PAIN – How to tell if your horse has kissing spine, gastric ulcers of arthritis
How do you know if your horse is in pain, and more importantly, where that pain is coming from?
In this episode, equine physiotherapist Dr Gillian Tabor explores the complexities of recognising pain in horses. From facial expressions and behaviour to the blurred lines between conditions like kissing spines, gastric ulcers and lameness, Gillian dives into the latest research to help you spot the subtle (and not-so-subtle) signs that something isn’t right.
Whether you’re a horse owner, rider or equine professional, this episode is packed with insights on how horses show pain, why behaviours shouldn’t be dismissed as ‘naughty’, and why thinking pain first could be the most important step in safeguarding your horse’s welfare.
Topics include:
- The science of how horses perceive pain
- Anticipatory vs actual pain behaviours
- Overlapping symptoms across common equine conditions
- Why girthiness isn’t always about the girth
- Key research from Dalla Costa, Dyson, Kumar and more
Join the conversation or ask Gillian a question? Reach out – she’d love to hear from you.
Dr Gillian Tabor is MSc ResM MCSP HCPCreg, a Chartered Physiotherapist, Cat A member ‘Association of Chartered Physiotherapists in Animal Therapy and has lots of great help and advice for horse owners – check out all of her work here – Dr Gillian Tabor
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Transcription
Here is a transcription of the podcast. (Please note this is an automated transcription, so we apologise for any errors from the original podcast.)
Hello and welcome to this podcast on pain in horses. So I deliberately picked a click baity title because I want to discuss the critical topic of pain recognition in horses. I think this is important for everybody who is involved in the care of horses, riding horses or observation of horses. I think that
If you come to me for an answer to the question of how to tell if your horse has kissing spines, gastric ulcers or arthritis, then listen on and then hopefully the conclusion that I’m going to end with will make some sense. So just to introduce myself, I am Gillian Tabor. I am physiotherapist and I work with horses, unfortunately horses in pain, but also rehab and management of performance horses.
So a lot of my job is to do with the recognition of clinical signs that might be manifesting as a result of pain and also to support the education of owners with regards to looking out for those signs and what they’re looking for. So let’s just have a sort of bit of an overview of pain to start with. What happens when the sensory receptors in the periphery, so you know, in the sort of ends of the limbs or in the skin or the outside of the body, the sensory receptors
happens when they’re stimulated? It’s fairly well understood. So the mechanism of how signals are transmitted through the body via those neurological pathways and then the process of what happens to those signals when they’re received by the central nervous system is, yeah, it’s fairly well understood. At a basic level there’s obviously so much more that we can learn but that sort of input and the transmission and then the processing of it is the same
for horses as it is for people and for other mammals because we have the same physiology. So what differs between us and other species and actually between individuals is the perception of the pain. So at what point you say something is painful and the point at which you say something is absolutely untollerable, unbearable is very individual.
and there have been some sort of reports in human literature as to, you know, the difference between males and females or the difference between ages. And there’s some sort of suggestion that different species have also these sort of interspecies differences. But when it comes to people, we’ve got the advantage that we can verbally express and reason that pain. So we can…
understand the cause and hopefully use logic to either sort of actively or passively manage that pain. The actual sort of definition of pain is that it is an unpleasant sensory and emotional experience associated with or assembling that associated with actual or potential tissue damage.
As a person, you can understand that obviously if you have had an injury, then you can understand why it hurts or perhaps you can see something that is going to hurt and then you deliberately consciously or subconsciously avoid that sort of onset of the pain. And we actually know that animals will do the same. It doesn’t actually have to be the current pain that they’re feeling that changes their behaviour and the clinical signs of pain, but it can also
be in anticipation and then also the actual pain, the actual sort of stimulus that they’re feeling at the moment. And that’s really important. As I go on through this podcast, I’m going to talk about some research that talks about some anticipatory pain. And then I’ve just mentioned there about actively or passively managing pain in humans. And that’s something that we do. We have people that cope with pain and they’ll push on through despite it. People that have that opinion that no pain, no gain. And then we get those that are
more fearful of pain and then they withdraw and they reduce their movement or their sort of lifestyle to passively cope with the pain. that also happens with animals as well. We know that there’s sort of expected differences between predators and prey species when it comes to pain and that really is all about survival mechanisms.
So understanding that as a human aids our sort of cognitive strategies to management of it and our choices to how we express or manage it. But when we think about horses in particular and we think about the differences between those sort of higher elements of their central nervous system, their brain, for example, we know that there is slight differences. They do have a prefrontal cortex.
but from our understanding, it’s less well developed and they don’t have those opportunities for reasoning, reflecting and planning that humans do. But there are some similarities in the way that pain can be read between non-verbal animals and also between non-verbal humans because we know that the induction of pain causes changes of behaviour.
So we’ve got some studies that have looked at that in horses. horses have been monitored in sort post-surgical situations and their facial expressions have actually been recorded and are quite consistent when it comes to the differences between horses that are suffering from pain and those that aren’t. So for example, Dalla Costa looked at post-operative pain.
and we’ve got GleaRap as well. And they looked at the induction of pain and then the positions of the ears, eyes and the muzzle. And so it’s also been consistently shown that behaviors demonstrated by horses when ridden are also linked to musculoskeletal pain. So if you’re familiar with Dr. Dyson’s Ridden Horse Pain Ethogram, there’s quite a depth to her and her group’s research with regards to
what happens and what the differences are between horses that are in pain and those that have had their pain abolished by diagnostic analgesia. So knowing that the horse demonstrates pain by both their facial expressions and their body language, it’s really important to be familiar with those, especially if you care for horses, because we should be on the lookout for signs of pain, so however subtle. But…
My question linking to the title of this podcast is can behaviors be shown by a horse in pain tell you where the pain is coming from? So if you look at social media, as always, you know, good place to start, you see that a lot of posts talk about absolutes, that X always equals Y, but others will tell you that Y definitely does not equal X. So when it comes to pain behaviors, there is a very clear pattern that’s not as simple as either of those extremes. So
It might seem obvious, but I think I’m just going to go through some of the research to reinforce that message. If we look at the clinical signs that are presented when a horse has subsequently undergone diagnostic analgesia and imaging to aid their clinical diagnosis, those behaviours, for instance with kissing spine, range from, and there is plenty of lists in the literature,
So poor performance, poor jumping, ill-defined hindlimb lameness, bucking resistance to saddling up. Another study suggested that they were presenting with complaints that included poor ridden performance manifesting either as pain or distress during riding, inconsistent shifting lameness, only apparent undersaddle, reticent and poor jumping performance, and the inability to build or maintain a paxial muscle mass was sometimes also present.
So that list comes from Kumaratel 2025. Then if we look at Priskatel 2019, complaints of poor performance under saddle ranging in severity from inability to maintain a particular lead while cantering to violent objection and incessant bucking that rendered the horse unsafe for ridden exercise. And then a more recent paper, 2021, looked at the clinical signs and they included rearing, bucking, reluctance to go forward, poor performance, aggressive behavior,
tension, stiffness, reduced flexion, bolting, combination above and other reasons. So those lists, if you listen to the overlap between them, basically poor performance comes up quite commonly. There are changes to the gait pattern, inconsistent shifting lamenesses, and then there are more sort of expressive clinical behaviors such as rearing and bucking.
as well as the more subtle sort of tension and stiffness as well and poor performance. So are those symptoms that you recognise from other diagnoses? Well, what about if we think about gastric ulcers? So there was a paper published in 2019 by Milières Ramirez and Lejeune. Pronunciation is always my strong point. I looked at gastric ulcers in groups of horses and they had 37 horses that
presented with girthiness and they said that girthiness manifested as flattening of the ears, obviously a facial expression, swishing of the tail, which is one of the Ridenhorse pain ethogram movements, biting, moving away, humping the back, which could be construed as bucking, and other general signs of discomfort and avoidance. And of those that they suspected that had ulcers, 13 underwent gas cross,
gastroscopy and 12 out of 13 were diagnosed with gastric ulceration. They said that in the horses that were then subsequently treated, those clinical signs were reduced following the treatment. But of the 37 horses that were brought to them with girthiness, 10 of the horses were diagnosed with other issues such as thoracolumbar vertebral osteoarthritis,
cervical vertebral osteoarthritis, bone spavin, front limb lameness, and three of the 37 horses had back pain which is attributed to an ill-fitting saddle. So I think from the literature, we can see that there is evidence to support the idea that there are overlapping clinical signs, behavioral changes between those horses that have been diagnosed with kissing spines and those that have been diagnosed with equine gastric ulcer syndrome. Because
honest, girthiness is quite a non-specific clinical sign so if you’ve got that it could be caused by multiple conditions. So the conclusion of the paper on the gastric ulcer suggests is that if you suspect that the horse has this issue with stomach ulcers then you need to have a complete physical and lameness examination carried out which includes the saddle fit.
And the only way to truly diagnose for equine gastric ulcer syndrome is to have gastroscopy, which sorry, I can’t say today, because that is the only real way of diagnosing them. So if we think that kissing spines and girthiness can cause lameness, what are the other signs of lameness? So according to Dyson at LL 2018,
bucking, rearing, gate too slow, intense stare, sclera explodes, eyes half shut or the eyelids closed, all signs of the issues of lameness. And when you’re thinking about ridden behaviours, then also there was some related to back pain and issues with tacking up. Some examples were
If difficulties were mounting immediately or straight afterwards, horses fidgeting, swishing their tail, chomping on the bit, extending their back, yanking down on the reins, tossing their head, and they need to be held when they’re being mounted. During tacking up, in a paper looking at these behaviors by Dr. Dyson, found that some horses were grinding their teeth, they were kicking out with a hind limb, they were pouring the ground and they were attempting to bite or they were yawning.
And in her paper, she found that there was a significant relationship between apaxial muscle pain, lameness, tight tree points of the saddle, and the behaviour scores of the horses observed during tacking up. So, what have we got? We have got a where we have got a range of clinical signs that are demonstrated by changes in behaviour.
in a number of papers that are looking at horses that have subsequently been given a clear diagnosis of kissing spines, of lameness, of equine gastric ulcer syndrome, and those signs are very similar. So if we’re thinking about the anticipatory pain, and this comes from the study looking at tacking up,
There is a suggestion that behaviour is an anticipation of pain either caused directly by the tack or reflecting in musculoskeletal pain during ridden exercise. So in answer to my question, can you tell whether the horse has kissing spines, lameness or ulcers due to their behaviour? It’s very clear that we haven’t got distinct patterns that link to only one of those conditions.
So there are some conditions that have only one clinical sign, for instance, I think tetanus is one of them and I think it’s called patho-pneumonic where you just have one very discreet sign and there’s no overlap. But we have got a huge amount of overlap here. So my conclusion is that we need to be aware that the behaviors displayed during tacking up and when ridden may be…
because of actual or in anticipation because of musculoskeletal pain or gastrointestinal pain and that the behavioral signs are common for all these different causes. So the important take-home note is, is if there is change in your horse’s behavior or you see behavior that reflects in any of those clinical signs, either facial expressions or body language that could be linked to pain,
So please, please, please, if you see any of these signs, think pain first. Think that your horse is actually telling you something. It is displaying the clinical signs because the behavior is linked to either actual pain or anticipation of pain due to that learned behavior. They’re not being naughty, they’re not being particularly difficult, they’re not being grumpy, they’re not being marriage. There’s no link between sex and these behaviors either.
So let’s keep our eyes open, watch our horses and make sure that we address any discomforts before we start to impact our horses’ welfare and happiness. So if you want to continue the discussion, please send me a message. I’ll be really happy to have a conversation with you about this topic. But otherwise, if you’ve got any concerns, then I would recommend you get in touch with your vet.
It’s always better to be safer than sorry when our horses are concerned. So thank you very much for listening.
