Common Injuries and Conditions in Dressage Horses

The dressage horse’s injury profile is shaped by what the discipline asks of the body: sustained, repetitive loading of the hindquarters and back rather than the high-impact peaks of jumping. The conditions that recur most in working dressage horses are suspensory ligament injuries — above all hindlimb proximal suspensory desmitis, the discipline’s signature problem — arthritis in the small joints of the hock, back and sacroiliac soreness, front-foot pain, and the tension-related and gastric issues of a stabled competition life. Most are managed rather than cured, many horses continue working with maintenance, and the difference between a career-ending problem and a lived-with one is usually the clinical picture, not the label. This page describes the injuries a horse in work develops; the separate question of what a pre-purchase examination finds at the moment of sale is covered in common findings decoded.

Two boundaries frame everything below. First, this is educational information about the injuries a discipline tends to produce, not veterinary advice — no individual horse can be assessed from a wiki, and every diagnosis, prognosis and management decision belongs with a treating veterinarian. Second, the vetting articles describe findings at purchase, read on a single day against an intended use; this page describes the conditions that a working career develops over years. The two overlap — a suspensory strain healed and disclosed becomes a vetting finding — but the angle here is the horse in work, not the horse on the examination day.

Why dressage loads what it loads

Every discipline injures horses in its own signature pattern, and the pattern follows the biomechanics. Jumping delivers high-impact peak forces through the front limbs on landing; racing loads the whole locomotor system at speed. Dressage does something different: it asks for collection, the progressive lowering of the hindquarters so the horse carries more weight behind and lightens the forehand, and it asks for it repetitively, over years, in the controlled environment of an arena.

That biomechanical demand concentrates load in three places. The hindlimb suspensory apparatus takes sustained strain as the hocks and hind end flex and carry in the collected work. The hocks — specifically the small, low-motion joints of the lower hock — absorb the compression of sitting work. And the back, which the training scale runs entirely over, is asked to lift, round and swing under the rider while the hindquarters engage. The result is a discipline whose characteristic problems are not fractures or acute traumatic breakdowns but cumulative, load-related conditions of the hind end, the hocks and the back — the price of asking the same structures to do demanding, repetitive work through a long career. The connection between what a horse is built to do this work and what breaks down under it runs through conformation and what makes a dressage horse.

Suspensory ligament injuries: the discipline’s signature problem

The suspensory ligament runs down the back of the cannon, supporting the fetlock, and its upper attachment — the proximal suspensory, at the top of the cannon just below the hock or knee — is the site that gives dressage horses trouble. Proximal suspensory desmitis (PSD), inflammation or degeneration at that origin, is the injury most identified with the discipline. Retrospective studies of dressage-horse injury patterns find the suspensory the single most frequent site of injury, and the hindlimb origin is the classic dressage location, produced by the repetitive overloading that collected work imposes on the hind end.

The front and hind versions behave differently, and the difference is what makes hindlimb PSD the harder problem. Forelimb proximal suspensory desmitis commonly responds well to rest and a controlled, incrementally increasing exercise programme over several months, with a good rate of return to work. Hindlimb PSD carries a more guarded outlook: the anatomy at the hindlimb origin is confined, conservative rest-and-rehabilitation regimes are less reliably rewarding, and the prognosis for return to full performance is generally reported as guarded to fair rather than good. This is the honest reason the injury looms so large in dressage — not that it is always career-ending, but that the discipline’s own signature injury is one of the less predictable ones to resolve.

How it presents. Hindlimb suspensory problems often show not as dramatic lameness but as loss of performance, hindlimb stiffness, reluctance to engage or push from behind, resistance in the collected work, or an asymmetry a rider feels before a vet sees. Because the ligament is soft tissue, radiographs largely do not show it; diagnosis rests on clinical examination, nerve blocks to localise the pain, and ultrasound (and sometimes MRI) of the structure. This invisibility to x-ray is exactly why the vetting process leans on history, palpation and — where indicated — ultrasound rather than trusting a clean radiographic set to rule the suspensory out.

Management and career implications. At an overview level, management runs from controlled rest and a graded return to work over months, through various veterinary interventions, to surgical options in refractory hindlimb cases — all decisions for a treating vet, and all with individual outcomes. Honestly stated: some horses return to full work, some return at a reduced level, and some do not return to demanding collection. A documented, well-rehabilitated suspensory injury with a return to full work is a known and priceable history; an active or recurring one is a genuine career question. Because soft-tissue injury is the finding x-rays cannot see and the one most dependent on honest disclosure, it is treated in the vetting literature as the single most important thing to ask about — “has this horse ever had time off, and why” — as common findings sets out.

Hock arthritis and bone spavin

If the suspensory is dressage’s most feared injury, arthritis of the lower hock is its most common one. Bone spavin is osteoarthritis of the small, low-motion joints at the bottom of the hock — the joints that absorb the compression of collected, sitting work. Degenerative change in these joints is among the most frequently seen findings in mid-career and older sport horses, to the degree that many actively competing dressage horses carry some lower-hock change and work comfortably under routine maintenance.

How it presents. Early signs are subtle: a shortened hind stride, stiffness that improves with warming up, resistance to work that loads the hind end, or a positive response to hock flexion. Because the affected joints are low-motion, the eventual natural history of some cases is fusion (ankylosis) — the joint stiffening into immobility — after which the horse may be comfortable again, since the pain comes from movement in a degenerating joint rather than from a fused one.

Management and career implications. Lower-hock arthritis is the condition that best illustrates dressage’s “managed, not cured” reality. Many horses continue in full work under a maintenance programme overseen by a vet — the details are individual and not for a wiki — and a teenage schoolmaster performing its job under routine hock maintenance is a market norm, not a warning sign. The schoolmaster-versus-young-horse decision turns partly on exactly this: older trained horses rarely vet “clean”, and the buyer chooses which manageable findings to live with, with the maintenance cost belonging in the ownership budget. The weight a finding deserves scales with age and ambition — mild change in a teenage horse doing its job differs sharply from the same change in a young horse with a decade of collection ahead of it.

Back and sacroiliac soreness

Because the whole of dressage is ridden over the back, back and pelvic problems bite harder in this discipline than in most. Two related regions matter: the thoracolumbar back itself, where impinging dorsal spinous processes (kissing spines) are the best-known structural finding, and the sacroiliac region, the junction between the pelvis and the spine that transmits hindlimb thrust into the back.

The central fact, carried over from the vetting literature, is that the image is not the disease. Radiographic kissing-spine findings are widespread in comfortable, working sport horses, and the buyer’s — and the owner’s — question is whether genuine clinical pain accompanies them. A back that palpates supple, swings through the topline and works into the contact is functioning regardless of what a film shows; a back showing pain, guarding, hollowing, cold-backed behaviour or resistance under saddle is a clinical problem whatever the film shows. This radiograph-versus-clinic distinction is the whole subject of the kissing spines guide, which covers grading, management and the surgical options at length.

Sacroiliac pain presents as reduced hindlimb engagement, difficulty with collection, an unlevel or scuffing hind step, or a general loss of power behind, and it can be difficult to localise, often sitting alongside hindlimb lameness rather than standing alone. Management and career implications: many horses with back and sacroiliac soreness are managed successfully with physiotherapy, targeted strengthening work, saddle-fit and rider review, and veterinary treatment, and continue in full work — the outcomes are individual and belong with a vet. A genuinely, persistently painful back is career-defining in a discipline built on the topline; a managed, functional one is compatible with a long career. Any noted back finding also carries an insurance consequence, since back exclusions are common where findings are recorded and follow the horse — the logic set out under insurance.

Front-foot soreness

Dressage does not pound the front feet the way jumping does, but front-foot comfort is non-negotiable in any ridden discipline, and the working dressage horse is not exempt. The relevant conditions cluster in the caudal (back) part of the foot and the navicular region — the podotrochlear apparatus once labelled “navicular disease” and now understood as a spectrum in which imaging and clinical significance correlate imperfectly.

How it presents. Front-foot pain shows as bilateral forelimb lameness that can look like general stiffness or a shortened, pottery front stride, often worse on hard ground or a circle, sometimes with a positive response to hoof testers or to flexion. Foot conformation and shoeing feed directly into it: the long-toe/low-heel foot or a mismatched pair, flagged at the conformation stage, is the same conversation from another angle, since foot balance influences the loading of the whole caudal foot.

Management and career implications. Much front-foot soreness is managed through farriery and foot balance, appropriate work surfaces and veterinary care, and many horses work comfortably for years under such management. As with the hock, mild, stable, well-managed change is livable; a progressive or clinically active front-foot problem is a more serious matter. The distinction — incidental radiographic variation, versus change with clinical correlation, versus progressive disease — is developed in common findings.

Tension-related and gastric conditions

Not every problem that limits a dressage horse is orthopaedic. The stabled, travelled, concentrate-fed life of a competition horse produces a cluster of stress- and management-related conditions, of which equine gastric ulcer syndrome (EGUS) is the most prominent. Gastric ulcers are common in sport horses — published prevalence figures for competition and show populations span a wide range and sit well above those of minimally worked horses — driven by stabling, high-concentrate feeding, exercise and the stress of travel and competition. They present variably: reduced appetite, weight or condition loss, girthiness, dullness, or performance and behavioural changes that can be mistaken for training or temperament problems, and are diagnosed by gastroscopy. Ulcers are treatable and frequently a management artefact rather than a structural fault, which is why they sit slightly apart from the musculoskeletal injuries above and why gastroscopy at purchase is usually reserved for indicated cases rather than routine screening. Related tension-driven issues — the tension a rider feels through the back, muscle soreness, and behavioural signs of discomfort — often trace back to a physical cause, which is the reasoning behind investigating a sudden behavioural or performance change rather than drilling through it.

Prevention: what the management consensus reports

There is no way to injury-proof an equine athlete, but the factors widely reported as protective in the management of working dressage horses are consistent, and they are reported here as that consensus rather than as guarantees:

• Footing. Consistent, appropriately cushioned, well-maintained arena surfaces are broadly regarded as central to limiting cumulative soft-tissue and joint strain; deep, uneven or inconsistent going is correspondingly implicated in overload.
• Programme variety. Cross-training — hacking, hill and pole work, and conditioning rather than continuous arena drilling — is widely credited with distributing load and building the supporting musculature, an approach visible in the way finished horses are managed with more conditioning and less repetitive schooling as they mature.
• Turnout and movement. Regular turnout and time out of the stable are associated in management consensus with musculoskeletal, digestive and behavioural benefits alike.
• Fitness and progression. Building strength gradually and matching the work to the horse’s stage of development — not asking for sustained collection before the body is ready — is the through-line of the whole training scale.

None of these eliminates the load-related injuries a demanding discipline produces; the consensus is that they reduce and delay them, which for a strength athlete in maintenance is the realistic goal.

The buyer’s takeaway

For anyone buying a dressage horse, this injury profile reframes the vetting process. The conditions a working dressage horse develops are precisely the ones the pre-purchase examination is built to surface: the hocks the x-ray set images, the back the spinous-process films and ridden assessment probe, the suspensory the history and ultrasound chase because radiographs cannot. Three points carry over. First, soft tissue is where dressage careers most often strain, and x-rays do not see it — the time-off question and honest disclosure matter more than any single image. Second, most of these conditions are managed rather than cured, so a horse with a finding under maintenance is a normal purchase, not a failed one, provided the management and its cost are understood. Third, findings become insurance exclusions, a permanent cost of acceptance that the insurance discussion prices before completing, not after. The realistic posture is neither alarm nor complacency: the working dressage horse is a strength athlete whose discipline loads specific structures hard, and buying, insuring and managing one intelligently means understanding which structures those are.

Sources

• Merck Veterinary Manual — Suspensory Desmitis in Horses (proximal suspensory desmitis, forelimb versus hindlimb prognosis), 2026. https://www.merckvetmanual.com/musculoskeletal-system/tendon-and-ligament-disorders-in-horses/suspensory-desmitis-in-horses
• Animals (MDPI) / retrospective study — Orthopaedic Injuries in 272 Dressage Horses (suspensory as most frequent injury site), 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12560884/
• Sykes B. W. et al. — European College of Equine Internal Medicine Consensus Statement: Equine Gastric Ulcer Syndrome in Adult Horses, Journal of Veterinary Internal Medicine, 2015. https://onlinelibrary.wiley.com/doi/10.1111/jvim.13578
• Gesellschaft für Pferdemedizin (GPM) — Röntgen-Leitfaden 2018 (risk-based interpretation of radiographic findings in performing horses), 2018. https://www.bundestieraerztekammer.de/tieraerzte/leitlinien/downloads/171020_GPM-Roentgen-Leitfaden.pdf