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and Greve 2016; Dyson et al. 2018a). When pain is neglected as a possible cause for why the horse resists commands or does not perform according to expectations, the horse risks being coerced to perform through more intense or punitive training measures (Jonckheer-Sheehy et al. 2012; Dyson et al. 2018a). Furthermore, when the presence of pain long predates its recognition, it entails the failure of timely initiation of appropriate treatment and thus potential deterioration of the underlying problem (Mullard et al. 2017). In order to protect the welfare of the ridden horse, education of the equestrian population to recognise and acknowledge signs of equine pain, and respond to these signs appropriately, is required. An increased focus on animal welfare has engendered
much effort to be invested in the field of objective pain assessment in horses. In furtherance of valid and reliable pain assessment tools, several facial expression ethograms (Dalla Costa et al. 2014; Gleerup et al. 2015; van Loon and van Dierendonck 2015) and composite face and body ethograms (Bussi
eres et al. 2008; Graubner et al. 2011; van
Loon and van Dierendonck 2015; Gleerup and Lindegaard 2016) have been developed to make pain evaluation in stabled/nonridden horses with various painful conditions as objective and consistent as possible. There is, however, increasing awareness that pain in some cases is only evident during ridden exercise, highlighting the importance of a ridden evaluation during the diagnostic work-up of horses with a suspected pain-related problem. Especially, musculoskeletal pain has been specifically linked to ridden work, as it has often been reported that horses can exhibit lameness or other gait abnormalities when ridden while appearing sound during movement in hand (Dyson and Greve 2016; Dyson 2016a, 2017; Dyson et al. 2018a). Other types of pain (e.g. oral pain or visceral pain) could, however, also sometimes be exacerbated by ridden work and thus be less apparent in the stabled/nonridden horse (Christoffersen et al. 2007; Pehkonen et al. 2019). That being said, the assessment should still include an evaluation of the potential implications of behavioural events outside of the ridden work; chronic pain could, for instance, be expressed as resentment of being tacked up (Dyson 2016a) or as aggression towards humans (Fureix et al. 2010). Assessment of pain in ridden horses is complicated by the diversity of pain manifestations related to the underlying clinical problem, the horse’s temperament and subjective perception of pain, and discipline in which the horse is used (Dyson 2016a). Furthermore, the accuracy of the subjective assessment of pain in ridden horses is limited since it is prone to experiential bias. Equine veterinarians that are unexperienced and/or have had little training in assessing pain-related behaviour in ridden horses might fail to recognise pain as a cause of performance and rideability issues. Thus, there is a need for an evidence-based understanding of how pain in the ridden horse can be assessed in a valid and reliable way. Recent studies have developed and applied ethograms that could be used to facilitate identification of pain in ridden horses (Hall et al. 2013; Dyson et al. 2017; Mullard et al. 2017; Dyson et al. 2018a, 2018b). The composite ethogram developed by Hall et al. (2013) describes behavioural features of general pain and pain originating from specific locations that may be expressed in ridden horses (Table 1). In continuation hereof, Dyson et al. (2018a) developed the ridden horse ethogram that is specifically related to musculoskeletal pain and
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TABLE 1: Behavioural features of different types of pain in ridden horses (adapted from Hall et al. 2013)
Pain type Behavioural features
General pain Restlessness, agitation, rigid stance, reluctance to move, fixed stare, dilated nostrils, clenched jaw
Abdominal pain Vocalisation (deep groaning), kicking at abdomen, flank watching, stretching, dullness, depression
Orthopaedic pain
Head and dental pain
Weight shifting between limbs, limb guarding, abnormal weight distribution, rotating limbs and abnormal movement, reluctance to move
Head-shaking, abnormal behaviour in response to wearing a bit, tilted head carriage
includes an adaptation of the facial expression of ridden horse (FEReq) ethogram (Dyson et al. 2017; Mullard et al. 2017) together with further features of general body language and behaviour while ridden (Table 2). Providing further validation of the ridden horse ethogram, its application was able to differentiate between lame horses before and after diagnostic analgesia and nonlame and lame horses, although there were some overlap and marked diversity among lame horses in the occurrence of behavioural features (Dyson et al. 2018b). Furthermore, a new study by Dyson et al. (2019) tested the inter-observer reliability of the ridden horse ethogram and confirmed that veterinarians can, with appropriate training, apply the ethogram with consistency to differentiate between nonlame and most lame horses. These studies accentuate that the application of an ethogram may improve the accuracy of pain assessments in ridden horses by providing veterinarians with a valuable tool for the identification of pain in horses presented with performance or rideability issues, and in turn help them to communicate a potential pain problem in the horse more effectively to their clients. Ultimately, this could help lead to an increased understanding among the equestrian population of signs of pain in the ridden horse which would undoubtedly improve the welfare of many horses.
Pain-related causes for performance and rideability issues
Poor performance and other rideability issues can be caused by a myriad of different clinical pain conditions, which can largely be divided into three groups: musculoskeletal pain, oral pain and visceral pain (Jeffcott 1980; Jeffcott et al. 1982; Dyson 2002, 2009, 2016a; Christoffersen et al. 2007; Franklin et al. 2008; Girodroux et al. 2009; Lindegaard et al. 2009; Anthony et al. 2010; Jonckheer-Sheehy et al. 2012; Barstow and Dyson 2015). Thus, it is necessary to consider a rather broad and disparate range of differential diagnoses, especially when presenting complaints are nonspecific and subtle (Table 3). The most common cause of performance loss or riding
problems in equestrian activities is musculoskeletal problems causing lameness or pain originating from the vertebral column (Jeffcott 1980, 1982; Gaughan 1996; Dyson and Murray 2003; Girodroux et al. 2009; Jonckheer-Sheehy
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