Orthopaedic Injuries in Dressage Horses Study

What a Longitudinal 5-Year Study Reveals About Pain, Performance & Early Intervention

Dressage horses are among the most closely scrutinised equine athletes, yet truly longitudinal, repeat-exam datasets are remarkably rare. A new open-access retrospective longitudinal study by Boado, Pollard & Dyson (2025) provides exactly that serial, standardised orthopaedic evaluations in 70 dressage horses, each examined at six-month intervals over 2.5–5 years by the same experienced clinician.

This type of dataset – consistent examiner, repeated structured assessments, and multi-modal imaging – is almost unheard of in equine orthopaedics. The findings are clinically important, highly relevant, and deeply instructive for anyone managing performance horses.

Dressage Horses Study Overview

This retrospective longitudinal study followed:

70 dressage horses (70% Warmblood, 24% Iberian)
At least five full orthopaedic examinations per horse
(spread over 2.5 to 5 years at ~6-month intervals)
Comprehensive diagnostics including in-hand, lunge and ridden evaluation, flexion tests, diagnostic anaesthesia, ultrasonography, radiography, and advanced imaging as indicated
Horses graded by work level and followed for performance progression, injury persistence, recurrence, and compensation patterns

Importantly, many owners reported the horses to be working normally and lameness was often not acknowledged or not recognised prior to examination.

Key Findings Every Veterinarian Should Know

1. Lameness Was Almost Universal – Yet Often Not Recognised

Only 3 of 70 horses (4.3%) were non-lame at the first examination. The most common lameness grade was 2/5, and many horses had multiple limb problems.

More horses showed lameness on the lunge (79%) compared with straight lines (50%). Riders and trainers had frequently failed to identify significant gait abnormalities under saddle, and only 43% showed lameness when ridden. It may also be that skilled riders can conceal low-grade lameness.

Why this matters:
Early, subtle lameness in dressage horses is easily missed by riders and trainers – especially when only assessed ridden. Routine, structured orthopaedic evaluations may dramatically, by early recognition of problems, improve long-term outcomes.

2. The Fetlock & Suspensory Apparatus Were the Major Pain Generators

At baseline, 58.6% of horses had pain in the metacarpophalangeal/metatarsophalangeal region.
Of these injuries, 90% were persistent or recurrent throughout follow-up.

Suspensory apparatus injury was a dominant and recurring pattern, with injuries in forelimbs occurring more frequently than in hindlimb injuries.

Clinical interpretation:
Advanced diagonal placement, extended paces, , increased metacarpophalangeal/ metatarsophalangeal joint extension, and demanding movements such as piaffe, passage, and pirouettes consistently place substantial strain on the fetlocks and suspensory ligaments.

3. Spinal Region Pain Increased Markedly Over Time

Spinal injuries (cervical, thoracic, or lumbosacroiliac) increased from 10% at the initial exam to 40% by the fifth exam.

Notably, 21.4% of horses with thoracic region pain later developed lumbosacroiliac pain.

This aligns with well-recognised biomechanical patterns: chronic limb pain leads to restricted thoracolumbosacral motion, muscle atrophy, altered stability, and subsequent axial skeleton pain.

Clinical message:
Spinal pain frequently develops as a consequence of limb pathology and altered biomechanics rather than as a primary problem.

4. Compensation Injuries Were Strikingly Common

The study clearly documented predictable compensation patterns:

46% of horses with unilateral forelimb lameness developed contralateral forelimb lameness
27% developed ipsilateral hindlimb lameness
Among horses with initial hindlimb lameness, 30% developed ipsilateral forelimb lameness, and
30% developed contralateral forelimb lameness
51.4% of horses initially lame in any limb developed subsequent spinal region pain

This is one of the first longitudinal datasets to show, clearly and repeatedly, that one orthopaedic problem begets another.

5. Many Horses Progressed in Performance Despite Ongoing Issues

A remarkable 61% of horses eventually reached Prix St Georges or higher, even though many injuries persisted or recurred.

However, the best outcomes were strongly associated with:

Mild or absent lameness (grade 0–1/5) at the first exam
Absence of neurological gait abnormalities

Breed differences were not statistically significant, although Iberian horses tended to have superior outcomes, a difference that may be biologically relevant.

6. Neurological Gait Abnormalities (Hypermetria/Weakness) Strongly Affected Outcome

At the initial examination:

42.9% of horses showed hypermetria
12.9% showed hypermetria combined with weakness

Only 22% of horses with hypermetria and weakness achieved a favourable performance outcome. Horses with no neurological gait abnormality were substantially more likely to progress to Prix St Georges level or above compared with those with hypermetria or hypermetria and weakness.

Clinical implication:
Abnormal high-stepping gait patterns should not be dismissed as “expressive movement”. They warrant careful investigation and carry prognostic significance.

Why This Study Matters for Equine Veterinarians

1. Subtle lameness is frequently missed

Riders and trainers often fail to recognise and / or acknowledge the presence of lameness.

2. Serial monitoring transforms outcomes

The consistency of six-monthly exams allowed patterns of recurrence, compensation, and progression to be clearly mapped.

3. It clarifies pathways of secondary injury

This data makes it easier to explain to clients why an apparently localised fetlock or suspensory issue often evolves into multi-limb or spinal pain.

4. It reinforces a key principle: spinal pain is often secondary

Axial skeleton pain frequently reflects downstream consequences of limb pain and altered biomechanics.

5. The findings have welfare and social licence implications

With dressage training under scrutiny, objective, repeatable veterinary assessment is a powerful tool for protecting equine welfare and maintaining public trust.

Clinical Take-Home Messages

✔ Don’t rely solely on rider’s or trainer’s assessment of ridden performance
Many horses with no history of lameness when ridden were lame when undergoing a comprehensive orthopaedic examination.

✔ Early, low-grade lameness matters
Horses with grade 0–1/5 lameness at first exam had markedly better long-term outcomes.

✔ Fetlock and suspensory injuries remain the primary threat
Particularly under modern dressage movement demands.

✔ Spinal pain commonly develops secondary to limb issues
Early intervention for limb pathology has the potential to reduce the risk of later axial dysfunction.

✔ Routine six-monthly orthopaedic evaluations add significant value
This study strongly supports a proactive sports-medicine model in dressage horses.