Basic clinical procedures in the horse

Basic clinical procedures in the horse

Lucy Middlecote


With training, horses are generally very amenable, but by nature they are unpredictable flight animals and even the quietest horse can become excitable or distressed. Horses are large, strong animals that may become anxious when placed in an unfamiliar environment and will often attempt to escape if they suspect that a situation is dangerous. Some horses may show aggressive behaviour as a result of anxiety or fear, while others may use aggression as a method of protection or dominance. It is important to be aware of the nature of the individual patient and the type of behaviour that is being displayed.

When carrying out any task with a horse it is important that health and safety is adhered to at all times. Long hair should be tied back, jewellery should not be worn and personal protective equipment (PPE) should be utilized. PPE should include a skull cap, gloves and suitable clothing, e.g. a long-sleeved top, trousers, overalls and suitable footwear (Fig. 14.1). In order to carry out any clinical examination or clinical procedure in the safest possible way, there is a range of recommended handling techniques that should be used.

Procedure: Approaching a horse

1. Action: Assess the horse’s behaviour as you approach.

    Rationale: This will enable you to gauge whether the horse appears relaxed or distressed and enables you to adopt an appropriate level of caution.

2. Action: Approach from the horse’s left side and towards the shoulder.

    Rationale: Horses are generally taught to be handled from the left side, so they are more familiar and therefore more comfortable with being approached from this side.

3. Action: Do not approach from directly in front of the horse.

    Rationale: The eyes of a horse are located on either side of the head and they have inhibited vision directly in front of the head and behind the body. Providing the horse with the greatest opportunity to see you is safest practice.

4. Action: Use verbal communication.

    Rationale: This allows the horse to hear you approaching, particularly if it has not already seen you and it is therefore less likely to be surprised by your presence.

Procedure: Putting on a head collar and lead rope

The majority of horses will be familiar with wearing a head collar, which is the most common piece of handling equipment used today.

1. Action: Ensure that you have a suitable head collar and lead rope for the size of the horse.

    Rationale: This will ensure that you do not waste time or risk applying a head collar that is too tight or too loose, which may be detrimental to the level of control that you have and to the comfort of the horse.

2. Action: Approach the horse as described above.

    Rationale: This is safest practice.

3. Action: Stand next to the horse’s left shoulder, facing forwards.

    Rationale: Horses are most commonly used to being handled from the left side, and the head collar fastener/buckle will need to be secured on this side.

4. Action: Place the lead rope around the horse’s neck or over your shoulder.

    Rationale: This will prevent the lead rope from hanging on the floor and potentially becoming a dangerous hazard. It will also give you more control if the horse tries to wander off.

5. Action: Insert the horse’s nose through the nosepiece (Fig. 14.2A) and place the noseband over the nose.

    Rationale: Use both hands to do this as this will give you greater control.

6. Action: Using your right hand, take the longest strap up and over behind the ears (Fig. 14.2B) and secure the fastener/buckle on the left side of the horse’s cheek.

    Rationale: This will ensure that the head collar is secure, and ready for use.

7. Action: Ensure that you can fit a hand’s width between the noseband and the horse, and that the noseband is approximately two fingers’ width below the facial crest.

    Rationale: This will ensure that the head collar is not too tight, and suitably fitted for control (Fig. 14.2C).

Procedure: Putting on a bridle with a bit

Many veterinary practices have a policy that all equine patients are handled using bridles in combination with a head collar because it gives the handler more control. This is particularly beneficial if dealing with a difficult, excited or enthusiastic patient. The bridle may simply consist of a head piece and a bit or may have a throat lash strap added for extra security.

Some animals may require the use of a Chifney or antirearing bit. This is a bit with a shallow inverted-port mouthpiece that has three rings – two for the cheek pieces and one for the bridle (Fig. 14.3). However, this must only be used by experienced handlers as it can cause injury or damage because of the way that it acts upon the horse’s tongue if it tries to rear or pull. Some horses, such as foals and young animals, may not be used to having a bit in their mouth. This must be taken into consideration and the appropriateness of use assessed on an individual basis.

1. Action: Approach the horse as described.

    Rationale: This is safest practice.

2. Action: Standing at the left shoulder, move your right hand under the horse’s mandible and around the front of the head.

    Rationale: This will secure the horse’s head in a suitable position.

3. Action: Hold the head piece of the bridle up against the front of the head, and with your left hand place the bit across the horse’s mouth (Fig. 14.4A). Then place your thumb in behind the incisors.

    Rationale: This will encourage the horse to open its mouth to accept the bit.

4. Action: Gently push the bit into the horse’s mouth, ensuring that it sits on top of the tongue.

    Rationale: Do not force the bit into the mouth as this can damage the incisor teeth and may result in the horse refusing the bit in the future.

5. Action: Once the bit is in the horse’s mouth, carefully place the head piece over and behind the horse’s ears (Fig. 14.4B).

    Rationale: This will keep the bit in position.

6. Action: Adjust the head piece to fit the horse, ensuring that there are no more than two creases at the edge of the mouth and that the bit is not dangling too low in the mouth.

    Rationale: This will ensure that the bit is comfortable and effective.

7. Action: Secure the throat lash (if applicable), ensuring that you can fit approximately a hand’s width between the throat lash and the horse.

    Rationale: This will further secure the bridle in place and ensure that it is not too tight or too loose.

8. Action: Attach a lead rope to the bit (Fig. 14.4C).

    Rationale: This will allow you to lead and restrain the horse safely and effectively.

9. Action: To remove the bridle, undo the throat lash (if applicable), and gently push the head piece forwards over the horse’s ears and slowly allow the bit to drop out of the mouth. A hand should be used to catch the bit as it leaves the horse’s mouth.

    Rationale: This prevents the bit from causing damage to the incisor teeth.

Procedure: Holding a horse for examination

1. Action: Apply the head collar and/or bridle as described.

    Rationale: This is safest practice.

2. Action: Using a lead rope, stand at the horse’s shoulder and where possible on the same side as the person carrying out the examination or procedure.

    Rationale: If the horse moves or jumps away it is more likely to move away from the person carrying out the examination. By standing on the same side as this person you reduce the risk of injury to yourself.

3. Action: Face towards the front of the horse or towards the person examining the horse depending on the procedure being carried out.

    Rationale: This allows for greater control of the horse but will depend on the procedure being carried out.

4. Action: The rope should be held with the near-side hand below the jaw (approx. 20 cm) and the remaining rope in the other hand.

    Rationale: Holding the remaining rope in the other hand will prevent it from dangling on the floor and becoming a potential hazard.

5. Action: The remaining rope should never be wrapped around the hand.

    Rationale: This could cause serious damage to your hand if the horse pulls or rears.

Procedure: Leading a horse

For the purposes of a clinical examination and investigation the veterinary nurse may be required to lead the horse in both walk and/or trot.

1. Action: Apply the head collar or bridle as described.

    Rationale: This is safest practice.

2. Action: Using a lead rope, the handler should face forwards and lead the horse from its left shoulder (Fig. 14.5).

    Rationale: The horse may run off if it gets too far ahead and is unlikely to move forwards if the handler is positioned too far forwards.

3. Action: The rope should be held with the right hand below the jaw (approx. 20 cm). Hold the remaining rope in the left hand.

    Rationale: Holding the remaining rope in the left hand will prevent the lead rope from dangling on the floor and becoming a trip hazard.

4. Action: The remaining rope should never be wrapped around the hand.

    Rationale: This can cause serious damage to your hand if the horse pulls or rears.

5. Action: Walk the horse out slowly and if necessary increase the pace to a trot. If you are on the left side the vet will observe the horse from the right side then as it walks towards him or her and then from back view.

    Rationale: This enables the veterinary surgeon to observe the action of the horse from all sides. Some conditions do not show up until the horse is going faster.

6. Action: To turn the horse, steady to a walk and turn it away from you in a fairly wide circle.

    Rationale: This gives a greater degree of control and prevents the horse standing on your heels or feet.

Procedure: Tying up a horse using a quick-release knot

It is important to be able to tie a horse up securely to prevent escape, e.g. during grooming, but it should always be tied using a ‘quick-release’ knot, which can be more easily released if an emergency arises.

1. Action: Fold the lead rope and thread it through baler twine (or a similar commercial product) that has been attached to a secure metal ring, and create a small loop (Fig. 14.6A).

    Rationale: Tying the horse to something that does not break can be extremely dangerous. Baler twine will break if the horse panics, reducing the risk of injury.

2. Action: Twist the loop and thread the lead rope through the loop (Fig. 14.6B).

    Rationale: This will produce a second loop.

3. Action: Pull the knot (Fig. 14.6C).

    Rationale: This will secure the knot.

4. Action: Do not leave the horse completely unsupervised.

    Rationale: Although the remaining end can be threaded through the second loop to prevent the horse from untying itself, the resulting knot is no longer ‘quick-release’. It is safer practice to leave the end unthreaded and the horse supervised. Supervision is always recommended for any horse that is tied up.

Procedure: Lunging a horse

Being able to lunge a horse is a vital skill for those working in equine practice. Observation of a horse moving on the lunge is a common part of lameness investigation and allows the veterinary surgeon to see the horse moving in a circle at a walk, trot or canter.

When lunging, the handler should stand in the centre of the circle slightly behind the level of the horse’s shoulder, which encourages the horse to move forward (Fig. 14.7).

1. Action: Prepare the equipment and the horse ready for lunging. Equipment should include your own PPE, i.e. hat, gloves and sensible footwear, and a lunge whip. The horse may be fitted with a lightweight lunging cavesson which should have adequate padding to the noseband. A long lunge rein is attached by means of a swivel joint and clip.

    Rationale: A bridle with a bit is recommended for safety and control. (Other types of reins, e.g. side reins, may be used to achieve better balance and increase the degree of control.)

2. Action: Move the horse to the designated lunging area.

    Rationale: This must be a flat area large enough for the lunging circle with a suitable non-slip surface.

3. Action: Position yourself in the centre of the area (Fig. 14.7). If you are lunging to the left, hold the lunge rein in your left hand and the whip in your right hand.

    Rationale: You should be forming a triangle, with the horse’s body, the lunge rein and the whip.

4. Action: Hold the lunge rein with the excess held in loops in your hand.

    Rationale: This will prevent the lunge rein from dangling on the floor and allow you to lengthen or shorten the rein easily if necessary.

5. Action: Carry the whip pointing slightly behind the horse and pointing down when not in use. Keep your wrists, arms and shoulders relaxed and supple.

    Rationale: This will encourage the horse to remain relaxed but continue to move forwards. You may raise the whip (if required) to encourage the horse to continue to move forwards or to increase the pace.

6. Action: Control the horse’s speed and pace with voice aids, using commands such as ‘stand’, ‘walk on’, ‘trot on’, ‘canter’, ‘steady’.

    Rationale: If the horse is being a little sluggish, you should move a little sideways so that you are further behind the horse; if the horse is going too fast you should position yourself more towards the head, raising the lunge whip in front of the nose as a barrier.

7. Action: Keep the horse from turning in on the circle by pointing the whip at the horse’s shoulder.

    Rationale: This will ensure that the horse remains on a circle and will allow the veterinary surgeon to assess the horse’s movement and identify any evidence of lameness.

8. Action: To stop the horse, ask the horse to slow and point the whip in front of the horse.

    Rationale: This will encourage the horse to slow down and eventually stop.

9. Action: Lunge the horse on the opposite rein to the one that you have started on.

    Rationale: The horse will now go in the opposite direction so that the veterinary surgeon can observe all the facts of the case.


Sometimes additional restraint may be required. For a number of procedures it is extremely important that the patient stands as still as possible. Additional restraint may be achieved using a device such as stocks or by lifting and holding a leg so that the horse finds it difficult to move around. Sometimes restraint may need to be more invasive with the application of a twitch or the use of chemical sedation.

The use of twitches, which are a means of providing a low-grade pain to a horse, are thought to distract a horse while a minor procedure is being performed. Research has now shown that twitches initiate the release of natural endorphins from the brain which have a short-term analgesic and sedative effect.

Twitches must always be used with care, and must not be left in place for more than 5 minutes at a time. If used for too long a twitch may cause detrimental effects and could result in permanent scarring. Ear twitches are not recommended as they may result in the horse becoming headshy.

A skin twitch applied to the neck, by firmly grasping a small amount of skin cranial to the shoulder, can encourage the horse to stand still for a procedure. A nose twitch (Fig. 14.8) is made of a length of wood, metal or rubber with a loop of rope attached at one end. Commercial humane twitches are also available but tend to have less effective results.

Procedure: Applying a nose twitch

1. Action: Ask a handler to restrain the horse.

    Rationale: Restrain the horse as previously described.

2. Action: Stand on the same side as the handler.

    Rationale: This will prevent the horse jumping on to you and the handler. If the horse moves it will probably move away from you.

3. Action: Place one hand on the handle of the twitch and the other hand on the rope loop.

    Rationale: This prepares you for applying the twitch.

4. Action: Holding the upper lip, place the rope loop over the horse’s upper lip (Fig. 14.8). Ensure that you have a firm grip on the handle of the twitch and on the horse’s nose at this point.

    Rationale: A firm grip will reduce the risk of the horse being able to move away, potentially causing the handle of the twitch to be thrust into the air.

5. Action: Twist the handle until a firm amount of the skin has been gripped by the rope loop (Fig. 14.8).

    Rationale: This will ensure that the desired effect can be achieved and reduce the risk of the rope loop falling off or becoming loose.

6. Action: Hold the handle firmly or twist the horse’s lead rope over the handle.

    Rationale: This will secure the twitch in place, and prevent the handle from causing injury to the horse or handler if the horse throws its head in the air.

7. Action: Monitor the horse’s behaviour carefully throughout, and remove the twitch immediately if there are any concerns.

    Rationale: Some horses will suddenly react or strike out when twitched.

8. Action: To remove the twitch, slowly unwind the twitch and gently release the horse’s upper lip, ensuring that the handle is held firmly at all times.

    Rationale: Some horses may throw their heads in the air at this stage so it is important not to let go of the twitch as this could cause injury.

Procedure: Lifting a forelimb to examine the foot

1. Action: Ensure that the horse is adequately restrained.

    Rationale: The horse may be tied up but, for safety reasons, it is also advisable to use an extra handler where possible.

2. Action: Allow and encourage the horse to stand square and weight bear on all four limbs.

    Rationale: This allows the horse to balance and enables it to be physically able to lift up a leg when requested.

3. Action: Stand at the horse’s shoulder, beside the appropriate leg and facing the tail (Fig. 14.9).

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Jan 8, 2017 | Posted by in NURSING & ANIMAL CARE | Comments Off on Basic clinical procedures in the horse

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