The Usual Suspects: 10 Common Culprits for Equine Health Mysteries

As an animal communicator, I receive a lot of calls from folks who are stumped about their horse’s behavior or health. Either they have drained their bank accounts working with the vet to try to identify possible sources for their horse’s discomfort and have come up empty-handed, or they are flummoxed by persistent disobedience that appears without any physical symptoms. Either way, they’re ready to try just about anything to figure out the problem, and that usually brings them to my doorstep. Of course, what seems like a great mystery to an unsuspecting owner or vet is usually quite obvious to the horse. By connecting with the animal to understand the discomfort and intuitively evaluating its source, the “mystery” is easily solved.

Surprisingly, a great deal of these equine mysteries are caused by just handful of sources, so I’ve comprised this list of the most common culprits you might not know to look for with your horse’s pain or behavioral issue. Though this isn’t an exhaustive catalogue, almost every horse I work with has at least one item from this list present, so it behooves horse owners to become aware of these “invisible” issues. The symptoms are not always obvious, but with a bit of education, most are identifiable. You can improve your relationship with your horse as well as his or her quality of life by knowing when and where to look for these problems, as well as how to address them. Of course, consult your veterinarian if you suspect any health concern with your horse.


1. SI & Pelvic Pain

SI stands for sacroiliac, which is the point in the horse’s body where the spine and pelvis meet. Veterinarians are starting to better understand the symptoms of SI pain, but largely this phenomenon remains undiagnosed. About half of the horses I connect with have SI pain, so it’s more rampant than you might guess, and unfortunately it leads to a myriad of health and behavioral challenges. Though the SI region is large and has many potential sources and areas for discomfort, I generally encounter either a crooked pelvis or a twisted/out of alignment sacrum, or the combination of the two.

  • Associated mystery problems: Hind-end lameness, compensatory front-end lameness, difficulty cantering and associated behavioral issues, difficulty jumping, refusal to move off the leg
  • Why you might miss it: Often the only external sign is resistant behavior, such as bucking, kicking out, refusing to move forward, or even rearing. When asked to canter, the horse may buck or transition explosively, which may appear to be a behavioral issue. When this condition causes actual lameness, the location of the lameness seems to move or change (“phantom”), making it difficult to identify or track down.
  • What to look for: Bunny-hopping, lead-swapping, crookedness under saddle, uneven gait, explosive transitions into canter, off-set tail (held to one side), uneven stance, uneven hips or muscling in hind end
  • What to feel for: Heat, swelling, or sensitivity¹ around the point of hip, dock, sacrum, and tight muscles between hip and buttock. Often if one point of hip is sensitive or inflamed, the opposite side will have pain or inflammation in the ribcage or flank.
  • What causes it: Blunt force to the hips such as falling or getting cast/hurt while rolling², incorrect riding (front to back instead of back to front), overuse, poorly balanced hind feet, colic episodes
  • How to fix it: Chiropractic³ tends to be the most effective solution, though acupuncture and bodywork can be beneficial once the subluxation is corrected. Look to the hind feet imbalance for horses who continually go out of alignment, or check for frequent, minor episodes of gas colic which may cause the horse to change its stance and misalign its pelvis as a protective measure. Educate yourself about correct riding and seek objective feedback about your skills and/or instruction for pain that persists.

2. Withers Pain

Above and beyond saddle-fit concerns, the withers is an area prone to pain and misalignment that can wreak havoc on a normally-happy horse. Sometimes the scapula is also affected.

  • Associated mystery problems: Front-end lameness (particularly “phantom” lameness), shortness of stride, gait irregularities, poorly-fitting saddle symptoms, body soreness and stiffness
  • Why you might miss it: Few vets tend to consider the withers as a source of problems except in cases of acute injury, so its role in the horse’s way of going and overall comfort is largely overlooked in favor of lower leg joints. Because of the withers’ placement and connection with the entire shoulder and leg movement, pain here can manifest in many different versions of lameness.
  • What to look for: Girthiness, gait irregularities, lack of desire to move forward, reduced stride length, disjointed movement, differences in stride or lameness between left and right direction, “moodiness,” changes to the withers in size or shape
  • What to feel for: Heat, swelling or sensitivity around the withers, top of scapula, and on the neck in front of the shoulder. Check for unevenness between the right and left side.
  • What causes it: Blunt force to the shoulder or withers such as getting hurt or cast while rolling, falling or tripping, poorly-fitting saddle, too much weight on the area such as with packing horses, overuse
  • How to fix it: Chiropractic is best for misalignment issues, though acupuncture and bodywork may help. For chronic withers pain, look to saddle fit or your riding practices. Veterinary care should be properly applied for acute injuries.

3. Poll Pain, TMJ Pain, & Headaches

Most of my clients are surprised to consider that their horses might have a headache because the concept is so far off of our radar as riders, due to a lack of identifiable symptoms. We do, however, recognize poll pain or TMJ pain (temporomandibular joint, which refers to the jaw and encompasses the cheek and ear region), which are typical sources of headaches for horses. The majority of horses I encounter have either poll or jaw pain that they can identify, and almost all of them suffer from headaches.

  • Associated mystery problems: Lack of submission to bit and bridle, fussiness or refusal to being bridled, lethargy, crookedness through head and neck, cocking head, resistance to stretching over topline, stiff jaw, head-shy behavior
  • Why you might miss it: Virtually invisible to detect unless the pain is severe, and easily confused with riding mistakes or evasions under saddle
  • What to look for: Itching and rubbing head vigorously during work or after bridle is removed, yawning or moving jaw while riding, crooked or inconsistent head carriage while not being ridden, dropping feed while eating or strange chewing habits that do not resolve with proper dentistry
  • What to feel for: Heat, sensitivity, or swelling around jaw, teeth, ears, and poll. Differences between one side and the other. Indications that your horse wants you to rub or massage him on the forehead or near the ears.
  • What causes it: Injury (such as pulling back against a fixed tie that doesn’t release), poorly-fitting tack (browband too small, thin crown piece, bit too thick or small, etc), heavy rein contact, use of gadgets such as draw or side reins and other equipment that restricts the head
  • How to fix it: Chiropractic for subluxations, massage or acupuncture for tension and headaches, properly fitting equipment, proper or non-use of gadgets

4. Allergies & Environmental Toxins

Just like people, horses are allergic to a whole host of different things. Some allergies are obvious, like if a horse is allergic to a topical ointment or has springtime allergies. Others are much more subtle.

  • Associated Mystery Problems: Ulcers that persist despite treatment, skin conditions or hair loss, lethargy, neurological symptoms, bizarre behavior and genuine medical mysteries
  • Why You Might Miss It: Veterinarians are often skilled at identifying allergies if they present in consistent ways, but chronic issues that don’t resolve with medication or seemingly unrelated issues like ulcers can stem from unidentified allergies or even toxins in the environment. Symptoms that come and go may be difficult to pinpoint.
  • What To Look For: Outside of traditional allergy symptoms like coughing or hives, consider allergies if you find unexplained symptoms that don’t resolve, or which come and go without consistent patterns, or very general and inexplicable conditions like lethargy, stiffness, or recurring colic
  • What To Feel For: Itchiness, fever, swelling, hives, rash, or general “out of character” feelings from your horse
  • What Causes It: Allergens can be almost anything. Typical contenders are plants, pollen or components in the horse’s feed. However, I’ve also encountered animals who are responding negatively due to something in their environment, like heavy metals, fumes, or contaminated water sources.
  • How To Fix It: This can be difficult for the average horse owner, because fixing the problem can only be done after identifying the allergen or toxin. However, success may be as simple as changing barns or using acupuncture or other holistic health practices. Medical intuitive skills may be put to good use in these cases.

5. Nerve Inflammation

Your vet would be the best bet to ask for a medical explanation on this topic, but it’s something I encounter now and then in horses. From their perspective, it feels like the area is so over-sensitive that even the slightest touch is painful or ticklish to an extreme such that they can’t help but react. Conversely, the nerve may be affected such that the horse feels numbness or a lack of sensation, which leads to a skittish and easily-startled manner.

  • Associated Mystery Problems: Explosive behavior, aggression, blanketing or saddling challenges, head-shy or avoidance to being touched, spookiness and fearful behavior
  • Why You Might Miss It: Unless you know what’s wrong and where, the symptoms of this condition seem to point to behavioral issues or phantom pain. The horse’s reactions may seem to come out of no where, which makes it hard to trace a source.
  • What To Look For: Aggression or irritability during grooming or blanketing, extreme reactions to everyday procedures, fear or anxiety around people and sensory experiences, physical stance and postures which are uneven (indicating possible protective or compensatory efforts)
  • What To Feel For: Horses with nerve issues usually hate to be touched because it either causes them pain or anxiety. Depending on the location of the problem, this can be a localized area (ie near the face), or might include the entire body. Stroking the horse gently in areas where he or she is comfortable, and then slowly but carefully moving around to see where the horse is less comfortable may help you map out the problem areas. That said, severe nerve pain will cause a horse to contort its body to try and avoid the discomfort, so other pain issues are often clouding the picture.
  • What Causes It: Injury or trauma, subluxation, dietary deficiencies, poor saddle fit
  • How To Fix It: Chiropractic may solve the issue if it’s caused by misalignment, but that’s not always the case. Injury may cause a nerve inflammation issue that comes and goes, and is difficult to solve. Bodywork and acupuncture may help, or veterinary intervention if you can pinpoint the problem. Properly fitting equipment is crucial for maintaining a horse who has had a nerve issue.

6. Deep Sulcus Thrush

Unlike its smelly and obvious cousin, deep sulcus thrush resides within the frog and eats away at the interior structures of hoof, making for an invisible yet excruciatingly painful problem. Think about walking with a nail through your foot, and you’ve got a good idea of what it feels like to a horse.

  • Associated Mystery Problems: Hoof pain, lameness, “navicular” that doesn’t disappear with treatment other than nerving
  • Why You Might Miss It: Thrush, in general, doesn’t show up with hoof testers because it’s not limited to a specific place like an abscess might be. Moreover, because deep sulcus thrush can be essentially invisible unless you’re looking for it, it’s not a “common” problem that vets see, so most don’t have it on their radar as a source of hoof pain unless it’s obvious from the outside of the hoof. Instead, deep sulcus thrush is usually misdiagnosed as navicular, coffin bone injury, or soft tissue problem. Because it often affects more than one hoof, deep sulcus thrush can also appear as phantom lameness.
  • What To Look For: Uneven stance, reluctance to walk or move, increased lameness or sensitivity after farrier visits, “looking” to the outside when being ridden (this is to try to take the pressure off the hooves), tenderness that doesn’t hoof-test. On the hoof itself, a crack between the bulbs of the heel or anywhere else it’s not supposed to be may indicate deep sulcus thrush, as well as any black “goo” deep in the crevices of the hoof. A deep cleft in the horse’s frog is also a sign, as healthy frogs have shallow clefts. However, depending on the entry point of the bacteria, the depth of the cleft may be hidden by the tissue of the frog itself, rendering the thrush “invisible” unless you go looking for it.
  • What To Feel For: Heat in the hoof, cracks or fissures in the hoof, heel, or frog
  • What Causes It: Bacteria and fungus that access the hoof due to muddy, wet conditions, poor hoof care, or poor hoof balance (contracted heels are a chief culprit)
  • How To Fix It: Commercially available thrush solutions will solve this in no time, as long as they get deep enough into the hoof to reach the thrush. Review horse keeping practices to see whether environmental or farriery adjustments are necessary to prevent recurrence. It may take a few weeks for the horse to become sound after treatment while the tissues regrow in the hoof.

7. Soft Tissue Injuries & Body Soreness

Many horses are considered to be “hot house flowers” because they don’t like being curried, or they seem ticklish when you touch them in certain places. I have never encountered a horse who is actually ticklish in this manner except in regards to clippers or the nerve issues mentioned above; this is a case of misunderstood body language. A horse that presents with ticklish or sensitive reactions may have soft tissue injuries to specific areas, or body soreness which has developed from underlying pain and compensatory efforts.

  • Associated Mystery Problems: Could be almost anything, depending on the severity and nature of the issue. Bucking, girthiness, refusal to move forward, refusal to stand at the mounting block, and being “cold backed” are common.
  • Why You Might Miss It: Most people are taught that flinching is just a sign of the horse being ticklish, so they don’t recognize this symptom as pain. Disobedience while grooming, mounting, or riding is usually seen as a behavioral issue instead of a symptom of pain.
  • What To Look For: Sensitivity like flinching, “ticklishness,” dislike of grooming or being touched, moving around while being groomed or tacked up, disobedience
  • What To Feel For: Heat, swelling, or sensitivity on any area of the horse. Do your best to map this out to narrow down the location of the problem, but know that the pain may be wide spread depending on how the horse has contorted itself to compensate.
  • What Causes It: Blunt force injury, overuse or overextension, poorly-fitting saddle, subluxation
  • How To Fix It: Address any underlying causes first, and then give rest and recovery time. Bodywork may help, as may alternative healing therapies like acupuncture or hands-on-healing. Once healed, bodywork and chiropractic are recommended to help address unevenness or imbalances that may still be present.

8. Ulcers and Pre-Ulcer Discomfort

You may have guessed that ulcers would be on this list, as awareness about this issue seems to be on the rise. However, the severity of the condition often gets lost to discussions about feed management and such, thus avoiding some important questions about the horse’s stress level. Considering how painful ulcers can be, it’s a matter that is often taken too lightly in the equestrian world.

  • Associated Mystery Problems: Colic, resistance under saddle, aggression, picky eating, “ticklish” flanks, discomfort while being blanketed, lethargy, sourness, “mean horses”
  • Why You Might Miss It: Up to 60% of performance horses have ulcers, which tells us that we’re quite good at creating stress in horses, but very poor at identifying when horses suffer from it. Some horses show classic ulcer symptoms, while others exhibit none at all. Some horses have ulcers in the hind gut that don’t show up during a standard scoping procedure, and others have ulcers that persist even after medical treatment. Additionally, the horse may have a painful belly that hasn’t quite formed ulcers yet, so nothing shows up on the scope, but that doesn’t mean the horse is free of discomfort.
  • What To Look For: Changes in the horse’s behavior, classic ulcer symptoms, horses who seem to dislike their jobs or their people, irritable or aggressive horses, girthiness
  • What To Feel For: Sensitivity around the barrel and flank may or may not be present
  • What Causes It: Stress and anxiety. Horses who are in pain for other reasons often develop ulcers due to their anxiety and discomfort, especially if they are forced to work while in pain. Horses kept inside with limited or no turnout are also prone to ulcers due to stress, as are those who have significant mental or emotional trauma leading to anxious personalities.
  • How To Fix It: Commercially available medication (omeprazole) can fix the ulcers, and preventatives are available through dietary changes, supplements, and natural remedies such as aloe or slippery elm root to assist horses prone to ulcers. However, the horse’s circumstances should be evaluated as well to see where unnecessary stress is placed on the horse through training or management practices. There’s a good chance such stress is harming the horse in other ways as well.

9. Gas Colic

Everyone knows about the scary “C” word, but few people – even vets -understand just how common it is. I certainly had no idea in my pony club days that horses experience mild colics so often, but probably 30% of the horses I encounter do so on a regular basis, up to 5 times per week! Mostly in such cases, the gas colic is merely a symptom which is the result of stress from an underlying issue.

  • Associated Mystery Problems: Refusing to be caught, refusing to stand still, refusing to be mounted, nipping or biting at handler or rider’s feet, lethargy, refusal to move off the leg
  • Why You Might Miss It: Symptoms, if present, are often mistaken for ulcers or disobedience. Most people associate colic only with classic (severe) symptoms, such as being off feed, kicking at their belly, lack of passing manure, lack of gut sounds, etc.
  • What To Look For: An educated eye can notice a minor change in stance, where the horse’s belly is slightly bulged to one side or the hips are uneven. Licking or nuzzling at an area behind the girth is a more overt sign. Frequent gas colics may cause a crooked pelvis due to the frequency of standing in this uneven manner.
  • What To Feel For: On the left side of the horse a few inches behind the girth you may feel a slight puffy or raised area, about 3-6” in diameter. The horse may try to lick at this spot, so it could be wet. This is not always present if the colic is extremely mild.
  • What Causes It: Pain, stress, and associated anxiety, particularly from ulcers or other stomach discomfort, though any type of pain can cause gas colic. These minor colics occur frequently at shows, where stress is added and the horse’s routine is disrupted. Poor experiences under saddle can lead to gas colic simply due to the anxiety level created about riding.
  • How To Fix It: During these episodes, gentle movement like walking or trotting (preferably without a rider) does help, but it’s best to stop gas colic at the source by addressing the pain or stress that is causing it. Check the horse for sources of undiagnosed pain and review management practices for horse-happy changes. Even barn atmosphere itself, or the personality of the handlers, may contribute to this problem. Ulcer-preventatives may be helpful, so that the stomach’s acidity level and associated discomfort doesn’t exacerbate the horse’s pain or anxiety.

10. Custom Saddles that don’t Fit

Awareness is growing in the equestrian community for the importance of proper saddle fit, which is a boon to the horses! However, many people believe that if they rely on a saddle fitter to help them, or invest in a custom saddle, that the problem is solved and they needn’t worry. Sadly for the horse and the pocketbook, there are no such assurances.

  • Associated Mystery Problems: All of the traditional ill-fitting saddle symptoms, such as bucking, girthiness, back pain, refusal to move, refusal to stand at the mounting block, cold-backed behavior, etc
  • Why You Might Miss It: If you’re assured by an expert or multiple experts that the saddle fits, it’s easy to look elsewhere for the source of the unwanted behavior. However, only the horse truly knows if the fit is correct!
  • What To Look For: Saddle brand reps with dollar signs in their eyes. Just kidding! Mostly. Brand reps often receive training only for their particular type of saddle, so their expertise is limited. Even if they offer the best fit their brand can provide for your horse, it still may not be a good match. Even independent saddle fitters may only have expertise with a certain type of horse or riding, and the quality of their education is not assured.
  • What To Feel For: Pain, sensitivity, swelling, or small, dry spots around the horse’s withers and back, particularly after riding. The pain may also manifest in another area of the back or withers if the horse is compensating for the bad fit by carrying him or herself differently. Hollows behind the withers are a sure sign of bad saddle-fit.
  • What Causes It: Not every brand is right for every horse. Moreover, not every tree is right for every horse. If the shape of the tree doesn’t fit, the width doesn’t matter. Panel shape, billet alignment, and numerous other factors also affect fit.
  • How To Fix It: Finding a saddle that fits both horse and rider can be done, but it may require outside-the-box thinking. Independent saddle-fitters may help point you in the right direction, but the horse will ultimately tell you if he or she is happy or not. Before buying the brand that your barn or trainer or friend recommends, do some research or work with an independent fitter for suggestions on your horse’s particular conformation. For those of you with wide or flat-backed horses, start looking for brands which offer “hoop” trees. These trees are shaped like an upside-down U instead of a classic A. An A frame is a fundamental mismatch for a body shaped like a barrel, yet I’ve encountered numerous clients who invested thousands of dollars into custom A-frames for their round horses on the advice of their saddle fitters. According to one saucy pony, “it’s not working, it has never worked, and it’s never going to work” no matter how much you adjust it. You’ll know when you have the right fit, as the horse’s way of going and cooperation under saddle will likely improve dramatically.

So there you have it! Hopefully this list leaves you a little wiser, and with a little more curiosity toward understand all of the behavior from your horse that might otherwise go unnoticed. As I’ve spoken about before, only in very rare cases do horses act up without a pain or trauma source, so building awareness for your horse’s state of being will help you understand what is normal or not for him. From there, you can use that knowledge to speak his language and learn what she’s trying to communicate to you for both of your benefit.

Notes: I am not a veterinarian, nor do I play one on TV. Always seek qualified veterinary advice for the care of your horse, as animal communication is not a substitute for diagnosis or treatment. That said, don’t be afraid to seek a second opinion if your vet doesn’t find something. Remember, your horse can’t lie about her symptoms. It’s up to us to figure out what she’s saying.


¹Pain responses from the horse may include flinching or wincing, ear pinning, moving away from your hand, holding breath, curling nostrils, anxiety and refusal to stand still while you examine the area, and even subtler signs. Use care when ever you evaluate an area you may believe is sensitive, and if possible, have a helper monitor the horse’s expression for signs of tension you may miss.

²You’ll note that several prominent items on this list which can cause severe difficulties under saddle may be caused by getting “cast,” or stuck, while rolling. This happens more frequently than we might guess, not just in a stall, but even outside near fencing or other objects. If you suspect your horse has gotten cast, or he comes in from the turn-out looking ragged or scraped up, schedule a chiropractic session to assess and fix any damage. Don’t wait until it comes back to bite you in the form of unwanted behaviors!

³Not all equine chiropractors are effective. Though it’s not easy to know if you have a competent professional, your horse will let you know. Chiropractors who are also veterinarians tend to be the best, but if in doubt, seek a second or third opinion. Many clients have come to me with a clean bill of chiropractic health, only to have a competent practitioner evaluate their horse and find significant problems. As a general rule, be cautious of anyone who blames attitude as the culprit instead of pain. Just because they can’t find it, doesn’t mean it’s not there!

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