Practical considerations for horses with lower neck problems

In nature, horses use their neck as a natural balancing entity. Ever seen a horse turning flat like a motorcycle but still keeping balance? They can do so by placing their weight into the inside front limb while cantilevering with the head and neck to the outside. Furthermore, nerves passing through the lower neck ensure good proprioception so the horse can keep good control over its limbs while doing so. But what if the neck is compromised?

From 2016-2019 I had the pleasure to work with 144 horses worldwide of which 40% presented lower neck problems to some extent. I am fully aware that 58 cases isn’t enough to create a credible data sample. Furthermore, I also recognize that these horses tend to ‘find’ me once word got out I had experience with these issues. Nonetheless, the high prevalence should not be ignored and I owe it to those horses to use my acquired abilities in spreading awareness and possibly help others.

In this article I will dive deeper into the two most common lower neck issues that I have encountered so far: ECVM and (osteo)arthritis. I will first elaborate on the morphology and the clinical ramifications of these conditions. Then, I will share some practical considerations to take into account and conclude with a summary of the most important lessons I learned.


ECVM stands for Equine Complex Vertebral Malformation, formerly known as C6/C7 malformation. The name change was the result of ongoing research indicating that the complexity of this malformation wasn’t justified by the simplicity of its term. Its effects reach far further than just the neck which makes this condition extremely complex in nature.

The malformation is congenital which means horses are either born with it, or aren’t. Certain bloodlines are known to have a strong hereditary predisposition.

For the best explanation of this condition I like to refer to renowned pathologist Sharon May-Davis who brought ECVM to light. She discovered her first introduction to the congenital malformation 20 years ago through the bones of a Thoroughbred named Presley. In her original paper (2013) she explained this condition as following: ‘‘In the 6th cervical vertebra (C6), either a unilateral or bilateral absence of the caudal ventral tubercle (CVT) was noted In the presence of the C6 malformation, the 7th cervical vertebra (C7) presented either as normal, or, with a unilateral or bilateral transposition of the CVT from C6 onto the ventral surface of C7 with an arterial foramen. This transposition onto C7 was noted to be present on the corresponding side as the absent caudal ventral tubercle on C6.’’

L: normal C6.

R: malformation C6.

May-Davis 2013

L: normal C7. R: malformation C7.

May-Davis 2013

So in short, the malformation presents in the absence of either one or both caudal ventral tubercles of either just C6 or C6&C7. These tubercles are important as they provide anchor points for cybernetic muscles arising from the chest such as Longus Colli. The malformation prohibits proper insertion of this muscle which results in asymmetry and general dysfunction:‘‘This study showed that the function of the L. Colli muscles had been several compromised in the presence of the congenital malformation in C6 and C7 and furthermore, that mechanical forces placed an asymmetric load at the points of attachment. Thus with impeded function the L. Colli muscle has faltered in its role as an intersegmental stabiliser, subsequently lead to vertebral instability, degenerative joint changes and asymmetrical articular processes (May-Davis 2014).’’

Furthermore, since the Longus Colli is cybernetic in nature – meaning a richly innervated muscle – any dysfunction results in neurological ramifications as it ‘‘would lead to the brain receiving incorrect neural messages due to abnormal paired left and right tension in the muscle and as a direct consequence, the horse would adjust its posture accordingly (May-Davis 2014).’’

Apart from muscle dysfunction, ECVM also has a direct effect on neurology due to changes to the intervertebral foramen – the canals through which spinal nerves pass. In some horses, the foramen show asymmetrical whereas in others they might be severely narrowed. Either way, the results are possible nerve compression making ECVM a very unpredictable condition.

The research has been ongoing and picked up by many scientists ever since the publication of the first paper. While it was first discovered in Thoroughbreds, it has now been identified as well in Friesians, Irish Sports Horses, Warmbloods, Standardbreds, Riding Ponies, Arabs and Crossbreds. The latest numbers show that 12/25 (!) dissected horses worldwide presented ECVM in 2018 (May-Davis 2019). With new discoveries, the list of associated clinical symptoms has grown of which you can find an overview below:

Muscular dysfunction and asymmetry As already explained, normal insertion of the Longus Colli muscle is not possible. Looking at overall muscle tone horses could often show compensatory patterns at Brachiocephalic, Scalenus, Cutaneous Trunci, Spinalis, Trapezius, Rhomboideus, Biceps, Thoracic Sling, Longissimus Dorsi, Middle Gluteal and Hamstrings.

Photo of a horse with both C6/C7 malformation with clear compensation patterns in muscle toning. This is a fairly extreme case, signals can also be milder. Due to weakness in the hindquarters, cuteanous trunci is used to compensate for bringing the hind legs forward; this is a fairly common pattern.

Pain upon palpation Horses can show spasms or discomfort upon trigger points located in the lower neck as well as behind the ears.

Ulcers Internal stress because of instability could lead to ulcers and stomach problems.

(Unexplained) lameness ECVM alters posture and limb action. A recent paper concluded that there is ‘’increasing evidence that nerve root injury may cause forelimb lameness (Dyson 2019).’’ As such, ECVM has been associated with inconsistent forelimb lameness.

Hoof issues A unilateral presentation of ECVM often leads to high heel/low heel syndrome with the foot going op. These horses tend to stand with uneven forelimb posture – predominantly one foot forward. In case of a bilateral presentation the front feet often point to the outside. These horses may toe land and behave ataxic over uneven ground. It is therefore that, in order to manage these horses, shorter trimming intervals of every 2-4 weeks are desired.

Dental & Jaw problems Some of these horses display 7 molars. Furthermore, a unilateral malformation might lead to crookedness of the jaw. Affected horses usually benefit from a shorter interval of dental treatment – every 8-10 months instead of every year.

Note that ECVM could also hinder the acceptance of the bit and general contact. Signs include resistance, open mouth, tongue over bit, chattering teeth, tilting etc.

Behavioral issues In case of ECVM there is only one certainty: these horses are predictably unpredictable. The range behavioural signs can vary within the individual. Some might be erratic, some might be stoic. Some might be clumsy, some might be generally nervous. It takes a lot of experience to differentiate between what is abnormal and what is a variation. In addition, the abnormal behaviour is not always present. It can be those horses that are total sweethearts for 95% of the time, but all of sudden do something that fall out of the ordinary and leave the owner surprised in a sense of ‘he has never done something like that’ or ‘I don’t know what had gotten in to him all of a sudden’.

Ever read the book Big Friendly Giant by Roald Dahl? I have a horse with both C6/C7 malformation who’s truly honours his nickname of BFG. But every now and then, something unexpected triggers a behavioural abnormality which has caused him jumping unto someone at a gate. And the thing is, afterwards he too looks confused as if he doesn’t understand what just happened. So it is like a ‘silent’ danger.

Neurological complications Horses with ECVM often show less stability, poor coordination and proprioception. A few owners have described their horses movement as that of a drunken human. Some cases get misdiagnosed with ataxia, wobblers syndrome or stringhalt.

Sternum, First rib & T1 malformations

In case of a C6&C7 malformation, the first sternal rib - sometimes also second - and the first/second thoracic vertebra (T1/T2) is also always malformed. Hence, the malformation doesn’t only affect the neck, but also the entire chest. Furthermore, these horses often display what is referred to as a ‘wavey’ sternum.

Horses might be girthy and experience problems for saddle fitting as the Trapezius Thoracis and Spinalis muscles could be dysfunctional as well.

Scoliosis in the lumbar spine This is present in 100% of the cases with ECVM so far and naturally limits performance. I personally also had quite a few cases combined with kissing spines in the caudal to lumbar spine - which I will share in the statistics section.

Overactive adrenals The adrenals are responsible for hormone production, especially cortisol. Due to instability, the body is always internally stressed and shows in cancerous cells on the adrenals upon dissection.

So in short, the congenital malformation is likely to produce clinical and functional ramifications of the thoracic inlet, thoracic limb and thoracic viscera with the

‘’probability of altering posture and locomotive function (May-Davis 2019).’’

It must be said though that the discovery of ECVM and its associated symptoms has led to a heated debate world-wide, both between supporters as well as detractors – some of the latter even denying its existence. A recent (2019) paper of Veraa et al. argued that ECVM should not be considered a malformation but instead a morphological variation without clinical ramifications stating that: ‘‘Homologous morphologic variation is common in the caudal cervical spine of Warmbloods (…) Radiographic presence of such variation does not necessarily implicate the presence

of clinical signs.’’

From years of experience, I wholeheartedly disagree with these outcomes that were measured for one point in time in a controlled environment. The complexity of ECVM requires observations for longer periods of time. I have never encountered a horse with ECVM without the presence of clinical signs to some extent. In most cases, the owners of those horses hold most valuable information as they observe their horses every day and are able to note any abnormalities or changes over time. It is thus not my intention to further criticise counter research as fact remains that the condition exists and looking from a rational perspective any congenital malformation will always have clinical ramifications as ‘‘logic dictates that asymmetric form comes with asymmetric forces (May-Davis 2019).’’

So by now, you should have enough information to make your own informed opinion. Let’s continue with the second most common lower neck issue I encounter: arthritis.


Osteoarthritis is a degenerative disease that results in inflammation of the joints. The symptoms associated with lower neck arthritis are quite similar to those of ECVM as listed earlier. This is because arthritis also has a secondary effect on the surrounding neck muscles, especially the cybernetic stabilisers. Proper function of these muscles is prohibited by inflammation and pain. Hence, the horse often compensates by contracting the longer neck muscles instead in an attempt to stabilise the neck during locomotion, usually making the entire neck stiff. Even with successful treatment to control the pain, the cybernetic stabilisers do not automatically resume their normal function. In addition, the loss of stability between consecutive vertebrae sets the stage for the development of further arthritic changes to other (cervical) vertebrae, ‘‘making neck arthritis a vicious cycle of inflammation, pain, and dysfunction (Stubbs 2016). ’’

In addition, arthritis can also cause nerve compression – just as with ECVM. A recent study (2019) by French professor Touzot-Jourde stated that ‘‘osteoarthritis in C6-C7 [and also T1 - own addition] can cause compression on the seventh cervical nerve, which is associated with the shoulder and foreleg sensation.’’ In her study, she found that horses with induced nerve compression presented shorter strides and tightened gaits. Clinical signs were most obvious in the shoulder area as she stated that ‘‘It’s like the shoulder wasn’t stuck to the body anymore (…) The horse would swing its shoulder out laterally and keep it deviated out while standing and would place the foot too far out to the side while stepping at the walk. The clinical signs were similar to a motor impairment of the supra-scapular nerve known as the Sweeney shoulder.’’

Photos of a horse with heavy osteoarthritis in the low neck.

The horse clearly has difficulty with coordination. The legs go everywhere with a pattern

of wide in front and narrow behind.

A study trying to identify the existence of a caudal relationship between ECVM and arthritis concluded that ‘‘there was no association between the morphology of C6 and articular process osteoarthritis (DeRouen et al. 2016)’’. So even though both conditions have been found together upon dissections, a direct causal relationship cannot be assumed.

The cervical vertebrae of show jumper Luc showed both C6 & C7 malformation and arthritis during dissection. Moreover, the vertebrae are extremely lightweight and look like a honeycomb. See photo on the right.

Furthermore, it most me noted that I am known to cases of severe lower neck (C6-C7) arthritis on horses that were barely ridden. However, naturally all these horses displayed poor posture and proprioception combined with some of the other symptoms listed.

So in conclusion, the clinical signs of ECVM and osteoarthritis of C5-C7 could be quite similar and should thus both be considered as probable causes of inexplainable cases of lameness, proprioceptive deficits, behavioral issues and loss of performance. To get a clear diagnosis, X-rays are always necessary. However, difference in quality and knowledge of grading could hinder proper diagnosis. This process falls without the scope of this article, but will be dealt with a separate article later on.

SOME STATISTICS… Since the high prevalence of lower neck issues there is an increasing demand on whether it is possible – and if so how – to manage these horses. Led by the horses who crossed my path, I ‘accidentally’ ended up specialising in the practical management and training of lower neck conditions. So now, lets’ get some data out I have been able to document so far.

I have had hands-on experience with 58 confirmed cases– diagnosed by X-rays – of ECVM and lower neck arthritis as well as distant involvement with another 9 cases, making up for a totality of 67 cases. Of these 67 cases, 43 presented ECVM, 18 lower neck arthritis and 6 of them a combination of both which I would classify as a ‘complete mess’.

There was a high variety in age, sexes, breed and discipline. All horses found themselves between 4-22 years old. 65% of the cases fell between 9-12 years old. Most owners reported a worsening of the clinical symptoms after the age of 11.

On the aspect of gender, 71% were mares and 29% geldings. No stallions have been presented to me yet. There was a high variety of breedsincluding: Thoroughbreds, Standardbreds, Arabs, Crossbreds and Warmbloods – the latter one making up for most of my data with 54%. ECVM is also known to affect other breeds as listed earlier, but I personally have not had any experience with those breeds yet.

In terms of discipline, 6% were horses competed in medium to advanced eventing. 12% were horses competed in medium to international dressage levels. 10% were horses competed in low level to medium jumping. 70% were horses that were either being reschooled– for example an ex racehorse, horses trained in classical dressage or for the desire to keep them healthy and balanced while varying multiple elements such as trail rides, liberty training, working equitation, carriage driving etc.

Of those cases diagnosed with ECVM, 63% showed a malformation of just C6 – with a high predominance of unilateral malformation - and 37% showed a malformation of both C6-C7– and thus also T1 and sternal. Out of 43 cases, 19 were also X-rayed on the thoracolumbar spine and 100% of these cases showed scoliosis and/or kissing spines to some extent in the caudal thoracic to lumbar area.

Of those cases diagnosed with lower neck arthritis 94% showed boney changes from C5-C7 with usually C6 the worst.

ALL horses showed a different combination of symptoms with the most common ones being poor proprioception, asymmetry and poor posture, behavioral oddities, hoof problems and difficulty with contact and collection.

Finally, out of the 67 cases I have currently lost 8(!) with an evenly split between diagnosed ECVM and Arthritis. These horses remained too unstable to lead a happy horsey life.


So now it is time to have a look at some practical considerations based upon my experience of working with these horses. I will first point out some general key points and then zoom in to specific elements concerning training.

First of all, as a general rule, do not mount a horse when you doubt the safety of a situation. This might seem obvious, but way too many times I witnessed riders getting on their horse without truly feeling as safe as they were told they had to ‘get through this’.

Second, when it comes to mindset, there are two important factors to consider: both conditions are chronic and the only guarantee is that those horses are predictably unpredictable. Because the conditions are chronic, it is important to realise that it is not about ‘fixing’ but rather a case of managing which requires a certain flexibility to deviate from training goals when needed.It is important to accept that your horse will always have good and bad days, the latter requiring a proactive adaption from a theoretical mindset to a practical one.

I have met many students who broke their skulls as so to speak, by wondering why their horse – who showed a lot of progress – all of a sudden experienced a relapse. Don’t get me wrong, of course you always need to look deeper for a cause – maybe your training was a bit too much or something changed in diet etc. However, if you have a confirmed diagnosis of ECVM or arthritis, sometimes it can be just as simple that some days it plays up and some days it doesn’t. We’re talking neurology here and there is so much we simply don’t know yet. So sometimes it is about changing your mindset from worrying to taking action instead. To realise that you might not always know why your horse is having a bad day, especially when circumstances haven’t changed, but instead that you are present and asking: ‘‘I am sorry, you obviously have a bad day, what can I do for you in this moment to make it better?’’

In addition, since every case is unique, training these horses will always be a process of trial and error. This also requires a certain mindset of not being too tough on yourself and allowing mistakes – as I can guarantee those will happen. Through experience, I wholeheartedly believe horses know the difference between an honest mistake and being unfair. Change is always uncomfortable in the beginning and rehabilitation is not always fun. I have spent some time in a military rehabilitation centre and when asking around, not a single person would describe the process as fun. Instead, it is really tough. The difference is that those militaries pulled through because they knew what they were doing it for and that they would feel better after. Our horses don’t. So therefore, the key element for them would be to do it because they trust us to have a vision and guide them in soft but determined way – just like any good leader would do. We can only do so if we recognise our humanity and our shortcomings and accept them to a certain extent – which has nothing to do with arrogance - otherwise we won’t be able to guide our horses properly. If you are too tough on yourself, you will be too tough on your horse(s).

Finally, regarding training, it is also important to stay flexible. For example, jumping a horse with coordination problems could potentially be a dangerous situation. In my experience, the key element that is decisive for successful rehabilitation is self-carriage through rewiring muscle memory. So in that sense, training is always about the brain. Think about it, muscles in itself are dead tissue without innervation. Muscle memory makes up posture. In case of lower neck issues muscle memory often proves to be ineffective and thus my main goal is to see whether I can ‘rewire’ the nervous system to address other postural stabilisers – cybernetic muscles – to compensate and improve posture. This way, posture does not only change when I am actively training a horse, but also when the horse is in the field on its own. So mechanical training is not enough as a handy rider can put a horse in balance between the aids. But then when the horse goes back into the field the body doesn’t ‘remember’ anything and the horse goes back into its crooked posture. And what difference does 30-40 minute training a day make compared to the other 23 hours a horse is on its own?

Photographs illustrating the power of muscle memory in horses with lower neck problems. From depressed with poor posture to a proud horse that shows a beautiful, extended trot in self-carriage.

So don’t train harder, but train smarter!

Key elements in my training to improve proprioception, muscle memory and thus posture are passive physio, vertical/horizontal balance, flexibility and stamina.I will elaborate on this in the following sections, but I must first state that pain management always precedes and has first priority before training can be started!

PASSIVE PHYSIO I use passive physio and brain games to train a proper proprioception. The first step in a training program is always about optimising management efficiency with minimal effort.

Providing opportunities to browse – eating from the knee up or higher – is an important adaption as this naturally strengthens the cybernetic muscles Longus Colliand Scalenusas well as the thoracic sling. You can plant bushes, feed your horse uphill or ramp, or hang up hay nets at different heights. I usually use a horse 70-30% ratio between eating from a low position and browsing.

This horse has C6 & C7 malformation. He always ate in a preferred position with his right foot forward. After the introduction of browsing, his self-carriage has improved enormously. He now often even stands square in a low position. In this way I have to "train" much less mechanically because the body has automatically saved this posture as a new starting point.

From there, I usually build a paddock with tyres – cut in half so the horse can’t stay stuck, poles and buckets upside down. I put food under the buckets and sometimes with the hollow side of the tyres. This way, the horse has to occupy its brain by trying to get the food as well consciously placing its limbs through the ‘maze’.

In addition, I also use some artificial aids such as balance pads, TTouch wraps and kinesiology tape. These tools provide the nervous system with a different sensation and ‘input’ from the outside that can help the horse to have a better feeling of where its body is in space. Finally, dynamic carrot stretches – so those done in a soft way within the actual range of motion of the horse could also help in flexibility and awareness of the body.

All these things are relatively easy to do and can have a very big effect on posture and locomotion. In addition, they can aid in the management as well. For example, as mentioned before these horses often require shorter intervals between trimming sessions. However, instability might make them difficult to trim. Applying a tape or a balance pad under the opposing limb might sometimes give them that extra support they need to stabilise.

Once the proprioception has improved, I continue with my ‘active’ training mainly focussing on vertical balance on squares and straight lines first.

VERTICAL/HORIZONTAL BALANCE It is a common belief that crookedness of the horse comes from its back or hind legs. However, in case of lower neck problems it usually is the front end that causes most asymmetry and dysfunction.

In many training principles it is believed that the horse engages its hind limbs under its body propelling itself upward and forward. However, in reality, most of the upward (vertical) propelling forces are produced by the front limbs: ‘‘In horses, and most other mammalian quadrupeds, 57% of the vertical impulse is applied through the thoracic limbs, and only 43% through the hind limbs (Merkens et al, 1993)''.

So in short, the hind limbs are mainly concerned with producing horizontal – forward movement - forces whereas the front limbs mainly produce vertical – upward - forces to provide an incline against gravity and thus ultimately balance control. If the front limbs don’t do their job properly, the hind limbs simply cannot engage. Horses with lower neck problems often show a clear negative Diagonal Advanced Placement (DAP) in the trot. When this happens, the front limb is not quick enough ‘out of the way’ for the hind limb and thus results in efficient gaits and overall stiffness.

DAP visualised. The right frontleg is still on the ground while the left hindleg is already in the air. The slow right frontleg now blocks the right hind leg from engaging underneath and the horse falls completely on the forehand leaning into the rein.

Since the front limbs are often dysfunctional, my main goal therefore is first to restore functionality in those limbs – which is not the same as working a horse from front to back but simply to ensure normal biomechanics.

Right: the progress of the same horse shown at the top left. From DAP to starting collection. It is not perfection, but a certain improvement in posture and self carriage.

Knowing that the the cybernetic muscle of Longus Colli – and often scalenus– is impaired with lower neck problems, I am trying to recruit the thoracic sling muscles instead to compensate and stabilise the neck from below. Unlike humans, horses don’t have a boney connection between their front limbs and torso. They rely upon the so-called thoracic sling muscles to suspend the chest between the front limbs and lifting the thorax. The thoracic sling muscles mainly consist of Serratus Ventralis assisted by the Pectorals.

A unilateral contraction of the sling muscles stabilises the ribcage when one of the front limbs is lifted as this develops the strength required to create straightness.

A bilateral contraction of the sling muscles holds the ribcage centrally between the front limbs contributing to good posture and allowing the horse to alleviate excess weight.

Vertical balance describes nothing more than the left-right distribution of weight on the front limbs and is thus mainly concerned with unilateral engagement of the thoracic sling muscles and aligning the spine. I usually observe the horse moving on its own to determine whether there is a dominant front limb and if so, I try to rebalance the weight more evenly using squares or straight lines – NOT CIRCLES. Circles are really something to avoid in the beginning as most horses with lower neck issues tend to rotate the inside hind – stifle, hip and hock – and are not able to stay on two tracks so I much prefer the square. I rebalance the horse vertically by either turning it a step to the outside or asking a slight counterbend on the shoulder. I do this on the ground either with one or two reins – depending on the amount of inverted rotation of the spine. Naturally I have to start in the walk, but whenever possible I go to the trot as

soon as the horse is able to as this gait is usually most important – which I will explain in the next section.

Once vertical balance has improved I train horizontal balance through body posture and half-halts aimed at engaging the thoracic sling muscles bilaterally and thus alleviating excess weight on both front limbs. You will experience lightness and it will bring the horse from leaning over the chest to standing straight under. Transitions to halt are of vital importance in this process.

However, if the horses braces the jaw or generally stiffens I have to prioritise this first and restore relaxation, again showing you there isn’t always a vast blueprint in training sequences and flexibility to adapt pro-actively is necessary.

So now let’s look a bit more into the practical considerations associated with the gaits.


In my personal experience, the walk and the canter are the most difficult gaits for these horses.In the walk, all limbs have to travel separately which requires good proprioception and this is exactly where many horses diagnosed with ECVM and/or lower neck arthritis suffer with. Furthermore, the walk doesn’t require a lot of muscular contraction as the back, belly and barrel moves loosest in this gait.

Therefore, trot work is key in my rehabilitation process as this gait provides diagonal support as well as more muscular contraction to assist the joints. Furthermore, trot transitions are an excellent means to create more stamina. So if the horse struggles in the walk, I quickly transition into the trot. When balance improves, I go back to the walk and see how long I can stay in the walk without the horse getting uncomfortable until I hopefully reach a point in which the horse can stay balanced in the walk for longer periods of time. From the trot, correct transitions to halt have proven to be very effective. The halt serves as a ‘checking’ tool to see if the horse has good proprioception and is able keep its thoracic sling engaged. A correct halt is a sign of good awareness and balance. When the horse doesn’t have good stamina, this means that in the beginning I prefer sometime 2-3 short sessions of 5-10 minutes a day 2-4 times a week over longer ones. Finally, If the horse stays obviously clinically lame in the trot, chances for successful management diminish considerably.

The canter usually is also tricky – as it is more connected to the walk. As stated before, lower neck problems result in scoliosis in the lumbar spine which also affects the functioning of the lumbo-sacral (LS) joint which is key for loin coiling and thus a good canter jump. Research confirmed a linear connection between canter velocities and LS movement (Johnson et al. 2010) . Therefore, these horses often struggle with a good canter and some of them even lack gait purity - it might degenerate into a four-beat or a non-suspension canter. As a general rule, the transition into the canter is key. When the transition is not right, the canter will not be right. Apart from a slight shoulder fore – which almost all horses need to canter straight – there is not a lot you can do in the canter and therefore you should go back to improving your walk / trot work instead.

This horse was always praised for its 'wonderful' and 'easy’ canter. However, it is not correct since the left hind leg is already pushing off for a new stride before the right leading front leg is completely off the ground. He therefore misses a moment of suspension, which can make the canter feel great, but it is definitely not correct!

LATERAL FLEXION A horse can have lateral flexion without bending, but never bending with flexion. This makes lateral flexion an absolute basic for straightness training. However, lower neck problems often results in a tilting of the head. Working on vertical balance should naturally improve this issue. From there, a cavesson could help in asking slight lateral flexion of the jaw to guide the nervous system into a different posture. It is important to never ever go against bracing or lose existing quality of established vertical balance.


Horses with ECVM or lower neck arthritis often show a deviation in flight arc of the front limbs affecting its ability for lateral movements – see picture to the left.

However, lateral movements are very important for straightening the horse. To improve flexibility I mainly use all lateral movement related to the shoulder-in. Travers on the straight line is known for the danger of inducing inverted rotation – which can always be recognized by overbending of the neck and/or tilting - and usually comes a bit more natural for these horses as it allows them to compensate.

Correct lateral bending coupled with axial rotation is thus very difficult.

Circles are not naturally the best means to acquire correct bending as it always confines the inside front limb on the smallest arc and ‘’anything that is confined cannot be become light (La Guérinière)’’.

When I have improved on the square, I continue to teach the shoulder-in on the straight lines – sometimes even before I do circles as the SI can help the horse to achieve the proper circular arc so then the SI serves as preparation for the circles instead as SI naturally incudes correct lateral bending with couple rotation. As a general rule, I teach the exercise on the easy side, and practice it on the difficult side and then make transitions to big circles and see how the horse goes.

The travers I usually only practice through the corners or in the form of the renvers and I refrain from the wall as much as possible.

It is thus important to know the essence of each lateral movement so that they serve as a means to an end and not just to ride a 'fancy' exercise. For example, if a horse falls over the right shoulder, I can ask the shoulder-in to the left on the long side to create freedom in the right shoulder. In order to prevent rotation of the inside hindleg in the corners, I can make a transition to the renvers to stimulate the right foreleg to create more upwards impulse and thus also increase loadbearing on the inside hind. Another good exercise is transitions from shoulder-in to half-pass to shoulder-in. And from there ride a straight again to see if the lateral movement served their purpose. The latter is very important since the most common error that I encounter within straightness training is forgetting to ride the horse straight.

In short, it can therefore be said that in particular lateral movements related to the shoulder-in are important to create flexibility, souplesse and straightness. I avoid the travers on the straight line as much as possible. Finally, it is not the endless execution of circles or lateral movements , but dynamic alternation through transitions is the key to effectiveness.

HEAD/NECK POSITION For all horses, ROM for lateral bending is highest in the cervical vertebrae. It is therefore that horses quickly tend to overbend in their head/neck when asked to move in a circular arc. However, I often observe that horses with lower neck issues tend to shorten / overflex their necks – so not always directly caused by the pulling of a rider – showing they have no idea how to balance and really lack strength and stability in their thoracic sling. The Brachiocephalic muscles are often very tight and might even spasm upon palpation.

This can be a pitfall as for some riders this justifies a rounded position stating the horse ‘chooses’ this position on its own. It might even be why horses with ECVM are very popular in demand as they let themselves easily be worked in a rounded position and provide spectacular gaits through hyper-mobility, even though it absolutely isn’t normal! So let’s evolve from such simplistic thoughts and consider that the horse is simply not able to balance properly.

On the other hand, long and low can also do a lot of damage as it loads the front limbs even more as well as extending the lumbar spine and therefore the LS joint has to counter lever with great strength causing even more wear and tear.

My intention is to always leave the head/neck alone as much as I can as when I work on the body, a natural basic head and neck position will follow.

From hyperflexion with tongue problem to neutral head/neck carriage.

A natural head position is one in which the horse has access to the full length of its neck– so not shorter but also not longer with poking the nose too much forward beyond initial length as an active extension causes the horse to pull on its neck muscles and stiffening that area. Furthermore, ideally, ears, withers and croup should be at roughly about the same horizontal line as a basic position. From there, the poll elevates naturally if the horse can collect a bit more.

In certain cases of incorrect past training, head/neck position needs to be corrected a bit with lifting the thoracic sling or opening of the jaw to step out from a pattern of self-learned helplessness.


As a final remark I have noted that most horses with lower neck problems struggle to go forward. Now let me start explaining that FORWARD isn’t the same as going FASTER. On the contrary, a fast horse usually isn’t a forward horse. The term forward is merely a directional concept which means the hind legs of the horse reaching forward under the body and thus creating carrying power.

Ideally, a horse should have an equal phase of extension – pushing power – and flexion – forward and carrying power. Horses with lower neck issues often push more which is sometimes visible in overdeveloped hamstrings and underdeveloped quadriceps, biceps and tensor fascia latae.

If this is the case, I need to work on the forward – which I can only do once vertical balance has improved and usually automatically happens as result. To create more forward thus has nothing to do with driving aids as this only creates a viscous cycle in which the horse becomes numb to the aid and the rider feels the need to even give more and more aids. Forward usually is created by slowing down the pace WITHOUT LOSING ENERGY. So the idea is not make a horse slow, but instead of pushing the energy out of the body going faster and falling on the forehand, the idea is to manage the energy within the body creating more balance and strength. In this way, the nervous system also gets the time to process and store information. The horse can then consciously control feeling and coordination of each leg. To conclude with the well-known statement: ‘slow and steady wins the race’.


So by now, you should have some insight in some factors that have proven to be key into managing horses with lower neck issues and possibly training them for soundness. Unfortunately, successful management is not possible for all of them and that is why we have to keep learning. Always.

You might still feel puzzled or wonder exactly how to do certain exercises. Let me state that a puzzling feeling is normal, that is exactly the complexity of these conditions. However, I can’t give more exact advice on paper as each case deserves intense individual guidance. So that is why you need to find the right people around you. I am blessed with a wonderful network of people that are willing to help so don’t hesitate to reach out to any of us.

So in conclusion, I can’t repeat enough that every case is unique. We’re talking nature in which there is an infinite number of grey and hardly anything black and white. In that sense, the more we learn the less we know. What I do know, is that we owe it to the horse to keep evolving. To not stick to simplistic interpretations such as ‘he is just naughty’, but to evolve to the best we can to serve the horse. They have served us for centuries. Now it’s our time to return the favour!

CONTACT You can contact the author via:

ACKNOWLEDGMENT I’d like to thank all the horses and owners who allowed me to learn and acquire essential skills to further understand and manage lower neck problems.

A special word of thanks goes to Zefanja Vermeulen & Sharon May-Davis from Equinestudies. Thank you for mentoring me and being the true voice of the horse.

COPYRIGHT Please take note that the content of this manual is copyrighted by Thirza Hendriks. It is strictly forbidden to change, publish or copy this document online without the explicit written consent of Thirza Hendriks herself.

DISCLAIMER This document has been compiled with great care to ensure the accuracy of the information. Thirza Hendriks cannot be held responsible for incorrect information in this document or any damage caused by incorrect use of this information. This document does not replace veterinary diagnosis and no definite medical conclusions can be drawn from this document.

BIBLIOGRAPHY May-Davis, S. (2014). Congenital Malformations of the 1st Sternal Rib. Equine Veterinary Science.

May-Davis, S. (2014). The Occurrence of a Congenital Malformation in the 6th and 7th Cervical Vertebrae predominately observed in Thoroughbred Horses.Equine Veterinary Science. Vol 34. Pages 1313-1317.

Touzout-Jourde, G. (2019) In: Lesté-Lasserre: How Might Neck Arthritis Affects Horses Gaits?

Dyson, S.J. (2018). Unexplained forelimb lameness possibly associated with radiculopathy.Equine Veterinary Education.

Johnson, J.L., Moore-Colyer, M. (2010). The relationship between range of motion of lumbosacral flexion-extension and canter velocities of horses on a treadmill.Equine Veterinary Journal. Vol 41: 3. Pages 301-303.

Veraa, S., de Graaf, K., Wijnberg, I.D., Back, W., Vernooij, H., Nielen, N., Belt, A.J.M. (2019) Caudal cervical vertebral morphological variation is not associated with clinical signs in Warmblood horses.Equine Veterinary Journal.

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Classical Horse Training

by Thirza Hendriks

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Classical Horse Training 

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