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Understanding and Using the Ridden Horse Pain Ethogram

For regular free content on horse health and wellbeing from Sue Palmer, The Horse Physio, click here.

The Ridden Horse Pain Ethogram (RHpE) lists 24 behaviours, the majority of which are ten or more times likely to be seen in a horse with musculoskeletal pain. Studies have shown that a horse who shows 8 or more of the 24 behaviours listed in the ridden horse pain ethogram is likely to have musculoskeletal pain.

Of course you want to know that your horse is physically well!

“Harmonious Horsemanship: Use of the Ridden Horse Ethogram to Optimise Potential, Partnership and Performance” by Sue Dyson and Sue Palmer will help! Published in October 2023, this book describes and explains the RHpE (which was developed by Dr Sue Dyson and colleagues), how you can use it to help monitor your horse’s quality of life, and its application in relation to equestrianism’s social license to compete. There are case studies, contributions from eminent professionals and organisations, and a description of the science that got us to this point.

Reading, digesting, using and sharing the information contained within this book will help you to understand how you can use the RHpE (the performance check list) to improve performance, and to monitor your horse's level of comfort in his / her ridden work. Find out more at

Find out more at

While chatting with clients, I realised that only some people know the RHpE, also known as the performance checklist. This blog is to help bridge that gap and share some of the basics. You can get an idea of the impact of the performance checklist through the award-winning film, ‘The 24 Behaviors of the Ridden Horse in Pain: Shifting the Paradigm of How We See Lameness’.

Click here to watch the 35-minute documentary, but have some tissues handy because this is an emotive subject!

Watch the award winning film at

Find out more about the team behind the film, Padma Video and Train With Trust, at

It turns out we’re not great at recognising lameness.

We all want to do our best for our horses and to believe that they are happy and comfortable. To know they are comfortable, we have to recognise better when they are uncomfortable. Several studies show that we’re not good at recognising lameness. We can all see when a horse is limping. But how about when he’s just slightly unlevel, when he’s lame on more than one leg, or when he’s as lame on his right hind as on his left hind so he still moves symmetrically?

We know from the research that it can be difficult for even qualified veterinarians to agree on which leg a horse is lame on, and the milder the lameness, the more difficult it is. We know it’s easier to see forelimb lameness than hindlimb lameness. The horse will use compensatory movements to avoid putting so much weight through the lame leg(s), and we’re starting to understand those compensations better, but they can make it hard to tell where the source of the problem is.

As human beings, it can be hard to accept that we need to change behaviour, and it's even harder to actually create that change and maintain it. Find out more at

We can use ridden behaviour to recognise pain and discomfort

All this, and more, means that using behavioural assessments such as the RHpE to recognise lameness in the early stages could improve horse welfare. This could be useful, for example, when there’s no lameness visible in hand, or when it’s so low level that it’s hard to see, or when the compensatory patterns of the horse’s movement mask the lameness.

We now have solid evidence linking certain ridden behaviours to musculoskeletal pain, in a format that can be used by all horse riders. We are sharing these behaviours with you in this book, alongside some of the studies providing evidence connecting pain and behaviour in ridden horses. Find out more at

You can assess your horse.

You can use the RHpE with your horse. After warming up, ask someone to video you riding him for 5 to 10 minutes. Include walk, trot and canter large on both reins, transitions within and between the paces, 10m circles in rising trot in a figure of eight, and any more advanced movements you and your horse can perform as a partnership. Video the horse moving in a straight line towards and away from you from two corners of the arena. Watch the video as many times as necessary to work through the list of 24 behaviours, marking them as ‘yes’ or ‘no’. A ‘yes’ scores 1, and a ‘no’ scores 0. You may want to use a stopwatch for some of them and a protractor to measure angles to get a more accurate score.

How about doing this exercise with a friend once a month to monitor your horse’s well-being? You can video your friend; they can video you, and you can go through the videos together. Like any skill, it will take practice and get easier with time. Keep a record of your horse’s score, and contact your vet for further investigation if he scores 8 or more out of 24.

You know that a horse can only communicate pain or discomfort through their behaviour or performance. If your horse has been in discomfort ever since you have known the horse, then you might not see any changes in that behaviour or performance. Find out more at 

You can be more confident that your horse is comfortable.

The earlier that a lameness is spotted, the easier it is to resolve it, in general. A study shows a link between higher scores of the RHpE and higher dressage penalties, a higher likelihood of elimination or retirement from the cross-country course, and a lower finish place at the 5* level. The most common score for horses competing at nine different World Cup Grand Prix dressage competitions was a comparatively low 3/24. There was a negative correlation between the RHpE score and judges’ scores – so the higher the RHpE score, the lower the judges’ good marks. The same relationship was observed at the British Grand Prix dressage championships.

Remember that 8/24 is the threshold that suggests underlying musculoskeletal pain. So, if you want to get better results at competitions or to be more confident that your horse is comfortable and monitor his ridden behaviour proactively, try using the RHpE.

You have probably come across the phrase 'social license' in relation to equestrianism. It's become a buzz phrase of the past year or two. But what does it mean, and how does it apply to you and your horse? Find out more at

The Ridden Horse Pain Ethogram

Just to remind you, the RHpE is a list of 24 behaviours, the majority of which are ten or more times likely to be seen in a horse with musculoskeletal pain. Studies have shown that a horse who shows 8 or more of the 24 behaviours listed in the RHpE is likely to have musculoskeletal pain.

The Ridden Horse Pain Ethogram (RHpE) is a list of 24 behaviours, each with strict definitions, that might be seen in a ridden horse. Studies have shown that if a horse displays eight or more of these 24 behaviours, then the horse is likely to have pain or discomfort. Find out more at

I have listed the 24 behaviours in the RHpE below. You can download a FREE field guide here, which includes the 24 behaviours in easy-to-follow picture format that you can use on your phone, as well as much more information about the RHpE. You can download a list of the behaviours in a handy checklist here, along with a suggested dressage-type test to use in your assessment and some useful tips on how to get the most from using the RHpE with your horse. You can also see the 24 behaviours in picture format daily on my Facebook page and yet another version here, courtesy of the Saddle Research Trust.

The 24 behaviours are divided into three categories: facial markers, body markers, and gait markers.

Facial markers

  1. The ears rotated back behind vertical or flat (both or one only) for five or more seconds, or repeatedly laying the ears flat
  2. The eye lids closed or half closed for two to five seconds
  3. Sclera (white of the eye) repeatedly exposed
  4. An intense stare for five or more seconds
  5. The mouth opening and shutting repeatedly with separation of teeth, for ten or more seconds
  6. The tongue exposed, protruding or hanging out, and / or moving in and out
  7. The bit pulled through the mouth on one side (left or right)

Body markers

  1. Repeated changes of head position (up / down, but not in rhythm with trot)
  2. Head tilted, repeated
  3. Head in front of vertical (more than 30 degrees) for ten or more seconds
  4. Head behind vertical (more than 10 degrees) for ten or more seconds
  5. Head position changes regularly, tossed or twisted from side to side, corrected constantly
  6. Tail clamped tightly to middle or held to one side
  7. Tail swishing large movements: repeatedly up and down / side to side / circular; during transitions

Gait markers

  1. A rushed gait (frequency of trot steps greater than 40 in 15 seconds); irregular rhythm in trot or canter; repeated changes of speed in trot or canter
  2. Gait too slow (frequency of trot steps less than 35 in 15 seconds); passage-like trot
  3. Hindlimbs do not follow tracks of forelimbs but deviated to left or right; on three tracks in trot or canter
  4. Canter repeated strike off wrong leg; change of leg in front and / or behind (disunited)
  5. Spontaneous changes of gait (e.g., breaks from canter to trot, or trot to canter)
  6. Stumbles or trips repeatedly; repeated bilateral hindlimb toe drag
  7. Sudden change of direction, against rider’s direction; spooking
  8. Reluctant to move forward (has to be kicked, with or without verbal encouragement), stops spontaneously
  9. Rearing (both forelimbs off the ground)
  10. Bucking or kicking backwards (one or both hindlimbs)


"I went home, thinking I was failing her, thinking my instincts were way off, and decided to find a professional to help." Find out more at

If you’d like to read further into the subject, World Horse Welfare have produced a document ‘Ridden Issues: Troubleshooting Unwanted Behaviours’, in conjunction with Sue Dyson, which I am confident will answer several of your questions. As stated on the website, “In this heavily illustrated and easy-to-navigate ‘myth busting’ guide, Dr Sue Dyson brings her decades of experience as a rider, trainer, and veterinary orthopaedic clinician to bear on a question that is likely to be relevant to many of us at some stage: Could my ridden horse’s behaviour be due to pain?” You can download the PDF for free here.

If you’d like to learn more, an excellent online course is available here through Equitopia Center. I have completed it and highly recommend it.

Sue Palmer MCSP, aka The Horse Physio, is an award-winning ACPAT and RAMP registered Chartered Physiotherapist, an Intelligent Horsemanship Recommended Trainer, and holds an MSc. Formerly a competitive rider and BHSAI, she works full-time treating horses. Through her multiple books and articles, Sue shares with you her passion for ethical and harmonious horsemanship.

Sue Palmer, The Horse Physio

Sue Palmer with Belvedere

For regular free content on horse health and wellbeing from Sue Palmer, The Horse Physio, click here.

The Supporting Science

If you’d like to look into the science and the studies behind and around the Ridden Horse Pain Ethogram, here are a few of them (in no particular order):

Dyson, Sue. (2021). The Ridden Horse Pain Ethogram. Equine Veterinary Education. 10.1111/eve.13468

Dyson, S., Berger, J., Ellis, A., Mullard, J. (2018a) Development of an ethogram for a pain scoring system in ridden horses and its application to determine the presence of musculoskeletal pain. J. Vet. Behav.: Clin. Appl. Res. 23, 47-57

Greve L, Dyson SJ. The interrelationship of lameness, saddle slip and back shape in the general sports horse population. Equine Vet J. 2014 Nov;46(6):687-94. doi: 10.1111/evj.12222. Epub 2014 Feb 27. PMID: 24372949

Greve, Line & Dyson, Sue. (2018). What can we learn from visual and objective assessment of non‐lame and lame horses in straight lines, on the lunge and ridden?. Equine Veterinary Education. 32. 10.1111/eve.13016

Mullard, Jessica & Berger, Jeannine & Ellis, Andrea & Dyson, Sue. (2016). Development of an ethogram to describe facial expressions in ridden horses (FEReq). Journal of Veterinary Behavior: Clinical Applications and Research. 18. 10.1016/j.jveb.2016.11.005

Dyson, S., Berger, J., Ellis, A., Mullard, J. (2017) Can the presence of musculoskeletal pain be determined from the facial expressions of ridden horses (FEReq)? J. Vet. Behav.: Clin. Appl. Res. 19,78-89

Dyson, Sue. (2017). Equine performance and equitation science: Clinical issues. Applied Animal Behaviour Science. 190. 10.1016/j.applanim.2017.03.001

Dyson, S., Berger, J., Ellis, A., Mullard, J. (2018b) Behavioural observations and comparisons of non-lame horses and lame horses before and after resolution of lameness by diagnostic analgesia. J. Vet. Behav.: Clin. Appl. Res. 26, 64-70

Dyson, Sue & Dijk, J.. (2018). Application of a ridden horse ethogram to video recordings of 21 horses before and after diagnostic analgesia: Reduction in behaviour scores. Equine Veterinary Education. 32. 10.1111/eve.13029

Dyson, Sue. (2021). The Ridden Horse Pain Ethogram. Equine Veterinary Education. 10.1111/eve.13468

Dyson, Sue & Thomson, K. & Quiney, Laura & Bondi, Anne & Ellis, Andrea. (2020b). Can veterinarians reliably apply a whole horse ridden ethogram to differentiate nonlame and lame horses based on live horse assessment of behaviour?. Equine Veterinary Education. 32. 112-120. 10.1111/eve.13104

Dyson S, Pollard D. Application of a Ridden Horse Pain Ethogram and Its Relationship with Gait in a Convenience Sample of 60 Riding Horses. Animals (Basel). 2020 Jun 17;10(6):1044. doi: 10.3390/ani10061044. PMID: 32560486; PMCID: PMC7341225

Dyson, S., Bondi, A., Routh, J., Pollard, D. (2020c) Gait abnormalities and ridden horse behaviour in a convenience sample of the United Kingdom ridden sports horse and leisure horse population. Equine Vet. Educ. doi: 10.1111/eve.13395

Dyson, S. (2019) Application of a ridden horse pain ethogram to horses competing at a 4-star three-day-event; comparison with cross country performance. Equine Vet. Educ. 32, Suppl. 10, 92-103

Dyson, S., Ellis, A. (2020) Application of a Ridden Horse Pain Ethogram to horses competing at 5-star three-day-events: comparison with performance. Equine Vet. Educ. doi: 10.1111/eve.13415

Dyson, S., Martin, C., Bondi, A., Ellis, A. (2020d) The influence of rider skill on ridden horse behaviour, assessed using the Ridden Horse Pain Ethogram, and gait quality. Equine Vet. Educ. 10.1111/eve.13434

Dyson, S., Bondi, A., Routh, J., Pollard, D., Preston, T., McConnell, C., Kydd, J. (2021) An investigation of behaviour during tacking-up and mounting in ridden sports and leisure horses. Equine Vet. Educ. doi: 10.1111/eve.13432

1Dyson, S., Pollard, D. (2021) Application of the Ridden Horse Pain Ethogram to elite dressage horses competing in World Cup Grand Prix Competitions. Animals 11, 1187.

Dyson, S., Pollard, D. (2021) Application of the Ridden Horse Pain Ethogram to horses competing at the Hickstead-Rotterdam Grand Prix Challenge and the British Dressage Grand Prix National Championship 2020 and comparison with World Cup Grand Prix competitions. Animals 11, 1820

For regular free content on horse health and wellbeing from Sue Palmer, The Horse Physio, click here.