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A Case Study: A relationship between pain and behaviour


This case study focuses on the successful treatment of a horse through a twelve-week program that incorporated weekly physiotherapy sessions, an exercise program, and hydrotherapy. The presenting complaint was a horse that had gradually become difficult to catch, struggled to build up topline and had reoccurring front end ‘Stiffness’.

The primary objective was to reduce any pain/discomfort that the horse was experiencing. Furthermore, transform the horse's behaviour from running away in the field to willingly approaching the owner. The results demonstrated significant improvements in the horse's behaviour and physical well-being, highlighting the effectiveness of this comprehensive treatment approach.


Horses, like humans, will avoid pain. They try to communicate with us through subtle changes in their behaviour and the development of avoidance techniques. However they can benefit from specialised therapeutic interventions to address the cause of the pain, which often also addresses the behavioural issues. This case study examines the transformation of a horse's behaviour through a holistic treatment program, which encompassed weekly physiotherapy sessions, a customised exercise program, and hydrotherapy.

Case Presentation:

2.1 Patient Information:

The horse in this case study was exhibiting avoidance behaviours, such as running away when approached in the field. These behaviours not only hindered the owner's ability to handle and ride the horse but also increased the risk of accidents and injuries. This horse had no known medical conditions or physical injuries that could explain the behavioural issues.

2.2 Assessment:

A comprehensive assessment of the horses behaviour and physical condition was conducted before initiating the treatment program. This included observing the horse in various environments and interactions, as well as a thorough musculoskeletal examination conducted by a qualified equine physiotherapist.


3.1 Physiotherapy Sessions:

The horse underwent weekly physiotherapy sessions. These sessions involved a range of techniques, including soft tissue mobilisation, electrotherapies, passive stretching exercises, and targeted muscle strengthening exercises. The physiotherapist tailored the sessions to address the horses specific needs, focusing on reducing pain, improving overall flexibility, balance, muscle strength and posture.

3.2 Exercise Program:

In conjunction with physiotherapy, an exercise program was developed to complement treatment. The program included a combination of ground exercises, lunging, and controlled riding sessions. These exercises targeted balance, coordination, and strength, gradually progressing in intensity and difficulty over the twelve-week period.

3.3 Hydrotherapy:

To further aid physical well-being, hydrotherapy sessions were incorporated into the treatment plan. These sessions involved controlled walking exercises in a water treadmill. Hydrotherapy provided a low-impact form of exercise, allowing the horse to build muscle strength and cardiovascular fitness while minimising the risk of injury.


4.1 Behaviour Transformation:

Within the first few weeks of the treatment program, significant improvements in behaviour were observed. The horse began to approach the owner willingly in the field, demonstrating trust and a desire for human interaction. This positive change fostered a stronger bond between horse and owner.

4.2 Physical strength and Injury Risk Reduction:

The comprehensive treatment approach greatly enhanced physical fitness and resilience. The combination of physiotherapy, exercise, and hydrotherapy resulted in improved muscle tone, flexibility, and balance. This not only reduced the discomfort causing the behavioural issues but reduced the risk of musculoskeletal injuries but providing a solid foundation for future training and performance activities.


This case study demonstrates the positive impact of a twelve-week treatment program consisting of weekly physiotherapy sessions, an exercise program, and hydrotherapy on a horse with pain induced behavioural issues. The successful transformation of behaviour, from running away to willingly approaching the owner, underscores the efficacy of this holistic approach. Additionally, the intervention resulted in a strong, resilient horse with reduced risk of injury.


By implementing a comprehensive treatment plan encompassing physiotherapy, exercise, and hydrotherapy, the behaviour and physical well-being of the horse in this case study were significantly improved. The treatment not only enhanced the horse's strength and resilience, thereby reducing pain and discomfort associated with exercise, but also transformed behaviour, allowing for a trusting relationship with the owner. This case study highlights the value of a holistic approach in equine rehabilitation and emphasises the importance of multidisciplinary interventions to address behavioural issues and promote equine welfare.

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