Case Study: “Beauty” — When Tripping Isn’t “Clumsiness”
- Dr. Beth Byles, DVM
- 3 days ago
- 5 min read
Presentation
“Beauty” is a 4-year-old Appaloosa mare who presented to Kinetic Equine Medicine after several episodes of tripping and falling under saddle over the past few months. She had previously received cervical injections at C3–C4, as well as an injection in her right stifle.
More recently, her owner noticed a new—and concerning—behavior: Beauty began kicking out with her left hind leg while trailering, and she attempted to kick when her left hind leg was picked up. This understandably made farrier work difficult and raised concern that something more significant was going on than “behavior.”
A proactive owner and important imaging findings
Beauty’s owner acted quickly and pursued diagnostic imaging.
On nuclear scintigraphy, areas of increased uptake were noted at:
T3–T8
the cranial and caudal dorsal scapular border
right deltoid tuberosity
right elbow
the costochondral junction of T3–T5
the sternum
Cervical radiographs identified congenital vertebral abnormalities consistent with Equine Complex Vertebral Malformation (ECVM):
Grade 3 ECVM involving the right C6 tubercle with transposition onto C7
Grade 1 ECVM variant involving the left C6 with transposition onto C7
Physical examination
Beauty arrived in good body condition and stood quietly for evaluation. However, her posture and body language suggested discomfort: she held her ears back at rest and had visible tension above her eyes.
Additional exam findings included:
Multiple small abrasions on the forelimbs and hindlimbs
Appropriate hoof angles; shod on all four feet
Base-wide stance in front and base-narrow stance behind
When lowering her head to eat, she shifted her right forelimb back and bent through the left side to reach the ground
Left front hoof wider and flatter; right front more contracted and upright
Asymmetry through the trunk with a right-sided “bulge,” and the scapula/barrel appearing displaced to the right
Palpation and mobility findings
Beauty demonstrated widespread reactivity and restriction:
Left side of neck largely non-reactive to palpation
Scapula held tightly to the body; marked reactivity over the left dorsal scapular cartilage
Back tight and tense with reactivity along both sides down to the points of the hips
Mild stifle effusion bilaterally
Left hind reactive to extension and abduction; right hind showed better range of motion
Right TMJ and right side of the neck very reactive to palpation
Right front suspensory ligament extremely reactive, with repeatable avoidance behavior (jumping away)
Sternum reactive to palpation but maintained good cranial–caudal mobility
Resistance to thoracic and thoracolumbar bending in both directions, escalating to behavioral responses when asked for more
Good flexion mobility at the lumbosacral region, but resistance to lifting and rounding through the back
Movement evaluation
Walk (on the lunge)
Tracking left:Beauty showed a forward, marching walk. The pelvis was held tightly to the left, and the left hind tracked slightly to the inside of the circle. A toe-stabbing gait was present in both forelimbs, with a shortened cranial phase most noticeable in the right front.
Tracking right:Beauty was reluctant, with ears pinned and tension above the eyes. When her head and neck moved to the outside of the circle, the right forelimb intermittently buckled at the carpus. In both directions, she lacked thoracolumbar bend.
Trot (on the lunge)
Tracking left:Beauty was unable to stretch down through her neck. She carried her head up and away, drifted through the outside shoulder, and pushed outward on the circle. The pelvis remained to the inside, resulting in mild “dog-tracking.”
Tracking right:She entered the trot with an elevated head and noticeably less forward drive than to the left. Right front restriction became more prominent, and an intermittent 2/5 right forelimb lameness was appreciated. As the session continued, resistance increased and escalated into behavioral episodes. Thoracolumbar bend remained absent in both directions.
Canter (on the lunge)
Tracking left:Beauty picked up the canter in a rushed, anxious manner and could not maintain it. She continued to drift outward through the shoulder. Head tossing and head shaking occurred during the gait. Right front scapular restriction was particularly apparent—she struggled to bring the limb forward.
Tracking right:Beauty was unable to canter right and became increasingly reactive and resistant when asked.
Additional observation: circumferential pressure sensitivity
When a lead rope was placed around the girth area to apply light circumferential pressure, Beauty became reactive when asked to trot and canter to the left. Following exercise, her neck reactivity improved, but the intermittent carpal “wobble” became more apparent.
Why this case raised serious concerns
Beauty was uncomfortable in multiple regions, and her movement patterns raised red flags for both pain and neurologic/coordination concerns. With ECVM cases, one of the most important conversations we have with owners is that “complex” is not just part of the name—it’s the reality.
Some horses with ECVM can be managed successfully and return to work. Some may never be comfortable under saddle, and some may never be safe to ride. Others may show few or no outward signs—until something changes.
A difficult truth we also share is that some horses can appear normal, even compete successfully, until they suddenly cannot. A misstep in the pasture, a hard stop in the trailer, or a single pull-back episode when tied can be enough to trigger a significant setback.
Listening to the “no” before it becomes a shout
This is the day Beauty presented—the video is one of my favorites because it shows how kind she is.
When she was first asked to trot to the right, she tried. Then she politely declined and offered to go left instead. She was corrected. She tried again—then said “no” more clearly. With each correction, her “no” got louder until she finally exploded with a very loud NO.
As horse people, we’re all guilty at times of missing the subtle “no’s.” We may label it as stubbornness, poor training, or attitude. One way I differentiate pain behavior from training behavior is this:
If the horse offers the same resistance across contexts—only in one direction, only for one limb, only for one lead, only when asked for a specific bend—then it’s much more likely to be pain-driven than a generalized training issue.
Where Beauty is now
Beauty is fortunate to have a dedicated owner who understood that the road ahead could be long, and that full recovery might not be guaranteed. After extensive treatment and structured rehabilitation, she is now happily trotting and moving in both directions, and she has begun a careful return to under-saddle work.
A final note
Solving body lameness is rarely quick or inexpensive. There is not always a guaranteed outcome. But when the right horse has the right team—and the right plan—meaningful change is possible. And sometimes, making that difference for even one horse is everything.
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