Sue Dyson pain scale: What is it and how does it work.
Valérie De Clerck
Last updated: 21/10/2025
Every rider knows the frustration of a horse that seems resistant, tense, or “naughty” under saddle, but what if those behaviours are actually cries for help?
Research by equine orthopaedic specialist Dr. Sue Dyson has shown that many of the signs we often dismiss as training or attitude issues are, in fact, clear indicators of pain. To help owners, riders, and vets recognize these signals, she developed the Ridden Horse Pain Ethogram (RHpE), commonly known as the Sue Dyson Pain Scale (Dyson, 2022).
This tool provides a structured way to spot subtle behaviors that reveal when your horse is uncomfortable, giving us the chance to address problems related to musculoskeletal pain sooner and improve both welfare and performance (Dyson, 2022).
Before we go further, it’s important you speak to your veterinarian and get medical advice if you believe your horse is in pain.
How the Sue Dyson pain scale works
The Sue Dyson Pain Scale is a scientifically validated system that identifies 24 specific behaviors linked to musculoskeletal pain in riding horses. When a horse shows 8 or more of the 24 markers, it strongly suggests pain is present.
These include signs such as:
1. The ears rotated back or lay flat for five or more seconds
2. The eye lids closed or half closed for two to five seconds
3. Head in front of vertical > 30° for ten or more seconds or more
4. The tongue exposed, protruding or hanging out
5. Head behind vertical > 10° for ten or more seconds
6. The mouth open with separation of the teeth for ten seconds
7. Tail swishing
8. Head tilted, repeatedly
9. The bit pulled to one side (left or right)
10. A rushed gait, irregular rhythm in trot or canter, or repeated changes of speed in trot or canter
11. Repeated changes of head position not in rhythm with trot
12. Stumbles or trips repeatedly or repeated bilateral hindlimb toe drag
13. Head position changes repeatedly, moving from side to side
14. Gait too slow: may resemble passage-like trot
15. Sudden change of direction or spooking
16. Bucking or kicking backwards (one or both hindlimbs)
17. Rearing (both forelimbs off the ground)
18. Hindlimbs do not follow tracks of forelimbs but deviated to left or right
19. Canter repeated strike off on wrong leg (incorrect lead) or change of leg in front and / or behind
20. Spontaneous changes of gait
21. Tail clamped tightly on the mid-line, or held to one side
22. Reluctant to move forward or stops spontaneously
23. Sclera is repeatedly exposed
24. An intense stare or looking zoned out, for five seconds or more
The scale works by scoring these behaviors during riding. While vets and trained professionals use the scale in clinical settings, everyday riders can benefit too.
By learning the common markers, you’ll be better equipped to:
- Spot when your horse’s behavior may not be attitude, but pain
- Record patterns and changes in behavior for your vet
- Advocate for your horse’s comfort and welfare
Conclusion
The Sue Dyson Pain Scale is a tool, not a diagnosis. Horses can show similar behaviors due to poor saddle fit, rider imbalance, or lack of fitness, so context is always important.
If you suspect pain, the next step should be a thorough check by your vet and other professionals such as a physiotherapist.
Once pain has been identified and addressed, it's worth looking for solutions to ensure long-term comfort for your horse. Tools such as balance pads, that work to improve deep core muscles resulting in improved stability and coordination, can help as part of a holistic approach.
For more information, feel free to take a look at our blog about the benefits of balance pads and our blog about how to use balance pads, which includes an 8-week schedule to improve proprioception.
