Musculoskeletal Injury: What the Research Says
Evidence from 22 peer-reviewed studies
What Professionals Should Know
- •Be critical of preventative claims for shoeing, supplements and other modalities — current research shows variable efficacy, so tailor interventions to individual horses rather than using standardised protocols
- •Track outcomes of your preventative approaches systematically; the gap between routine use and proven benefit suggests many current practices may need reassessment
- •Advocate for evidence-based preventative strategies within your discipline — continued use of unproven measures delays development of genuinely effective protocols
- •Avoid inconsistent turn out schedules and disruptions to routine; foals maintained on 24/7 turn out had significantly lower injury rates than those with interrupted access
- •Prioritize larger paddock areas (particularly before weaning) as this simple management change reduced subsequent musculoskeletal disease by up to 24% per acre
- •These findings support maintaining consistent, unrestricted turn out practices on stud farms, as restricted or variable turn out substantially increases musculoskeletal injury risk in young stock
- •Monitor stride length and speed trends across multiple races as early warning indicators of impending musculoskeletal injury—declining metrics 6+ races before injury provide a detection window
- •Pay particular attention to younger horses early in their racing careers, as they show the highest MSI risk
- •Implementing longitudinal stride monitoring systems may enable preventative management before injury occurs
- •Antibiotic use in post-covering treatments is common but often administered without ultrasound evidence of uterine fluid, suggesting need for evidence-based protocols to justify treatment decisions and reduce unnecessary antibiotic exposure
- •Nearly one-third of pregnant mares experience disease or injury requiring veterinary care, with musculoskeletal problems being the leading concern—consider management strategies to minimize these conditions in breeding stock
- •High medication usage during gestation (47% receiving non-reproductive drugs) warrants discussion with veterinarians about necessity, timing, and potential effects on developing foetus
- •Monitor young horses closely during early season racing and conditioning, particularly managing rapid workload accumulation which appears to be a major risk factor for fatal outcomes
- •Exercise caution when transitioning horses between surface types (dirt/synthetic to turf), as this surface change was associated with increased fatality risk
- •Consider jockey strategy and field positioning as modifiable risk factors, as early-finishing horses in large field races showed increased fatality rates that may relate to race tactics
- •Start training 2-year-olds earlier rather than later—delaying training actually increases injury risk; commencing training should be based on individual readiness rather than arbitrary age cutoffs
- •Incorporate high-speed work and multiple training preparations strategically into conditioning programs, as both reduce injury hazard in young racehorses
- •Use non-ridden training modalities (lunging, swimming, treadmill) as part of preparation, particularly for colts and horses showing dorsal metacarpal disease risk factors
- •Monitor first-time training horses intensively, as initial training preparations carry highest injury risk—adequate rest between preparations is protective
- •Mortality risk in standardbred racehorses is multifactorial and driven primarily by competition intensity and workload management rather than musculoskeletal injury alone—monitor cumulative training stress and performance decline as early warning signs.
- •Sex and age significantly influence mortality risk; tailor training and competition schedules accordingly, with particular caution for older horses and certain sex-age combinations.
- •Implementation of management protocols targeting high-risk combinations (intense competition at elite levels, lower-level qualifying races) and progressive performance monitoring may identify horses at cumulative risk before fatal events occur.
- •Fetlock and sesamoid bone injuries are the leading cause of racehorse fatalities; farriers should focus on optimal hoof balance and shoeing to minimize stress on these high-risk structures
- •Post-mortem examination rates are critically low (31.5%), limiting the ability to identify preventable causes; advocate for increased necropsy protocols to improve safety interventions
- •Jockey injuries are a secondary but significant consequence of horse fatalities; track safety and fall prevention strategies may reduce both equine and human injury
- •Expect temporarily elevated musculoskeletal injury risk for 49 days following local corticosteroid injection; this increased risk likely reflects disease progression rather than treatment effect
- •Counsel horse owners that corticosteroid injections target symptom relief, not tissue repair, and do not reduce subsequent injury rates in racing Thoroughbreds
- •Monitor closely for 7 weeks post-injection; consider restricting work during this high-risk period, particularly in horses with pre-existing carpal or fetlock pathology
- •Stress fractures account for over half of fractures in training racehorses, suggesting current training intensities and progression schedules may exceed skeletal adaptation capacity in young horses
- •Trainers should prioritize monitoring for early signs of stress injury (particularly in pelvis and tibia) as these account for nearly 3 in 10 fractures and may be preventable with adjusted workload
- •Evidence supports reviewing and individualizing training programs based on skeletal maturity and response to work, rather than standardized high-intensity protocols
- •Amniotic fluid represents a viable, non-invasive source for obtaining equine stem cells with superior stability compared to other MSC sources, potentially simplifying procurement for therapeutic use
- •The demonstrated safety profile and lack of chromosomal abnormalities in long-term culture support the feasibility of developing AF-MSC-based therapies for equine musculoskeletal injuries
- •Practitioners considering stem cell therapy options should note this as an emerging alternative source that may reduce ethical concerns and logistical challenges associated with traditional bone marrow or adipose-derived stem cell collection
- •Perform thorough pre-exercise assessment of each horse's strength, symmetry and postural control before designing conditioning or rehabilitation programmes
- •Incorporate core strengthening exercises into regular training to improve stability and reduce re-injury risk in working horses
- •Tailor exercise programmes to individual needs rather than using one-size-fits-all approaches to maximise both performance and welfare outcomes
- •Build rehabilitation around controlled exercise with careful progression of limb loading—avoid the temptation to rest completely or return to work too quickly
- •Consider combining modalities (exercise + electrophysical therapy + injectables) based on individual horse presentation rather than relying on any single treatment
- •Work with an equine physiotherapist to develop a structured, evidence-based plan that accounts for your horse's temperament and your realistic capacity to manage the programme
- •Track condition significantly influences how horses move and their injury risk—surface assessment cannot be separated from performance analysis
- •Standardized methods for measuring and documenting track surface properties are needed to improve injury prevention strategies in racing operations
- •When evaluating racing injuries, consider track conditions and their effects on stride mechanics alongside intrinsic horse factors
- •Nearly half of eventing horses experience musculoskeletal problems; focus preventive strategies on the foot and joint structures as priority areas for your population
- •Injury prevention strategies should differ by context: educate riders about competition-related hoof/tendon injuries and training-related ligament/stifle injuries
- •Recovery time varies dramatically by injury type (2 weeks to >12 months); set realistic owner expectations and tailor rehabilitation protocols accordingly
- •Adopt a collaborative, multi-disciplinary approach involving veterinarians, farriers, physiotherapists, and riders to comprehensively address equine welfare and performance issues.
- •Consider environmental and human factors alongside equine health when evaluating and treating musculoskeletal and other non-infectious conditions in sport horses.
- •Engage with professionals across multiple settings and sectors to develop holistic rehabilitation and care protocols that account for the complexity of equine-human-environment interactions.
- •Most trainers use sand and synthetic surfaces for slow-work but underutilize turf for galloping despite it being the primary racing surface—consider increasing turf-specific training to improve musculoskeletal adaptation to race-day conditions
- •Nearly all trainers employ alternatives to ridden exercise; document which methods (e.g., swimming, treadmills, lunging) are most effective for injury prevention and fitness maintenance in your training program
- •Current training practices show limited alignment between training surface exposure and actual racing surfaces, suggesting a potential gap in injury prevention strategy that warrants investigation
- •Controlled hand walking, therapeutic shoeing, ice, and PRP represent the core rehabilitation toolkit across equine practices—these are broadly accepted and implemented.
- •If using injectable biologics (PRP, IRAP, stem cells), ensure veterinary administration; however, many modalities can be safely and effectively delivered by trained technicians, farriers, or physical therapists under appropriate supervision.
- •Consider developing collaborative relationships with equine physical therapists to expand rehabilitation capabilities, as currently only one-third of practices do so—this represents an opportunity to enhance patient outcomes.
- •Farriers and veterinarians should recognize that shoeing and surface choice directly influence limb loading mechanics and injury risk across disciplines
- •Poor understanding of foot-ground interface factors suggests need for individualized assessment rather than one-size-fits-all approaches to managing high-speed performance horses
- •Focus on managing peak loads, impact, and vibration through surface and shoeing optimization may reduce musculoskeletal injury in performance horses
- •Implement proactive, holistic management involving coordinated care from multiple health professionals to reduce musculoskeletal injury risk in sport horses
- •Design age-appropriate exercise programmes for young horses starting pre-weaning, aligned with the horse's natural cursorial evolution, to build musculoskeletal resilience
- •Consider strategic introduction to competition early in a horse's career, as this is associated with improved longevity rather than shortened careers
- •Surface type significantly affects how the hoof experiences collision forces during landing—tarmac creates predictable mechanical stress patterns while sand is more variable, suggesting surface selection matters for injury prevention
- •The foot's natural shock absorption mechanisms work differently on different terrains; farriers and veterinarians should consider track surface properties when investigating lameness and designing therapeutic interventions
- •Shoe type and hoof care modifications may influence collision force transmission, warranting further research to optimize protection for horses working on different surfaces
- •Foot imbalance creates measurable, sustained shifts in loading patterns that the horse cannot self-correct—even small wedge angles (3.7–5°) matter
- •Higher loads concentrate in the elevated region of an imbalanced foot, potentially damaging hoof structure and horn growth over time; early detection and correction are critical
- •Shoeing changes should be assessed carefully, as the horse's loading pattern stabilises within 24 hours, making longer-term monitoring essential to evaluate therapeutic benefit
Key Research Findings
Current preventative measures for distal forelimb health (therapeutic shoeing, nutraceuticals) lack robust evidence despite routine use in equine practice
Few interventions have demonstrated capacity to reduce inflammation or promote regenerative pathways in joint and forelimb tissues
Evidence base for prophylactic measures is variable with inconsistent clinical outcomes reported
Longitudinal studies and evidence-based medicine approaches are needed to establish efficacy of single and multi-modal preventative strategies
Overall incidence of musculoskeletal disease or injury was 5.3 cases/100 foal-months at risk
Turn out times between 9–23 hours daily (over 7-day periods) were associated with 4.6-fold increased injury rate compared to 24/7 turn out
Each additional acre of turn out area during the 4th month of life reduced musculoskeletal disease/injury rates between 6–18 months of age by 24%
Disruptions to turn out routines increase injury risk; larger paddock access before weaning may provide protection against subsequent musculoskeletal problems
Risk of MSI increased by 1.18 for each 0.1 m/s decrease in speed over career race starts (P<0.001)
Risk of MSI increased by 1.11 for each 10 cm decrease in stride length over time (P=0.01)
A marked rate of decline in speed and stride length was observed approximately 6 races prior to injury
Risk of MSI was highest early in the horse's racing career
55-73% of Thoroughbred broodmares received reproductive medications (pre-oestrus, ovulatory agents, post-covering treatments) during breeding season
69% of post-covering treatments included antibiotics, with 37% of mares receiving treatment despite absence of fluid on ultrasound
34% of pregnant mares experienced at least one veterinary-attended disease or injury episode, with musculoskeletal conditions (23%) and placentitis (5%) most prevalent
Evidence Base
An Evaluation of Current Preventative Measures Used in Equine Practice to Maintain Distal Forelimb Functionality: A Mini Review.
Clarke Emily J, Gillen Alex, Turlo Agnieszka et al. (2021) — Frontiers in veterinary science
Associations between turn out practices and rates of musculoskeletal disease and injury in Thoroughbred foals and yearlings on stud farms in the United Kingdom.
Mouncey Rebecca, Arango-Sabogal Juan C, de Mestre Amanda et al. (2024) — Equine veterinary journal
Changes in Thoroughbred speed and stride characteristics over successive race starts and their association with musculoskeletal injury.
Wong Adelene S M, Morrice-West Ashleigh V, Whitton R Chris et al. (2023) — Equine veterinary journal
Descriptive Study of Medication Usage and Occurrence of Disease and Injury During Gestation in Thoroughbred Broodmares.
Mouncey Rebecca, Arango-Sabogal Juan Carlos, de Mestre Amanda et al. (2022) — Journal of equine veterinary science
Factors Associated with Fatality in Ontario Thoroughbred Racehorses: 2003-2015.
Physick-Sheard Peter, Avison Amanda, Sears William (2021) — Animals : an open access journal from MDPI
Survival Analysis of Training Methodologies and Other Risk Factors for Musculoskeletal Injury in 2-Year-Old Thoroughbred Racehorses in Queensland, Australia.
Crawford Kylie L, Finnane Anna, Greer Ristan M et al. (2021) — Frontiers in veterinary science
Factors Associated with Mortality in Ontario Standardbred Racing: 2003-2015.
Physick-Sheard Peter, Avison Amanda, Sears William (2021) — Animals : an open access journal from MDPI
Thoroughbred fatality and associated jockey falls and injuries in races in New South Wales and the Australian Capital Territory, Australia: 2009-2014.
Wylie C E, McManus P, McDonald C et al. (2017) — Veterinary journal (London, England : 1997)
Musculoskeletal injury rates in Thoroughbred racehorses following local corticosteroid injection.
Whitton R C, Jackson M A, Campbell A J D et al. (2014) — Veterinary journal (London, England : 1997)
Descriptive epidemiology of fractures occurring in British Thoroughbred racehorses in training.
Verheyen K L R, Wood J L N (2004) — Equine veterinary journal
Evaluation of stability and safety of equine mesenchymal stem cells derived from amniotic fluid for clinical application.
Kim Eun Young, Lee Eun Ji, Kim Ryoung Eun et al. (2024) — Frontiers in veterinary science
Equine osteoarthritis. Part 2: rehabilitation and injury prevention
Rachel Salz (2025) — UK-Vet Equine
Evidence-based rehabilitation of the competition horse
Katherine Hanousek (2025) — UK-Vet Equine
Turf track surface interaction with speed and musculoskeletal injury risk in Thoroughbred racehorses.
Legg K A, Gibson M J, Gee E K et al. (2025) — Equine veterinary journal
Musculoskeletal Injury and Illness Patterns in British Eventing Horses: A Descriptive Study.
Tranquille Carolyne A, Chojnacka Kate, Murray Rachel C (2024) — Animals : an open access journal from MDPI
The Triple-E Model: Advancing Equestrian Research with Perspectives from One Health.
Keener Michaela M, Tumlin Kimberly I (2023) — Animals : an open access journal from MDPI
Track Surfaces Used for Ridden Workouts and Alternatives to Ridden Exercise for Thoroughbred Horses in Race Training.
Morrice-West Ashleigh V, Hitchens Peta L, Walmsley Elizabeth A et al. (2018) — Animals : an open access journal from MDPI
International Survey Regarding the Use of Rehabilitation Modalities in Horses.
Wilson Janine M, McKenzie Erica, Duesterdieck-Zellmer Katja (2018) — Frontiers in veterinary science
The foot-surface interaction and its impact on musculoskeletal adaptation and injury risk in the horse.
Parkes R S V, Witte T H (2015) — Equine veterinary journal
Proactive Management of the Equine Athlete.
Rogers Chris W, Bolwell Charlotte F, Gee Erica K (2012) — Animals : an open access journal from MDPI