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The Ridden Horse Pain Ethogram: A Tool for Equine Wellness and Performance

Join me on a journey as we delve into the significance of ‘Harmonious Horsemanship’ and the transformative Ridden Horse Pain Ethogram! Let’s uncover insights shared during a recent webinar I presented with Dr. Sue Dyson hosted by Gillian Higgins of Horses Inside Out. Listen by clicking on the video below, or scroll down to read!

If you want to stay in the loop and receive more tips, updates, and exclusive discounts from Sue Palmer, The Horse Physio, sign up for her free newsletter. Let’s continue this journey together toward happier, healthier horses!

Question from Sue Dyson to Sue Palmer: How does the Ridden Horse Pain Ethogram fit into your work as a Chartered Physiotherapist?

That’s a great question. As a Chartered Physiotherapist, I take a detailed history when I first meet a horse. I feel through his muscles, looking for tightness and soreness. I assess the range of movement through his spine and his limbs. I look at how he moves, and I ask a lot of questions. I’ve always said that the most important of these questions is how the horse feels to the rider. You talked about it in your presentation just now, discussing ‘rideability’. The Ridden Horse Pain Ethogram (RHpE) gives me the science to back up how important the rider’s feeling is and gives me a way of measuring it. 

Maintenance, prevention and performance

A lot of my daily work treating horses involves the maintenance of health and well-being, preventing pain, and improving performance. Those are areas I love working in. I’d rather work to prevent a problem from happening in the first place than wait until something is broken before I fix it. With my regular clients, I recommend that riders use the RHpE themselves regularly, usually once a month, to monitor their horse’s musculoskeletal comfort and be confident in their horse’s comfort.


For physical therapists working in rehabilitation, the RHpE is a great tool to help measure change over time. Once a horse has received a diagnosis from the vet and has begun treatment, the vet, owner, or therapist can use the RHpE on perhaps a weekly basis to assess the horse’s response. It might be that the scores gradually get lower, indicating an improvement in comfort levels. Or it might be that something happens and the score goes up one week, which would flag up a discussion with the team and perhaps a temporary slowing down of the rehabilitation program or further veterinary treatment.

An evidence-based tool for communication

On another side of my work, as a specialist in the links between pain and behaviour in horses, I use the Ridden Horse Pain Ethogram as an evidence-based communication tool that can be used by owners, riders, vets, and others involved with the horse. Working with horses who are showing behavioural problems or performance problems in their ridden work and yet are not obviously lame can be a bit like detective work, and using the RHpE is an essential part of the process. It could be me, the vet, or the owner who uses it because it is a tool anyone can use, and the information can be shared amongst the team.

Question from Sue Dyson to Sue Palmer: How can the Ridden Horse Pain Ethogram help owners, riders, coaches, and other paraprofessionals?

We wrote about this in Chapter 4 of Harmonious Horsemanship, ‘The When and Why: Uses of the Ridden Horse Pain Ethogram’. The RHpE is a valid and reliable tool, supported by robust science, that can help us determine how happy our equine athletes are. Some examples of its use could be:

  • By the leisure rider who wants to be confident that their horse is not in unnecessary pain or discomfort.
  • By the competition rider, because recognising early symptoms of pain and discomfort means recognising early aspects of performance that could be improved.
  • By the work rider, as a regular assessment to check for musculoskeletal pain in your horses.
  • By the trainer, coach or instructor concerned that a horse they are working with is not performing as it should be.
  • By the vet, where the RHpE could become a standard part of a lameness work-up when evaluating the ridden horse.
  • By the saddle, bridle or bit fitter, who could use the RHpE during the fitting process.
  • By anyone working in the equine industry, perhaps as a physical therapist, farrier, equine dental technician, behaviourist, nutritionist, or another professional, to flag up and monitor musculoskeletal pain in the horse.
  • By anyone buying a new horse through applying the RHpE to videos of the horse before travelling to see it.

Valuable contributions

To reinforce to readers the value of the Ridden Horse Pain Ethogram, we have contributions from organisations, associations, and paraprofessionals, as well as eleven real-life case studies. I’ve listed these at the end of this blog if you want to know more.

Maintaining equestrianism’s social license to compete

The Ridden Horse Pain Ethogram is also invaluable in reducing the risk of injury, improving performance, improving welfare, and maintaining equestrianism’s social license to compete. A horse in pain is at greater risk of injury, either to itself or the rider. Scientific studies have found that at both high and low levels of competition, high RHpE scores were generally associated with lower finish places or failure to complete and lower RHpE scores with higher placings. With welfare, your horse can only communicate his pain or discomfort through his behaviour or performance. It is your job to listen; the RHpE gives you a tool to do this. To maintain equestrianism’s social license to compete, we must continue to educate ourselves, keep up to date with the latest knowledge, and use this in our decision-making regarding the management and training of our horses.

Question from Sue Dyson to Sue Palmer: What would you like to achieve through our book, Harmonious Horsemanship?

A few years ago, I wrote a BHAG. For those who don’t know, that’s a Big Hairy Audacious Goal, a term coined by Jim Collins and Jerry Porras in their book ‘Built to Last: Successful Habits of Visionary Companies.’ It’s a long-term, 10 to 25-year goal guided by your core values and purpose. My BHAG is that by 2035, every horse person will recognise that there are links between pain, behaviour, and performance in horses. Our book Harmonious Horsemanship goes a long way towards achieving this goal. 

I would like equestrians worldwide to be able to use the Ridden Horse Pain Ethogram to be more confident that their horses are comfortable. I would like riders to be able to use the RHpE as a tool to communicate what they instinctively know when their horse is not right, yet he is not obviously lame. I would like the RHpE to be used as an evidence-based communication tool by the paraprofessionals working to support a horse and its owner.

Your messages of support keep me going when I’m exhausted. This one, from Kirsty H, encapsulates one way in which Harmonious Horsemanship and the Ridden Horse Pain Ethogram are doing to reduce the suffering of horses and their owners. 

Kirsty says, “Hi Sue, I owe you a thank you… but you’ve never met me. My trainer recommended your teachings to me last year.

About a year ago, I bought a 5-year-old project mare. She was very weak, so we spent six months doing lots of very steady strengthening work. At around the six-month mark, she didn’t seem to be improving at all; in fact, she got a lot worse and just lost the ability to want to canter forward. 

She was “sound”, not lame, and you couldn’t really pinpoint an issue. However, something was obviously not right; I used the Ridden Horse Pain Ethogram, and she scored extremely high. 

We booked her into the vet for multiple X-rays, and the poor girl had a multitude of issues, including a severe disc injury, which they can only presume was from a rotational fall prior to me buying her. They think maybe she was highly steroid-dosed, which was why I didn’t see the behaviours for the first six months.

Unfortunately, nothing could be done to help her. However, I am thankful that she ended up in my hands, not being passed pillar to post. Your research meant I could look past the “That horse isn’t lame; there can’t be anything wrong” approach and “Keep working on her” approach when I knew something just wasn’t right.

I think this proves how stoic horses can be, and the knowledge I have gained from you means I see so much more than just a horse not being lame. Once you have opened your eyes to it, it’s amazing how much you see! Thank you.”

I want our book, Harmonious Horsemanship, to improve the lives of horses and their owners worldwide, and messages like Kirsty’s prove that it is already doing so.

The organisations and associations that contributed to the book Harmonious Horsemanship are:

Human Behaviour Change for Animals

British Equine Veterinary Association

Register of Animal Musculoskeletal Practitioners

Association of Chartered Physiotherapists in Animal Therapy

Association of Animal Osteopaths

McTimoney Chiropractic Association

Society of Master Saddlers

Saddle Research Trust

The individuals who contributed are:

Dr Rosie Jones-McVey

Dr Lynda Birke

Dr Jo Hockenhull

Dr Jessica Mullard

Dr Tamzin Furtado

Dr Jessica Kidd (Veterinary medicine)

Sonya Nightingale (Physiotherapy)

Dr Vav Simon (Chiropractic)

Eleanor Andrews (Osteopathy)

Mark Aikens (Farriery)

Ellie Tomlinson (Saddlery)

Grant Chanter (Dentistry)

Clare MacLeod (Nutrition)

Mary Wanless (Coaching)

Boo Riley (Riding and Training)

Kelly Marks (Horsemanship)

The case studies are:

Alice and Star

Kathy and Devine

Hannah and Brio

Hayley and Jacko

Rachel and Copper

Claire and Digger

Thea and Johnny

Heidi and Ricky

Anne and Sam

Joanne and Ripley

Giselle and Mickey

If you haven’t yet ordered your copy of Harmonious Horsemanship, subscribe to my free newsletter today to receive a 20% discount.

Meet Sue Palmer

Sue Palmer MCSP, aka The Horse Physio, is an award-winning author, educator, and Chartered Physiotherapist who promotes kind and fair treatment of horses through education with empathy. Sue specialises in understanding the links between equine pain and behaviour, and is registered with the RAMP, the ACPAT, the IHA, the CSP and the HCPC.

Popular books and online courses include:

Harmonious Horsemanship, co-authored with Dr Sue Dyson (book)

Understanding Horse Performance: Brain, Pain or Training? (book)

Horse Massage for Horse Owners (book)

Horse Massage for Horse Owners (online course)

Stretching Your Horse: A Guide to Keeping Your Equine Friend Happy and Healthy (online course)

If you want to stay in the loop and receive more tips, updates, and exclusive discounts from Sue, sign up for her free newsletter, and let’s continue this journey together toward happier, healthier horses!