ISSN 2398-2977      

Musculoskeletal: manipulative tests



  • Adjunctive tests to accompany gait evaluation Musculoskeletal: gait evaluation.
  • Flexion, extension and other manipulative techniques place stress or strain on joints and soft tissue structures.
  • Assessment of the response to manipulative tests can aid localization of the site of pain, although manipulative tests are generally considered to be non-specific.
  • Stress or strain may elicit a pain response, and exacerbate or induce lameness.
  • The degree of movement in a joint or joints may be limited by a pathologic process, for example fibrosis associated with chronic degenerative joint disease.
  • A lack of response does not preclude pain causing lameness or poor performance.



  • Non-invasive.
  • Simple routine tests performed without special equipment.
  • Can aid in the identification and localization of pain causing lameness.


  • Subjective tests - responses maybe inconsistent.
  • Flexion tests can induce lameness that is of no clinical significance i.e. false-positive result.
  • A negative result does not preclude pain causing lameness in the tested region.
  • These tests are generally non-specific and should be used in conjunction with a full gait assessment and other diagnostic procedures such as diagnostic analgesia.
  • Manipulation of fracture sites may cause further soft tissue damage and complicate fracture management, eg by converting an open to a closed fracture Musculoskeletal: fracture.
Performing manipulative tests on a fractious horse can be dangerous and must be done with care.


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Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Dyson S & Greve L (2016) Subjective gait assessment of 57 Sports Horses in normal work: A comparison of the response to flexion tests, movement in hand, on the lunge, and ridden. J Equine Vet Sci 38, 1-7 VetMedResource.
  • Armentrout A R, Beard W L, White B J & Lillich J D (2012) A comparative study of proximal hindlimb flexion in horses: 5 versus 60 seconds. Equine Vet J 44 (4), 420-424 PubMed.
  • Starke S D, Willems E, Head M, May S A & Pfau T (2012) Proximal hindlimb flexion in the horse: Effect on movement symmetry and imiplications for defining soundness. Equine Vet J 44 (6), 657-663 PubMed.
  • Kearney C M et al (2010) Which anatomical region determines a positive flexion test of the distal aspect of a forelimb in a nonlame horse? Equine Vet J 42 (6), 547-551 PubMed.
  • Busschers E & Van Weeren P R (2001) Use of the flexion test of the distal forelimb in the sound horse: repeatability and effect of age, gender, weight, height and fetlock joint range of motion. J Vet Med A Physiol Pathol Clin Med 48 (7), 413-427 PubMed.
  • Meijer M C, Busschers E & Van Weeren P R (2001) Which joint is most important for the positive outcome of a flexion test of the distal forelimb of a sound horse? Equine Vet Educ 13 (6), 319-323 VetMedResource.
  • Keg P R, VanWeeren P R, Back W & Barneveld A (1997) Influence of the force applied and its period of application on the outcome of the flexion test of the distal forelimb of the horse. Vet Rec 141 (18), 463-466 PubMed.
  • Verschooten F & Verbeeck J (1997) Flexion test of the metacarpophalangeal and interphalangeal joints and flexion angle of the metacarpophalangeal joint in sound horses. Equine Vet J 29 (1), 50-54 PubMed.
  • Adams S B & Belvins W E (1989) Shoulder lameness in horses - Part I. Comp Cont Educ Pract Vet 11 (1), 64-70 VetMedResource.
  • Adams S B & Blevins W E (1989) Shoulder lameness in horses - Part II. Comp Cont Educ Pract Vet 11 (2), 190-196 VetMedResource.
  • May S A & Wyn-Jones G (1987) Identification of hindleg lameness. Equine Vet J 19 (3), 185-188 PubMed.
  • Dyson S (1986) Diagnostic techniques in the investigation of shoulder lameness. Equine Vet J 18 (1), 25-28 PubMed.

Other sources of information

  • Ross M W (2010) Manipulation. In: Diagnosis and Management of Lameness in the Horse. 2nd edn. Eds: Ross M W & Dyson S J. Elsevier, USA. pp 80-88.

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