Don't let them be
misunderstood.

The Ridden Horse Pain Ethogram is a validated clinical tool developed by Dr Sue Dyson. It consists of 24 behavioural markers observable when a horse is ridden — each defined with strict criteria. A score of 8 or more out of 24 is associated with the presence of musculoskeletal pain. The RHpE does not diagnose the source of pain — it quantifies ridden discomfort and indicates when clinical investigation is required.

This is one of the most common situations the RHpE was created for. There is clear evidence that many horses are apparently sound in hand — even after flexion tests, when lunged or trotting on a hard surface — and yet show signs of pain when ridden, manifesting as performance or behavioural problems under saddle.

A 2021 study of 148 horses found that while 28% were lame in hand, 62% were lame when ridden. Being assessed in hand and carrying a rider through demanding movements are two very different efforts. Lameness is also often subtle enough to escape the human eye, and compensatory movement patterns — particularly when a horse is lame on two limbs simultaneously — can produce apparent symmetry that makes classical lameness assessment insufficient.

This is why behavioural assessment under saddle is critical to detect pain in ridden horses.

This is a very common assumption, and one that research has systematically challenged. We have traditionally labelled horses displaying behavioural signs of pain as "moody", "mareish", or "difficult". But studies conducted on hundreds of horses show a clear and causal link between the 24 markers of the RHpE and the presence of underlying musculoskeletal pain.

Your horse is most likely communicating its discomfort. The RHpE gives you an objective way to hear it.

No — and this is an important distinction. The RHpE is not a linear scale of pain intensity. A horse scoring 16/24 is not necessarily in more pain than a horse scoring 9/24. The score reflects the horse's expressiveness as much as the severity of its condition: an introverted or stoic horse may score below 8 and still have a significant underlying lesion, while a more expressive horse may show more markers for a comparable level of discomfort.

What the score does tell you: most of the 24 markers are at least 10 times more likely to be observed in a horse with musculoskeletal pain than in a sound horse. And a score of 8/24 or more is associated with the presence of pain.

The RHpE is a personal baseline for each horse — not a tool for comparing pain levels between horses.

In a controlled study of 40 horses, each ridden by their usual rider and a single professional rider in a random order, the more skilled rider could improve gait quality. Although some of the behaviours of the RHpE were different with the two riders, the more skilled rider did not reduce the RHpE scores.

We recommend applying what Dr Sue Dyson calls the two-week rule: it is not alarming for some markers to appear when introducing a new exercise, or in a horse that is not yet fit enough for what is being asked. In a pain free horse the RHpE score does not usually reach the threshold score of 8/24. However, if the markers persist after 14 days of practicing the new exercise, this is a clear sign of underlying pain that warrants investigation.

Riding through persistent markers does not resolve them — it delays the identification of their cause.

No. The RHpE is a screening and monitoring tool, not a diagnostic instrument. It tells you whether the ridden picture shows signs consistent with musculoskeletal pain — it does not identify the source. A high score should prompt a clinical veterinary investigation, not replace one.

A score that does not substantially decrease after resolution of a known pain source means that another source of pain is likely present, or that treatment failed. Dr Sue Dyson recommends investigating the possibility of bilateral lameness, the cause of canter dysfunction, oral pain, thoracolumbar pain (primary, or secondary to an ill-fitting saddle), lumbosacroiliac region pain, or neck pain.

This is one of the key strengths of the RHpE: it is the complete resolution of pain — not the assumption of it — that guides the investigation. The tool keeps asking the question until the horse stops communicating its discomfort.

The report includes the RHpE score out of 24, the individual markers observed, their frequency and duration, and a professional summary with suggested next steps. Every assessment is reviewed by a certified professional trained on Dr Dyson's method before the report is released.