equine bodywork

Hiring an Equine Chiropractor: 10 Crucial Questions You Need to Ask

June 28, 2025 by Jane @ THB Leave a Comment

When you’re hiring an equine chiropractor, it’s really important to ask some questions first. And I don’t mean just the usual ‘what do you charge’ and ‘do you work on Saturdays’, although you can obviously ask those too.

You see, there are chiros and then there are chiros. One group consists of equine chiropractors who are genuinely qualified and skilled, while the other includes chiropractors who are not.

Unfortunately, when it comes to hiring a correctly trained chiropractor, word of mouth recommendation isn’t always enough. (I look at some of the issues in an earlier post, Why Do Horse Owners Keep Hiring Unqualified Equine Chiros?)

And unfortunately, it’s often hard for horse owners to ask the right questions of professionals, because the fact is that many of us don’t know enough to know what to ask.

Why does this matter?

Equine chiropractic is one that’s called an invasive approach. This means it frequently involves the use of high pressure to get results (here’s a good university overview).

And the thing with approaches that use high pressure is that everything is fine – until it isn’t. That one mistake can be catastrophic, because a high-pressure move was applied in the wrong place or at the wrong time on a particular horse. This is very well expressed in this article by a veterinarian.

Note that some non-chiro equine vets are sceptical about the benefits of chiropractic. Some of this comes down to different uses of the word ‘subluxation’ – if you’re interested, holistic vet Dr Madalyn Ward DVM explains this aspect very well.

Questions you can ask a horse chiropractor

The following 10 questions may be helpful if you’re thinking of hiring an equine chiropractor.

Some of the answers may be on their website, so do take a look. If there’s no website, ask when you speak to them.

A qualified professional will not mind being asked at all, although do remember they may be busy. But with non-vet chiros, I’d count an irritated response to being asked as a potential red flag 🚩

By the way, if you’re thinking of hiring a chiropractor who’s a veterinarian, then you can be reassured that there’s a high level of professional regulation in place. This protects your horse and you as a customer. This also applies if you live in a region where all equine therapists are heavily regulated. In such cases, you may not need to ask more questions at all.

Otherwise, here’s where you can start.

1. “What is your qualification?”

The answer to this does not always tell the whole story, but is definitely a good starting point. You’ll most likely find it on the website.

It’s not always true that big qualifications make good practitioners. However, when it comes to invasive practices – i.e. those that use a higher level of pressure, meaning moves will have an impact, come what may – solid qualifications are essential. No qualification is a cause for concern 🚩

2. “Where did you train?”

It follows that their qualification needs to come from a reputable training organisation. Find out the answer (it’s likely to be on the website), and then look it up. Is it accredited? Does it come with approvals from regulatory bodies? If not, 🚩

3. “Does your work involve pressure?”

This follow-up question might relate to the practitioner’s understanding of their work and its effect. This is a roundabout way of identifying the possible use of high pressure or force – read this post about Unqualified Equine Chiros for more on this.

If the question can’t be answered, the chiropractor may not even understand what it means, or why it’s important. And if they don’t the answer, how much are they thinking about your horse’s experience of their work? Red flag alert🚩

4. “How exactly do you get results?”

Again, if joints are simply being pushed and pulled, or if the practitioner learned just by watching someone else, this question may be tricky to answer 🚩

On the other hand, if the chiropractor answers articulately, you may not understand what they are on about – anatomy and physiology can certainly be hard to dip into. If you’re not clear, try a follow-up question.

5. “Is there somewhere I can read about that?”

This is a follow-up question if you’re feeling bamboozled by science. Every practitioner should be able to point to a source of information, somewhere, or offer to send a link through later. A vet may be busy, but they’ll at least mention their professional association’s website. Other qualified professionals will appreciate their customers being interested.

If you’re brushed off or the subject gets changed, take note 🚩

6. “Will you be able to tell me what’s wrong with my horse?”

This question is a bit of a bear trap. Diagnosing is telling you specifically what a condition is and trained professionals should know that only a vet can diagnose. So, if a non-vet chiropractor answers ‘yes’, you may have a red flag answer 🚩

7. “Does your approach always work?”

The answer should be that there’s never a guarantee, that some conditions can’t be helped (although the secondary effects can), that veterinary diagnosis and/or intervention may be required, or that not every approach works best for every horse.

If the practitioner says yes, they are either wearing rose-tinted glasses, don’t know as much as they should do, or are over-selling what they do 🚩

8. “How do horses respond to your work?”

If you care about the experience your horse is being lined up for, this is an important one to ask. “They like it” is not an adequate answer 🚩 You definitely need to hear a bit more about what happens with the horse after the session and what you can expect.

9. “Are you insured?”

This one can elicit an interesting answer, given that association membership and up-to-date qualifications are usually required for chiropractic due to its invasive nature (regulations vary by country and region).

I’d recommend that you NEVER hire a chiro who isn’t insured 🚩

10. “How many sessions do you recommend – and why?”

If you hear that all will be sorted out in one session, do not believe them 🚩 If they suggest that your horse should be treated every time they visit the area, hide your horse and padlock your wallet 🚩🚩

To sum up…

Now I realise that not every practitioner is super-articulate. In any group of professionals, there are those who speak well and those who are more introverted.

Hopefully, the information you’re looking for will be readily available on a website if not in conversation.

Yet as with any group of professionals, even with all questions answered positively, there’s no guarantee of high-level skills or ability – or sensitivity to your horses’ responses.

But you will be dramatically lowering the chance of hiring a poorly trained and less knowledgeable chiropractor who could be unwittingly putting your horse at risk.

Why Do Horse Owners Keep Hiring Unqualified Equine Chiros?

November 14, 2024 by Jane @ THB 2 Comments

Let’s take a moment to talk about unqualified equine chiropractors.

I’m not talking about veterinary chiropractors, or those who’ve trained with well-regarded institutes. These are professionals who approach a horse with a safe pair of hands and a head full of knowledge.

I’m talking about the ones we could loosely call the whackers and crackers. The ones who lean right in when they’re pushing, and who lean right back when they’re pulling – because that’s how you adjust a great big ol’ horse.

These are the guys – and the majority are male – who do the endless rounds of repeat visits, adjusting the same horses over and over.

And who often deliver on-the-spot diagnoses, despite never having had a day’s veterinary training in their life.

Note: This is the first of two posts. Once you’ve read this, take a look at Hiring an Equine Chiropractor: 10 Crucial Questions You Need to Ask

Right, but my chiro is great

Of course, many people will say yes, they know there are bad chiros out there, but their chiro is great and really helps their horse, so what’s the problem?

The problem is this. When everything’s going right and all is well, the problem won’t be seen. Yet when a mistake is made, the outcome can be disastrous.

This is because chiropractors perform moves that can be invasive. This means that a result is achieved by applying a direct physical pressure that the horse’s body can’t resist or avoid.

Let’s look at how that plays out in practice.

The nature of the chiropractic move

1. Untrained chiropractors

The moves unqualified chiropractors perform are what is called high velocity, non-specific joint adjustments, and they’re usually made with long lever techniques. For example, a leg is moved at high speed to address a series of vertebral joints, or a number of joints in the leg.

These moves may take joints beyond, just beyond or even well beyond their usual range of motion. It all varies according to the level of skill involved. The joints may have different limitations, but the individual assessment isn’t always there.

2. Qualified chiropractors

A highly trained chiropractor who is a vet or who has an accredited qualification performs specific, high velocity and low amplitude (HVLA) adjustments. Here’s one definition of HVLA: it’s “a rapid use of force over a short duration, distance, and/or rotational area within the anatomical range of motion of a joint to engage the restrictive barrier in one or more planes of motion to elicit the release of restriction.” (LaPelusa, 2023.)

Note the word ‘anatomical’ – this is where a healthy joint should be able to move. This is different to the physiological range of motion, which is where a joint is currently able to move, given the issues that might be limiting it.

Why high-level training is important

Sounds complicated? Well, that’s because it is – and so it should be.

When it comes to chiropractic adjustments, the specific location and angle needs to be spot on, as if performed incorrectly, they can cause damage.

If you’re going to go past the physiological to reach the anatomical range of motion, then you need to know exactly where each of those is. You also need to understand the tissue structures and issues that might be limiting the joint’s movement.

Based on that information, there are times when a move shouldn’t be performed at all.

A qualified chiropractor knows exactly where and what the locations and angles are, and understands the tissue damage, conditions and restrictions that mean a move shouldn’t be made (called ‘contraindications’). This involves nerve function as well.

The unqualified chiros, not so much.

This is not something you can just pick up as you go along, because you’ve always been around horses, or heard about it from some bloke you used to work with at the racing stables.

Because get it wrong and force a joint too far at the wrong time, and matters can go south very quickly indeed. The consequences can be minor, but equally they can be disastrous.

It’s a risk many people hiring equine chiropractors don’t even know is there.

10 reasons why unqualified chiros get hired

Let’s be aware of what influences our decisions, including those to hire unqualified chiros. (And I’ll own here that I’ve been impressed by the wrong people at times in the past, so I’ve no intention to judge people who are trying their best.)

So, understanding that many people just want to help their horse, here’s the good, the bad and the ugly of this owner decision.

1. The word-of-mouth recommendation is shaky

A friend mentions a name and describes an experience that sounds positive. However, what if they don’t know quite as much as they appear to know?

2. The practitioner has an innate air of authority

A lot of these chiros are used to walking up to racehorses with a manner that demands obedience and stops any trouble before it starts. It sure works, but confident body language doesn’t only work on horses, it convinces people too.

3. Male horse people often prefer male practitioners

A percentage of men do prefer other men to do the job, and view cracking the horse’s body as a practical, fuss-free approach they can relate to. Not all men, of course, but plenty of them.

4. It’s seen as a physical job that requires a man

This is the belief that the work requires strength, for instance when lifting a solid back leg up without getting kicked. For those who believe it should be done this way, it can follow that a muscled bloke is preferrable. To a horse owner who believes big horse bodies need to be pushed or pulled into alignment because, well, they’re big, then this sure looks impressive.

5. Men are still seen by many as experts

Sadly, many horse owners, many of whom are female, still seem to believe that an expert man is more expert than an expert woman. I find the chiro’s words are often repeated with such reverence that you’d think he was up there alongside the equine vet. Please women, let’s change this mindset!

6. Some vets still support these chiros

It’s true. Inexplicably, some vets still informally refer to these practitioners who are 100% qualification-free and never do any update training, and even deliver quasi-diagnoses. Meanwhile, an unsuspecting owner absolutely trusts their vet – who would blame them?

7. The cracks are impressive

That noise. As we know, it’s carbon dioxide gas bubbles escaping the synovial fluid as a joint moves (‘cavitation’), or a ligament or tendon moving suddenly over bone. Yet for the uninformed owner, both of these are the sound of a joint going ‘back in’ and a problem being resolved.

8. This method does the job and it’s quick

Yes, but so is tying a loose tooth to a door handle and then slamming the door. Does that make it the best or the right intervention, especially when it comes with risks?

9. It’s cheap

This is naturally seen as a good thing, and for anyone on a tight budget, it is. However, most chiropractors who’ve spent years in expensive education and training can’t afford to give their work away.

10. There’s nobody else in the area

I understand. Honestly.

So, what can horse owners do?

When choosing an approach, use imagination and engage empathy to think about how you would like your body to be handled.

Next, asking questions before engaging or hiring a professional is a good way to start assessing the level of training and professionalism in the chiro you’re hiring.

Checking the person’s website and checking professional association lists can go some way towards getting answers – once you know what questions you need answering.

That’s why I’ve written this additional post that should help: Hiring a Horse Chiropractor: 10 Crucial Questions You Need to Ask

Note: The images in this post were all sourced in the public domain on social media and third party websites.

How to Create Better Before And After Photos of Horses (and Spot Misleading Ones)

February 22, 2024 by Jane @ THB 3 Comments

Bodyworkers love before and after photos. Done correctly, they can show great results of our work, making them powerful promotional tools.

Equally, if done incorrectly, they may say something rather different to what we want. In fact, there are many ways to leave areas of doubt and raise viewer questions. That’s why I rarely use them anymore.

To help you avoid some of the pitfalls, here are some pointers for making your before and after bodywork photos more effective.

1. Make sure the horse is standing relaxed and in the same position

It sounds obvious, but so many people get this wrong.

In some photos, the horse is actually doing different things, or looks as if it has just paused during eating, stepping forward, looking into the distance, etc.

All of these things can change its posture, just as post-bodywork relaxation can. This is not comparing like with like.

The horse needs to be standing in a settled state. Standing square if possible, or otherwise in its default ‘parked’ position.

Either way, all four feet need to be on the ground, even if standing square isn’t possible.

Example 1: When the horse can’t stand comfortably

This OTTB was unable to stand without resting a hindlimb due to his sacroiliac and lumbosacral issues.

While this is part of his problem, and the owner and I knew that, nobody looking at the photos can be expected to know it. He looks like he’s just having a rest. If it’s not self-evident, it’s not worth using.

*OTTB with hoof imbalance (negative plantar angles) and sacroiliac issues. Without appropriate hoofcare over time, his problems would simply persist. (c) thehorsesback.com*

2. Use the same lens angle

This must be the second biggest error in before and after photos: One photo is taken with the lens angled slightly downwards, while the other is more level. This can unintentionally change how the horse’s outline looks.

Here’s how you can tell.

First, look at how the lens is positioned for good square-on conformational photos. It’s usually somewhere on the girthline, pointing horizontally around halfway up the horse’s body.
Now create an imaginary tracking line running in front of and behind each front hoof.
The distance between these lines should be roughly the same in both photo (when the horse is standing fairly straight).
If there’s a wider space in one photo, then the lens is probably angled downwards.
To compare like with like, the distance needs to be the same in both.

The distance between imaginary tracking lines can help show whether the lens angle is the same, or close to it. The horse is standing slightly wider in the first image, but the distances are still similar.

3. Ensure the lighting direction is the same

This is simple to achieve, but so many people get it wrong.

Changes in lighting can highlight or obscure ribs, bony landmarks, tight muscles, you name it. There can be numerous changes to what we’re seeing.

Yet in some photos, the horse is in a different location, it’s a different time of day, or even indoors in one photo, and outdoors in the other.

To get a true and fair representation of the improvements, ensure the set up is close to identical in each photo, so that lighting changes don’t create a false impression.

Your great results need to shine on their own.

Example 2: Poor set up

These age-old, low res photos from my files were only taken as records over 15 years ago. Afterwards, I certainly wished I’d organised the taking of them better.

Taken at the start of session 1 and session 3, they show a change in coat colour. However, the passage of time and his weight gain can also account for this…

*This TB had old fence injuries to the hindlimbs and lumbosacral issues. (c)thehorsesback.com*

In this age of Canva, it’s not worth trying to explain changes that can come with other explanations.

4. Take photos in the same season

All too often we see a before photo taken in winter, and an after photo taken in summer.

So guess what? The horse looks worse when it has a long, dull winter coat.

And it looks vastly improved in the summer, when it has a short, gleaming coat. Even more, it has a bellyful of tucker.

It’s better to avoid such a major difference, as it again only serves to obscure your great results.

Example 3: When it’s OK to break the rules

The following photos of the paint horse were originally intended for my personal records.

Shortcomings are clear: the horse is facing a different way; one photo is not fully square-on; horse is looking at camera; standing in a different location in the yard.

The strengths are big ones: same lens height and angle; lighting similar.

As this is about posture and not muscle development, the changes are unmissable. I gave credit to hoof balance improvement as well as bodywork.

I would never plan to do a before and after in this way – if this horse’s changes had been minor, the photos wouldn’t have worked at all.

5. Include the legs!

It’s very common to see before-and-after photos showing only the horse’s back from a side-on view, or only the hindquarters from the rear.

This is to leave rather a lot of relevant information out of the image.

Why? Because without the limbs and/or head and neck in the image, your viewer can’t assess the horse’s posture.

Instead, they’re asking themselves questions such as: Is the horse standing square? Is it standing under or camped out? Is it angled away from the camera?

Most importantly, the simple matter of foot placement affects how the back and hindquarters appear in your two photos.

*A close up image removes all the reference points that help viewers to understand what the image is supposed to show.*

The exception is the overhead view down the back, as the legs obviously can’t be seen. In these cases, including the head and neck is helpful, as it says a lot about posture.

Example 4: Including extra information

Here are the full images of the WB used in the header for this post.

Both pics were taken in the same spot, but at different hours of the day. I couldn’t alter that, but it did mean that the sunlight was different and this accentuates the shoulder imbalance in the first picture.

What is important is that a lot is included in the images. This allows us to reference that the hindquarters are square-on and the head and neck position close to the same height.

I always explain that that the owner was also doing in-hand training with the horse, and had instigated hoofcare improvements.

6. Select the same stage in the session

You are not comparing like with like if your before photo is taken at the start of a session, and the after photo is taken at the end of a session. You may indeed be showing a valid change in the horse, BUT…

Many therapeutic approaches have a pain-relieving effect, which is often temporary. Posture can temporarily improve.

Once the effect wears off, the horse returns to experiencing the uncomfortable effects of its pathologies again. At this point, all the improvements may cease to be visible.

It’s a bit like taking a photo when the horse is on pain relief, and saying ‘here, look at this great change’.

A more valid comparison is to show the horse at the beginning of session one and then at the START of a later session.

This shows how the improvement has held once the horse returned to its regular routine.

Example 5: When a sequence works better

This Arabian was experiencing lumbosacral pain. As with the OTTB earlier, this caused him to constantly rest a hindlimb.

*A sequence of photos throughout a session can create an engaging story that is interesting in its own right. (c) thehorsesback.com*

A straightforward before and after would have been unconvincing.

On the other hand, a sequence of photos (we have both walks and short breaks during a session) shows him adjusting his posture. This reflects my focus on the day.

7. Tell the whole story

Ahh, now here’s one that many people overlook when putting together before and after photos.

What was the horse doing the day before, or the day before that, or earlier the same day for that matter?

What else has been happening to the horse between visits that may have made a difference?

If the horse had completed a demanding event just before the first photo, then it’s possible that physical tiredness came into play.

If the horse has had rehabilitation in the form of hoofcare, new training or exercise protocols, a change of saddle, etc, between your visits, then that needs to be mentioned.

Hint: veterinary care is also important!

*An old, low res image of an Arabian I worked on with fractured withers. The change in shoulder symmetry was due to work on the cervicothoracic spine (deep to withers). (c) thehorsesback.com*

8. Is there an identifiable change?

Sometimes, before and after photos are almost the same, but for minor changes that could be down to any of the above points.

They may be valuable, but they don’t show up much in images and take some explaining before they can be seen.

While some background information is helpful, if you’re having to write several paragraphs, then something is missing.

If you have to draw lines on the horse to show changed muscle development, then it’s also possible that your photos aren’t too clear.

Oblique body shots are really hard to repeat accurately. In the second image, the lens is further out from the shoulder and in a slightly lower position. This changes everything and detracts from the real improvements seen.

And if you’re doing this, DO draw them correctly. Tracing different outlines or arbitrarily changing a line from straight to curved fools nobody!

Good before and after photos need no explanation, because they create their own impact.

Summary: how to achieve great before and after photos

The best before and after photos are taken:

From the same angle.
With the same lighting.
During the same season.
When the horse is standing settled, square if possible.
When the horse is not doing anything else.
At the same point in the session.
After the same work beforehand.
When there is a clearly visible change.

This means setting your photos up carefully and being quite technical in your approach. While there’s no need to go full-on scientific, giving a little thought to reducing all the above variables could go a long way to making your photos more effective, both for yourself and other people.

In the end, it’s rarely possible to get everything perfect. What’s important is that enough is correct, so that the images show what can be achieved with bodywork as a vital part of an integrated management approach.

More Than a Blemish: How a Knocked Down Hip Can Affect Horses

August 2, 2023 by Jane @ THB 14 Comments

$Appaloosa with severe fracture of tuber coxae$

‘Knocked down hip’ is a common name for a fracture of the tuber coxae (point of hip). This is usually the result of a horse having an impact with a gate post, fence or trees, a barrel in a race, another horse’s hoof, or the ground.

A piece of bone is often completely displaced, disappearing downwards and forwards into the paralumbar fossa – the space between the transverse processes of the lumbar vertebrae, internal abdominal oblique muscle, and the last rib.

This displacement can then change the outline of the pelvis on the damaged side. That said, it isn’t always visually obvious, and many horse owners often don’t even know it has happened.

It’s the least damaging of pelvic fractures as it doesn’t involve a joint or compromise the pelvic structure, and for this reason it’s often said that its long term effects are purely cosmetic.

But does that really mean it has no lasting effects whatsoever?

This post presents a range of potential issues, from none whatsoever to an altered gait that affects performance, and explains why you should always thoroughly assess your horse for effects after a tuber coxae fracture.

(c) Jane Clothier, thehorsesback.com. With thanks to Dr Sharon May-Davis for checking this post and catching my errors.

The elusive nature of the problem

I know a horse whose owner reported a succession of minor come-and-go issues in the hindlimb.

These either failed to warrant veterinary attention (there being no lameness) and with no diagnoses made when a vet was consulted. The problem was intermittent and elusive.

Older Arabian with a recent tuber coxae fracture — *A recent fracture in a veteran Arabian, showing some swelling. (c) J Clothier, thehorsesback.com*

There was no visible asymmetry and no muscle atrophy.

However, the horse was outwardly rotating the right stifle and swinging the leg outwards in the forwards (cranial) phase of the stride.

When I palpated the right tuber coxae, it had a section knocked away halfway up the bone.

Could there be a connection? Very likely!

Let’s take a closer look at the tuber coxae and how a fracture can affect the action of the hind limb on that side.

Why is the knocked down hip so common?

Besides being the widest point of the pelvis and therefore vulnerable to traumatic injuries of all varieties, the horse’s point of hip has another key weakness.

It’s part of a growth plate. It’s an epiphyseal plate, which means it’s separated from the main body of the pelvis by a physis, the line where bone is produced during growth in early life.

Growth plate on TB pelvis — *9-yo TB pelvis, showing remaining growth plate at the tuber coxae (Note: some has broken away during cleaning). (c) J Clothier, thehorsesback.com*

This means we’re looking at the ‘cap’ of the tuber coxae, which is a weaker cap of bone until at least 5 years of age, and often later depending on the breed.

These are vulnerable to getting displaced – the growth plate of the elbow (ulna) being another example.

Skeletal specimens such as the one in the image show us that even beyond 5 years of age, the growth plate may not be fully attached and is a weaker structure. The tuber coxae in the mature horse still has a roughened surface due to muscle attachments, which gives it a rather open honeycomb structure. This makes it far easier to damage.

More than a cosmetic feature

The clue as to why this fracture can be damaging, even though it doesn’t affect the structural integrity of the pelvis, lies in its function.

Yes, its function. Even though it’s not a moving part, the tuber coxae is much more than a cosmetic feature. Like the withers and the elbow/ulna, its function is to provide an anchor for some important muscles.

It serves as the attachment point for muscles involved in flexing the hip and extending the stifle to move the entire hindlimb forwards (more on those later). For this reason, the attachment point needs to be extremely stable.

Anglo with tuber coxae fracture — *Anglo gelding with tuber coxae fracture (c) J Clothier thehorsesback.com*

The tuber coxae must serve as an anchor point in this way while powerful propulsive forces are conveyed via the pelvis to the spine.

That’s why the tuber coxae are tuberosities – they sit wide and proud and, like handlebars on a motorbike, remain relatively stable in spite of the forces being transmitted from the hind legs forward along the spine.

The location of the fracture

Although generally similar, tuber coxae vary in shape from horse to horse. Fortunately, as they come in matching pairs, it’s possible to identify damage by comparing one side to the other.

Visually, it can be easy to spot a horse with an old tuber coxae fracture due to its pelvic asymmetry. How visible generally depends on the fracture’s severity.

Alternatively, good old manual palpation can reveal its presence.

Here are the main possibilities.

Upper piece of bone is displaced

QH tuber coxae fracture — *Quarter Horse with old tuber coxae fracture affecting the upper section of the tuberosity. (c) J Clothier, thehorsesback.com*

The upper part of the tuber coxae (ie. dorsomedial aspect) may be chipped off. This is usually, but not always, a visible type of fracture, as the point of hip acquires a rounded appearance. This is generally what gives the knocked down hip its name.

Central piece of bone is displaced

Tuber coxae fracture WB gelding — *Tuber coxae fracture showing loss of bone in the centre of the tuberosity (c) J Clothier, thehorsesback.com*

In this case, both ends of the tuber coxae are intact, so the overall shape isn’t much different.

However, if you palpate carefully, there’s a divot in the middle where a chip of bone has been dislodged. Identifying this involves comparing both sides of the horse.

Lower piece of bone is displaced

OTTB with old tuber coxae fracture — *Ex-racehorse with displaced lower part of the tuber coxae. (c) J Clothier, thehorsesback.com*

Only the lower part of the bone (ie. ventrolateral aspect) may be missing.

This is harder to see, but easy to feel: the tuber coxae’s ‘ledge’ is noticeably shorter.

This variation of the fracture is common as it’s the outer corner, the widest point, that’s been knocked off.

One study of 29 horses reported that when only the lower, outer aspect of the bone (caudolateral) was fractured, injured horses returned to work in around 3.5 months. [1]

Whole tuber coxae is displaced

Appaloosa tuber coxae fracture — *The entire tuber coxae is displaced and the horse has experienced severe muscle loss. (c) J Clothier, thehorsesback.com*

In severe cases, the entire tuber coxae is displaced. The visual asymmetry is more obvious. It can also be more serious: with palpation, it may be possible to feel the wider, deeper section of bone remaining, where the ilial shaft becomes the ilial wing.

In the study, when the entire tuber coxae was fractured, the recovery period was longer at around 6.5 months from injury. [1]

Could there be more damage?

If the horse has fallen hard enough to fracture the tuber coxae, it may have damaged other areas of its pelvis too. The various sacroiliac ligaments are prime contenders, as is the sacroiliac joint itself, along with the lumbosacral joint.

Then there are the structures of the actual hip joint (acetabulum and coxofemoral) and head of the femur.

There may even be an incomplete fracture of the ilium that we don’t know about, or separation at the pelvic/pubic symphysis. A full veterinary assessment should always be sought if your horse is lame and you suspect a trauma. Radiographs, ultrasound and scintigraphy have been used to image the tuber coxae and identify the extent of the damage. [2]

Sometimes, palpation and left to right comparison is the only way to identify the damage to the tuber coxae, in this case on the right side. It’s possible (r) to see the dip in the bone once you know it’s there. (c) J Clothier, thehorsesback.com

On a more superficial level, a ridge of what feels like soft tissue can sometimes be moved over the remaining tuber coxae – this is where a muscle attachment or its associated tendon or fascia has been damaged.

Small masses may also be palpated, which may be displaced bone chips. Small avulsion fractures have been observed in young racehorses, at the attachment of the Superficial gluteal muscle.

If there’s a pain response when you palpate these, bear in mind that it may be a sequestrum – ie. a bone fragment that has caused a lingering infection. This needs veterinary attention.

Alternatively, as Dr Sharon May-Davis explains (having examined fractures in dissections), these may also be ‘repair jobs’ that have happened as a result of bleeds. Smaller lentil-sized masses are calculi, ie. mineralized lumps, while the larger grape-like masses are lipomas, caused when a specialized fat is deposited in an effort to repair damaged tissue.

Thoroughbred gelding ex racehorse — *Off the track Thoroughbred with an old tuber coxae fracture. With more heavily built horses, the bone loss may be still harder to identify visually. [Brand obscured.] (c) J Clothier, thehorsesback.com*

What are the lasting effects of a tuber coxae fracture?

If there are no further pelvic issues, the general view is that following recovery, the lasting effect of a tuber coxae fracture is little more than a cosmetic blemish.

Radiographic view of tuber coxae fracture — *Dorsomedial-ventrolateral 50° oblique radiographic view of the tuber coxa of the ilium in a horse. Large bone fragement (arrow) displaced ventrally. (c) JAVMA, 234. 10.*

Our study of 29 horses says that:

“The majority of horses in this study did have muscle atrophy or abnormal bony flattening over the affected tuber coxae. Horses with tuber coxae fractures have an excellent prognosis for returning to athletic use but will most likely have a permanent blemish associated with the area.” [1]

So, a couple of things here.

First, the horses in the study were sufficiently injured, ie. lame, for veterinary attention to be sought. This suggests the fractures were fairly severe, and it therefore follows that the fracture site would be noticeably different upon healing.

But second, what we don’t know about is the quality of the horses’ work post-recovery. They returned to their previous athletic work, but were they the same as before?

*Ultrasound images of a fractured vs normal tuber coxae in the same horse. (c) IMV Imaging*

One lameness text states that this may only affect the careers of dressage horses, because they look asymmetrical, and judges may mark down due to this imprecision. [3]

Otherwise, the assumption tends to be that the localised trauma is no more than a superficial injury that leaves only a visual blemish, with occasional minor changes in gait quality.

As to whether horses are left with just that, quite a few people believe otherwise.

In fact, the rise of manual therapies has led to a lot more observation of gait changes and anomalies, such as those in the horse mentioned earlier.

Even while writing this, I went out and placed my hands on two more horses with this fracture and a noticeable effect on their movement.

*WB gelding with smaller fracture in the centre of the tuber coxae. [Brand obscured] (c) J Clothier, thehorsesback.com*

The most affected muscles

Down to the nitty gritty – why my concern?

Let’s take a look at the effect on some significant muscles that have origins on the tuber coxae, and the related effect on movement if these attachments are damaged through the fracture.

Tensor fasciae late

The Tensor fasciae late muscle originates on the tuber coxae and the gluteal fascia. It has multiple insertion points, including (via fascial connections) the crest of the tibia bone and the lateral patellar ligament.

Its job involves flexing the hip, while extending the stifle (femeropatellar joint) as the hindlimb comes forwards.

It has a stabilising effect on the stifle through its connection to the patella ligament in front and the tibia.

This muscle does lose function when its attachment is permanently damaged. Even if it’s a small area of bone that’s lost up there, the effect lower down is broader.

Superficial gluteal

This muscle originates on the rear side of the tuber coxae (caudal) and the gluteal fascia.

It inserts onto the femur at the third trochanter. Its job is also to help flex the hip, while adducting the limb (bringing it inwards).

Internal abdominal oblique

The Internal abdominal oblique muscle originates from the tuber coxae and the inguinal ligament, and inserts onto the cartilages of the last 4 or 5 ribs, the linea alba, and the prepubic tendon.

Dr Sharon May-Davis writes that this muscle becomes overworked when engaged in supporting a hind limb lameness, and hypertonic when “excessively aiding pelvic engagement or [adopting] a supportive role in hind limb lameness.” [5]

[Biomechanical issues follow below.]

Ex-racehorse with severe tuber coxae fracture — *The Tensor fasciae lata muscle is compromised in this ex-racehorse with a tuber coxae fracture. (c) J Clothier, thehorsesback.com*

The biomechanical issues…

I’m sure you can see where this is heading now.

If muscles dedicated to flexing the hip suffer from impaired function due to a tuber coxae fracture, there’s going to be a negative effect on movement.

The horse can still move its hindlimb and flex the hip, of course, but an element of fine tuning is going to be lost. At least.

There’s also going to be compensation from other muscles, a functional asymmetry, and some stress in joints.

Generally speaking, the more bone that’s lost, the larger the negative effect on hindlimb control on that side.

Here’s what I’ve observed in various horses on the side affected by a tuber coxae fracture.

1. Outward rotation of the femur

The stifle is angled outwards, and the foot lands toe out.

The horse is less comfortable working in the same direction as the fracture, ie with the fractured tuber coxae on the inside of a circle. I’m presuming there’s a lack of stabilisation from the Tensor fasciae late and reduced function in this muscle.

*Outward rotation of femur in Anglo gelding with fractured left tuber coxae. (c) thehorsesback.com*

2. Overdevelopment of the Rectus femoris muscle

This is the largest muscle of the quadriceps and the only one that attaches to the pelvis. It’s responsible for flexing the hip and extending the stifle. I presume this hypertrophy is due to compensatory action.

3. Reduced function in the Superficial gluteal

This muscle is also responsible for flexing the hip. In cases with full tuber coxae fractures, this muscle is atrophied behind the point of hip, adding to the change in the outline of the hindquarters on that side.

4. Tension in the Iliacus muscle

Along with Psoas major, this muscle forms the Iliopsoas. I’ve presumed this tension from the positive responses to corrective moves for the Iliopsoas muscles on this side.

5. Lumbar imbalances

I’ve observed vertebral rotation and restriction, and painful tension in the caudal Longissimus dorsii muscles.

I assume this is due to the compensatory ‘swing and haul’ action required for protracting the hindlimb when there’s insufficient controlled flexion at hip level. Again, this would depend on the extent of the tuber coxae fracture.

Muscles that may also be directly affected

Depending on the anatomy of the individual horse, other muscles may also be affected. How much so depends on the extent of the fracture and the anatomical variations between individuals.

Iliacus muscle

Forming the Iliopsoas along with Psoas major, Iliacus is responsible for flexing and rotating the hip. It has an origin under the ilium and insertion on the lesser trochanter of the femur, along with the tendon of Psoas major.

Middle gluteal muscle

This massive muscle has multiple origins, including the ilium, and inserts onto the greater trochanter of the femur.

In some horses, the lateral edge of its origin on the ilium is close to the tuber coxae, and may be affected by a fracture. This major muscle is largely responsible for extending and abducting the hind limb (ie. moving it outwards, away from the body).

Accessory gluteal muscle

This smaller muscle is below the Middle gluteal, and works with it so closely that some texts describe it as part of the bigger muscle.

However, it is largely separate and has its own flat tendon that attaches to the greater trochanter of the femur. This insertion means that it also aids in abduction of the hind limb (ie. moves it outwards, away from the body).

Assessing the individual

In many cases, the apparently quick recovery from lameness can cause the horse’s owner to believe the fracture of a tuber coxae is of little consequence.

It may be true for some, but for others it may be more serious.

The only way to tell is to examine the horse as an individual, starting with a visual assessment and palpation with the hands, comparing one tuber coxae to the other.

The horse’s hind limb action should also be assessed for balance and evenness. The horse may not be lame, but may have limitations in its movement on the side of the fracture.

If muscles flexing the hip aren’t working as they should, other muscles may be compensating, and these in turn can lead to secondary pain.

If the effect on hindlimb action appears to be significant, it is worth considering veterinary imaging to measure the extent of the damage (although this can usually be felt).

At any rate, some rehabilitative work is probably going to be needed so that better muscle condition and strength can be developed on the fracture side.

Ultimately, in severe cases, we have to remember that ‘we can’t put back what’s gone’. This injury may well mean the horse is unsuited to certain sports.

But please, never assume that this is simply a cosmetic blemish.

References

[1] Dabareiner, R. M. and R. C. Cole (2009). Fractures of the tuber coxa of the ilium in horses: 29 cases (1996-2007). Journal of the American Veterinary Medical Association 234 10: 1303-1307.

[2] Pilsworth, R. C. (2003). Chapter 51 – Diagnosis and Management of Pelvic Fractures in the Thoroughbred Racehorse, Diagnosis and Management of Lameness in the Horse. M. W. Ross and S. J. Dyson. Saint Louis, W.B. Saunders: 484-490.

[3] Van Wessum, R. (2020). Lameness Associated with the Axial Skeleton. Adams and Stashak’s Lameness in Horses: 763-800.

[4] Ashdown, R. R.; Done, S. H.; Evans, S. A. (2000). Color Atlas of Veterinary Anatomy: Vol. 2: The Horse, 2nd ed. Mosby Elsevier: Edinburgh.

[5] May-Davis, S. (2023). Dissecting Out The Facts. Author’s workshop manual.

10 Equine Bodywork Responses That Tell Us Heaps About Horses

July 29, 2023 by Jane @ THB 8 Comments

In an equine bodywork session, having a feel for the horse’s mental and emotional state is important.

It helps us to understand where they’re at, why they’re responding the way they do, and how we’re likely to be moving onwards in future sessions. We can then use this understanding to improve our connection and the holistic health outcomes.

Here are 10 of the common responses I see in horses I work with. For ease of communication, I’ve given them names.

It’s not science (and isn’t meant to be), but it is all about listening to the horse.

See any horse you recognise here? Enjoy 😉

(c) Jane Clothier, The Horse’s Back. No reproduction of text or images without permission.

1. The Enthusiast

This horse is the equine bodywork practitioner’s number one fan. If there were a t-shirt, they’d be wearing it.

They nicker at the sight of the therapist, and when led to the yard will often walk alongside their bodyworker instead of their owner. Someone’s made them feel good and THEY LIKE IT.

As a result, they exude huge warmth and give great cuddles and neck hugs.

And let’s just say they look bereft when ‘their’ therapist arrives and works on a different horse. They’ll probably stand nearby to tune into the energy of the session anyway.

2. The Child

This horse is often but not always young, projecting an air of total innocence.

And it’s genuine: they’re full of wonder for everything good that happens in their world.

And it’s safe to assume that up until now, it has all been good. As a result, they’re curious about everything that happens around them.

They’ve no defences set up and respond to the GOOD FEELS easily, sometimes apparently to their own surprise.

Their eyes will lock onto the therapist, the source of this remarkable experience.

Then they’ll turn their head from one side to the other, eyes following you as you move around the yard after the session.

‘Who are you? What did you do? Why am I feeling this?’

It’s impossible not to be enchanted by their bright, beautiful curiosity.

3. The Lightweight

This horse is a sensitive flower who has mixed feelings about this whole therapy business.

Their responses come super quickly, for good or for bad. Then they’ll take a huge amount from very little, and that goes both ways, for better or worse.

They can flinch at the unfamiliar nature of touch. If all’s well after that, they’ll often zone out at the first opportunity.

If you touch a spot with even a tiny problem, be prepared for flattened ears, a swinging head, tail swishing and a raised foot – sometimes all at once.

This horse is often a mare, affectionately known as ‘princess’ by her owner. But some geldings get complimentary membership too.

Once you get it right, don’t expect thanks, but do take heart watching the softness that unfolds before you.

Next time, you’ll be back to the beginning, but not quite, for now you’ll know very well that less is more.

4. The Superior Being

This trouper of a horse is a great competitor. They brush minor issues aside. They’ll often look down on you from a great height, as if at a mildly irritating fly. They don’t care to do anything as weak as going with the flow – yawning, licking and chewing is for losers.

‘Oh, are you still down there?’ … goes on to win 1st LWT. (c) J Clothier

They occasionally forget themselves and the eyes start to close. It doesn’t last though: they’ll catch themselves and return to consciousness, with a ripple of irritation.

This doesn’t mean they’re not feeling it. They’ll remain tight-lipped until the pesky human is out of sight, then do all of their letting go in private.

Stallions and lead mares often march to this drum too.

5. The Survivor

This horse shows you very little at all.

They’ve often been through a previous episode of pain that lasted too long. Or, they may have become used to locking down a source of pain, as they still have a chronic issue today.

At the slightest recurrence of pain, they revert to the lock down posture or attitude they had before. It’s what got them through it last time – they’ve survived by gritting their teeth and ploughing on.

A recent hoof abscess sent this mare back into her old laminitis responses. (c) J Clothier

You can almost hear this horse ignoring you and your hands. When you first work with them, they don’t yield and go with the flow. Instead, they stand with firm lips and a fixed stare.

But unlike the Superior Being, their vibe isn’t a light one.

Any effects happen in their own time, when the halter is off. They may stand in a corner or seek the presence of their closest friend… You’ll only know how well it went on the next visit, when the horse suddenly starts to respond.

6. The Anxious

This is the horse that can’t switch off.

They stand with their head up, always on the lookout, with a giraffe like posture that’s not great for their body and especially not for their neck.

They don’t feel safe and their attention flits around. Their breathing is shallow and/or fast.

Some of them can’t let go. They’ve a nervous system in overdrive and its buzzing signals won’t allow the horse to relax.

This is your challenge: to help this horse rediscover a deactivated state.

Pain may well be an issue, particularly in its shoulders and neck (and a headache). Nutrition and environment, too. Oh, and humans.

Initially settle for a horizontal neck, with a slightly closed eye being a bonus.

7. The Controller

This horse prefers not to let go, even if they show early signs of doing so. They step and move around frequently. Displacement activities include chewing the rope, rubbing their head on the handler, a fence, anything. They can be mouthy.

Although there’s no real hostility, there’s a constant ‘push back’ as you work – and you’ll be aware of it. Don’t expect to feel quickly accepted. Better get used to life outside their bubble – and their tough-guy efforts to keep you there, outside their safety zone.

Controlling their space and tuning you out: there’s usually a reason. (c) J Clothier

However, it can all change when you successfully relieve an issue that they never, ever expected to go. Suddenly you’re allowed in and find yourself looking into their huge, deep eyes.

This can be because they’ve been resolutely ignoring an uncomfortable body issue. If so, their fidgeting may have been because you were drawing their focus to exactly that.

8. The Watcher

This horse may stand in a quiet manner that’s initially encouraging. They may show early signs of relaxation, yet there’s still the feeling that they’re holding something back.

Then whoah! You’re met with a sudden tail swish, a swing of the hindquarters, or a snap of the teeth. You’ve touched a trauma spot and they’re telling you: ‘It’s right there! Watch yourself!’

The horse has some pain and you’ve just committed the cardinal sin of touching it.

Some may be alert throughout the session as they wait for you to find that spot. Little do you know that you’re being subject to a test. Better tune up your psychic abilities…

No matter what you do, the horse holds on and won’t let go until that breakthrough moment when you find the problem that’s highest in their awareness.

The painful spot may be an old or newer issue, but one thing is sure: there’s a lot of emotion wrapped around it.

Stay safe.

9. The Over-Trained

This horse stands with resolute obedience, as they know they should. They’ve been taught to wait with statuesque stillness, no matter what happens around them.

Whatever happens, they’re just waiting until it’s over, doing their best not to get in the way. They’ve learned that if they do, there’ll be a reprimand or sometimes heavy correction.

Receiving bodywork, these horses are often in their new home, where more self-expression is allowed.

To the therapist, this horse feels mentally and emotionally absent from their own party.

Some horses have been taught that they must remain completely still until asked to move. I find it’s very common with working station horses. (c) J. Clothier

Watch out for this horse’s return to their body, as their responses may be elevated.

They may love you to pieces, or they may shout about a problem that’s been long overlooked. Finally permitted to say what they think, they’ve lost the volume control.

It’s up to you to find a way through this, along with their people.

10. The Depressed

This horse knows it’s not worth even trying to connect or respond, probably because last time they did, it got them nowhere.

Their vibe is a dull one, and their eye contact is minimal or non-existent. They’re not into engaging with you.

They may stare off into the middle distance, as if disocciating. There’s very little response until the relaxing sensations completely take over – then you may receive a single look, or a tentative touch on the hand.

It’s a start. That has to be enough for now.

This horse will hopefully learn from the beneficial after-effects of the work. They will slowly start to feel that life can feel better and that humans have something to give.

With these horses, working with their mind and emotions is even more important. If they’ve had physical stresses forced on them in the past (and they usually have, leading to pain issues), the last thing we want to do is pressure them again.

Negotation is always the best way when we need to move forward, with lots of acceptance and thinking time.

Now I said there’d be ten, but there’s one more to come. I don’t meet too many of these extreme cases, and for that I’m grateful.

11. The Broken

This horse is so badly damaged that there seems to be no way back.

Very often, they’ve had multiple negatives in their lives, on multiple levels. Pain is a huge factor, with the horse having a condition that’s been ignored and frequently overridden (literally… it’s often back pain).

Some are both desperate and furious, having been forced beyond their limits. They can be highly dangerous to work with.

This horse has probably given enough for one lifetime – or had it taken from them.

I met this chestnut mare in a UK horse sanctuary. (c) J Clothier

Bodywork is our fleeting gift as we try to help these horses feel better.

By helping to ease their stress, we may to a tiny extent counter the less positive experiences they’ve had at the hands of other humans.

In return, they take us into a silent place, with depths unknown. Go gently while you’re there.