Jo Johnson Equine Physiotherapy

10/10/2026

🐴 Understanding Equine Back Pain

Another super presentation from the recent ACPAT seminar was Dr Anna Ehrle’s talk on the diagnostic approach to the equine thoracolumbar spine.

One of the key messages was something I think is so important when assessing horses with suspected back pain:

An abnormality on an X-ray doesn’t automatically mean that it is the source of pain.

Thoracolumbar abnormalities are surprisingly common in horses, including overriding dorsal spinous processes (‘kissing spines’), articular process osteoarthritis, spondylosis and transitional vertebrae. The challenge is determining whether an imaging finding is actually clinically relevant to that individual horse.

Dr Ehrle highlighted the importance of looking at the whole picture, including:

⭐️Clinical examination
⭐️Lameness assessment
⭐️Functional movement
⭐️Radiography
⭐️Ultrasound
⭐️Scintigraphy where appropriate
⭐️CT in selected cases

Horses with apparently similar radiographic changes can have very different clinical presentations. Pain isn’t necessarily determined simply by how much the dorsal spinous processes overlap. Anatomy, soft-tissue involvement and differences in innervation may all influence the clinical picture.

The interconnected nature of the structures around the thoracolumbar spine. The multifidus, interspinous ligament, supraspinous ligament and thoracolumbar fascia form an interconnected system, which helps us appreciate why a problem in one structure may have wider biomechanical and myofascial implications.

Dr Ehrle discussed a range of approaches to managing horses with overriding dorsal spinous processes, including local injections, controlled exercise, surgery, manual therapy, systemic medication and mesotherapy.

There was also discussion of research investigating multifidus muscle changes during rehabilitation following treatment for overriding dorsal spinous processes.

The over-riding message throughout however:

Don’t diagnose the radiograph - diagnose the horse.

Imaging is an incredibly valuable part of the diagnostic process, but it needs to be interpreted alongside the clinical findings, lameness assessment and functional presentation.

It’s this combination of diagnostic imaging, clinical reasoning, functional assessment and appropriate rehabilitation that allows us to build a much more complete picture of the horse. 🐎

06/10/2026

Wolff’s Law & Why Progressive Loading Matters After Injury …

When a horse has suffered a ligament or tendon injury, it’s difficult to know when and how much to increase the workload during rehabilitation.

It’s tempting to think:

“The ligament has healed, so we can get back to normal work.”

However, healing and capacity to cope with load are not necessarily the same thing.

Wolff’s Law is the principle that bone adapts to the mechanical loads placed upon it.

Although Wolff’s Law specifically relates to bone, the same fundamental concept of mechanical loading resulting in biological adaptation is hugely important when rehabilitating tendons and ligaments too.

Like bone, tissue also adapts to the demands placed upon it.

Following injury, the tissue undergoes a period of repair and remodelling. Its collagen structure, organisation and mechanical properties gradually change.

This is why progressive loading is such an important part of rehabilitation.

⬇️ Too little loading for too long → the tissue may not develop the capacity required for normal work.

⬆️ Too much loading, too soon → the tissue may be exposed to forces beyond its current capacity, potentially disrupting the healing process or causing re-injury.

The aim is to find the “sweet spot”:

🚶🏼‍♀️‍➡️Enough controlled mechanical stimulus to encourage adaptation
🧘🏼‍♀️Enough recovery time for the tissue to respond
🏃🏼‍♀️‍➡️Gradual increases in duration, intensity and complexity as capacity improves.

A horse may be comfortable and moving well before the injured tissue has regained the strength and load tolerance required for its previous level of work but rehabilitation isn’t just about the horse feeling better.

This is why a structured return to exercise might progress through:

🐴 Controlled in-hand exercise
🐴 Increased duration of walking
🐴 Gradual introduction of trot
🐴 Progressive increases in workload
🐴 Changes in surface and terrain
🐴 Pole work and proprioceptive challenges
🐴 Eventually, sport-specific demands

Each stage provides a different mechanical stimulus.

The appropriate stimulus results in a tissue response, encouraging it to adapt. As capacity increases we gradually increase the demand on the tissue.

Remember: “sound” doesn’t automatically mean “ready.”

The goal is to build a tissue that is capable of coping with the work we are asking it to do.

Progressive loading should always be individualised according to the injury, stage of healing, veterinary findings and the horse’s response to exercise.

03/10/2026

🐴 ACPAT Seminar 2026 – Practical Physiotherapy Approaches & Neuromotor Control

My lovely equine clients have been keeping me very busy these past couple of months, which I’m incredibly grateful for. 🥰

The downside? I haven’t managed to share much here- including some really interesting insights from the recent ACPAT Seminar 2026, which I attended a couple of weeks ago.

A brilliant day packed with talks covering equine back pain, neuromotor control, diagnostic imaging, kissing spines, rider biomechanics and saddle fit.

Starting with Dr Lesley Goff’s presentation on Practical Physiotherapy Approaches and Neuromotor Control for Equine Back Pain, one of the key messages I took away was that spinal stability is an active process involving the neuromuscular system.

Following injury, pain or altered loading, normal neuromuscular control can be affected. This can alter muscle activation, spinal stability and movement patterns, potentially contributing to an ongoing cycle of pain and dysfunction.

An interesting concept was the ‘neutral zone’ - the area of intervertebral movement around the neutral spinal position where there is relatively little resistance from passive structures such as the ligaments and joint capsules.

Changes to this system can have implications for spinal stability.

Multifidus isn’t primarily there to produce big movements of the spine. It has an important role in fine motor control and segmental stabilisation, helping to control movement between individual spinal segments.

Rehabilitation therefore isn’t just about ‘strengthening the back’. It’s about re-establishing coordinated control between the stabilising and mobilising systems, and then progressively challenging that control through functional movement.

Some of the practical approaches discussed included:

⭐️Dynamic mobilisation exercises (baited stretches)
⭐️Reflex exercises such as thoracic lifts and rounding (‘bottom tucks’)
⭐️Controlled rein-back and tail pulls
⭐️Pole work to challenge coordination, balance and proprioception
⭐️Thoracic sling activation
⭐️Progressive exercises incorporating turns and changes of direction
⭐️Progression into ridden work

The emphasis was on breaking more difficult exercises down into smaller components when a horse struggles, rather than asking for more repetitions of an exercise they can’t yet perform well.

It was also a useful reminder that we shouldn’t automatically assume an exercise is activating a particular muscle just because it looks like it should. Understanding the neuromotor goal of the exercise is key.

Alongside manual physiotherapy techniques, adjunctive modalities can also have a role, including laser/photobiomodulation, neuromuscular electrical stimulation and kinesiology taping, alongside appropriate active rehabilitation. Acupuncture (vet only!) is also shown to be beneficial in some cases.

For me, the biggest takeaway was:

We aren’t just trying to make a horse’s back stronger. We’re trying to help the horse regain the ability to control and stabilise its spine during movement.

Lots of ideas to take into clinical practice. 🐎

25/09/2026

Did you spot me? 😄

25/09/2026

Is a “tight” or painful back always the source of the problem?

Following on from my last post’s central message that pain, movement, biomechanics and behaviour need to be considered together rather than looking at one finding in isolation, a recent 2026 study has highlighted why equine thoracolumbar pain can be much more complex than simply finding an area of tension on palpation.

The new study by Resano-Zuazu et al. investigated thoracolumbar myofascial pain in 20 working police horses using three different assessment approaches: palpation, objective AI-based gait analysis and the Ridden Horse Pain Ethogram.

All 20 horses had at least one thoracolumbar myofascial trigger point, but importantly, the clinical signs of myofascial pain did not correlate with objective gait asymmetry or ridden pain behaviours.

In other words, a horse can have a painful or restricted area through the back without that necessarily being the primary explanation for an observed movement asymmetry.

The study also found differences in gait symmetry between horses being assessed in-hand and ridden, highlighting the influence that rider and ridden work can have on equine biomechanics.

And although many horses displayed behaviours included within the Ridden Horse Pain Ethogram, these behavioural observations did not directly correlate with the palpation findings or gait asymmetry either.

So what does this mean clinically?

It reinforces something I believe is at the core of equine physiotherapy:

One finding rarely tells us the whole story.

A painful muscle may be the primary problem…. but it may also be responding to another issue elsewhere in the horse.

That is why I like to consider:

📆 The horse’s history and workload
👀 Posture and static assessment
🤲 Palpation and tissue response
↔️ Range of movement
🏇 Movement in-hand and, where appropriate, ridden
🐴 Behaviour and ridden responses
🩺 Veterinary findings and diagnostic information
🔗And then how all of these pieces fit together

Relating an area of soreness to how the horse is moving and functioning is where clinical reasoning becomes so important.

Reference: Resano-Zuazu A, Carmona JU, Argüelles D. A multimodal approach to equine thoracolumbar myofascial pain: integrating clinical examination, AI-based gait analysis, and the Ridden Horse Pain Ethogram. 2026.

Read the research via Mad Barn

22/09/2026

Where is the pain… and why is it there? 🐴

One thing I find really interesting when assessing horses is the difference between where we find pain and why that area has become painful in the first place.

A diagnostic block can be incredibly useful. If blocking a particular structure changes the horse’s way of going, it gives the veterinary team valuable information about where the pain contributing to the lameness may be coming from.

But that doesn’t necessarily answer the question:

Why has that structure become painful?

For example, a horse may present with a sore foot, but could altered loading, reduced strength, previous injury, restricted movement or a change elsewhere in the body have contributed to the increased stress placed on that foot?

Likewise, a horse with discomfort around the hocks may have changes in the way it uses its hindquarters because of weakness, reduced mobility, poor coordination or another painful area.

That doesn’t mean that every foot problem originates in the back, or every hock problem is caused by muscle weakness. Sometimes the painful structure really is the primary problem.

It’s about not stopping the investigation at the first answer.

Think of the horse as a connected system

The horse doesn’t use individual joints and muscles in isolation.

To jump, turn, collect, accelerate, decelerate or to carry a rider efficiently, they need coordination between the feet, limbs, pelvis, spine and musculature.

If one area isn’t functioning optimally, another area may have to compensate.

Over time, that compensation can increase mechanical load on tissues that weren’t originally the problem.

This is why, during a physiotherapy assessment, I’m not only interested in what feels tight or sore today.

I’m interested in:

• How the horse stands
• How it moves
• How it distributes weight
• Muscle development and symmetry
• Range of movement
• Spinal and pelvic mobility
• Hindlimb engagement
• Strength and coordination
• Previous injuries and veterinary diagnoses
• Saddle, rider and training factors
• Whether the horse is physically prepared for the work being asked of it

And this is where rehabilitation becomes so important.

Pain relief may be an important part of treatment, but reducing pain is not necessarily the same as resolving the factors that contributed to the problem.

Once veterinary treatment has addressed the pathology and the horse is ready to rehabilitate, we need to progressively rebuild its ability to perform its job.

That means developing strength, coordination, mobility, proprioception and tissue capacity for the demands that horse is actually going to face.

A horse doesn’t necessarily need to be doing more work.

It needs to be doing the right work, at the right stage, with appropriate progression.

So perhaps one of the most useful questions we can ask when a horse develops a recurring musculoskeletal problem isn’t:

“Where does it hurt?”

but also:

“Why is that area being asked to do more than it can currently tolerate?”

That way, we have a chance of changing the factors contributing to it.

Where is the pain? And why is it there? Both questions matter.

Physiotherapy assessment should complement, not replace, appropriate veterinary investigation and diagnosis.

19/09/2026

🐴 ACPAT Equine Day Seminar 2026 🐴

Tomorrow I’ll be heading off to the annual ACPAT Equine Day Seminar - a highlight of the CPD calendar. ✨

There’s a fab programme lined up- a mix of research, clinical practice and practical application, covering areas that are hugely relevant to the work I do.

🐴 Equine back pain – practical physiotherapy approaches and neuromotor control with Dr Lesley Goff

🐴 The thoracolumbar spine – developing our diagnostic understanding with Dr Anna Ehrle

🐴 Kissing spines – the latest perspectives and updated results surrounding interspinous ligament surgery with Richard Coomer

🐴 The rider as an athlete – assessment, profiling and performance strategies with Robyn Dunn

🐴 Saddle fit & the thoracic spine – exploring the relationship between saddle fit and spinal health with Master Saddler Mark Fisher

I will hopefully come away with some new ways of thinking about the horses I work with!

I hope to share some highlights and key takeaways from the day afterwards. 📚

08/09/2026

STANCE OBSERVATION ~WHAT IS YOUR HORSE TELLING YOU? 👀

One of the simplest parts of the physio assessment of a horse is watching how they choose to stand.

Before asking a horse to walk, trot, lunge or perform a ridden movement, their static posture can already give valuable information.

👀 Are they equally loading through both forelimbs?

👀 Are they consistently resting one hindlimb?

👀 Are they subtly pointing one toe?

👀 Is one forelimb positioned slightly further forward than the other?

👀 Are they standing with one limb tucked underneath them or repeatedly shifting their weight?

These changes can be incredibly subtle.

A horse may not be dramatically lame or obviously uncomfortable, they may just be adopting a slightly different stance to redistribute load or find a position that feels more comfortable.

For example, a horse that consistently points a forelimb may be telling us that loading that limb differently feels preferable. Equally, asymmetrical loading through the forelimbs may prompt us to consider what is influencing distribution - from the foot and distal limb, through the joints and soft tissues, to the neck, thoracic sling and overall posture.

Importantly, stance is not a diagnosis.

A horse can stand asymmetrically for completely innocuous reasons and a horse can also stand square despite having a problem.

I like to observe the horse’s preferred stance and use it as a piece of the puzzle.

🐴 What does the horse look like standing?

🐴Does the pattern repeat?

🐴Does it change when they are repositioned?

🐴What happens when they walk away and turn?

🐴Is there a difference between left and right?

🐴Does their dynamic movement support what is seen statically?

🐴And how does all of this fit with their history, workload and any veterinary findings?

The smaller observations can be so valuable.

So, next time you’re with your horse, take a few seconds to watch them stand.

And, instead of asking “Are they standing square?”

Ask:

“How are they choosing to stand?” 👀

Their stance might well be telling you something.

02/09/2026

The recommended first-line diagnostic test for older horses showing signs like long curly hair, muscle wasting, lethargy, or recurring laminitis…

CARE ABOUT CUSHINGS

Complimentary ACTH tests are now available until 31st October for eligible* horses.
The laboratory fee is free. The visit fee and blood sample fee will still be due.
*For eligibility criteria and further information please see the Care About Cushings website: https://careaboutcushings.co.uk/

If you would like to take advantage of this seasonal offer, please contact the office on 07380 711300 to book an appointment.