We're back with another guest blog from our friend Charlotte of Equinesio Therapy. Charlotte is an equine therapist in Belgium and we are so grateful to have her share her knowledge with us. This blog post will be focused on common questions she gets surrounding therapy methods for our equine athletes. Enjoy #TeamVE!

What is the difference between physiotherapy, osteopathy and shiatsu?


Shiatsu is a holistic, complementary form of medicine. Holistic = Holism (Greek: holos: the whole) is the idea that the properties of a system (physical, biological, technical, chemical, economic, etc.) cannot be explained by taking the sum of its elements alone: you have to look at the full picture. Complementary means additional, so it is not intended as a single treatment, but can be used as prevention.

It is a type of Japanese pressure point massage and works on energy channels that run through the body and can be influenced by pressure. The idea is that this energy is out of balance or disturbed by stiff joints and muscles, and by working on meridians or important nodes, this balance can be restored. A shiatsu therapist looks at the entire horse, including nutrition, equipment, and management. Most courses take about 2 years, without the necessity of having previous training.


Osteopathy is aimed at restoring balance in the body using manual techniques on muscles, connective tissue and joints, but also organs fall under their “treatment” area. In order to become an osteopath for horses, there are different routes, some requiring you to have a medical background, others don’t.


Physio aims to optimize the quality of life of animals by improving their functionality and movement. An important pillar of physio is that physios work from an evidence-based background: they want to work with techniques that have been scientifically proven to have the desired effect as much as possible. This is not always attainable: it is a difficult discipline to obtain hard scientific evidence because so many factors are involved, but this is a physio’s starting point. Physios work with manual techniques that work on muscles, connective tissue (fascia) and joints, but they will also give exercises to improve the movement pattern of your horse, and to maintain improved mobility or an improved movement pattern. A physio does not want you to be dependent on them, their goal is that you can continue to work on your horse on your own as much as possible. Some horses do benefit from regular maintenance, just like people, they can be stiff after training from time to time and if this continues to go on, this can cause problems.

All physios must first complete a physiotherapy course for humans. In Belgium this is 5 years at university, in other countries it varies between 3 and 5 years, and only then can they move on to a two or three year course for animals. This ensures that they have an extensive knowledge of the physiological processes in the bodies of mammals, they know their way around scientific research, and master various techniques before they learn to transfer them to animals. Just about all techniques have been tested and used on humans before they are transferred to animals, so sometimes we can try new things that turn out to work for horses as well!

As you can see, there are many similar techniques used by all three professions. In my view, it is not necessarily the title of the therapist that matters, but how good the therapist him (or her) self is. You can have a physio who has studied for 7 years, but then decided that he / she knows everything, or you can have someone who has completed a one-year course, but is constantly improving, doing additional courses, diving into everything new they encounter. In my opinion, that is the quality of a good therapist, in addition to an observing, good eye, and the ability to clinical reason.

I personally chose the physio course because I mainly liked the down to earth, and scientifically framed education. I think it is important that there is scientific evidence, or that there is a substantiated explanation behind a technique.

How does a horse with muscle pain behave?

To recognize pain in a horse, we must observe it carefully. There are some indications that our horse gives to show that he or she is in pain, regardless of the type of pain (organs, muscles, joints, ...) these signs have been examined and documented, and are summarized in the equine pain face scale and are also recognizable by behavior.

Two nice ethograms for this are the Equine Pain Face, developed by Gleerup, and the Horse Grimace Scale by Da Costa.

A horse’s behaviour will be altered when it is in pain, but it’s behavioural cues will not always differ depending on the source of the pain. More thorough assessment is needed for this. Do keep in mind that there are tell-tale signs for certain things, for example, kicking at its stomach does often relate to stomach pain or colic, but it is not possible to determine if a horse has muscle pain, purely through observation. Feeling the muscles and gait observation can help you narrow the options down, but a trained professional and veterinarian will need to help you decide if the pain if coming purely from muscles, or if there are joint issues at the base of the problem.

What does it mean when a horse carries its tail off center?

There are a lot of reasons your horse’s tail can be crooked, but lets’ get one thing straight: if your horse suddenly starts carrying his tail off center, something is wrong! This could be from a restriction in the muscles, issues with the joints of the back or the pelvis, asymmetrical development of muscles, neurological deficits, bad saddle fit…there are many reasons that can attribute to this, but they are not normal.

If you notice this in your horse all of a sudden, you need to have it checked! Call your local #TeamVE therapist!

What can you do to make a stiff horse more supple?

Just as some people are stiffer than others, so are horses. This is often congenital, but that does not mean that we cannot influence it. We can do this by doing certain exercises under saddle…bends, transitions, side passes, poles. But, we can also do this without the saddle…by stretching their legs, neck and back. There are some great exercises posted earlier on the blog, if you are interested!

If your horse is very stiff, or it gets worse or comes on suddenly, it is worthwhile to have it checked by the vet and a therapist to rule out that there are no underlying problems such as a vitamin or mineral deficiency, or a pain component.

How can I build up my horse’s topline?

Through good training, consistency and patience! Actually, the matter of building your horse’s topline shouldn’t be something you need to focus on specifically. When we look back at the creation of dressage (with which I mean general flatwork, aimed at working your horse in a good fashion, and improving its strength, flexibility and reactivity), its main goal is getting the horse to use their back and carry its bodyweight with their hindlegs forward. We want our horses to work in this frame, because this enables them to carry the rider with ease. When this is achieved, the horse will automatically be nicely on the bit and have the posture we all want to show in the arena. When the horse is working like this, they are training their topline.

Unfortunately, the goal of riding seems to be lost over time. Instead of working to obtain the correct frame through activation of core and hindleg muscles, a lot of riders work on the head position. The head needs to be down, then they have done a good job. Forcing the horse’s head down without having them work correctly from behind on, will make them hollow their back and thus, not develop topline.

Aside from this, there are ways to help your horse achieve the correct posture by making them stronger so that they can carry their weight in their hindlimbs, keep their back lifted under the weight of the rider and tack, and use the correct neck muscles. Doing baited stretches to activate their neck muscles, ground poles and hillwork to get those abs and glutes firing, and a lot of transitions with bends will help reach your goal!

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