Improving Horse Welfare Through Physiotherapy
- Horses Inside Out
- Jun 18
- 5 min read
As owners, riders, trainers and therapists we are all striving to ensure our horses are symmetrical and sound. But what does that really mean? Soundness and symmetry in the horse refers to the balance and harmony of the musculoskeletal system and its impact on how the horse moves.
While we understand that both symmetry and soundness are essential for the optimal health, welfare and performance of horses, how do we achieve it – is it just a case of correct training, management and therapy?
The Horses Inside Out 2026 Conference will study this topic in detail over three days – 21 – 23 February 2026. There is a fabulous line up of speakers who will all help us to get to grips with what soundness and symmetry is, what we need to alter in our management and training to achieve it, and what problems we may face along the way.
In this article one of the speakers, Dr Gillian Tabor, Chartered Physiotherapist & Programme Manager for the MSc Veterinary Physiotherapy course at Hartpury University discusses the role of physiotherapy for soundness and symmetry in the horse.
A Key Part of the Horse's Team
The role of the musculoskeletal therapist in equine practice is as part of a multidisciplinary team, aiming to reduce or manage injury and improve long-term soundness and performance. Whether a horse is preparing for a five-star event or enjoying regular hacking, optimal musculoskeletal function is central to both performance and welfare.
While some equine performance issues are obvious, such as overt lameness, many more are subtle, manifesting as slight asymmetries, reduced engagement, or a persistent “something is not quite right.” These early signs may go unnoticed or dismissed by riders and owners, allowing discomfort to persist.
This is where the physiotherapist’s skillset becomes crucial. The ability to identify and interpret asymmetry or dysfunction, often before pain becomes severe, requires not only refined palpation and observational skills but also the use of objective, evidence-based assessment strategies.
In the first of two sessions I will be presenting at the Horses Inside Out Conference 2026, titled "Physiotherapy for Soundness and Symmetry: Evidence-Based Assessment Strategies," I will focus on unpicking the relevant understanding about musculoskeletal asymmetry in horses, both in static posture and dynamic movement. Drawing from current literature, this session will explore what can be measured with confidence, what tools and protocols are most reliable, and where the physiotherapist must still exercise clinical judgement.
Objective Tools and Critical Evaluation
A structured assessment process is essential, one that integrates subjective impressions with as much objective data as possible. While equine professionals have traditionally relied on visual gait assessment, advances in technology now offer more robust tools such as inertial sensors and AI gait analysis systems. However, the effectiveness of these tools’ hinges on proper application in the field, repeatability, and interpretation.
My own research and clinical focus has been on using reliable outcome measures to inform treatment decisions. Without a secure, unbiased baseline, clinical reasoning may be flawed, reducing the effectiveness of any subsequent intervention. Importantly, the assessment phase is where the physiotherapist’s role must be clearly delineated. When findings indicate pain or pathology outside the therapist’s scope of practice, referral to a veterinary surgeon must follow. Understanding and respecting these boundaries not only protects the horse’s welfare but also strengthens interdisciplinary trust.
Symmetry: The Gold Standard or a Red Herring?
Symmetry, though often idealised, is rarely achievable in practice.
Horses, like humans, are naturally asymmetrical to some degree. The question then becomes: what level of asymmetry is acceptable, and when does it cross into dysfunction? The literature tells us that even sound, high-performing horses demonstrate measurable asymmetries. This includes differences in limb loading, range of motion, and muscle mass. The key is in recognising whether an observed asymmetry is a functional adaptation or a compensatory pattern driven by pain or restriction.
Static postural evaluation can give clues to habitual loading patterns or compensations, while dynamic assessment provides insight into how these patterns manifest during movement. Gait asymmetries may reflect discomfort, neuromotor inefficiency, or influence by environmental factors and distinguishing between these is part of the art and science of physiotherapy.
In practice, therapists must investigate whether the horse has the capacity to change its posture or movement and, if not, why not. Questions to ask include: Does the horse have sufficient joint range and soft tissue extensibility? Is pain acting as a limiting factor? Is there appropriate neuromotor control to achieve the desired outcome?
A solid foundation in functional anatomy, physiology, and biomechanics is essential to answer these questions.
From Insight to Intervention
The second session, "Physiotherapy for Soundness and Symmetry: Evidence-Based Treatment and Rehabilitation," focuses on what comes next - how we use assessment findings to inform targeted, effective intervention.
Whether the goal is to restore symmetry, improve posture, or build tolerance to athletic demands, interventions must be chosen with a clear rationale. In this session, I’ll explore both manual therapies (such as mobilisations and soft tissue techniques) and active rehabilitation strategies. Here, the evidence base is still growing, but we do know that progressive, functional exercise is essential for long-term change.
The distinction between pain-free function and perfect symmetry will be a central theme. While perfect symmetry is desirable, it’s not achievable, and drawing knowledge from our human athletes, it may not always be necessary. A more realistic and meaningful goal is functional, pain-free movement appropriate to the horse’s discipline and workload. For example, a dressage horse may benefit from greater straightness and limb loading balance than a hacking horse, but both require a base level of musculoskeletal resilience.
Rehabilitation programmes must be dynamic and responsive. Horses with chronic asymmetry may initially require pain management before active intervention. Others may show improvement simply through careful loading and strengthening over time. As therapists, our responsibility is to continually evaluate, adapt, and justify our treatment plans using both clinical findings and current literature.
Empowering Owners and Enhancing Welfare
Another key element in both sessions is owner engagement. Many therapy gains can be undone between sessions if the owner does not understand the purpose of the exercises or recognise early signs of dysfunction. Educating owners to monitor changes, understand what is “normal” for their horse, and implement prescribed exercises correctly is part of our therapeutic process. Technology may support this, particularly with tools like wearable sensors or tracking apps that allow for greater owner involvement in monitoring progress.
Ultimately, our aim as musculoskeletal therapists is to support the long-term soundness, performance, and welfare of the horses in our care. This cannot be achieved through treatment alone, it requires robust assessment, evidence-informed reasoning, collaboration with vets and farriers, and a commitment to continual learning.
In addition to the two lecture sessions at the conference, I will be running small group practical workshops to apply these principles in a hands-on setting. Soundness and Symmetry In Practice takes place on Monday 23 February 2026 at Vale View Equestrian, Leicestershire. These sessions will focus on developing clinical reasoning through structured assessment, observation and measurement of asymmetry, and selection of appropriate manual and exercise-based interventions.
Symmetry and soundness are not absolutes, but dynamic qualities that reflect the horse’s history, environment, and training. By refining our assessment strategies and grounding our treatment approaches in evidence, we become better practitioners and better advocates for equine welfare.
I look forward to sharing these insights, case examples, and practical takeaways at the Horses Inside Out conference 2026.
Gillian Tabor
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