The Horse Physio - Delivering care with expertise since 1992

Is Your Horse A Pain In The Neck?

Research into neck pain in horses


Neck pain in horses is complicated. It might manifest as lameness, poor performance, or a behavioural change. Changes in behaviour can vary from the downright dangerous, such as rearing or bolting, to the “he feels slightly off.” Unlike pain due to lameness from a leg or from kissing spine, for example, the neck cannot be nerve blocked. This makes it harder to diagnose neck pain as the root of a problem. It’s not even like the symptoms are easy to interpret. Fortunately, research is progressing in investigating, diagnosing and treating neck pain in horses. Recognition that neck pain might be causing a problem is gradually increasing, which means that issues potentially originating from the neck are being more thoroughly investigated. A 2021 report in the journal ‘Animals’ discusses “Equine Cervical Pain and Dysfunction: Pathology, Diagnosis, and Treatment”. You can read the full report hereor read on for our article on this study.

“Recognition that neck pain might be causing a problem is gradually increasing.”

Why is this research needed?

As Chartered Physiotherapists, we see many horses that are not so lame that they need a full lameness work-up but are not quite right. Often the issues we experience with our horses stem from the back or neck. Physio is an effective method to treat neck and back issues in horses, and we can work with your vet to create a treatment plan. The research into neck pain and dysfunction in horses shows different causes, and offers various treatment methods. While neck pain or dysfunction can be hard to diagnose, it is up to us to advocate for our horses. Ask a trusted professional for advice if you feel your horse isn’t quite right or his behaviour has changed.

What causes neck pain in horses?

Different conditions within the horse’s neck can cause neck pain. Horses’ bodies, like our own, are made up of different structures which work together to achieve amazing things. Issues in any one of these structures can cause problems. Neck pain can originate from the skeleton, with bony changes creating problems. Dysfunction of the nerves that run through the neck may be the root cause of the problem. Sometimes, the nerves can become damaged due to trauma or be “pinched” by the skeleton. Muscles can become tight, damaged, or weak, causing pain and associated changes in the position of the head and head. Joints can become inflamed or diseased, either the joint itself or the synovial fluid within. Ligaments and tendons can be subjected to trauma or wear and tear over time. All of these structures interact together to enable the horse to move, and if one is damaged, sore, or dysfunctional it can affect the whole horse. The complexity of the structures and the interconnections can make it very difficult to identify the root cause of the issue and provide the best treatment.


“A 2021 report in the journal ‘Animals’ discusses ‘Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment’.”

What are the symptoms?

Much like us, horses vary in their response to pain. Some are incredibly stoical and will endure what can be assumed to be considerable pain before reacting, while others appear to be overdramatic. Even in humans, where we can describe our pain verbally, pain is highly subjective and personal. A horse, unable to describe it, can only show us what and where hurts through his actions. Our job as horse owners and lovers is to do our best to understand what the horse is trying to tell us.

Neck pain is unlike lameness, and there is often no obvious indication of a problem. Changes in behaviour are our warning sign of a problem. Take note if your hitherto friendly, easy-going horse suddenly refuses to be caught one day. Has he fallen in the field overnight? Is he in pain? Is he standing alone? Once you have caught him, observe his behaviour. Some horses are very reactive to touch, so you may be able to identify areas on his body where he reacts to pressure. If he is not ordinarily reactive to being groomed and suddenly becomes reactive, this could indicate a problem. Sudden behaviour changes may be due to a traumatic injury. We can’t watch our horses 24 hours a day, and they are more than capable of injuring themselves whilst charging around their fields or rolling in their stables. Sudden changes should be an immediate red flag that they may have injured themselves.

Subtle changes over time can be harder to spot. Often issues will show up in ridden work. Does your horse find it harder to bend one way than the other? Does he seem more reluctant to work in an outline than he did last week? Does he feel heavier in one hand than the other? It can be easy to miss these slight changes, and it is often only when we look back over time that we realise how long the problem has been going on. In some cases, the symptoms may show as loss of appetite or weight loss, for example, if your horse struggles to reach his food due to the pain in his neck.

As good horse owners, we must constantly be vigilant to observe changes in our horses so that we intervene before a problem magnifies.

“As Chartered Physiotherapists, we see many horses that are not so lame that they need a full lameness work-up but are not quite right.”

How is it diagnosed?

Diagnosis of neck pain in horses can be complex. If the horse is lame, the vet can nerve-block sections of the leg to help pinpoint the location of the problem and help narrow down a diagnosis. We cannot do this with the neck. In trying to figure out what’s wrong, a detailed history, including any changes in the horse, either in their general behaviour or in their ridden work, is an excellent starting point.

A thorough examination of the horse is the next step. When examining a horse, we look for differences between the two sides. This can be seen in the lack of, or more significant growth of, muscles on one side of the neck. Any unbalance between the two sides gives us an indication of a problem. Observing how the horse moves his neck will help find the root cause. He may be able to bend one way but not the other, or may be able to flex freely to a certain point before twisting his head to compensate. Carrying out a series of stretches and movements will help to diagnose the neck problem.

Medical imagining is often carried out to confirm the diagnosis or help to locate the problem area. CT scans are considered one of the best options as they give a comprehensive picture of what is happening within the body. However, it is worth noting that horses can show bony changes without presenting symptoms, so just because we can see changes does not mean that they are causing problems.

These complexities only further show why the diagnosis of a neck issue is a complicated and multi-layered exercise. The best practice is for the vet to use a combination of the above to arrive at a diagnosis. A diagnosis can be altered depending on how the horse responds to treatment. Sometimes two similarly presenting conditions may need different treatments, and it is through the treatment that you can confirm the diagnosis.

“Diagnosis of neck pain in horses can be complex.”

What are the treatment options?

Different treatment options are available depending on the type and severity of the issue. As with many things, these often work best when used in conjunction. Systemic medications include painkillers such as NSAIDs (non-steroidal anti-inflammatory drugs, for example, phenylbutazone), though research indicates these are not always successful. Other medications can be used, such as gabapentin or muscle relaxants. Physical medicine includes physiotherapy, acupuncture, and therapeutic exercise, which can all have a positive effect as they work with the physical changes in the body. Indeed, physio is highly successful in treating neck pain in humans.

Other treatments include intra-articular corticosteroids; one study on horses showed a 71% positive result. As a last resort, surgical intervention may be an option. However, many horses will respond well to a less invasive treatment plan using a combination of medication and physical therapy to reduce the pain and realign the body. Ongoing management of the horse will help reduce or delay the likelihood of a reoccurrence of the issue and give the horse the best chance of returning to work healthily and happily.

“As responsible horse owners, we must advocate for our horses’ welfare.”

In Conclusion

As responsible horse owners, we must advocate for our horses’ welfare. You know your horse better than anyone, so you know when they are not right. Even if, to an onlooker, they may appear fine, you will be aware of subtle changes in their behaviour and character. These changes are important indicators. If you think there is a problem speak to your trusted professionals and investigate. We know how unpleasant neck pain is, so we must do our utmost to ensure that our horses are comfortable and pain-free. Regular physio treatments for your horse can help maintain its physical health and well-being. Please seek professional advice and support if you have concerns about your horse.

About The Horse Physio

Sue Palmer and Belvedere

Sue Palmer, aka The Horse Physio, is an award-winning ACPAT and RAMP registered Chartered Physiotherapist, an Intelligent Horsemanship Recommended Trainerand holds an MSc. Formerly a competitive rider and BHSAI, she works full-time treating horses. Sue shares her passion for ethical and harmonious horsemanship through multiple courses, books, and articles. Sign up at to be the first to hear about new releases.


Horse Massage for Horse Owners

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Confidence from the ground: Exercises for the horse owner

Finding the sore spot: Exercises for the horse owner

Polework: Exercises for the horse owner

Warm-up: Exercises for the horse owner

Stretching: Exercises for the horse owner

Easing stiffness: Exercises for the horse owner


‘Horse Massage for Horse Owners’

Horse Massage for Horse Owners

‘Understanding Horse Performance: Brain, Pain or Training?’

Understanding Horse Performance: Brain, Pain, or Training?

“Harmonious Horsemanship: How to use the Ridden Horse Ethogram to Optimise Potential, Partnership, and Performance” (due for release summer of 2023)

Sue Dyson and Sue Palmer, authors of ‘Harmonious Horsemanship’

Coming soon: 100 Handy Hints On Horsemanship (with illustrations by Sarah Brown)

100 Handy Hints on Horsemanship

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