animal Health Trust (AHT), gave a presentation at the Saddle Research Trust conference yesterday (8 December), on her study into the application of the ethogram.

The ethogram comprises 24 behaviours more likely to be seen in lame than sound horses. The presence of eight or more is likely to reflect pain.

It was applied to footage of 21 horses by a trained analyst and 10 people who had not had specialist equine behaviour training. Results for the lame horses before and after musculoskeletal pain had been “substantially” reduced by diagnostic nerve-blocking.

It was found that although the untrained assessors generally marked a higher number of behaviours exhibited by the lame horses than the trained observer, all of them showed a “highly significant decrease in overall behaviour scores” after the diagnostic nerve-blocks.

“Encouragingly, this study shows that the ethogram can be used by both trained and non-trained assessors,” said Dr Dyson. “However, training of assessors is required for accurate interpretation of all features of the ethogram.”

Continued below…

Top vet identifies ‘naughty’ behaviours that might show your horse is lame

The latest research by Dr Sue Dyson to identify lameness through a horse’s behaviour and facial expressions has successfully completed

Is your horse in pain? New videos explain the key signs

The aim of the video series is to improve welfare and performance in ridden horses

Subscribe to Horse & Hound magazine today – and enjoy unlimited website access all year round

The fact the behaviour changes are clearly measurable after the musculoskeletal pain has been removed indicates that the ethogram is not only helpful in recognising the presence of the pain, it may also be a good tool for monitoring progress after treatment.

The ethogram was developed by Dr Dyson and her team at the AHT to help owners, trainers and vets recognise pain in ridden horses early, rather than dismissing some signs as behavioural or “just the way the horse has always gone”, and therefore not seeking veterinary advice until the problem has become worse.

For more news from the Saddle Research Trust conference, see Horse & Hound magazine, on sale Thursday 13 December

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

A bra guide for riders has been published after research found 40% of ladies suffer from breast pain when in the saddle.

The Horse Rider’s Guide to Bras has been produced by the British Equestrian Trade Association (BETA), with the British Equestrian Federation (BEF).

It is based on large-scale research by Dr Jenny Burbage, a biomechanics specialist at the University of Portsmouth, and Lorna Cameron, of Sparsholt College.

They found that 40% of 1,324 riders surveyed experienced breast pain, which was significantly related to increased cup size (news, 8 October 2015).

They also discovered that less than 35% of women wear a sports bra while riding and at least one bra-related issue was reported by 59% of participants.

“About 900,000 women in the UK ride at least once a week and many of them will experience exercise-induced pain at some time,” said BETA executive director Claire Williams.

“We thought that the study undertaken by Dr Burbage and Ms Cameron would be of great interest to both riders and retail members who stock sports and rider-specific bras in-store.”

The free six-page leaflet offers guidance on how to know if a sports bra fits correctly, and some simple checks that can be done in the changing room to quickly find out it will be suitable for riding.

It also gives details on the three common types of sports bra available — encapsulation, compression and combination — and who these are best suited to.

“This new guide should go a long way to helping riders find a bra that fits well and is beneficial in helping to keep them pain-free and comfortable,” added Ms Williams.

Related articles:

• Breast pain puts some women off riding
• Does a good bra equal good riding? Research intends to find out
• Vets use bra to save miniature pony’s eye

During the study, the researchers also found that breast pain could be stopping some women from riding.

Respondents to the survey, which they carried out between September and December 2014 placed breast pain as the fourth-greatest barrier to women riding. This was behind not having enough energy, time and work commitments.

For a copy of the guide, visit www.beta-uk.org or email Laura Clegg on laurac@beta-int.com.

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Breast pain could be stopping some women from riding, a study has found.

A total of 1,324 women responded to a survey between September and December 2014.

It found that breast pain was the fourth greatest barrier to women riding, behind not having enough energy, time and work commitments.

Forty percent of the respondents also reported having breast pain when riding.

The study was carried out by academics at Sparsholt College and the University of Portsmouth, including biomechanics specialist Dr Jenny Burbage.

Dr Burbage said they decided to research this area as they had heard a lot about it anecdotally.

“We have evidence now that breast pain is quite prevalent in the riding population,” she told H&H.

She also wants to establish the cause of pain and the biomechanics of the effect it has on riding.

The six-part, 32-question survey asked participants about their bra and bra fit, physical activity, breast pain, breast history and demographics.

Almost half of the respondents competed in affiliated regional, national or international-level events and 51% of riders were classified as being large- breasted — having a cup size of “D” or larger.

The study found that pain was “significantly related” to cup size.

The most painful activity was found to be sitting trot and 21% of participants reported that pain affected their performance.

A spokesman for the charity Women in Sport said the research is an “excellent example” of what can be done to improve the sporting experience for women and girls.

“We support any developments that provide insight aimed at unearthing and addressing participation barriers for women and girls in sport,” he said.

“Currently, around two million fewer women than men play sport on a regular basis.”

H&H reported earlier this year on research into whether there is a link between good breast support and good riding (news, 9 July 2015).

This was carried out by Sparsholt College masters student Felicity Goater and the University of Plymouth.

Ref: H&H 8 October, 2015

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Deciding if a horse is in pain is a matter of knowing what to look for.

Persistent, severe pain can cause weight loss, changes in eating and sleeping patterns and modifications in normal behaviour.

But the greatest difficulty lies in detecting mild, but persistent pain, which may occur due to long-standing conditions such as a sore back or an arthritic limb.

Signs of acute pain include:

• A pulse rate of more than one beat per second (ie 60 beats a minute)

• An increased respiratory rate

• A raised temperature

• Sweating

• Trembling

• Colic: Never forget that this is a key sign of pain

For the full article on pain management, see Horse & Hound (12 August, ’10)

Ground-breaking research into assessing pain in horses could provide vets with the first definitive protocol for assessing its severity. Work by Rachel Eager and her colleagues at the Royal (Dick) School of Veterinary Studies, Edinburgh University, should also make it easier to evaluate current analgesics (painkillers) — and in the long term, help in the development of new ones.

Rachel, a PhD student whose latest work has been funded by the ILPH, has spent four years researching equine pain assessment systems. Her project offers far more than better ways of keeping horses comfortable, though that in itself is a real benefit.

Rachel, who has also been funded by the British Equine Veterinary Association, the British Veterinary Association Animal Welfare Foundation and the Bransby Home of Rest for Horses, says that the effects of pain can have a profound effect on welfare. They may range from loss of appetite and suppression of the immune system to slower healing, prolonged recovery from surgery and even a greater risk of death.

At one time, some vets and researchers believed horses didn’t feel pain to the same extent as some other animals because they did not show the same reactions. However, that is now believed to be a survival strategy.

“The horse is a prey animal and masks or hides pain to avoid being picked off as weak,” says Rachel. “This means it is difficult to recognise pain and the changes we see may be very subtle. Owners often say that a horse is ‘not quite right’. They can perceive some change in behaviour, but can’t find an objective reason for it.”

Rachel’s preliminary work was prompted by a debate among vets suggesting that it was unnecessary to give analgesics after castration. A survey by the Edinburgh equine pain research group found that 45% did not provide analgesics in this situation and 37% provided them only occasionally.

Vets questioned for Rachel’s project cited the horse’s demeanour or changes in heart rate as indicators of pain. But as she points out, one vet’s definition may not be the same as another’s — and there was a lack of consensus about the level of pain experienced in various conditions and how to manage it.

“Effective pain management relies on good recognition of pain, but there’s no universally accepted and tested model of assessing it and little scientific evidence,” she says.

She set out to provide both, using clinical research on horses undergoing surgery, and post-operative and laminitis cases. All the horses’ owners gave permission for the non-invasive work, no pain was induced by the research and analgesics were given in line with standard practice. Because hospitalisation could be a factor itself, she also looked at its effect on normal, pain-free horses.

Rachel used hi-tech equipment and a range of techniques, including continuous behavioural assessment, human interactive testing, heart rate monitoring and heart rate variability analysis.

Continuous assessment via CCTV cameras allowed Rachel to investigate horses’ “activity budgets”. This included changes in their position, time spent feeding and in exploratory behaviour, restlessness and head position, as well as stamping, weight-shifting and lifting limbs.

An observer outside the stable recorded subtle changes such as ear position and lip tension. Information also came from human interactive testing: the horse’s reactions were noted when an assistant approached it, placed a hand on its neck and applied consistent light pressure down towards the girth.

Heart rate variability analysis carried out with the Animal Health Trust recorded changes in the regularity of beats. Although we talk about horses having an average number of beats per minute, it is now recognised that in a healthy animal there are constant subtle changes.

“It is thought that high variability is a sign of health and adaptability, whereas reduced variability indicates physiological and psychological stress,” says Rachel.

Early results from the project show that horses in pain behave differently from normal horses. Horses who had been castrated standing up, under sedation, stamped “significantly more” in the first 6hr after surgery than those used as a control group. They also shifted their weight more.

Ponies with laminitis spent less time resting a hind limb than normal horses. This is interesting because it is a reduction in the normal behaviour that a clinically sound horse would perform frequently; the laminitic ponies also lifted their forelimbs more frequently than the control animals.

So what practical implications does this have — for vets and horse owners? Rachel, who hopes to continue the research, says that one of the main aims was to develop a “multi-dimensional pain assessment system”. She believes that if this were used as standard, it would be an important tool for assessing the effectiveness of analgesics and would also help vets find the best way of managing pain medically.

“In a hospital situation especially, vets may only see horses for a very short time,” she points out. “If you had a more objective system it could be used not just by vets but also by trained veterinary nurses.”

In the future, it could also help in the evaluation of new analgesics.

“No one has really known how to assess pain, so when you come to assess a new analgesic regime or drug, how do you assess if one is better than another?” she asks.

Vet Richard Payne from Rossdale and Partners says that Rachel’s research will provide a valuable baseline for objective pain assessment. However, he adds that it is important to remember that horses, like people, are individuals.

“If you perform the same operation on 10 people, three might be crying with pain the day after, two might say they experience pain but to a lesser extent, four might talk of discomfort and one might be out jogging!” he says.

“Similarly, you can get Thoroughbreds who think they’re dying when they get a twinge of colic, but stoic Shires or cob types show little sign of pain even when they are in a disastrous state internally.

“Pain assessment has always been a subjective thing, but if this leads to interpretation that is objective rather than subjective, it will be very helpful.”

This veterinary feature was first published in Horse & Hound (31 March, ’05)

A horse’s natural response to fear or pain also involves the release of a number of hormones into the blood, such as adrenaline, corticosteroids and endorphins.

These are all naturally occurring painkillers and do give the animal some relief, albeit temporary. The response also causes a very high heart rate, and the horsemay tremble and sweat.

A horse with acute severe colic, which rolls so violently it injures itself elsewhere, and seems to be unaware of these new injuries, provides a dramatic example of a violent response to pain.

Another example of the horse’s hormonal response temporarily anaesthetising the effects of pain is a horse severely injuring its leg in a race but keeping going. It doesn’t start to show the signs of pain (trembling, sweating and a refusal to take weight on the leg) until it has pulled up.

In these cases, there is little doubt that the animal is in severe pain, and the site of damage is usually (but not always) obvious.

If the painful area is more generalised, deciding what actually hurts becomes more difficult, as the horse can no longer, easily, “favour” the damaged site.

Examples include acute laminitis and muscle damage caused by azoturia; in both these cases the only protective mechanism is for the horse to remain still, or even lie down.

The signs of pain

The objective signs of elevated pulse rates, trembling and sweating, will be present, although they are indicative of “shock” as well as of pain.

The degree of response does not necessarily correspond to the degree of tissue damage or pain, and a violent reaction may be successful in removing the cause.

Horses also react violently in anticipation of pain. Most vets encounter horses that have undergone a lot of treatment previously and have become ‘needle shy’.

When the horse has been in pain for a long time (chronic pain), it no longer responds violently, and it becomes much more difficult for people (ownersor vets) to assess the real degree of suffering.

By this stage, there are no objective signs; heart rates are normal and the horse does not sweat. He will try to reduce pain by his stance; for example favouring a painful limb, or “goingshort”, with his head raised and ears back, if both forelimbs are affected.

Often, chronic pain is the result of arthritic lesions in a number of different sites, and it is impossible for the horse to favour all.

One of the best methods of judging the degree of pain is the response of a horse to painkillers such as ‘bute’, or its modern counterparts.

Where applicable, a vet may also use nerve and joint blocks with local anaesthetics to pinpoint the site of pain.

How horses respond to pain

• A horse’s hormonal response to sudden acute pain shows itself as an increased heart rate, trembling, sweating and, if possible, flight.
• Repeated infliction of pain (eg, ‘needle fear’) will provoke a ‘fight’ response.
• The degree of response does not necessarily correspond to the degree of tissue damage or pain.
• Certain physiological problems cause a horse to assume a typical pain attitude – for example the typical stance of an acute laminitic to relieve the pain in his feet.
• Chronic pain will cause a horse to favour the area of pain and make its cause harder to detect.
• Evidence of acute pain is a signal to call your vet immediately.
• Horses in shock from pain caused by illness or injury should be kept warm and as tranquil as possible. Don’t add to his distress by panicking.
• Never be tempted to give your horse that odd sachet ofbute you have in the tack room. It will mask the symptoms and make veterinary diagnosis more difficult.
• Long-term pain has a ‘wind up’ effect, making a horse more pain sensitive.
• While horses don’t smile or frown as we do, we can learn to recognise signs of physical unease or distress, both when we ride and in the stable.
• Individual horses, like individual people, have different levels of tolerance to pain.

Readmore veterinary advice:

• All about kick injuries
• Understanding azoturia
• All about colic

Animals often do not show clear signs of being in pain, so their discomfort may go unnoticed, particularly in the early stages.

However, it is important to be careful in administering painkillers (analgesics), as some drugs in large doses can conceal or disguise pain, so that the danger signal is ignored and further damage is done.

Types of pain

In the horse, the two predominant types of pain are:

Musculoskeletal or somatic pain: soma is Greek for body and this type of pain can be divided into superficial somatic pain affecting the skin and deep somatic pain involving the muscles and skeleton, but, overall, it is pain on the outside of the body.

Visceral pain: viscera is Latin for the organs of the body cavity.

This refers to pain from the internal organs. With the horse, we tend to think of colic, but there are other types of visceral pain, such as pleuritis, which means inflammation of the chest cavity linings.

This can be incredibly painful in horses to the extent that they will refuse to move. It may be confused with laminitis, which is somatic pain due to inflammation of the laminae within the horse’s feet.

Acute v chronic

There are differences in pain related to the duration of discomfort.

The distinction between acute (sudden, sharp) pain and chronic (long-lasting, particularly for days) pain means that there are fundamental differences in the processing of these types of pain by the central nervous system.

Tolerance levels

Individual horses vary in their tolerance of pain, but horses generally are a lot less tolerant of pain than other animals. Abdominal pain in the horse is usually obvious as colic, while a cow may show minimal discomfort.

Many older horses show less clear responses to abdominal pain thanyounger ones. Colic signs in the older horse can be confusing and they may be in more pain than they appear on first examination.

Identifying pain

Pain-induced poor performance is apparent in a variety of signs, including:

• Swishing the tail, ears held flat back, grinding teeth and tossing head
• Inability to round the back and/or neck
• Being slow out of a starting gate
• Rushing fences and refusing to jump
• Intermittent subtle lameness.

Loss of appetite can be an excellent indication that a horse is unwell. However, in some fit competition horses their reluctance to eat may be related to their peak of fitness and not a sign of pain.

It is important to know andunderstand the horse in your care so you pick up pain problems early on.

Painkillers

Pain relief is best administered as early as possible before pain takes hold.

Good nursing is important. It is well recognised that a horse with a leg injury will be helped by a good support bandage to stabilise the injury, plus a decent haynet to distract him, as well as the drugs given by the vet.

Careful observation is vital. A horse cannot tell you where he hurts, but, equally, he can give good clues as to what is wrong.

Recognising the signs

• Restlessness
• Sweating
• Increased pulse
• Increased respiratory rate
• Lying down more than usual