What Happens During a Lameness Examination?
- May 27
- 4 min read
Understanding How Veterinarians Investigate Lameness
Lameness examinations are designed to identify where discomfort is originating and how it is affecting the horse’s movement. While some horses present with an obvious head nod, hip hike or limp this is more often that not the case. Many performance horses instead show subtle changes such as reduced impulsion, uneven transitions, reluctance in certain movements, or a horse that simply feels “not quite right” under saddle.
Because movement abnormalities can arise from multiple structures and compensation patterns may develop over time, a structured and systematic approach is important when investigating lameness.
Why a Structured Lameness Examination Matters
Lameness does not always originate from the area that appears most abnormal during movement.
Horses often adapt their gait to reduce load on painful structures, which can alter the way the entire body moves. In some cases, compensation patterns may influence multiple limbs, spinal motion, or muscular function.
A lameness work-up aims to:
identify the source of discomfort
determine which structures may be involved
assess the severity and significance of findings
guide appropriate treatment and management
Having a detailed history available at the time of consultation is always very valuable. This allows us guage a timeline in the chronicity of a problem which can help when weeding through differential diagnoses. This could include performance or behavioural changes as well as husbandry such as saddle fit, shoeing and management changes.
Approach to a Detailed Assessment
Physical Examination
A full clinical examination is performed before assessing the horse in motion.
This may include evaluation of:
conformation
muscle development and symmetry
posture
hoof balance and foot conformation
joint effusion or swelling
range of motion
muscular tension or sensitivity
The goal is to identify regions that may warrant closer investigation during gait assessment.
Gait Assessment
The horse is then assessed in hand and where indicated under saddle. Ideally the horse should be assessed through multiple gaits (walk, trot canter), in multiple circumstances (straight line & lunge) and on different surfaces (hard & soft).
Veterinarian visually assess for symmetry, stride length, pelvic and head movement, limb flight patterns & coordination and balance. A neurological assessment is also important to determine a horses body control and awareness of where their body is in space.
Objective Gait Analysis
Objective gait analysis is a very valuable tool to add to gait assessment, particularly in horses with subtle or complex asymmetry. There are multiple different systems that provide detailed insight into gait, with the validated systmes all providing very similar information about stride symmetry through measurement of the poll and pelvic movements.
These technologies can be particularly valuable to help quantify:
low-grade multi-limb & subtle asymmetry
response to nerve blocks
response to a rehabilitation program
Objective gait analysis does not replace clinical examination and does not tell you where in the leg the horse is lame. Rather it is a tool to provide additional information alongside the veterinary assessment.
Flexion Tests
Flexion tests involve placing controlled stress on specific regions of the limb before reassessing the horse’s gait. These tests may help identify regions of discomfort or joints that are painful, guide further diagnostics and highlight more subtle lameness.
Diagnostic Nerve Blocks
Diagnostic nerve blocks are commonly used to help localise the source of pain.
Small volumes of local anaesthetic are placed around specific nerves or joints to temporarily numb targeted regions of the limb. The horse’s gait is then reassessed to determine whether the movement abnormality improves.
This process helps veterinarians systematically narrow down which region is contributing to the lameness.
Nerve blocks are often one of the most valuable stages of a lameness work-up because they help guide diagnostic imaging and treatment decisions.
Diagnostic Imaging
Once the source of discomfort has been localised, diagnostic imaging may be used to assess the structures involved.
This may include:
radiography (x-ray)
ultrasound
advanced imaging where indicated
Different imaging modalities provide information about different structures. In many cases, imaging findings are interpreted alongside the clinical examination and response to nerve blocks.
Why Some Cases Are More Complex
Not all lameness cases are straightforward and there can either be multiple sources of discomfort or embedded compensatory patterns. Spinal discomfort can also make assessment complicated due to either compensation or primary problems that mimic limb related lameness.
This one of reasons why a methodical and whole-horse approach is important during lameness investigations.
FAQ's
What is a lameness work-up?
A lameness work-up is a structured veterinary investigation used to identify the source of discomfort affecting a horse’s movement and performance.
Why do some horses not look obviously lame?
Some horses compensate well and develop subtle movement adaptations rather than overt lameness. They may instead feel uneven, stiff, weak behind, or inconsistent under saddle.
Are nerve blocks painful for horses?
Why is imaging not always performed immediately?
Imaging is most useful once the painful region has been localised. This helps ensure the correct structures are being assessed and improves interpretation and relevance of findings.
Lameness investigations involve much more than simply watching a horse trot.
A structured and systematic approach helps veterinarians identify the source of discomfort, understand how it is affecting movement, and guide appropriate management for both performance and long-term soundness.
Got questions about your horses soundness? Book in for a lameness assessment today.
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