Objective Assessment of the Equine Patient
Introduction[edit | edit source]
After completing a comprehensive subjective assessment, equine therapists must carry out an objective assessment to identify specific dysfunction in their patients. Equine physiotherapists do not need a pathoanatomical diagnosis to develop management plans for their patients. Rather, they approach the assessment from a functional perspective, observing any movement dysfunctions or impairments that may be contributing to a problem.Objective physiotherapy tests in equine assessment are very much based on functional assessment and palpation skills. This page will cover the following: functional assessment, ROM, palpation, special tests and neurological examination.
Functional Assessment[edit | edit source]
Conformation vs posture[edit | edit source]
Conformation refers to the structure and shape of a horse. Proper conformation is believed to be important for a horse's balance, power and manoeuvrability. It is considered one of the most reliable predictors of athletic ability and long-term soundness in most horses.
Conformation cannot be changed and is usually related to skeletal development. It also includes structural joint alignment. Posture, unlike conformation, can be improved. It is dynamic and related to muscle tone and activation. If a horse has poor confirmation it may be at risk of injury, harder training, and lameness.
Conformation and posture assessment[edit | edit source]
- Observe the horse standing on a flat, firm surface
- Look at the horse's natural stance – how is the horse most comfortable standing?
- Next encourage the horse to stand as square as possible
- View the horse from the left, right, front and rear
- How easy is it for the horse to stand square and balanced?
- When the horse is made to stand square, can it maintain this posture? Is its muscle development symmetrical? Are its feet balanced? What is its the limb alignment like?
Back Conformation[edit | edit source]
Typically, a horse's back should be one-third of its length (from the highest vertebra of the withers to the point of the hip). Long backed horses are generally more flexible, but weaker. They can be prone to injury as they often find it hard to work correctly and strengthen their core. Short backed horses are typically strong, but they are more ridged and it can be difficult to fit their saddles as they tend to ”run out” of thoracic spine.
Leg Conformation[edit | edit source]
|FORELEGS - see infographic with images|
|Base Wide||Standing with forelimbs outside the plumbline||This results in increased weight on the medial side of the hoof, which can lead to medial stress on joints and medial splint bone stress|
|Base Narrow||Standing with forelimbs inside the plumbline||The horse tends to land on the outside of their hoof wall - this can lead to lateral sidebone, lateral heel bruises and lateral strain on joints|
|Toed Out||Toes point outwards||There is an inward arc when the horse is advancing - this can interfere with the opposite forelimb especially if this conformation is combined with a base narrow stance|
|Pigeon Toed||Toes point inwards||There is an outward deviation of the foot during flight (i.e. winging-out) which interferes with the hind limb|
|Bowlegged||Varus deformity of the carpus||There is increased tension on the lateral collateral ligament and the medial surface of the carpal bones|
|Knock-Kneed||Valgus deformity of the carpus||There is increased stress on the medial carpal collateral ligaments, outward rotation of the cannon bone, fetlock and foot|
|Camped Out||The entire forelimb from the body to the ground is too far forward||This causes excessive pressure on the hooves, knee and fetlock joints - this stance might be due to conformational defects, but can also indicate hoof pain (e.g. navicular syndrome, laminitis)|
|Calf Kneed||There is a backward deviation of the carpus||This causes excessive strain on the back ligaments and leg tendons, and pressure on the front of the carpal joint - this means that the horse is more prone to carpal arthrosis, carpal chip fractures and injuries to the check ligaments|
|Camped Under||The entire limb below the elbow is placed too far under the body
This can be a conformational fault or be associated with disease
|This overloads the forelimbs, shortens the cranial phase of stride and lowers the arc of foot flight, potentially resulting in stumbling|
|Buck Kneed||There is forward deviation of the carpus
The knees knuckle forward, so this conformation is dangerous for the rider
|This distributes pressure unevenly over the leg, thus causing strain on sesamoid bones, the suspensory ligament, superficial digital flexor tendon and extensor carpi radialis muscle|
|REARLEGS - see infographic with images|
|Sickle Hocked||There is excessive angulation of the hock (<53)||This results in high stress on the hock joint and ligaments / tendons, potentially causing issues such as curbed hocks, bog spavin (i.e. tarsal hydrarthrosis or tarsocrural effusions) and bone spavins (i.e. osteoartosis in the distal tarsal joints)|
|Post Legged||There is an extremely straight hock angle (the opposite to sickle hocked)||This results in high stress on the back of the hock joint and the soft tissue support structures, potentially leading to bog and bone spavins|
|Cow Hocked||Medial deviation of the hocks
Accompanied by base wide from hocks to feet
|Excessive stress on the hock can lead to bone and bog spavins|
|Base Wide||The distance between the hooves is greater than the distance between the centre of the thighs
This is commonly associated with a cow-hocked conformation
|Strains to medial structures of the limb|
|Base Narrow||The distance between the hooves is less than the centre of the thighs
The horse is heavily muscled
This is often accompanied by a ‘bowlegged’ conformation where the hocks are too far apart
|Strains to lateral structures of the limb|
Hoof Conformation[edit | edit source]
Hoof conformation and the hoof pastern axis may also interfere with proximal joints and ligaments. The pastern helps to absorb shock when the hoof lands on the ground and, thus, has an impact on the soundness of the entire leg. The hoof pastern axis refers to an imaginary line that runs from the centre of the fetlock, through the pastern, continuing straight from the coronet to the ground:
- Normal angle: 48 – 55 degrees
- Sloping angle: 45 degrees or less
- Upright angle: 60 degrees or more
- Broken back
- Occurs when this imaginary line is broken at the coronet through to the ground surface. The hoof is at a lesser degree angle compared to the pastern. This can cause strain on the tendons and may result in wear on the navicular.
- Broken forward
- Occurs when this imaginary line is broken at the coronet through to the ground surface. The hoof is at a greater degree angle compared to the pastern. This can cause strain on proximal joints.
Gait Assessment[edit | edit source]
When performing a gait assessment have the horse:
- Walk away from you, past you and towards you
- Trot away from you, past you and towards you
- Walk in a circle with limbs crossing (turn on the forehand)
- Rein back
- Trot on a circle in both directions (usually on the lunge)
It is important to consider the surface you are examining the horse on as this can influence lameness. Where possible, try to perform an entire sequence on both firm and soft surfaces. As a rule of thumb, soft tissue lameness (i.e. tendons and ligaments) will be more obvious in soft or deep surfaces such as a sand arena. Joint lameness is usually more evident on hard ground. Trotting on bricks or concrete may sometimes assist when assessing lameness as you can better hear the horse's foot-fall rhythm.
Lameness[edit | edit source]
The definition for lameness is when a horse has an abnormal stance or abnormal gait, either due to a structural or functional cause. This will lead to an inability or unwillingness to stand or move in a normal way. It is the most common reason for loss of function in horses. The cause can be congenital / acquired, due to trauma, infection, metabolic disorders, or nervous / circulatory system disease. Lameness in horses is a clinical sign of pain (most common) / mechanical restriction leading to a change in stance, gait or neuromuscular disease.
Grading Lameness[edit | edit source]
There are many types of scales that grade lameness and, as Tabor and Williams note, there is significant variation when veterinarians score lameness. The most widely accepted grading system is the American Association of Equine Practitioners (AAEP) scale.
|Grades||Degree of lameness|
|Grade 0||No lameness under any conditions|
|Grade 1||Lameness difficult to observe, not consistently present under any conditions, including weight-bearing, circling on inclines or hard surfaces|
|Grade 2||Lameness is difficult to observe when walking or trotting in a straight line, but it is consistently present under certain conditions such as weight-bearing or circling on inclines or hard surfaces|
|Grade 3||Lameness is consistently seen when trotting under all conditions|
|Grade 4||Lameness is obvious - the horse mobilises with clear head nodding or short stride|
|Grade 5||Lameness is obvious - the horse has minimal weight-bearing in motion and / or at rest or is unable to move|
Veterinarians also commonly use the lameness locator to assess lameness. This is a machine that analyses movement through motion sensors. It objectively quantifies how a horse moves through space and weight bears.
Range of Motion (ROM)[edit | edit source]
Flexion Test[edit | edit source]
Flexion tests are often performed during a lameness examination or pre-purchase vetting assessment to exacerbate any lameness that may be present. The animal's leg is held in a flexed position for around a minute. The horse is then trotted off and its gait is analysed for any abnormalities / unevenness. This test stresses the joint capsule, soft tissue of the joint and, sometimes, the bone and cartilage as well. This pressure exacerbates problems that may not otherwise be obvious. A horse may take a few uneven steps after the test or be lame for several minutes. However, this test is not specific, its interpretation is subjective and there is a significant amount of variation between observers.
Active ROM[edit | edit source]
It is very difficult to isolate most equine joints for active ROM assessments. Thus, animal therapists tend to assess active ROM during functional movements and then measure passive ROM. However, reflexes and baited stretches can be used to test cervical and thoracic movements.
Reflexes[edit | edit source]
Ventrodorsal Lift Reflex (Withers Test)[edit | edit source]
This tests thoracic vertebra flexion. To perform this test:
- Apply firm pressure with fingernails, pen cap or blunt hoof pick to the midline of the level of the horse's girth
- This will cause the horse to ‘lift’ the cranial thoracic region
Lateral Reflex[edit | edit source]
This tests lateral flexion. To perform this test:
- Apply firm pressure with fingernails, pen cap or blunt hoof pick to the biceps femoris line on the contralateral side and around the buttocks
- This causes the horse to laterally flex the lumbar and caudal thoracic regions
- Consider the horse's ROM
Rounding Reflex[edit | edit source]
This tests lumbar flexion. To perform this test:
- Apply firm pressure with fingernails, pen cap or blunt hoof pick to the caudal border of biceps femoris bilaterally
- Ensure you are standing to the side of the horse and beware of being kicked
- The horse will flex
- Consider the horse's rotation and ROM
Extension Reflex[edit | edit source]
This tests lumbar or thoracic extension. To perform this test:
- Stand on a box behind the horse, draw your fingers or two hoof picks caudally along the lumbar / thoracic paravertebral musculature
- Observe for quantity and symmetry of movement
Baited Stretches[edit | edit source]
Baited stretches are used to assess the active movement of the spine (in the cervical and cranial thoracic regions). During these movements, the therapist uses a treat (e.g. a carrot) to encourage a movement. Remember to compare both sides for lateral movements.
Cervical Spine[edit | edit source]
- Cervical flexion - guide the horse’s muzzle towards its upper chest to effect a nodding movement (at the poll) *the poll is the part of the horse's head behind the ears
Caudal Cervical Spine[edit | edit source]
- Flexion - for lower cervical / upper thoracic flexion, guide the horse’s muzzle down between fetlocks (or observe horse grazing – check for even weight distribution between forelimbs). Also guide the horse’s muzzle towards the sternum to check mid-cervical flexion
- Lateral flexion - guide the muzzle around along horse’s lateral trunk towards the flank and compare the range on each side
- Lateral flexion / flexion - guide the horse's muzzle around towards the carpal region and compare the range on each side
Thoracic Spine[edit | edit source]
Passive ROM[edit | edit source]
Cervical Spine[edit | edit source]
- Guide the muzzle upwards and stabilise with one hand gently over C1
- Apply a gentle overpressure from underneath the muzzle
- Assess end-feel
- Guide the muzzle towards the upper chest and stabilise with one hand gently over C1
- Apply a gentle overpressure to the front of the muzzle
- Assess end-feel
- Stabilise with one hand over C2 and guide the horse’s muzzle towards you on a rotatory axis
- Apply gentle overpressure via the muzzle
- Compare range of motion and end-feel side to side
- Motion at each cervical level between C3–C6 can be assessed by palpating the ‘opening’ of the cervical vertebra when an assistant laterally flexes the horse’s neck away from the assessor
- Alternatively, you can stabilise over the vertebral body with one hand to effectively ‘block’ motion from the chosen level
- You then gently guide the horse’s muzzle toward you, in a lateral flexion direction
- Apply gentle overpressure and assess the range of motion and end-feel
- You will need to compare sides
Thoracic Spine[edit | edit source]
It is very difficult to assess the passive ROM of the thoracic spine due to deep joint levels, tight connective tissue structures and restrictive facet joint morphology. It is possible to mobilise the wither, but there is very little movement. Some rib springing may be possible depending on soft tissue tone.
Lumbar Spine[edit | edit source]
It is not likely that the mobilisations discussed below cause any real movement at a vertebral level. However, they do generate reflex muscle guarding in muscles associated with the affected vertebral motion segment.
Unilateral dorsal-ventral mobilisations:
- Standing on a tall box or step, apply a gradual downwards force over the transverse process of each consecutive lumbar vertebra
- Perform on both sides
Central dorsal-ventral L5 and L6:
- Standing on a tall box or step, apply a gradual downwards force over the spinous processes of L5 and L6
- Horses with pain in this area (usually ligamentous in origin) will dip away from the pressure
- Horses who have no pain will show no response (and no movement should be palpable)
- Standing on a tall box, stabilise the lumbar segment above the testing vertebra and grip the dock of the tail with your other hand
- Pull gently on the dock towards you and grade the mobilisations
Sacroiliac Joint (SIJ)[edit | edit source]
All movement tests for the SIJ are non-specific as it is not possible to isolate SIJ movement from lumbar movement.
Active Testing[edit | edit source]
Weight-bearing weight displacement
- Stand on a box behind the horse (or next to the horse if you suspect it may kick)
- Palpate the tuber sacrale bilaterally, and have an assistant lift one hind leg
- Feel for any cranial shift of the contralateral tuber sacrale as the SIJ of the weight-bearing leg assumes its close-packed position
- Repeat with the other leg
Movement during limb protraction
- Stand on a box behind the horse (or next to the horse if you suspect it may kick)
- Palpate the tuber sacrale bilaterally, have an assistant lift one hind leg and stretch it forward
- Feel for a slight caudal shift of the contralateral tub sacrale
Passive Testing[edit | edit source]
On passive testing of the SIJ, a horse's response is an indication of joint irritability, rather than joint restriction or mobility. Because movement of the pelvis also causes movement in the lumbar spine and hip, it is important to carefully observe where the movement originates.
- Stand on a box or step next to the horse
- Apply a slow, repetitive downwards force on the tuber coxae
- Feel for reflex muscle guarding in response to the movement
- A horse who does not have pain should allow a soft oscillation of the ilium
- Compare to the other side
Peripheral Joints[edit | edit source]
The following table summarises the active and passive ROM tests included in an assessment of the peripheral joints.
|Joint||Active Testing||Passive Testing|
|Glenohumeral||Observed through gait||Full flexion can be assessed in this joint, as can adduction and abduction - internal and external rotation can also be assessed when the elbow is stabilised|
|Elbow||Observed through gait||Full flexion can be assessed, along with external and internal rotation|
|Carpal||Observed through gait||Full extension and flexion may be assessed. With flexion, there is slight accessory rotation and lateral glide available|
|Proximal Interphalangeal||Observed through gait||Full flexion and extension may be tested - during flexion, accessory movements of abduction, adduction and rotation can be assessed|
|Distal Interphalageal||Observed through gait||A relative cranial glide of PIII on PII may be achieved and medial and lateral rotation accessory glides can be assessed|
|Hip||Assessed during gait - to assess abduction and adduction, look at lateral gait work|
|Stifle||Assessed during gait - look for any locking||Tibiofemoral joint can be assessed in conjunction with the hock for both flexion and extension. Medial and lateral rotation through the tibia may be used to assess ligament integrity|
|Tarsal||Assessed during gait||Full flexion may be assessed. Extension is coupled with the stifle - if you can reach full extension of the hock independently, it can raise suspicions of a rupture of peroneus tertius|
Muscle Strength Testing[edit | edit source]
It is difficult to test individual muscles for strength in equine patients. It is not possible to use the Oxford Scale, so muscle strength is tested globally through functional testing (e.g. a horse who struggles with pushing behind will generally have weak gluteal muscles).
Strength can also be tested by assessing the horse's stability. Please note it does test a number of things at once for e.g. neural function, balance and the ability to load. To test stability, lift a leg and shift additional weight to the contralateral limb by gradually pushing against the horse. A normal horse will immediately match the applied force in order to maintain its balance. It is important to note that this does test a number of elements at once, including neural function, balance and the horse's ability to load a particular quadrant.
- This test can be done on both the front and hind limbs, and while it is non-specific, it provides information about how comfortable the horse is with loading.
- If a horse is reluctant to load a particular limb, he will hop sideways, or make postural adjustments with the remaining two weight-bearing limbs. There may also be a lag in response from the horse. This narrows down the region of dysfunction to then be assessed in greater detail.
Special Test - Stork Test[edit | edit source]
- When one hind limb is lifted, the SIJ on the contralateral hind limb assumes its close-packed position
- To test for potential SIJ pain, the SIJ is loaded unilaterally by lifting the opposite hind leg into slight abduction, thereby increasing the load on the weight-bearing hind limb
- After 60 seconds, the horse is immediately trotted away in a straight line
- The test is positive if the horse exhibits an increased lameness of the WEIGHT-BEARING leg, not the flexed leg
- The test should be repeated on the other side to compare
Palpation[edit | edit source]
When palpating a horse, there are both general and specific features to consider.
A general palpatory scan consists of quick palpation of all major muscle groups to pick up obvious changes in soft tissue. Palpation should be firm, but gentle and slow. Any sudden movements or pressure can cause an excessive muscle response, thus creating a false impression of tenderness. A horse's first response to palpation may not be the most accurate. The same pressure should be repeated a few times over a potentially symptomatic area to ensure the observed response is consistent. General soft tissue palpation will provide information about:
- Muscle tone
- Soft tissue thickening or swelling
- The horse's overall reactivity to touch
Specific muscle palpation occurs after the therapist has developed a hypothesis of which muscle/s may be the primary source of symptoms. Once this potential area of soft tissue abnormality has been identified, the area can be assessed in more detail starting with a more precise palpation of structures in the area.
It can help to divide the horse up into anatomical regions, so that you can palpate all the functionally related structures.
The following table summarises key areas that should be palpated in equine patients.
|Head and Cervical Spine||Fore limb||Thoracolumbar Spine||Hind limb|
Neurological Assessment[edit | edit source]
Complete neurological assessments are necessary when a horse has symptoms that appear to be associated with neurological disease or if it is important to demonstrate that a horse does not have any neurological impairments (e.g. for a vetting examination). Neurological assessments are usually performed by the veterinarian, but it is important for physiotherapists to understand how they are performed because we:
- Sometimes are the first health professional to detect a problem / issue
- Need to be able to identify any issues to help ensure safety / reduce the risk of a horse falling due to neurological issues
Differential Diagnosis[edit | edit source]
The following are neurological conditions seen in equine patients:
- CVM (Cervical Vertebral Malformation)
- EHV -1 (Equine Herpes Virus)
- Cauda Equina Neuritis
- West Nile Virus
- Spinal Cord Trauma
- Post-anaesthetic myoneuropathy
Cranial Nerve Testing[edit | edit source]
The following table, adapted from Johnson, summarises the function and assessment process for the 12 cranial nerves.
|I. Olfactory||Smell||Not often assessed|
|II. Optic||Vision||Assess menace response and the pupillary light reflex (PLR) - a lesion to this nerve results in blindness and the loss of PLR. A menace response can be elicited by a threatening hand gesture towards the horse's eye.Youtube video|
|III. Oculomotor||Pupillary constriction, extraocular muscles||Assess PLR and pupil size, medial movement of globe, eye position, and palpebral fissure size - a lesion of this nerve results in lateral and ventral strabismus, ptosis, mydriasis, and loss of PLR|
|IV. Trochlear||Extraocular muscle (dorsal oblique)||Look at eye position - a lesion of this nerve results in dorsomedial strabismus|
|V. Trigeminal||Sensory (head), motor (masticatory muscles)||Assess palpebral blink and nociceptive response when the horse's head is touched - a lesion to this nerve results in loss of sensation and palpebral and corneal reflex
Chewing, jaw tone, masticatory muscle size are affected - a lesion causes atrophy and a dropped jaw
|VI. Abducent||Extraocular muscles (retractor bulbi and lateral rectus)||Look at globe retraction and lateral movement of the globe - a lesion to this nerve results in medial strabismus and a loss of the corneal reflex|
|VII. Facial||Motor (muscles of facial expression), parasympathetics (salivary and lacrimal glands)||Look at facial symmetry, palpebral blink, ear and muzzle / lip movement - a lesion to this nerve results in facial paralysis, loss of palpebral reflex and blink, and dry eye|
|VII. Vestibulocochlear||Posture, balance and hearing||Assess head and eye position (strabismus) and nystagmus - a lesion to this nerve results in head tilt, nystagmus, a loss of balance and deafness|
|IX. Glossopharyngeal||Sensory and motor to the pharynx||Look at the horse's ability to swallow - a lesion to this nerve results in dysphagia and displaced soft palate|
|X. Vagus||Sensory and motor to the pharynx and larynx||Look at the horse's ability to swallow and its laryngeal movement - a lesion to this nerve results in dysphagia, laryngeal paralysis and a displaced palate|
|XI. Spinal accessory||Motor to the cervical muscles, larynx and oesophagus||Look for muscle atrophy - otherwise this nerve is not routinely assessed|
|XII. Hypoglossal||Motor to the tongue||Assess tongue strength and symmetry - a lesion to this nerve results in atrophy and paralysis|
Posture[edit | edit source]
The veterinarian will observe if there is any abnormal posture of the head (e.g. tilting), neck and body position. This can be assessed in the stall or outside.
Gait[edit | edit source]
When assessing gait for neurological issues, you should:
- Walk the horse in a straight line looking for abnormalities or ataxia
- Trot the horse in a straight line looking for abnormalities or ataxia
- Walk the horse in serpentine looking for abnormalities or ataxia
- Walk the horse with its head elevated
- Walk the horse while pulling the tail in both directions and note any balance issues or abnormal behaviour
- Walk the horse on a small circle noting any abnormal gait patterns or balance issues
- Rein back noting any high stepping or ataxia
- Walk the horse on uneven terrain noting any abnormalities in gait
Clinical Reasoning[edit | edit source]
Like with human patients, it is important to clinically reason throughout your assessment. After a subjective assessment, it is necessary to plan which tests are applicable and which are not. When moving through your assessment, you may change the order of the objective assessment based on your findings. The following provides a basic framework for clinical reasoning. Please note, however, that symptoms may not always present in this way and it is always important to consult with the horse's veterinarian:
- Lame on a circle in deep sand, but sound on a straight line with inconclusive nerve blocks = check for SIJ dysfunction
- Owner complains that a clinically sound horse will not move forward or has developed behavioural issues to leg = check for back pain or SIJ dysfunction
- Sound horse disuniting in the canter = check for SIJ dysfunction or hind limb strength
- The horse is not taking the contact on one rein or struggling to turn = check contralateral stirrup bar fitting or for TMJ dysfunction
- With TMJ dysfunction always check the poll too
Ridden Assessment[edit | edit source]
Although ridden assessments are not routinely performed, it is important that as human and equine therapists, we can assess both the rider and the horse as they influence each other. This type of assessment may be indicated when a horse's dysfunction is related to a specific activity when the horse is ridden (i.e. it cannot be replicated in hand). This might include canter pirouette in dressage or sliding stop in western riding. They may also be useful if therapists want to establish if certain abnormalities observed in-hand worsen when the horse is ridden.
During a ridden assessment, check for symmetry of movement of the rider on the horse, as well as balance as these can influence the horse. Questions to ask include:
- Is the rider shifting to the left or right?
- Does she / he rotate in the saddle?
These assessments should be discipline-specific - if you are assessing a jumper, you need to look at these factors during a jump. When looking at the horse during these assessments, it is useful to look at:
- ROM of the hips, ankles and spine
- Muscle strength (particularly important groups like gluteus medius, abdominals (including transversus abdominis), multifidus, deep neck flexors, sling muscle groups
When conducting a ridden assessment, please note that as an equine physiotherapist, you are there to assist with the rider's biomechanics rather than his / her technique - you are not the coach.
During the ridden assessment, any concerns about tack fit should also be assessed, including:
- Saddle fit
- Bit and bridle
The ridden assessment is discussed in more detail here.
Summary[edit | edit source]
- There are numerous aspects to an objective equine assessment
- Much of your assessment is based on functional movements and palpation
- From your objective assessment, you will be able to derive a management plan
References[edit | edit source]
- Paulekas R, Haussler KK. Principles and practice of therapeutic exercise for horses. Journal of equine veterinary science. 2009;29(12):870-93.
- Goff L. Physiotherapy Assessment for the Equine Athlete. Vet Clin North Am Equine Pract. 2016;32(1):31-47.
- Melbye, D. Conformation of the horse. University of Minnesota Extension.
- Duberstein KJ. Evaluating horse conformation. Available from: https://extension.uga.edu/publications/detail.html?number=B1400&title=Evaluating%20Horse%20Conformation (cited 20/4/2021).
- Chelin S. Assessment of the Equine Patient Course. Physioplus, 2021.
- 1966mlazyc. Equine conformation Available from: https://www.youtube.com/watch?v=cUDL2qMEWPM [last accessed 5/5/2021]
- Melbye D. Conformation of the horse. Available from: https://extension.umn.edu/horse-care-and-management/conformation-horse#back-1158661 (cited 20/4/2021).
- Dar KH, Dar SH, Qureshi B. Bog Spavin and Its Management in a Local Horse of Kashmir-a Case Report. SOJ Vet Sci. 2016;2(1):1-2.
- Björnsdóttir S, Arnason T, Lord P. Culling rate of Icelandic horses due to bone spavin. Acta Vet Scand. 2003;44(3-4):161-9.
- Genius Equestrian. The Importance Of Hoof Pastern Axis And Working Together To Achieve Good HPA. Available from: https://www.geniusequestrian.com/the-importance-of-hoof-pastern-axis-and-working-together-to-achieve-good-hpa/ (cited 20/4/2021).
- Olivia Child. How does a horse's conformation affect its quality of movement and long-term structural health? Available from: https://www.youtube.com/watch?v=5DRpwU98mNI&t=79s [last accessed 21/4/2021]
- Van der Walt A. Assessment and Management of the Equine Spine Presentation. Physioplus, 2021.
- Adams, S.B. Overview of Lameness in Horses. MSD MANUAL Veterinary Manual. Sep 2015.
- Tabor G, Williams J. Objective measurement in equine physiotherapy. Comparative Exercise Physiology. 2020 Feb 5;16(1):21-8.
- American Association of Equine Practitioners. Lameness exams: evaluating the lame horse. Available from: https://aaep.org/horsehealth/lameness-exams-evaluating-lame-horse (cited 20/4/2021).
- Equinosis Lameness Locator. How it works. Available from: https://equinosis.com/veterinarians/#q-analysis (cited 20/4/2021).
- Kaneps AJ. Diagnosis of lameness. In: Hinchcliff KW, Kaneps AJ, Geor RJ, editors. Equine sports medicine and surgery. Second Edition. Edinburgh: Elsevier, 2014. p239-51.
- Marshall JF, Lund DG, Voute LC. Use of a wireless, inertial sensor-based system to objectively evaluate flexion tests in the horse. Equine Vet J Suppl. 2012;(43):8-11.
- McGowan C, Goff L, editors. Animal physiotherapy: assessment, treatment and rehabilitation of animals. John Wiley & Sons; 2016 May 2.
- Clayton HM, Kaiser LJ, Lavagnino M, Stubbs NC. Dynamic mobilisations in cervical flexion: Effects on intervertebral angulations. Equine Vet J Suppl. 2010;(38):688-94.
- Zikmann P. Assessment and Management of the Equine Spine Course. Physioplus, 2021.
- Johnson AL. How to perform a complete neurologic examination in the field and identify abnormalities. AAEP Proceedings. 2010;56:331-7.
- The Ophthalmic Examination – Part 1: Menace response, pupillary light and dazzle reflexes. VMCLI. Nov 2018.
- LMU CVM. 1 Equine Cranial Nerve Evaluation. Available from: https://www.youtube.com/watch?v=0GpgWWh_QA4 [last accessed 21/4/2021]