EQUINE VETERINARY EDUCATION Equine vet. Educ. (2022) 34 (2) 103-112 doi: 10.1111/eve.13400
Review Article
Performance and rideability issues in horses as a manifestation of pain: A review of differential diagnosis and diagnostic approach
L. N. R. Kjærulff and C. Lindegaard* Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark *Corresponding author email:
casper.lindegaard@
sund.ku.dk
Keywords: horse; pain; poor performance; rideability issues; differential diagnosis; diagnostic approach
Summary Nonspecific performance and rideability issues are more likely a manifestation of pain in the ridden horse rather than a true behavioural problem. A systematic and thorough investigation focusing on the potential presence of pain- related conditions is thus crucial in horses with such complaints. It can, however, be challenging to determine whether the complaint is indeed related to pain, where the pain is located, and what the underlying cause is. This review describes the challenges of pain recognition in ridden horses and summarises the recently developed ridden horse ethograms that might enable pain to be assessed in an objective, valid and reliable way. Furthermore, the differential diagnosis and diagnostic approach to horses presenting potentially pain-related performance and rideability issues are discussed.
Introduction
In recent years, societal concern about animal welfare has increased, and one frequently discussed topic in the animal welfare debate is the welfare of the ridden horse. Addressing this contentious issue, the International Federation for Equestrian Sports (FEI) has produced a code of conduct for the welfare of the horse that requires all stakeholders to ’acknowledge and accept that at all times the welfare of the horse must be paramount’ and that the ’welfare of the horse must never be subordinated to competitive or commercial influences’ (F
ed eration Equestre Internationale
2020). The competition in modern equestrian sports is hard, and for horse and rider to succeed, it requires that both rider and horse perform to the best of their ability. Combined with an increased focus on equine welfare from all stakeholders, even subtle changes in performance and behaviour are often recognised and investigated. Performance and rideability issues are thus common presenting complaints in equine practice, and the types of clinical problems that may be encountered include poor performance, subtle lameness, alteration in gait, stiffness, bucking, rearing, unwillingness to work, and/or otherwise resistant or evasive behaviour (Dyson 2010a, 2016a). All of these types of ridden behaviours may be expressions of pain but are unfortunately sometimes ascribed to the horse being ‘bad-tempered’ (Jonckheer-Sheehy et al. 2012; Hall et al. 2013; Dyson et al. 2018a). However, most horses have a compliant demeanour, leaving only a very small minority of cases to be attributed to a genuine behavioural issue. This emphasises the importance of recognising and investigating all behavioural and
performance issues as potential manifestations of pain. The diagnostic investigation can be challenging since the clinical manifestations are often nonspecific and include a broad list of differential diagnoses. The differential diagnosis can be largely divided into conditions causing either musculoskeletal pain, oral pain or visceral pain. The standard diagnostic work- up should always include a thorough medical history and a complete physical examination, which, depending on the clinical presentation, may be followed by an orthopaedic examination, oral examination and/or various diagnostic tests (Dyson 2010a, 2016a, 2016b; Davidson 2015). Cases that remain undiagnosed after a standard work-up should be subjected to further examination focusing on the potential presence of visceral pain associated with various types of internal medical issues (Lindegaard et al. 2009). Establishing whether the complaint is indeed pain-related might prove particularly challenging, and the work-up may call for alternative methods and tools for such investigations. The present review aims to describe objective means of
identifying behavioural signs indicative of pain in ridden horses and to discuss potential diagnoses and the diagnostic approach to horses with performance or rideability issues suspected to be related to pain.
Recognition of pain in ridden horses
Pain negatively influences the quality of equine performance and rideability, and impairs the welfare of the ridden horse. Thus, it is of great importance for all stakeholders in the equestrian businesses that equine pain is identified and managed appropriately. The first step towards successful alleviation of pain is the recognition of its presence, which, however, might pose a significant challenge (Gleerup et al. 2015; Gleerup and Lindegaard 2016). The recognition of pain in prey animals, such as the horse,
is complicated by the behavioural evolution of prey species to suppress expressions of pain as a survival strategy (Hall et al. 2013). Furthermore, the assessment of pain in horses is confounded by the subjective nature of pain resulting in many different manifestations of pain. These challenges contribute substantially to human error when assessing equine pain and increase the risk of equine pain going unnoticed. For instance, subtle performance and behavioural changes in ridden horses are not always recognised by the owners, riders or trainers as a potential manifestation of pain, but may instead be ascribed to either riding or training problems or the horse being ‘bad-tempered’ (Jonckheer-Sheehy et al. 2012; Hall et al. 2013; Greve and Dyson 2014; Dyson
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