Review argues trigger points may be overlooked in equine lameness

A newly published review is pressing equine clinicians to rethink where lameness starts. In Frontiers in Veterinary Science, Markus Scheibenpflug and Kevin K. Haussler argue that myofascial trigger points, not just joints, tendons, or ligaments, can be a primary source of lameness in horses, and that these lesions are often overlooked in routine workups. The paper was published May 20, 2026, in the journal’s anesthesiology and animal pain management section. (frontiersin.org)

That argument pushes against the conventional lameness paradigm the authors describe as largely joint- and tendon-centric. In the review, they say the standard algorithm relies on gait observation, perineural and intrasynovial anesthesia, and imaging, while muscular pain generators may receive less systematic attention. Their proposed change is straightforward but potentially practice-shifting: integrate systematic myofascial palpation into the routine equine lameness assessment as a first-tier step, rather than treating muscle pain as an afterthought once orthopedic causes have been exhausted. (frontiersin.org)

The review builds its case around biomechanics and neurophysiology. It describes trigger points as hypersensitive nodules within taut muscle bands that can produce local pain, altered muscle activation, reduced range of motion, and referred pain. That referred pain is central to the paper’s clinical message. The authors argue that proximal trigger points, including in the gluteal and thoracolumbar regions, may create signs that look like distal hindlimb or back pathology, creating what they call a diagnostic trap. They further contend that standard distal nerve blocks may not reliably eliminate pain of myofascial origin because the primary nociceptive input remains proximal. (frontiersin.org)

The paper doesn’t claim the evidence base is complete. It is a narrative review that cites 58 references and explicitly says comparative human and animal literature was included when equine-specific data were lacking. Still, it points to several equine signals that support closer attention. One recent small study in sport horses found trigger points in all horses examined, with prevalence exceeding 60% in the thoracolumbar musculature across dressage and show-jumping groups. Another study cited in the review found that dry needling of active trigger points in horses produced measurable reductions in local tenderness and improvements in gait symmetry within 24 to 48 hours in responsive cases. (frontiersin.org)

Outside the review, the broader equine sports medicine conversation has already been moving toward a more holistic view of poor performance and asymmetry. In an October 8, 2024, The Horse commentary, Erin Contino, DVM, Dipl. ACVSMR, advised that horses showing directional asymmetry, such as a crooked or “crab” canter, should be evaluated for lameness and musculoskeletal pain before the issue is written off as weakness or training. That perspective doesn’t specifically validate the new review’s claims about trigger points, but it does reinforce the paper’s core practical message: don’t assume crookedness is behavioral or training-related until pain has been ruled out. (thehorse.com)

For veterinary professionals, the implications are less about replacing established lameness diagnostics than about widening the front end of the exam. If the review’s framework gains traction, clinicians may place greater emphasis on palpation skills, pressure algometry, ridden pain behaviors, and response-to-treatment patterns when conventional imaging and analgesia don’t fully explain gait asymmetry. The paper also highlights a challenge for adoption: palpatory identification of trigger points is skill-dependent, and the authors acknowledge that inter-examiner variability and limited equine validation remain real constraints. In other words, the review is making a strong clinical argument, but it is also asking the profession to build the training and evidence base needed to support it. (frontiersin.org)

What happens next will likely depend on whether follow-up studies can move the field from plausible mechanism to reproducible protocol. The authors call for more controlled equine research, particularly studies showing objective gait improvement after trigger-point-directed treatment and more clinician education in systematic myofascial palpation. Until then, the review is best read as a challenge to current diagnostic habits: when a horse presents with unexplained asymmetry, poor performance, or a lameness pattern that doesn’t fit the imaging, muscle and fascia may deserve a more deliberate look. (frontiersin.org)