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      Lameness Examinations – Diagnosing A Lame Horse

      Lameness is one of the most common issues that afflict horses, and it can be difficult to diagnose without a thorough examination. In this article, we discuss the lameness diagnosis process, what to expect during an exam, the causes of lameness, and the treatments available. We also provide lameness prevention tips to keep your horse healthy and active.

      Key Takeaways:

      • Lameness is a common equine health issue that should always be addressed promptly
      • Treatment and therapies vary depending on the type of lameness
      • A lameness exam usually consists of a visual inspection, a physical examination, and diagnostic tests
      • After a lameness diagnosis, the horse can be treated with a range of therapies, including PEMF and laser therapy.

      What Is Lameness?

      Lameness is an abnormal gait in horses, often caused by pain or injury in the limbs and/or joints. Lameness is incredibly common and can range in severity from mild to severe. It can have a range of origins as well, making diagnosis difficult.


      diagram showing the centre balance point of a horse

      Image courtesy of:

      Types of Lameness

      Horses can experience several types of lameness, depending on the origin of the problem. When evaluating lameness, it is crucial to determine what type of lameness the horse is experiencing to provide the most effective treatment.

      Front-End Lameness

      Front-end lameness is when the horse’s front legs are affected and may be caused by shoulder, elbow, or neck issues or other issues such as ringbone.

      Front-end lameness is often the easiest to spot, as horses with this type of lameness usually show obvious signs of a limp. The horse may also bob its head when it uses the lame limb.

      Hind-End Lameness

      Hind-end lameness is when the horse’s hind legs are affected and may be caused by issues in the hocks, stifles, or hips.

      Hind-end lameness is often harder for horse owners to stop than front-end lameness. Horses with lameness in the hind end area may not have a good range of motion with the painful limb and may exhibit an uneven gait. You can typically tell something is wrong but can’t pinpoint the exact cause.

      Back Pain

      Back pain can cause lameness in horses, resulting from issues such as kissing spine or sacroiliac pain.

      Horses with back pain usually have short strides and balk at being ridden, saddled, or groomed.

      Lameness Caused by Neurological Disease

      A lame horse may have a neurological disease like equine protozoal myeloencephalitis (EPM), a rare but serious condition.

      Horses with neurological diseases can have either perceptible lameness or subtle lameness. They may have difficulty keeping their balance, especially in turns or when a leg is lifted, and may stumble and trip regularly.

      Compensatory Lameness

      Compensatory lameness is when a horse tries to compensate for pain or weakness in one limb by putting more pressure on the opposite limb. Unfortunately, causing undue stress on the previously healthy limb causes lameness issues. This worsens the horse’s original problem and often complicates diagnosing lameness because both limbs are affected.

      Symptoms of Equine Lameness

      Horses with lameness may show different signs, depending on the cause.

      Symptoms may include:

      • Lameness in one or both limbs or an unusual gait
      • Reluctance to walk, trot, or canter
      • Pain when touched on the affected limb
      • Swelling of the affected area
      • Difficulty maintaining balance when turning or lifting limbs

      Lameness should always be treated seriously. Proper movement is vital for the horse’s health, and further damage may be done if left untreated.

      The Potential Causes of Lameness

      As we’ve discussed, there are many potential causes of lameness in horses, including:

      The best way to approach lameness in horses is to consult a vet.

      Diagnosing Horse Lameness

      Lameness diagnosis is often complicated, requiring a multi-step process. The first step is usually an evaluation of the horse’s medical history and an assessment of the horse’s lifestyle and diet, followed by a lameness exam, which we discuss in detail below.

      Performing a Lameness Exam

      After the vet has a thorough knowledge of the horse’s history, daily diet, and general lifestyle, they can proceed with the lameness examination.

      Observing the Horse at Rest

      First, the vet observes the horse at rest. To assess your horse, your veterinarian must observe them while standing still on level terrain. The vet can meticulously analyze the horse’s anatomy, body condition, and weight-bearing in that position.

      The vet can also determine if any distress or tension is visible in the animal’s stance.

      Observing the Horse in Motion

      To accurately diagnose lameness, your vet will assess how your horse moves when walking and trotting. They observe the horse’s gait from all angles while the horse is led by hand in a straight line.

      The veterinarian also observes as the horse trots, canters, and walks in a circle to check for movement inconsistencies, such as plating or winging, unusual range of motion, and abnormal hoof positioning. Lameness can become more apparent when a horse attempts to circle or turn instead of moving in a straight line, so this is a critical part of the lameness examination.

      This “horse in motion” portion of the exam may take some time as the vet may want to see the horse circle and move in a straight line on various surfaces.

      Physical Examination

      After a visual exam, the vet generally performs a thorough hands-on exam.

      During a comprehensive physical exam, your veterinarian examines the hooves, limbs, or any other area that could be causing pain. They look for potential swelling and heat generated by an injury and behavior changes, among other things.

      Using Hoof Testers

      To detect sources of pain in your horse’s hooves, your vet may use a hoof tester. This scissor-like tool applies pressure to the various areas of the foot to see if the horse shows signs of discomfort.

      If the hoof is sensitive or painful, the horse responds with reflexive action such as pulling back or lifting its leg away from the source.

      Hoof testers are excellent diagnostic tools for detecting hoof bruises, minor puncture wounds, abscesses, and other physical abnormalities. Hoof testers can also diagnose laminitis, fractures, and White Line Disease.

      Flexion Tests

      Flexion tests may also be used to assess the horse’s limb movement. During this test, a veterinarian gently flexes each of the horse’s limbs to see how the horse reacts. A reaction may occur when a horse experiences pain in one or more of its legs while in a flexed position.

      After flexing the horse’s legs, the vet watches the horse move again to see if the joint flexion tests have caused any change in lameness or range of motion.

      Diagnostic Tests

      In addition to a careful examination, the vet may need to run diagnostic tests.


      X-rays are typically recommended when the vet suspects the lameness issue originates in the bone.

      X-rays provide a comprehensive picture of what is happening with an animal’s skeletal structure and can help detect underlying issues like fractures, bone cancer, and laminitis.


      Ultrasounds assess a horse’s soft tissue, such as tendons, ligaments, muscles, and fascia.

      An ultrasound is often recommended when the vet suspects the horse’s lameness is due to soft tissue injuries, as these usually cannot be seen on X-rays.

      Nerve Blocks

      When it is difficult to determine the precise source of your horse’s pain, a nerve block may be used. By injecting a local anesthetic in select areas of the body, the veterinarian temporarily deadens sensation in that area.

      Once the anesthetic has its intended effect, a handler trots the horse away from the vet and back to evaluate its soundness. The trouble spot has been located if the horse becomes sound after an injection.

      Nuclear Scan (Bone Scan)

      If the cause of your horse’s lameness is still uncertain, your vet may recommend a nuclear scan, also called a bone scan. This process entails injecting the horse with radioactive material and should always be done in an animal hospital.

      With a special imaging machine, the nuclear scan detects inflammation occurring inside the horse’s body.


      Arthroscopy is a minimally invasive procedure involving an arthroscope (a type of camera) that looks inside the horse’s joints. This can help detect any damage that may be causing the lameness.

      Neurological Exam

      To conduct a comprehensive neurological evaluation, it’s usually necessary to take a sample of the cerebrospinal fluid and perform genetic testing.

      The “tail pull” test may also be part of some lameness exams. A healthy horse naturally resists any attempts to be pulled by the tail. But, if it’s afflicted with a neurological condition, its reaction may not be as strong.

      Synovial Fluid Test

      The synovial fluid test is conducted by taking a sample of the fluid that lubricates your horse’s joints and assessing it for markers of infection or inflammation.

      What to Ask Your Vet During the Examination

      When lameness occurs in horses, it’s important to ask your vet the following questions during the examination:

      • What tests need to be done?
      • What type of treatment or therapy do you recommend?
      • How long will the horse need to rest and recuperate?
      • Are there any recommended exercises or therapies to help the horse regain strength?
      • Are there any possible complications that could arise from this condition?

      Prevention and Treatment of Equine Lameness

      Prevention is always better than cure when it comes to equine lameness. Be mindful of how the horse is handled and ridden, as improper techniques can cause lameness. Also, ensure horses have regular check-ups, vaccinations, and exercise, utilizing therapy tools as needed to condition sound horses and treat lame ones.

      Therapy modalities such as cold/heat therapy, shockwave therapy, and laser therapy can all help with lameness and improve the horse’s overall well-being.

      Laser Therapy

      Laser therapy (or light therapy) is a popular, non-invasive treatment. Laser therapy uses a focused beam of light to penetrate tissues and stimulate healing at the cellular level. In horses, laser therapy is often used to treat tendon and ligament strains, arthritis, and back pain.

      With proper use, laser therapy can benefit horses recovering from injuries and improve their overall well-being.

      Laser therapy can be targeted with a convenient handheld laser, like the Activo-Med Laser Pen, or applied more broadly with a comprehensive therapy tool such as an Equine Solarium system.


      PEMF (Pulsed Electromagnetic Field therapy) is a non-invasive therapy used for a variety of equine conditions. This therapy involves applying electromagnetic fields to the affected area of the body to stimulate cellular repair and reduce inflammation.

      PEMF therapy is often beneficial when treating lameness. You can target PEMF therapy directly at the hooves with Activo-Med Combi Hoof Boots product to focus on specific hoof problems, like laminitis, cracked walls, and bruised soles.

      Activo-Med Leg Wraps also work well for treating various causes of lameness in the legs.

      It’s also worth noting that equine acupuncture is also becoming more popular.



      a horse with a pemf rug on

      View the Activo-Med Equine Power Pad

      Water Treadmills

      Water treadmills are a popular rehabilitation tool for lame horses. A water treadmill allows the horse to exercise in a low-impact environment. The buoyancy of the water reduces the weight-bearing load on the horse’s limbs and hooves, while the water’s resistance helps build muscle strength.

      Additionally, the water temperature can be adjusted to a coolness that helps decrease inflammation and improve circulation.

      Equine Spas

      An equine spa is an ideal rehabilitation tool. An equine spa, like the Activo-Med Hydrotherapy Equine Spa, combines multiple therapies into one session. It’s designed for safety and comfort and is perfect for horses on box rest.

      The spa fills with water, and the injured horse stands inside, receiving the benefits of cold water, salt water, and sometimes floor vibration with minimal weight bearing.

      FAQs About Lameness in Horses

      Lameness evaluations can be tricky, but most horse owners have to perform or participate in a lameness evaluation at some point. We answer some FAQs about lameness below.

      How Can Horse Owners Prevent Lameness?

      PEMF and laser therapy not only treat lameness but help prevent it. Regular exercise also helps by building muscle strength and flexibility while improving cardiovascular fitness.

      Exercise on a treadmill is often especially useful for rehabilitating performance horses. A balanced, nutritious diet is also key.

      What If Lameness Disappears?

      If a horse has been experiencing lameness, but it disappears, don’t ignore the issue.

      While it may be tempting to assume that the horse has fully recovered, the cause of the lameness could still be present and may require treatment to prevent a recurrence.

      What If Lameness Isn’t Consistently Apparent?

      Lameness in horses can be challenging to diagnose, particularly if it isn’t consistently apparent.

      Lameness may be intermittent, only showing up during certain activities or times of the day. Additionally, some horses may “mask” their lameness by compensating with other limbs. In such cases, you can work closely with a veterinarian to identify the underlying cause.

      What Is the Lameness Scale?

      The lameness scale is a tool vets use to grade the severity of lameness on a numerical scale. The scale ranges from 0, which is sound, to 5, which is severe lameness to the point of the complete inability to bear weight and/or move.

      The American Association of Equine Practitioners created the scale to provide a standardized method for assessing lameness.

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