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Updated: Aug 12, 2023

Practical considerations for ECVM affected horses


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?

Unfortunately, the cervical region is sometimes overlooked as a source of pain and dysfunction in general equine veterinary practice. However, from 2017-2020 I have had the pleasure to work with 152 horses worldwide of which roughly 40% presented with lower neck problems to a certain extent. I am fully aware that these numbers are not enough to create a data sample. I also acknowledge the fact that more cases with lower neck problems presented to me once word got out I had experience with these issues and this might have affected the representativeness of the numbers.

Nevertheless, the high prevalence should not be ignored as numbers continue to rise. I owe it to these horses to share their stories in an effort to spread awareness and potentially help others. In this article I want to elaborate on one of the common radiological findings in the lower neck that I have encountered so far: Equine Vertebral Complex Malformation. (I will discuss osteoarthritis in a separate article).

I will first explain its morphology and possible variations. Then, I will continue to discuss its clinical relevance and potential ramifications. I will conclude the article with various practical management and training considerations for affected horses.


Equine Complex Vertebral Malformation, or ECVM, is a congenital malformation found in the 6th cervical vertebrae (C6) and potentially extends to the 7th cervical vertebra (C7) as well as the first and second sternal rib(s) (T1 – T2) in horses. ECVM has a hereditary aspect and although genetic research is being conducted in the USA, the gene(s) responsible are unfortunately yet unknown (Equus-Soma 2021).

ECVM was brought to light by renowned anatomist Dr. Sharon May-Davis. 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 follows:

‘‘In the 6th cervical vertebra (C6), either a unilateral or bilateral absence of the caudal ventral tubercle (CVT) was noted in the presence of 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.’’

Put simply, ECVM presents in the absence of either one (asymmetric malformation) or both (symmetric malformation) caudal ventral tubercles of C6. C7 can either be normal, or it can show transposition of the missing CVT(s) of C6 unto C7. The malformation can potentially also extend to the first and second sternal rib(s) that in turn affects the curvature of the sternum and its associated structures.

Left: normal C6 & C7. Right: unilateral malformation C6 with transposition to C7

While it was first discovered in Thoroughbreds, it has now also been identified in Andalusians, Arabs, Crossbreds, Friesians, Irish Sport Horses, Quarter Horses, Riding Ponies, Standardbreds, and Warmbloods.

In addition, the occurrence of ECVM is not geographically isolated, with studies identifying the congenital malformation in Europe, USA, UK, Australia, and Asia.


Interestingly, the occurrence of ECVM is not completely new. In the late 1900’s a malformation of the cervico-thoracic junction was reported in Holstein Dairy cows (Agerholm et. al 2001). The condition was termed CVM (Cervical Vertebral Malformation) and became a global affliction due to artificial insemination (May-Davis 2020).

The congenital malformations found in horses were not too dissimilar from CVM observed in cows, hence the name ECVM came about. Caution is warranted to not confuse ECVM with CVM in horses, the latter referring to Wobbler's syndrome, which is a completely different condition.

MORPHOLOGIC VARIATIONS & RAMIFICATIONS Potential variations of the malformation include:

Malformation of C6 only Malformation of C6 and C7 Malformation of C6, C7 and T1 Malformation of C6, C7, T1 & T2

Illustration: Malformation of T1. Adapted from May-Davis 2016.

From this listing, it becomes clear that the sixth cervical vertebra (C6) is the only constant factor. ECVM thus begins with alterations to the ventral caudal tubercles at C6 and then potentially progresses through the successive vertebrae and ribs.

The latest numbers show that ECVM presents in a ratio of 4:2:1 (!) meaning 4 out of 10 horses will present malformation of C6. Two of those will show transposition to C7 and one of those will also show malformation of the ribs. (May-Davis 2020)

Additional consequences observed with ECVM include altered sternum curvature, facet joint and vertebral canal symmetry, variations in musculature, altered nerve pathways, scoliosis, and trachea malformation. Let’s have a closer look to some of these additional ramifications.

ECVM influences musculature through alteration of attachment sites. Nature is a genius architect that designs anatomy in such a way that it allows for optimal bodily function of any creature. Within the cervical spine, C6 is the only vertebrae designed with two caudal ventral laminae. So why is that? The answer is that it provides anchor points for stabilizing paravertebral muscles such as M. Longus Colli.

Known as a V-shaped cybernetic muscle, the Longus Colli provides dynamic intersegmental stability as well as postural control. Rombach (2014) highlighted the importance of paravertebral stabilizers stating:

“Effective stabilization by the deep paravertebral muscles may reduce the risk of osteoarthritis and development of neck pain in horses, which is a limiting factor for performance of such animals.”

Ex-vivo studies showed that horses affected with ECVM display altered muscle attachment of M. Longus Colli on C6:

‘‘This study showed that the function of the L. Colli muscles had been severely 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 stabilizer, subsequently lead to vertebral instability, degenerative joint changes, and asymmetrical articular processes.’’ - May-Davis 2014

Furthermore, since the Longus Coli is cybernetic in nature any dysfunction also 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 altered muscle attachment, ECVM also has a potential direct effect on neurology due to changes to the intervertebral foramen - the canals through which spinal nerves pass. In some horses, the foramen present asymmetrical whereas in others they might be severely narrowed. Unpublished field research also shows C6-C7 vertebral canal symmetry in ECVM horses is often compromised. These changes may result in nerve compression.

Additionally, ex-vivo specimens as well as radiographic evidence, also suggests a potential ink between ECVM and scoliosis in the vertebral column.

Ilustration: a horse with unilateral malformation of C6, C7 and the first rib. The horse also presented a wavey sternum and scoliosis in the neck and lumbars.

Finally, ex-vivo studies also revealed that ECVM horses often show malformation of the trachea, however further research is needed to investigate potential causality and clinical relevance of this feature.

Malformation of the trachea in an ECVM affected horse.

METHODS OF ASSESSMENT A standardized method of ‘’assessment and diagnosis in live horses would allow for scientifically robust, quantitative studies into the relevance of this syndrome’’ - Gee et. al 2020

The cervical region is sometimes overlooked as a source of pain and dysfunction in general equine veterinary practice and there is a high likelihood ECVM is frequently under diagnosed as ‘’standard veterinary neurological and clinical examinations may well miss what is suspected to be an intermittent and dynamic instability in some cases.’’ Gee et. al 2020

For those reasons, radiographic examination is the only viable method of assessment to determine ECVM. Correct orientation and positioning of the machine are critical to reliably diagnose ECVM radiographically. Gee. et al (2020) have developed a protocol that includes a left and right 30◦ dorsal to ventral views in conjunction with laterolateral views of C6 and C7: ‘’A lateral 30 degrees dorsal to ventral oblique highlights the lamina of C6 against the radiolucent trachea (…) The left and right 30 ◦ dorsal to ventral views, in conjunction with the laterolateral views of C6 and C7, are necessary for a diagnosis or exclusion of ECCMV. The potential issues arising from these osseous malformations and their subsequent altered muscular attachments can be appreciated on the vertebrae in cranial and ventral views. ‘’

Above: normal C6 C7. Bottom left: unilateral malformation C6. Bottom right: transposition C7.

Good quality radiographs taken from the right angles allow for detection of ECVM in live horses and provides a platform for further studies into its clinical relevance. Including these radiographs into purchase exams will bring about more transparancy to breeders as well as prospect buyers into the prevalence and relevance of the condition.

CLINICAL RELEVANCE Ever since Sharon May-Davis documented and quantified the condition in 2013, the clinical relevance of ECVM is widely debated. A 2016 paper by De Rouen et al. concluded that:

“The alteration of the attachment site for regional musculature due to anomalous C6 may lead to altered biomechanical forces resulting in perceived pain or reduced range of motion” (…)

‘’Anomalous C6 vertebrae in our population were associated with a higher likelihood of cervical pain (P = 0.013). Authors propose that morphologic variations in the C6 ventral laminae could be linked to other developmental abnormalities such as vertebral canal stenosis, might affect regional biomechanics, and should therefore be considered clinically relevant in horses. Future, controlled prospective studies are needed to test this theory.’’

In 2019, Veraa et. al came to a different conclusion 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.’’

However, the control group consisted of young horses presented for pre-purchase examination and are thus less likely to be symptomatic. Furthermore, the criteria of the radiographic findings differed. The subjectivity of the neurological examination and detection of subtle clinical signs and behavioral abnormalities challenges interpretation of these results.

In contrast to these results, a more recent study conducted by Becatti et. al (2020) did find a significant link between abnormalities of the ventral lamina of C6 and clinical signs of cervical disease such as pain and ataxia:

‘’In agreement with De Rouen et al, horses with abnormalities of the ventral lamina of the sixth cervical vertebra (AVL-C6) had 4.73 greater odds of showing neck pain, characterized here as clinical signs of inability to eat from the ground and/or straddling the forelimb excessively and/or neck fixing and/or forelimb lameness (…) Horses with AVL-C6 had 8.2 times higher odds of showing clinical signs of spinal ataxia (…) In addition, it has also been demonstrated that horses with AVL-C6 had an intravertebral sagittal ratio less than 0.5 at the C6 site, suggesting that AVL-C6 may be associated with other simultaneous regional developmental abnormalities.'' There is thus increasing evidence suggesting that ECVM has potential clinical and functional ramifications that might affect the horse's overall well-being and locomotive function.

The main limiting factor of all studies conducted so far is the time frame of observation. The complexity of ECVM requires observations for longer periods of time, but unfortunately, to date, there are no longitudinal studies assessing the progression of ECVM throughout the horse’s life.

However, there is plenty of empirical evidence from horse owners and professionals working in the field that have been able to observe the life of ECVM affected horses over an extensive time. Common clinical symptoms that have been reported include:

1. Asymmetry

ECVM causes structural asymmetries (osseous and soft tissue) that can’t be overcome. Structural asymmetry has high clinical relevance as ‘’logic dictates that asymmetric form comes with asymmetric function.’’ – May-Davis

Evidence also shows a high prevalence of scoliosis in affected horses, making the condition even more complex to quantify.

Furthermore, empirical evidence also reports a high prevalence of additional asymmetries found in the teeth (crooked jaw) and feet of affected horses.

Horses with unilateral ECVM tend to stand with uneven front limb posture, predominantly one foot forward. The ipsilateral frog may atrophy, and affected horses may have high-heel low-heel syndrome due to uneven loading of the feet.

Horses with bilateral ECVM tend to stand base wide in front with feet point to the outside. These horses may toe land and behave ataxic over uneven ground or going down the hill. In general, ECVM affected horses tend to jump with uneven forelimb position.

Clinical manifestations of asymmetry might present through resistance behavior such as contact problems, difficulty turning and bending to one side, difficulty accepting the bit, bucking, rearing etc. Physical symptoms include uneven muscle development, head/neck tilt, compensation patterns, reduced load capacity and lameness’s. These asymmetries can affect saddle fitting.

Since straightness is an important aspect when it comes to athletic performance, ECVM is a potential risk factor for the performance horse.

2. Gait issues

ECVM horses are often reported to display gait abnormalities that include unexplained (intermittent) front limb lameness’s and neurological abnormalities. These abnormalities might either be present from a young age or develop later through life.

In 2018, Dyson et al. found ‘’increasing evidence that nerve root injury may cause forelimb lameness.” In this study, 3 of the 25 horses in the study had overt ECVM. The altered nerve pathways associated with ECVM might thus play a role into the development of (intermittent) lameness in affected horses.

Horses with unilateral ECVM may walk with a stilted action in the forelimb. When the ribs are also affected, there may be abduction of the front limb as well.

Furthermore, horses with ECVM often show less stability, poor coordination, and proprioception. Affected horses may stumble often and some cases might display stringhalt or an ataxic gait.

Canter problems are often reported. Horses may show a four-beat or non-suspension canter and struggle with flying changes and/or collection.

In general, it is often reported that affected horses fail to perform to expectation. Age might play a factor as it seems most symptoms worsen after +9 years of age.

3. Behavioral abnormalities

ECVM horses are often described as predictably unpredictable. Behavioral abnormalities can be related to pain, general discomfort and/or nerve compression.

The range of behavioral signs can vary within the individual. It might be random or even dangerous behavior. Some might be erratic; some might be stoic. Some might be spooky; Some might be clumsy; some might be generally nervous. The behavior is not necessarily present all the time. The horse can be fine for 95% of the time, with only sudden behavioral abnormalities that appear seemingly for no reason. Therefore, longitudinal observation is so important.

ECVM affected horses can tend to bite or scratch themselves on the shoulder. Furthermore, they can be girthy and/or may be problematic with rugging. Extreme hormonal behavior of mares has also been reported.

An anatomical explanation of stress-related behavior can lie in ex-vivo findings of the adrenals in ECVM affected horses. The adrenals are responsible for hormone production, specifically cortisol. The dissection of numerous ECVM affected horses revealed enlarged adrenals that often display adenomas. This suggests the horse has had a high level of (internal) stress.

4. Presence of co-existing pathologies

It seems that the complexity of many ECVM cases that are reported to be difficult or even impossible to manage lies in the presentation of multiple co-existing pathologies.

Unfortunately, studies into the causal relationship between ECVM and additional pathologies are limited. Rombach (2014) suggested that horses with altered lower cervical biomechanics are more prone to degenerative changes and pain. However, studies trying to identify the existence of a causal relationship between C6 abnormalities and osteoarthritis concluded that: ‘‘there was no association between the morphology of C6 and articular process osteoarthritis.’’ – DeRouen et. al 2016 (…)

‘’This study supports the findings obtained by DeRouen et al. (…) Considering that there were no differences in the severity of radiographic abnormalities related to osteoarthritis of the articular process joints in horses with and without AVL-C6’’ – Beccati et. al 2020

So even though both conditions have been found together upon dissections, a direct causal relationship cannot be assumed.

However, empirical evidence of 10 ex-vivo specimens and 40+ case study reports of horse owners reveal a high prevalence between ECVM affected horses and various co-existing pathologies, including scoliosis. When asking horse owners about the background of their ECVM horse they often begin the answer with ‘’it’s a long and complicated story….’’ After which a long list of performance problems and other pathologies follows.

The question is thus: can ECVM be linked to the development of any additional pathologies? Do they arise out of long-term compensation for structural asymmetry and/or altered nerve pathways? Or are they the result of exceeding the load capacity of these horses by asking maximal athletic performance?

Radiological detection of ECVM often occurs only at a later stage in life when performance problems are already noted. But are these problems because of ECVM or because of non-related pathologies?

To answer this question, early detection of ECVM is crucial so that young, unridden horses can be monitored over time to see how ECVM manifests throughout life and if, through correct management and training, additional pathologies can be prevented or not.

PERSONAL EXPERIENCE Now that I have extensively elaborated on ECVM as a complex phenomenon, it is time to share some personal data and experience that I have gained through doing whole horse dissections, being a horse owner and as a professional rehabilitation specialist world-wide.

I have been working with ECVM in the field since 2017 and have had hands-on experience with 46 confirmed cases – of which 3 are horses owned by myself and the other 43 owned by clients in Australia, Taiwan, New Zealand, The Netherlands, and United Kingdom.

There was a high variety in age, sexes, breed, and discipline. All horses found themselves between 4-19 years old, with the majority being between 7-12 years old. Most owners reported a worsening of the clinical symptoms after the age of 10.

On the aspect of gender, roughly 70% were mares and 30% geldings. No stallions have been presented to me yet. There was a high variety of breeds including: Andalusians, Arabs, Crossbreds, French Trotters, Standardbreds, Thoroughbreds and Warmbloods, the latter one making up for most of my data with roughly 55%.

In terms of discipline, roughly 5% were horses competed in medium to advanced eventing. 20% were horses competed in medium to international dressage levels. 10% were horses competed in low level to medium jumping. 65% 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.

Roughly 60% showed a malformation of just C6 – with a high predominance of unilateral malformation - and 40% showed a malformation of C6 and C7 transposition. 22 cases were also radiographed on the thoracolumbar spine and/or the limbs. In roughly 85% of these cases additional pathologies including scoliosis were found.

All horses showed clinical symptoms. Some horse owners reported the symptoms started at a later age when higher performance was asked, but some also reported the horse had never been totally ‘’right’’. Interestingly most owners reported that symptoms worsened when the horse was asked to be ridden.

The most observed symptoms included poor proprioception, asymmetry and poor posture, behavioral oddities, spookiness, being girthy, hoof problems and difficulty with contact, bending and collection.

Out of the 46 cases I have lost 7 of which 2 ended up on the dissection table. These were all complex, multifaceted cases that unfortunately had to be freed from their body to find peace.

In my years of experience, I have never come across an ECVM affected horse without (mild) clinical symptoms. However, since there is a high subjectivity between evaluating clinical symptoms, it might well be that other professionals do not list these as relevant or consider them as within ‘’normal range’’. Due to the lack of consensus as to when a symptom is ‘’clinically relevant’’ the discussion will remain.

However, there is consensus that straightness is an important aspect for the trained horse in any discipline. Straightness enhances balance which in turn promotes performance and decreases the risk of injury. Crookedness on the other hand promotes imbalance and increases the risk of strain and injury due to uneven loading. Therefore, it is my opinion that ECVM should always be considered as clinically relevant. I owe this statement to the 46 amazing horses and their owners who allowed me in their lives. Does this mean ECVM is always career ending or a death-sentence? No, I think that is too bold of a statement as each horse is an individual and multiple factors must be considered. ECVM affects individuals differently. The environment the horse is placed in, the work it does, it's character, its overall health, it's fitness and athletic ability all affect

the severity of symptoms and when they occur.

The fact remains the condition exists and that it affects many horses and their owners worldwide. Due to the high prevalence of ECVM there is an increasing demand as to how to manage these horses – if possible – to the best extent.

Led by the horses who crossed my path as well as dissection findings, I have experimented with various management and training solutions that I will discuss in the next section.


When it comes to management training of ECVM affected horses it is important to realize that the condition is structural in nature meaning it can’t be overcome, but only managed. The condition will remain, but conscious management could contribute to prevent or minimize any potential discomfort experienced by the horse.

From my experience, there are four key-factors when it comes to establishing the potential possibilities towards successful management and training of ECVM affected horses. These include: 1. Early on detection

2. Degree of malformation

3. Clinical symptoms 4. Performance goals

First, early detection is key so that the trainer / owner of the horse knows what is going on inside and can adapt management timely.

Second, the degree of malformation influences the complexity. So far, it seems that horses with C6 malformation only are somewhat easier to manage than those that show transposition to C7 and malformed ribs as well.

Third, the presentation of clinical symptoms. If symptoms are mild, chances for successful management and performance are higher compared to those horses that show severe clinical symptoms – for example dangerous explosive behavior. In the latter case, these horses might not be safe to train.

Fourth, the performance goals should be considered. As mentioned earlier, jumping is usually a risk-factor due to asymmetry and poor coordination.

In general, it can be said that the higher the athletic demands placed on the horse, the greater the risk of compensation and associated behavior. Can ECVM affected horses perform at top sport levels? Perhaps, as it is commonly known that horses can go a long way by compensating. However, this always comes at a high cost eventually – usually around the age of +9.

Training should be about functionality, not about spectacle. There should be something in it for the horse, something to gain, instead of having to suffer or compensate.

For these reasons, I believe that ECVM horses are best managed if not pushed to the extremes. Training should be a celebration of what the horse can do, not a punishment for what he can’t.

ECVM affected horses will require more time on the ground to prepare their bodies adequately for the demand at hand considering the extra level of asymmetry they are dealing with. If they can be ridden, training mindset should always be flexible to adapt whenever the horse requires it.

The combination of the four-key elements described will determine chances for successful management of ECVM affected horses. However, individuality should also be considered. Each case is truly unique and therefore outcomes may differ from horse to horse.

Despite the high individual character of each ECVM case, I have found a couple of common denominators that contributed to improving general quality of life and/or performance of affected horses.

LET’S TALK PRACTICAL In this section I will share practical solutions that have proven to be key in those cases that could be effectively managed.

Before I dive into specifics, I want to state that freedom of pain is an essential part of horse welfare. When a horse exhibits pain related behavior, pain management always has priority. However, it should be considered that ECVM affected horses might be dealing with neuropathic pain for which traditional pain medication such as NSAIDS or corticosteroids may not provide relief, as these drugs are as designed for inflammation related pain. Thus, if a horse does not appear be responding to pain medication, it doesn’t necessarily mean the horse is not experiencing pain, but simply that it might be dealing with a different type of pain which requires a different treatment.

Having said this, let’s have a look at some practical solutions for the management of ECVM horses, starting with environment adaptations.

‘’There were the horse spends most of it time, we can gain the most benefit’’ – Jessica Krul

Since horses spend at least 23 hours a day on their own, it is extremely important to create a dynamic and stimulating environment for them to spend it in. Generally, there are two very important factors to consider:

- The possibility of free movement

- Implementation of Passive Physio ®

ECVM horses do best when they can roam freely as much as possible. Free movement allows for dynamic balance that in turn promotes overall health. Long term stabling on the other hand is more stressful for the body. Second, the implementation of passive physio ® is an important management tool for ECVM horses. Passive physio describes offering various feeding positions and surfaces in the daily environment of the horse. In the wild, horses graze for roughly 80% of the time, but they also browse from bushes and trees for roughly 20% of the time. Browsing creates more variation in posture and evidence shows that it activates deep cybernetic muscles which are crucial for stability of the vertebral column.

Apart from browsing, horses in the wild also move over various surfaces which improves proprioception. Offering variation of surface is an easy implementable solution to naturally improve coordination of ECVM horses.

The postural differences of grazing versus browsing in the same horse

Examples of passive physio implementations include planting bushes, feeding up a ramp or hill, creating a track with various surfaces, placing obstacles in the paddock / pasture. A little creativity goes a long way. Creating a dynamic environment is the most efficient way of training as it requires zero time in the arena.

Now let’s have a look to some important considerations when it comes to active training. First, as mentioned before, training an ECVM affected horse requires a flexible mind-set. These horses are predictably unpredictable, and this requires flexibility to deviate from training goals when needed.

Expect the unexpected. ECVM affected horses often show ups and downs in performance. The lack of consistency or linear progression might be considered frustrating, but when dealing with ECVM horses this is simply something to adapt to. If performance drops, it is not a matter of the horse not wanting to meet your expectations, but simply that it can’t. The job of the trainer is then to listen and adapt to the horse’s needs.

Second, it is extremely important to set the horse up for success by properly preparing it for the demand at hand. There are three elements that need to be addressed: 1. Training elements 2. Training positions

3. Training surface

Training elements

As the saying goes: ‘’you get what you train.’’ As such, for any training to be effective the right elements and intervals must be selected to achieve a goal. Within the horse, there are roughly five elements that can be trained: 1. Endurance 2. Coordination 3. Flexibility 4. Resiliency (strength) 5. Speed

Due to the nature of the condition, ECVM affected horses mostly require coordination and resiliency to function as best as possible. Coordination to improve or optimize proprioception, resiliency to improve stability. Unfortunately, experience shows that most trainers focus on flexibility and speed instead, with all consequences thereof. I would like to argue that focusing on the wrong training elements hugely complicates the situation and it might be a potential contributor to the development of compensation related symptoms.

Although flexibility is a necessary element towards straightness and balance, it must never become a weakness. Due to the nature of the condition, ECVM poses a limitation to flexibility. Affected horses simply can’t be ‘’straightened’’ out as the asymmetry is structural.

Resistance towards (lateral) flexion is unfortunately often mistaken as a symptom of muscular stiffness and thus the horse is subdued to suppling exercises. ECVM horses are often not stiff, but unstable. Focusing on flexibility instead of resiliency with a primarily unstable horse is simply counter-productive. Furthermore, a horse that shows contraction is more in need of relaxation rather than suppling.

Translating this to practical exercises I generally advise to cut back on circles and laterals. Consider the square and rectangle as a baseline instead with a focus on vertical / horizontal balance. For lateral softness, consider rein chances in hourglass shape instead of rounded figures of eight. If laterals are possible, then close the angle a bit more to maintain a proper balance between sideways and forwards. Lateral softness is needed, but excessive focus towards suppling is a high-risk factor for additional compensation in the ECVM affected horse.

Apart from cutting back on suppling exercises initially, also consider cutting back on speed and continuous driving aids. Increasing speed in the unbalanced horse will make it go faster, but less forward. The trunk and lower neck will succumb under increasing forces with all consequences thereof. Speed will make the unstable ECVM horse only more unstable. It is thus very important to not confuse speed with forward as the first will only drive the ECVM horse more into the ground whereas the second is the natural result of correct training.

For the reasons mentioned above, it is thus clear that flexibility and speed are not the right training elements for ECVM affected horses. Instead, training programs should focus on coordination and resiliency simply because that is what these horses lack.

The next question might be what muscles you need to address to improve coordination and resiliency. For the purpose of this article, I want to highlight one important system, namely the thoracic sling.

As horses do not have a clavicle, they rely on strong muscles that act like ‘’slings’’ to suspend the chest between the front limbs and lift the thorax.

It is a common belief that crookedness of the horse comes from its back or hind legs.

However, in case of ECVM it 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, 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

As such, the hind limbs are mainly concerned with producing horizontal forces whereas the front limbs mainly produce vertical forces to provide an incline against gravity and thus, ultimately balance control. In the case of the front limbs not functioning properly, the hind limbs are not able to engage.

Knowing that the cybernetic neck muscles are impaired in ECVM affected horses, recruiting the thoracic sling through establishing neuromuscular pathways is essential as it supports the base of the neck and provides balance control against gravity. Proper thoracic sling activation will improve contact and bring about an optimal head and neck carriage relative to the level of collection asked. For more information on the thoracic sling please click here for a separate article on the topic.

Training positions So now that I have described some important training elements, let’s have a look at the five training positions available:

1. Groundwork

2. Work in Hand 3. Lunging 4. Long Reigning 5. Riding These positions merely describe the physical placement of the trainer relative to the horse and does not imply specific tack to be used in its execution. From experience, the lunging and the riding positions are mostly used. However, I would like to argue that ECVM affected horses hugely benefit from working more in the groundwork, work in hand, and long reigning position simply for the fact that it reduces load on the horse and encourages self-carriage instead. Some ECVM affected horses can’t be ridden, but they can be worked on the ground. For these horses, movement becomes therapy. Even for those horses that can be ridden, spending more time on the ground doing postural movement exercises greatly reduces the risk for additional complications compared to horses that are only lunged or ridden.

Training surfaces

Lastly, also the training surface must be considered. From experience, most ECVM affected horses do best on a somewhat firmer surface such as a pasture ground as this provides more stability in proprioception. If the horse does well, there can be progressed to sand. Deep sand is to be always avoided as this puts strain on tendons, but also on proprioception as the hoof sinks further after initial contact due to the sand giving away under the weight of the horse.

In conclusion, it can be said that multiple factors need to be considered when it comes to managing and potentially training ECVM affected horses. Since every case is highly individual, it will always be a process of trial and error with no guarantees. Some affected horses can be managed and trained, some cannot. I have lost my beautiful warmblood gelding Armando at 15 years old. He suffered from unilateral C6 malformation with transposition to C7 and scoliosis. At young age (4), he had difficulties to be broken in. He was girthy, nervous during mounting, could spook out of nowhere and had difficulty with bending. Due to a lack of diagnosis, he was not understood and pushed beyond his boundaries. At the age of 8 he had developed a tongue problem as well as navicular and hip problems. At the age of 10, when he came into my life, he was broken. I managed to rehabilitate him to a certain extent but had to let him go at the age of 15 as his body was too unstable and he started to become dangerous as well.

My younger mare with unilateral C6 malformation suffered from anxiety (sudden spooks) and struggled with coordination. She was also girthy and would occasionally grind her teeth on the bit. Instead of pushing her through, the owner decided to sell her to me. I spent 1,5 years in various groundwork positions mostly to improve her coordination and resiliency without additional load. I have slowly started to ride her again taking it very slow (walk and trot only at this stage), but it feels good.

Two horses affected by ECVM, but two completely different outcomes. There are no guarantees, but due to the high prevalence of ECVM learning how to potentially manage the condition is important to optimize the welfare of these horses.

CONCLUSION ECVM is a complex and unpredictable heritable condition in the cervicothoracic junction that can limit a horse’s athletic ability and/or its quality of life.

Due to the high prevalence, it is my personal wish that neck radiographs become standard protocol during purchase exams. Since the clinical relevance is highly debated, I understand that interpretation of radiographic findings might be difficult. In the context of transparency, I believe that making note of what has been observed is a valuable first step towards a better understanding of this condition. This way, the owner or buyer at least knows what is going on inside and can make their own informed decision with respect to suitability of the horse for breeding or performance purposes.

Due to the complexity, more longitudinal studies are necessary. In 2020, a great initiative towards this goal was launched in the form of a website. On you can find all scientific articles published on this topic. Furthermore, you can also enlist your ECVM affected horse into a database to enhance research. The more we learn the less we know, but we must keep on learning. Horses have served us for centuries. Now it’s our time to return the favor. Let’s evolve!

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 ECVM affected horses

A special word of thanks goes to Zefanja Vermeulen & Sharon May-Davis from Equinestudies.

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

BIBLIOGRAPHY Agerholm JS, Bendixen C, Andersen O, Arnbjerg J. Complex vertebral malformation in holstein calves. J Vet Diagn Invest. 200113(4): 283-289.

Beccati, F., Pepe, M.,Santinelli, I.,Gialletti, R.,Di Meo, A., Romer J.M. Radiographic findings and anatomical variations of the caudal cervical area in horses with neck pain and ataxia: case-control study on 116 horses. Vet Rec. 2020 187(9)

Clothier, J. All you need to know about the hidden C6-C7 malformation that’s bringing horses down. 2017. Accessible via:

DeRouen, A.; Spriet, M.; Aleman, M. Prevalence of anatomical variation of the sixth cervical vertebra and association with vertebral canal stenosis and articular process osteoarthritis in the horse. Vet. Radiol. Ultrasound 2016 (57): 253–258.

Dyson, S.J. Unexplained forelimb lameness possibly associated with radiculopathy. Equine Veterinary Education 2018. 32(10): 92-103.

Gee C, Small A, Shorter K, Brown WY. A Radiographic Technique for Assessment of Morphologic Variations of the Equine Caudal Cervical Spine. Animals 2020 10(4): 667.

May-Davis, S. Congenital Malformations of the 1st Sternal Rib. Equine Veterinary Science 2017 (49): 92-100.

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

May-Davis, S. Sharon May-Davis discusses Equine Complex Vertebral Malformation. 2020. Accessible via:

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

Rombach, N.; Stubbs, N.C.; Clayton, H.M. Gross anatomy of the deep perivertebral musculature in horses. Am. J. Vet. Res. 2014 (75): 435–439.

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I have a 5 yr old with ECVM.

If anyone would like to study him or give me any extra feedback on this please contact me.

I have owned him since 9m. I spent numerous hours training and finally I found this out. I would be happy to share my information and help others on this.

Donita Densmore


I am in Texas

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