The Down Horse

I saw a thread on the Internet about a "down" horse and whether it would live or not. Can you please explain what that term means and if that horse has a chance to survive?


The down horse presents special difficulties in both care and diagnosis.

The "down horse" refers to a horse which has become recumbent and cannot rise. The term is a clinical sign and is a non-specific development of a number of disease conditions; the causes can be many. Horses which are suffering from neurological conditions (such as equine protozoal myeloencephalitis, EPM) that affect the spinal cord can develop severe deficits in muscle strength and/or coordination, leading to the down condition. If the neurologic lesion is in the neck area, it will affect the forelimbs and the hind limbs, such that the horse will have little strength at either end when attempting to rise. If the lesion is in the spinal cord somewhere between the forelimbs and the hind limbs (in the area of the thoracic vertebrae: a classic T3-L3 lesion), the horse will retain strength in the forelimbs, but the hind limbs will be weak or paralyzed. These middle back lesions often result in a down horse which can sit up using the strength of the forelimbs, resulting in the so-called "dog-sitting" posture.

Other neurologic conditions causing paralysis and the down condition include botulism and equine lower motor neuron disease (EMND). The neurologic form of the rhinopneumonitis virus (equine herpes virus) can lead to the down condition. In addition, more rare occurrences, such as spinal cord tumors, can lead to the down state. I have seen several gray horses become acutely neurologic and progress to recumbency from the gray horse tumor melanoma occurring in the spinal cord.

Also, many types of trauma affecting the vertebrae, such as fractures in the neck or back, can damage the spinal cord and lead to the down condition. There are numerous types of fractures of the leg bones or pelvis that can make it impossible for the horse to rise.

It should be mentioned that one of the disease rule-outs for the down horse condition is rabies. If you are presented with a horse which is recumbent without other obvious reason, rabies should be considered and precautions should be taken not to allow human exposure to any of the body fluids of the horse.

In addition to the musculoskeletal or neurologic disorders that can lead to the down state, there are several "metabolic" disorders that can result in weakness severe enough to cause recumbency. Advanced malnutrition, severe shock, and "white muscle" disease in foals can lead to the down state. White muscle disease is related to a vitamin E and/or selenium deficiency, which causes muscle damage and weakness. Foals are more susceptible to becoming completely recumbent from white muscle disease than adult horses.

Disturbances in blood electrolytes (potassium, calcium, and so on) related to severe colic, diarrhea, and toxicities, as well as various forms of shock, can lead to the down state. Many of these down cases create a diagnostic dilemma due to the numerous causes and the difficulty in making a diagnosis.

The down horse presents special difficulties in both care and diagnostics to determine the illness responsible for the condition. It is extremely difficult to perform an adequate physical examination on a down horse. The first difficulty lies in the danger of getting hurt by a thrashing horse. Most down horses retain some degree of strength, and depending on their temperament and illness, can become quite violent in their efforts to rise--they are especially dangerous when they don't have much control over their bodies. Another factor adding to the difficulty is that many of these horses go down in tight spaces (on the trailer is one of the most dangerous) where there is limited room to work on them or get out of the way in a hurry. Many of these horses will need to be relocated to a clinic to obtain adequate treatment--no easy task.

If you must move a down horse, it is best to recruit a company specializing in equine rescue. There are special trailers and skids that make moving a down horse an easier and safer proposition. Many of these companies have the ability to place the horse in a sling and transport it. It should be mentioned that a veterinarian should be present, as many of these horses could require sedation or anesthesia to be moved safely. As with people, if there is a fracture somewhere or severe shock, an effort to stabilize the horse prior to transport should be made or you could do more harm than good.

The management of a down horse, irrespective of the cause, is a daunting task fraught with complications. Many of these horses do not eat well and rapidly lose weight. Large horses, and many times light ones, suffer from muscle damage due to the constant pressure placed upon muscles and the subsequent swelling of the muscle tissue (a form of tying-up). Severe pressure sores on the skin quickly develop, and there is a greater risk of pneumonia and colic.

Treatments can include intravenous fluids and nutrition, prophylactic antibiotics, extensive physical therapy, and constant repositioning, in addition to treatments for the primary disease. The use of a sling, if facilities exist and the horse tolerates it, can be of benefit in the recovery of some of these cases. There also are some facilities that make use of flotation pools in the management of these horses.

In conclusion, it often is difficult to acquire an accurate diagnosis for a down horse, and he can be extremely difficult to manage. Most of the disease processes causing this state prompt a guarded prognosis for the horse's survival, and for each day the horse is recumbent, the prognosis becomes significantly worse.

About the Author

Michael Ball, DVM

Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, N.Y. He is also an FEI veterinarian and works internationally with the United States Equestrian Team.

Ball authored Understanding The Equine Eye, Understanding Basic Horse Care, and Understanding Equine First Aid, published by Eclipse Press and available at or by calling 800/582-5604.

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