Statistics about equine dental disease are striking. A 1994 survey of 500 equine skulls found evidence of dental disease in 80% of subjects. By 2012, a UK study identified dental irregularities in 95.4% of horses aged fifteen and over — yet only a quarter of owners were aware their horse had a problem requiring attention. Despite decades of routine dentistry, these numbers have barely shifted. Christina Hall, writing for the London College of Animal Osteopathy, asks a provocative question: could the way we approach equine dentistry be part of the problem?
Hall, who practises as both an equine osteopath and a qualified equine dentist in the United States, brings a rare dual perspective to this thesis. Her central argument is that modern equine dentistry operates almost exclusively within an allopathic framework — addressing the visible signs of dental abnormality, from hooks and ramps to ulcerations and malocclusions, without asking why those abnormalities exist in the first place. She contends that the answer almost always lies in immobility somewhere in the body, and that osteopathic assessment is the tool best placed to find it.
The thesis draws on A.T. Still’s four principles of osteopathy to reframe every aspect of dental care. If a horse presents with recurring tongue ulceration, for instance, the standard response is to file the offending tooth surface. But Hall argues the cause is likely restriction at the temporomandibular joint — and that restriction, in turn, may originate in a hoof imbalance, a visceral restriction, or a fascial tension pattern running from the hind limb to the skull. The concept of the ‘six legs’ — the three paired extremities of mandible, forelimbs, and hindlimbs that govern mobility patterns across the horse’s entire body — is introduced as a clinical lens for understanding how restriction in one region cascades throughout the whole.
Hall reserves particular concern for routine dental practices such as prolonged speculum use and head positioning on extended dental stands, arguing that these techniques place the upper cervical spine into hyperextension and impose excessive strain on the apical ligament and the temporomandibular joint disc. With nine of twelve equine myofascial kinetic lines originating or terminating at the skull, the downstream consequences of dental procedures performed in biomechanically unsound positions may be far greater than is currently appreciated. This is a thesis that will challenge the assumptions of every equine professional who reads it.
The hoof is often treated as a farriery problem — a question of angles, balance, and correct trimming. But what if poor hoof morphology is not just a foot problem, but a whole-body problem? In this thought-provoking and expertly reasoned thesis, Cheryl Hammerson makes the case that osteopathy and farriery are not separate disciplines, but deeply interconnected partners in equine health.
Anchored in the second principle of osteopathy — that structure and function are interrelated — Hammerson walks the reader through a compelling argument: that the body and the hoof shape each other in a continuous, dynamic feedback loop. When a horse develops pathology in the stifle or hip, compensatory loading patterns over time distort hoof morphology. Conversely, poor hoof structure — long toes, low heels, broken hoof-pastern axes — imposes abnormal forces on the entire musculoskeletal system, generating postural dysfunction, back pain, and eventually lameness.
The paper is enriched by real-world case examples, including a detailed account of a show pony whose refusal to jump, aggressive pain response, and postural collapse were traced to severely imbalanced hind hooves. Once the farrier addressed the foot balance and osteopathic treatment restored mobility to the horse’s soft tissues and spine, the pony returned to competition. Three comparative hoof assessment examples — measured with the HoofmApp tool — further illustrate how hoof asymmetry correlates with diagnosed pathology in the opposite limb.
Hammerson also draws on emerging research in human osteopathy and posture science to strengthen the case for equine application. The conclusion is clear: to care effectively for the horse’s hooves, you must care for the whole horse — and that is exactly what osteopathy is designed to do.
Equine osteopathic manual therapy is widely used to improve biomechanics and support rehabilitation, yet its systemic physiological effects have rarely been rigorously measured. In this thesis, Carla Pujadó analyses the findings of a landmark controlled study involving thirty Thoroughbred horses to examine how a single OMT session — using Pascal’s high-velocity, low-amplitude technique — produces measurable changes across three of the body’s most important regulatory systems: the autonomic nervous system, the immune system, and thehypothalamus-pituitary-adrenal axis.
The results are striking. Blood serum cortisol rose significantly in the experimental group immediately after treatment, then declined toward baseline within an hour — a transient HPA axis activation consistent withpatterns observed in human OMT research. White blood cell counts showed a parallel fluctuation, indicating an acute immune response rather than a sustained inflammatory shift. Body temperature increased significantly in treated horses, pointing to autonomic involvement in thermoregulation, while heart rate trends suggested a shift toward parasympathetic dominance, even when changes fell short of statistical significance.
Pujadó situates these findings within ten clinical cases — horses presenting with neurological deficits, pelvic asymmetry, suspensory desmitis, and chronic thoracolumbar pain — demonstrating how the physiological responses documented in the study map onto real-world presentations. The thesis also confronts an uncomfortable gap: despite OMT’s growing clinical use, only one published study examines its systemic physiological effects in horses. Pujadó identifies the methodological, funding, and standardisation barriers that have slowed this research, and makes a compelling case for why closing that gap matters — not just for science, but for the horses practitioners treat every day.
Every horse carries its physical history in its body. The old falls, the awkward landings, the years spent compensating for an undiagnosed restriction — these experiences accumulate as somatic dysfunctions that quietly shape how a horse handles, moves, and responds under saddle. In this practical and perceptive thesis, Bethany Rice — drawing on more than a decade as a full-time professional trainer before qualifying as an animal osteopath — explores the physical roots of some of the most common and frustrating problems in horses.
The thesis is structured around three categories: handling issues, behavioural problems, and performance limitations. For each, Rice identifies the likely anatomical origins, walks through the clinical reasoning, and outlines an osteopathic treatment approach. Head shyness is traced to atlanto-occipital dysfunction and compression of the poll nerves. Resistance during farriery maps to joint pain, brachial plexus nerve impingement, or sacral and lumbar lesions, depending on which limb is involved. Girthiness reliably points to rib head and thoracic vertebral dysfunction at segments T8-T12. Bucking at canter, a behaviour often managed through training alone, is reframed here as a probable expression of sacral or lumbar neuralgia that worsens as the horse transitions to a different gait.
Performance limitations receive equally detailed treatment. Bit resistance is examined through the lens of the atlanto-occipital joint, C2 dysfunction, and the hyoid apparatus. Preferred bend patterns are categorised as Type 1 or Type 2 lesions — each with a distinct presentation, origin, and treatment pathway. The concept of diagonal synchrony is used to explain why a restriction in one limb produces a corresponding reduction in the contralateral diagonal.
Throughout, Rice makes a clear and compelling argument: that what trainers often interpret as stubbornness or training failure is often the body communicating a need for restoration rather than correction.
What separates a well-trained horse from a truly high-performing one? According to Asia Peruzzetto’s thesis, the answer lies not in genetics or training intensity alone, but in the structural harmony that underpins every stride, jump, and transition. Her comprehensive exploration focuses on the role of osteopathy in equine athletic performance. By integrating biomechanical research, breed-specific anatomy, and clinical evidence, the work makes a strong case for incorporating manual therapy as a fundamental component of sport horse management.
Peruzzetto begins by mapping the diverse physical demands placed on horses across disciplines — from the torsional hock stress of reining to the thoracolumbar strain of dressage collection, the tendon load of flat racing, and the metabolic demands of endurance. The study analyzes how breed morphology influences both athletic capability and injury risk. Specifically, it notes that Thoroughbreds are prone to suspensory inflammation during intense training; European Warmbloods require diligent management of their sacroiliac region; and Arabians competing over long distances need structured, gradual conditioning to safeguard their flexor tendons.
This thesis provides a compelling argument for the multidimensional effects of osteopathy on athletic horses. The evidence presented goes beyond improved joint mobility, drawing on studies that demonstrate osteopathic treatment induces changes in autonomic tone, cortisol regulation, and immune markers. This highlights how manual therapy contributes to the horse’s overall physiological resilience, not just its musculoskeletal health. Key areas where osteopathy offers measurable value include: enhancing post-competition recovery, improving proprioception, and facilitating the early detection of compensatory movement patterns.
The thesis closes with a call for larger, inter-breed comparative studies to consolidate osteopathy’s place within evidence-based equine sports medicine — a field the author clearly intends to shape professionally.
When a horse resists the aids, tosses its head, or suddenly loses rhythm through a transition, the instinct is often to look at the training. But what if the problem isn’t in the schooling — what if it’s in the body? This is the central question explored in Anne Éfféré’s thoughtful and well-structured thesis, which makes a compelling case that many of the most common riding problems are not behavioural in origin, but physical — and that equine osteopathy offers a meaningful path to resolving them.
Drawing on current research and established osteopathic principles, Éfféré systematically maps the links between specific physical dysfunctions — including musculoskeletal imbalances, joint restrictions in the sacroiliac and cervical spine, and compensatory movement patterns — and the riding problems they cause. A horse labelled stubborn for refusing to bend may simply have cervical spine restrictions. A horse that bucks during transitions
may be communicating discomfort in the sacroiliac region. Without understanding the physical root cause, training corrections not only fail to resolve the problem — they can make it worse.
The thesis also introduces key osteopathic techniques, including structural mobilisation, soft tissue manipulation, Osteopathic Articular Balancing (OAB), and craniosacral therapy, exploring how each addresses specific dysfunctions. Importantly, Éfféré emphasises that osteopathy works best as part of a collaborative approach — one that brings together the practitioner, trainer, and rider to observe, respond, and adapt. A valuable read for anyone working with horses who don’t quite feel right under saddle.
Alexandra Jones’s comprehensive thesis highlights a critical issue in veterinary practice: the equine sacropelvic region, despite its immense biomechanical significance, remains clinically underserved. This area is vital as the pivot point for transferring propulsive force from the hindlimbs to the spine, a key stabiliser during stance, and a frequent source of performance issues in sport horses. However, Jones argues that current traditional veterinary methods face considerable limitations in accurately diagnosing and effectively treating pathologies in this crucial region.
Jones’s work systematically examines the sacropelvic complex, starting with a detailed anatomical description of the ilium, sacrum, hip joint, stifle, and related musculature. She then correlates this anatomy with the clinical presentation of somatic dysfunction in the area. Drawing heavily on Thoresen’s seminal 2006–2007 study of 374 horses with suspected sacroiliac or hip issues, Jones identifies the primary clinical signs: restricted femoral extension and abduction, gluteal syndrome, dorsal ilial displacement, and spasm of the thoracolumbar epaxial muscles.
Evidence strongly supports the efficacy of osteopathic manipulative treatment (OMT). For instance, Thoresen’s research on horses with sacroiliac joint restrictions documented a 79% positive outcome rate following OMT. Furthermore, OMT’s effects extend beyond local mechanics, demonstrating measurable systemic changes. A study conducted in Lithuania showed that OMT influenced the autonomic, immune, and HPA systems, evidenced by changes in heart rate, respiratory rate, cortisol levels, and white blood cell counts. This systemic impact is corroborated by infrared thermography data, which revealed significant gluteal temperature shifts post-treatment, consistent with improved sympathetic nervous system regulation.
Jones’s conclusion is that OMT provides both immediate and lasting advantages for horses suffering from sacropelvic dysfunction. The implications of this treatment are significant, reaching far beyond the specific area treated.
Navicular syndrome remains one of the most challenging and emotionally draining diagnoses in equine medicine. For decades, it has frustrated veterinarians, farriers, therapists, and owners alike — not because it is rare, but because it is complex, progressive, and rarely simple to manage well.
Traditionally, navicular disease treatment focused on pain control and corrective shoeing. While those remain essential, modern understanding has moved well beyond a single-structure model of disease. What we now call navicular syndrome is more accurately understood as a form of caudal heel pain syndrome — a condition involving multiple tissues, biomechanical forces, and compensatory patterns throughout the horse’s body.
Emerging clinical evidence and practical experience both point toward the same conclusion: sustainable management requires more than symptom control. It requires a coordinated, whole-horse approach that integrates veterinary care, farriery, and appropriate supportive therapies.
Understanding Navicular Syndrome: More Than Just a Bone Problem
The navicular bone sits deep within the hoof, positioned between the deep digital flexor tendon (DDFT) and the coffin joint. It plays a crucial biomechanical role in force transmission, shock absorption, and movement efficiency.
However, navicular syndrome in horses is no longer viewed as isolated navicular bone degeneration. Instead, it is understood as a multifactorial condition involving a network of interconnected structures, including:
Navicular bone remodeling and surface changes
Deep digital flexor tendon inflammation, degeneration, or adhesions
Navicular bursa inflammation
Collateral sesamoidean ligament strain
Impar ligament pathology
Coffin joint involvement
Altered vascular perfusion in some cases (the exact role of vascular factors remains debated)
For many horses, the disease develops gradually. Lameness is often subtle at first — intermittent, inconsistent, and easily dismissed as stiffness or training-related soreness. Over time, discomfort becomes more persistent, particularly on hard or uneven surfaces.
What makes navicular syndrome especially challenging is not just the local pathology, but the way the horse adapts. As pain develops in the caudal heel region, movement patterns change. These compensations don’t stay in the foot — they ripple through the limb, the back, and the entire musculoskeletal system.
anatomy-of-the-equine.com
Traditional Navicular Disease Treatment: The Foundation
Despite advances in integrative care, conventional veterinary management and corrective farriery remain the non-negotiable foundation of navicular treatment.
Veterinary Medical Management
Standard veterinary approaches typically include:
NSAIDs as first-line pharmaceutical support to control pain and inflammation. The careful management of pain is critical, as uncontrolled discomfort leads to further biomechanical compensation and accelerated deterioration.
Bisphosphonates (such as tiludronate and clodronate) in selected cases, where osseous pathology is evident and pain modulation is required
Intrasynovial or intra-articular injections of corticosteroids and/or hyaluronic acid when coffin joint or navicular bursa involvement is confirmed
Historically, vasodilators such as isoxsuprine were widely used, though evidence for their effectiveness has been inconsistent and they are now less commonly relied upon in modern protocols.
Medical management plays a vital role, but it is not a cure. Its purpose is to reduce pain, slow progression where possible, and support function — not to reverse established pathology.
The Critical Role of Farriery
Corrective farriery remains the cornerstone of navicular management. The goal is biomechanical: reduce stress on the navicular region, improve breakover, optimise loading patterns, and support healthy hoof function.
Egg bar or heart bar shoes for heel support and load redistribution
Wedge pads or raised heels to reduce DDFT tension
Rolled or rockered toes to ease breakover
Wide-web shoes for increased support
Carefully managed barefoot protocols in select, appropriate cases
Effective navicular management requires active collaboration between vet and farrier, with regular reassessment and adjustment as the horse’s response evolves.
hevari.eu and madbarn.ca
The Biomechanical Cascade: Why Navicular Syndrome Affects the Whole Horse
A horse with caudal heel pain doesn’t just have a sore foot — it has a changed movement strategy.
To avoid discomfort, the horse alters stride length, loading patterns, and limb timing. These adaptations create secondary stress throughout the musculoskeletal system:
Altered loading travels up the limb, affecting joints, tendons, and ligaments
Asymmetry develops between limbs
Diagonal loading patterns increase strain on compensating limbs
Back muscles adapt to uneven propulsion
Thoracolumbar and cervical tension patterns develop
Over time, these compensations can become sources of pain in their own right. Back soreness, pelvic tension, neck stiffness, and secondary limb issues are not “separate problems” — they are often downstream effects of the primary pathology.
This is why treating only the foot often produces incomplete results.
Beyond Traditional Treatment: Integrating Complementary Approaches
Conventional treatment remains essential. But addressing the secondary biomechanical consequences of navicular pain can significantly influence long-term comfort and function.
The Role of Manual Therapy in Navicular Management
Manual therapy, including osteopathy, can play a supportive role when used appropriately and ethically within a veterinary-led plan.
It does not treat the navicular pathology itself. It addresses the compensatory patterns created by it.
For navicular horses, osteopathic assessment commonly focuses on:
Thoracolumbar restrictions
Sacroiliac and pelvic asymmetry
Shoulder and cervical loading patterns
Myofascial restrictions
Global postural balance
The goal is not cure — it is functional efficiency. By reducing compensatory strain, the horse can move more comfortably within its physical limitations.
Manual therapy should always:
Be coordinated with veterinary care
Support, not replace, medical management
Work alongside farriery strategies
Respect inflammatory and pathological boundaries
Therapeutic Exercise and Rehabilitation
Complete rest is rarely beneficial long-term. Thoughtfully structured movement supports circulation, tissue health, muscle conditioning, and joint function.
A sensible rehabilitation approach may include:
Controlled hand-walking on appropriate surfaces
Managed turnout
Gradual, progressive strengthening work
Balance and proprioceptive training
Low-impact conditioning modalities where available
Movement is not about workload — it’s about quality, control, and consistency.
Nutritional and Metabolic Considerations
Body condition matters. Excess weight increases loading forces through the caudal heel and accelerates mechanical strain.
While equine metabolic syndrome (EMS) is not directly causative in navicular disease, systemic inflammation, insulin dysregulation, and obesity can negatively influence tissue health, recovery capacity, and overall biomechanics.
Good management focuses on:
Maintaining optimal body condition
Supporting metabolic health
Preventing secondary conditions such as laminitis
Managing inflammatory load through nutrition
The Interdisciplinary Team Approach
Successful navicular management is never the result of a single intervention.
It depends on coordinated care between:
Veterinarian: diagnosis, imaging, medical management, monitoring
Farrier: biomechanical correction and hoof support
Manual therapist: management of compensatory dysfunction
Rehabilitation specialist: structured movement planning
Owner: daily consistency, observation, and care
No single role is more important than the others — but none can replace the foundation of veterinary diagnosis and farriery.
Lateromedial radiograph of the foot of one of the limbs with measurement lines for illustrative purposes: DIPJ: distal interphalangeal joint angle—The angle between the central axis of the middle phalanx and the dorsal aspect of the distal phalanx. Please note the latter is translated more palmarly. The angle of the dorsal border (DB) and palmar border (PB) of the navicular bone, as well as the solar angle of the distal phalanx (SAP3), were measured to the horizontal weight-bearing surface. Credit: BEVA Equine Veterinary Journal study ‘Caudal foot placement superior to toe elevation for navicular palmaroproximal-palmarodistal-oblique image quality’
When to Integrate Osteopathic Care
Osteopathic care may be appropriate when:
Compensatory gait patterns persist despite medical management
Secondary back, neck, or limb pain develops
Performance plateaus despite correct farriery and veterinary care
The veterinary team recommends supportive manual therapy
Long-term maintenance of comfort is a goal
It is not appropriate when:
The horse is in acute pain crisis
Veterinary diagnosis has not been established
It is used as a substitute for medical treatment
Active inflammation requires rest and medical care
The guiding principle is simple: manual therapy supports management — it never replaces it.
The Classical Osteopathy Perspective on Navicular Care
Classical structural osteopathy, emphasises the interconnectedness of structure and function throughout the horse’s body. This philosophy aligns particularly well with the modern understanding of navicular syndrome as a condition with whole-body biomechanical implications.
From an osteopathic perspective, the navicular horse doesn’t exist in isolation—it functions as part of an integrated system. When pathology develops in the navicular region, the body’s natural compensatory mechanisms create a cascade of adaptations that, while initially protective, eventually become dysfunctional themselves.
Osteopathic assessment for navicular horses extends beyond the symptomatic limb to evaluate:
Pelvic symmetry and sacroiliac function
Thoracolumbar mobility and any restrictions
Cervical function and poll mobility
Forelimb and hindlimb loading patterns
Fascial continuity throughout the body
Overall postural balance and movement quality
This comprehensive assessment helps identify not only the primary pathology but the entire pattern of adaptation the horse has developed. Treatment then addresses both the compensatory restrictions and works to optimise the body’s inherent capacity for adaptation and healing.
Prognosis and Long-Term Management
Navicular syndrome is a progressive, degenerative condition. There is no cure.
What is possible is management.
Many horses maintain comfort and quality of life for years with appropriate care. Some remain in modified work. Others require lifestyle changes and workload adjustments. Outcomes vary widely.
Prognosis depends on:
Stage of disease at diagnosis
Quality of management
Consistency of care
Owner commitment
Individual biological variation
Honest conversations about expectations, limitations, and welfare are essential.
Conclusion: A Comprehensive Approach to Navicular Care
Navicular syndrome is not just a foot problem. It is a whole-horse condition with whole-body consequences.
Veterinary care and farriery remain the foundation. But long-term success often depends on recognising and managing the biomechanical, postural, and compensatory effects that develop alongside the primary pathology.
When professionals work together — vet, farrier, therapist, and owner — care becomes clearer, more ethical, and more effective.
Not because navicular disease can be cured.
But because horses deserve management that is intelligent, coordinated, and compassionate.
FAQs
What is navicular syndrome in horses?
Navicular syndrome refers to chronic pain in the caudal heel region involving the navicular bone and surrounding soft tissues.
Is navicular syndrome the same as caudal heel pain?
Caudal heel pain describes the clinical presentation. Navicular syndrome describes the anatomical structures involved.
Can horses with navicular syndrome stay in work?
Some horses can remain in modified work with appropriate management, veterinary care, farriery, and monitoring. Outcomes vary by case.
Elite dressage places extraordinary demands on the horse. Pirouettes, piaffe, passage, tempi changes — each of these movements loads the hindlimbs, strains the lumbar-sacral region, and requires sustained cervical flexion that, over time, can tip from healthy exertion into chronic dysfunction. Dr. Amelie Villeneuve-Moore’s rigorously researched thesis asks a precise and important question: Does equine osteopathy have a specific role to play in supporting dressage horses, and if so, what does that look like in practice?
Through an extensive literature review of 44 papers, Dr. Villeneuve-Moore identifies two dominant patterns of dysfunction in elite dressage horses: hindlimb suspensory ligament injuries, which can be career-ending, and myofascial trigger points — particularly in the cervical and thoracic regions — which can silently limit performance without causing outright lameness. Dressage horses, the research reveals, carry significantly more myofascial trigger points than showjumpers, with the brachiocephalic and cervical muscles most commonly affected. These findings have direct implications for how osteopaths assess and treat top-level performance horses.
This thesis presents a compelling argument that routine osteopathic interventions can significantly reduce injury risk and aid in the rehabilitation of horses. It assesses various osteopathic methods, including ischemic compression, longitudinal myofascial stretches, and OAB-based systemic rebalancing. This work is highly relevant and sophisticated, offering valuable insights for equine osteopaths, veterinarians, and dressage professionals.
Castration is the most commonly performed surgical procedure in equine practice. It is also one of the most routinely dismissed when it comes to long-term consequences. The scar heals, the horse goes back to work, and the surgical site is rarely examined again. Yet equine osteopaths have long observed that geldings sometimes present with unexplained movement asymmetries, hindlimb stiffness, and pelvic dysfunction that conventional diagnostics cannot explain — and that often improve when the castration site is addressed. Pauline Bürgermeister decided to put that clinical intuition to the test.
This thesis presents an original study of 25 geldings — a mix of Standardbred trotters and riding school horses — in which castration scars were systematically assessed for five clinical signs: depression of the scar tissue, fibrotic scarring, pain on palpation, discharge, and oedema. Gait asymmetry was evaluated using Sleip AI, a validated markerless motion analysis system, capturing head, pelvic, and total asymmetry scores. The results are striking.
The composite clinical score showed a strong positive correlation with pelvic asymmetry (ρ = 0.71, p < 0.001) and a moderate correlation with total asymmetry (ρ = 0.53, p = 0.007). Tissue depression, fibrotic scarring, and oedema were the most influential individual signs. Pain alone did not reach significance — suggesting that the most clinically relevant changes are structural and chronic rather than acutely painful. Discharge appeared to dilute the composite score, highlighting the importance of weighting variables appropriately in future work.
The thesis contextualises these findings within osteopathic anatomy, examining how fascial restriction, impaired lymphatic drainage, and the well-documented formation of neuromas in spermatic cord remnants might mechanically and neurologically contribute to pelvic dysfunction. The study is honest about its limitations — small sample, no blinded assessment, heterogeneous population — and frames its findings as a call to action rather than a conclusion. For any practitioner encountering unexplained hindlimb asymmetry in a gelding, this work offers a compelling reason to look further down the leg.
