Chronic lameness can be divided between those conditions where the cause is known, the problem incurable, and those where the cause is not known, therefore problematical in a different way. There is little point discussing the conditions where the cause is known, though opinions differ and some relatively intractable problems can respond with better diagnostics and a different approach. Lameness from undiagnosed, or improperly diagnosed, origins is widespread and it is important to understand why perceptions need to change at a professional level and why critical aspects of equine lameness are not being correctly prioritised.

What has changed

The foot is still a major factor in lameness. The influence of shoes and shoeing lead to problems caused by poor foot balance and/or infection, but other areas of the limb – like the fetlocks and knees – can be affected by interference with the natural dynamic balance of a limb and this can sometimes be corrected through the foot, by altering the way concussion is absorbed through the limb. None of this expresses a change from past lameness.

What has changed is the incidence and nature of muscular and other soft tissue injuries affecting areas above the knee and hock, also the way these affect spinal dynamics and spinal origin pain.

Why has it changed

There are two basic and obvious reasons: firstly, because the routine process of strapping was dropped; secondly, because of the widespread advent of artificial surfaces, some of which do not provide stability on ground contact. Muscular injuries are a common consequence of shifting surfaces and may happen imperceptibly yet start a complex of events that has to date gone unrecognised by academic equine medicine. A primary injury may go unnoticed, or appear to resolve without complication, however, the effect alters movement and provokes compensatory responses that may ultimately affect all four limbs. This may well be the precipitating factor in many cases of back pain and the process through which it happens will be elaborated on in the section on muscular lameness in due course.

Furthermore, it is not coincidental that the two major changes, mentioned above, have been accompanied by a tendency towards stiffer gallops and more demanding training regimes.

How is this lameness expressed

Generally, lameness emanating from upper body sources is reflected in a change of gait. Lameness from restricted movement, or from altered spinal dynamics, is not seen as a straightforward head nodding, as pain is felt in movement rather than on ground contact. Pain may also be precipitated by the weight of a rider, or by poor saddle design transferring that weight onto the weaker part of the back.

The origins of the problem are, in many cases, not immediate, but part of a process that initially alters movement and can gradually lead to a degree of pain that may make athletic expression difficult or impossible. Some horses suffer pain with little protest while others may refuse to be ridden. A far greater understanding of pain and its recognition is required of those who care for horses. Bucking, rearing or other forms of protest may mean danger for a rider, yet merely represent a way of the horse saying there is pain.