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welfare. Recognition of pain in ridden horses can be challenging, but the quickly evolving field of equitation science holds great promise for facilitating pain recognition by means of recently developed ethograms (Hall et al. 2013; Dyson et al. 2018a). When pain is suspected as the underlying cause of nonspecific performance or rideability issues, the further investigation requires consideration of various possible musculoskeletal, oral and visceral pain conditions. While many underlying pathologic conditions may be relatively straightforward to diagnose when paying careful attention to the history and following a systematic diagnostic plan, there also exist cases that remain undiagnosed after a standard work-up. These cases require that the clinician carefully combines the information retrieved from the history, the understanding of the specific demands of the relevant discipline, and what that specific horse cannot or will not do with a deep knowledge of anatomy and biomechanics in order to imagine which anatomical areas and pathologic processes might be involved. We believe that many causes of pain and poor performance described in humans may also exist in horses. Therefore, successful diagnosis in difficult cases with rare aetiologies requires that the clinician is open- minded to new and unconventional diagnostic approaches while still adhering to a systematic diagnostic approach focusing on ruling out the most common aetiologies before considering more rare ones. We hope that this review will provide useful inputs to the, at times, complex challenges associated with the interpretation and investigation of performance and rideability issues in horses.


Authors’ declaration of interests No conflicts of interest have been declared.


Ethical animal research Ethical review not applicable for this review article.


Sources of funding None.


Authorship


Both authors framed and planned the layout of the review. L.N.R. Kjærulff prepared the first draft of the majority of the


review, and C. Lindegaard corrected and gave input for its final version. Both authors have reviewed and approved the final version of the manuscript for submission to Equine Veterinary Education.


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