Conformation Fault or Compensation Pattern?

When you look at a horse, are you evaluating the bone structure, leg alignment, musculature, balance and body proportions; that is, are you judging the horse’s conformation?

What if I told you that many of the so-called conformation faults are not inherited or fixed but actually compensation patterns?

Ever since horses were domesticated approximately 6,000 years ago, breeders have aimed to perfect their shape and structure to increase their ability to do the work they were bred for.

Many different breeds developed, and within each, extensive texts have been written listing conformation traits and teaching us to distinguish between the ‘ideal’ ones and those that are considered ‘faults’.

The problem, however, is that conformation tends to be judged and described as a set of fixed traits, rendering some horses more ‘valuable’ than others and, as I will explain in this article, many of the so-called conformation faults are not inherited or fixed but actually compensation patterns that develop as a result of pain and injury. This is both, good news and bad news…

The bad news of this perspective is that ‘ideal’ conformation can deteriorate as a result of dysfunction and pain caused by injuries, incorrect trimming/shoeing and/or bad management and training.

The good news is that when we uncover and treat the pain or dysfunction that is causing them, compensation patterns can be changed and so-called conformation faults and quality of life can be improved.

Birth trauma

A great example to kick-start this discussion is the foal. During foaling, the foal’s body is placed under a great deal of pressure as it’s pushed and squeezed through the birth canal. These pressures can cause damage which is now known as ‘birth trauma’.

Dr Ian Bidstrup, one of the most qualified veterinarians in chiropractic and acupuncture in Australia, has been highlighting the long-term effects of birth trauma for many years – from teeth wear to leg and hoof conformation, to unevenness and one-sidedness in gait, to behaviour and even stomach ulcers.

For an in-depth look at birth trauma follow Dr Ian Bidstrup’s series of articles exclusive to the magazine, and starting with the January-February 2021 issue.

Research has confirmed the effect; for example, writing in the Equine Veterinary Journal in 1999, D. Jean and colleagues found broken ribs or a disruption between the junction of the ribs and the breastbone in over 20% of foals.

Soft tissue trauma to the foal’s shoulders and pelvis is even more common. From my own clinical observation, I estimate that 80% (or more) of foals born have some kind of birth trauma that causes compensation patterns of varying degree and severity.

The compensation can compromise the nervous system and show up as ‘windswept foals’ or ‘pigeon-toes’, ‘knocked-kneed’ or other forms of so-called conformation issues.

Other symptoms like the high heel-low heel syndrome or a club foot can can be compensation patterns from birth trauma that are often overlooked and classed as conformation faults.

The good news is that if you intervene early and help with the underlying problem, these issues can be corrected. Often, the correction, if intervened early, is easy and all it takes is maybe a chiropractic or acupuncture treatment from a certified practitioner.

However, if the problems are not recognized, they can lead to long term soundness problems throughout a horse’s life, as well as cause us to judge the horse as less valuable for having bad conformation, something that is especially sad when they are trying to compensate for a problem that could have been addressed early on.

If you are a breeder, find a chiropractic and/or acupuncture veterinarian who is experienced in diagnosing and treating foals, and have all new arrivals checked for birth trauma early.

Pain and conformation

From foal to adult, horses can develop all sorts of leg alignment issues like pigeon-toed, bow-legged or knock-kneed in the front legs, and cow-hocked, sickle-hocked in the hind legs and many more.

These horses can indeed have a conformation fault (a definite twist or deviation of the bones) or they can be compensating for some pain, either in their upper body or their feet, and it is muscle, rather than bone, that lead us to think we have a conformation fault.

In previous articles I have emphasised that horses are amazingly effective at hiding signs of pain.

Horses may have adapted to conceal any signs of weakness, but this does not mean they feel pain less, they just don’t show it as obviously. A wild horse that is obviously lame or shows other signs of being unwell catches the attention of predators and will become their target.

This means that by the time a horse shows an obvious lameness, it is often too late and the physical damage has been done. Catching issues early might make all the difference between a horse that just needs some treatment or a horse that is deemed unrideable due to physical damage.

The horse, when in pain, starts to “compensate’ i.e., changes posture, gait and behaviour in an attempt to protect the area from further physical damage while avoiding showing predators a weakness.

There are giveaway signs though, especially for those who are trained or know their horse well. There will be small and subtle changes somewhere in their body that (if you learn what to look for), can be identified as a pain-related compensation pattern.

The key is learning to distinguish between compensation and conformation, so let’s look at some examples.

Leg alignment

When looking at a pigeon-toed horse, most people assume that this is a classic conformation fault – i.e. it can’t be changed. This can be the case if the bone structure has grown in a way that turns the feet inwards.

However, there are many horses who are classified as pigeon-toed because one or both toes turn inwards but actually have quite a straight bone structure.

Series of images to show that on this particular horse, the evident 'pigeon toe' may actually be a compensation pattern that could be improved.
IMAGE A: Conformation or compensation? Standing square, this horse’s legs are not bearing weight evenly. The right front foot is closer to the midline and the left front appears pigeon-toed. IMAGES B & C: To check if it is a conformation fault or compensation pattern, start by checking the alignment as described in the text. IMAGES D & E: Since the pigeon-toed foot can be easily corrected, there’s a good chance it a compensation pattern. The next trick is to work out if the horse is compensating for a foot or upper body issue so it can be treated accordingly. Photos by Cristina Wilkins.

The horse may be turning the leg due to pain, either in the feet or the upper body. The way to distinguish between a conformation or a compensation issue is fairly easy.

Pick the leg up and hold it loosely by the cannon bone, letting it ‘hang’ where it wants to (Images C & D). If the muscles are relaxed and the horse is standing square, the foot will hang in alignment with the hind leg on the same side.

If there is some muscle tension due to a compensation , the leg might hang either outside the hind leg on the same side or point towards the space between the hind legs or even towards the diagonal hind leg.

Now take the leg forward, holding it behind the knee joint (carpal joint) and let it hang as shown in the photos. If you can easily adjust the ‘crooked’ joints and hoof capsule, it’s likely that the leg alignment can be changed.

If the bone structure itself has a bend or a twist it is likely a more permanent conformation issue.

The same test can be done when you look at knock-kneed horses or any other conformation fault in the front legs.

Inverted or u-neck

Although different breeds have been selected to carry themselves with a higher or lower head carriage (think of the difference between the high head posture of a Friesian horse and the lower carriage of a Quarter Horse for example), a u-neck refers to a degree of tension through the neck that is impacting their health, biomechanics and behaviour.

When we see a horse with an inverted or u-neck, it is generally due to the horse compensating for pain in the body. A horse that is sore in the front end and/or back will compensate and alter the head carriage holding the head higher. Commonly, you can also see a dip in front of the wither.

This posture creates a great deal of tension through the neck muscles, places pressure on the temporomandibular joint (TMJ) the hyoid and the poll, and even result in dental problems because a tight TMJ changes the way they chew. The horse may also become head shy, as he tries to stop you from touching a sore poll.

Series of images showing conformation faults
IMAGE A: Uneven shoulders caused by leg alignment issues. IMAGE B: A tell-tale sign of compensation patterns can be seen in the fascia lines. IMAGE C: Checking hind leg alignment to determine if it’s conformation or compensation. IMAGE D: An inverted or u-neck showing over-developed underline and under-developed top line. Image B by Cristina Wilkins. All other images courtesy Animal Biomechanical Solutions.

We often see horses develop a u-neck and their riders complain about that the horse not wanting to stretch out anymore or accept a contact with the bit. The high head carriage can limit the horse’s vision and since this posture is associated with flight and running, it will raise their arousal level and make them more reactive and spooky.

Changes in the head and neck posture and muscles can be caused by incorrect training and/or pain, and often, the pain will derive from the front end.

Problems with the front feet, legs, shoulders and/or neck can all cause the horse to change their head carriage.

U-necks are usually a sign of compensation, not conformation, and can often be greatly improved, first by addressing the underlying pain, and then with a training program that encourages the head and neck to function as it is meant to.

Shoulder angles

We talk about good horses having ‘good sloping shoulders’ and tend to criticise those who have shoulders that are too upright, but it pays to remember that the horse’s shoulders are only held to the body by muscle – they have no bony connection to the rest of the skeleton.

For this reason, when we look at shoulder angles, it can be tricky to know what the horse’s ‘true’ shoulder angle is and whether we are looking at a conformation issue or a compensation pattern.

A sign that we are dealing with a compensation pattern in this area is, for example, a high neck carriage or u-neck, which forces the shoulder blade into a more vertical position. Another sign is whether we can see fascia lines in the shoulder area, which are a sign of overloaded soft tissue.

We may see uneven shoulders – either one is higher than the other or the muscles on one side are more developed. Often, this is caused by a high heel – low heel syndrome. We talk about high heel – low heel syndrome when a horse has a more upright foot on one side and a flatter foot on the other side. This is caused by a change in loading through the legs due to either foot pain or pain somewhere else in the legs. The more upright foot is usually the sore one and the shoulder on the side will usually appear flatter. The flatter hoof being overloaded and the shoulder on that side will usually be the one that appears overdeveloped.

The only exception is a true club foot which is rare and will not cause uneven shoulders. But most upright feet are man-made club feet that are caused by an off loading off the higher foot and overloading of the flatter foot.

Another common reason for a high heel-low heel syndrome, are one-sidedness (a preference for one side when moving) as well as shoulder and neck issues. As discussed above, both can be related to birth trauma in foals or the trend to breed long-legged horses that can’t easily reach the ground as foals. This is because it leads to a change in grazing behaviour, stance and biomechanics that can lead to lifelong changes in the horse’s musculo-skeletal makeup.


When viewed from the back, a cow-hocked horse will stand with the hocks closer together than the feet. You can tell this posture is a compensation pattern when the horse presents with very tight adductor muscles (the muscles up high on the inside of the leg).

The tension causes the horse to turn the hocks in and the toes out, normally to compensate for pain either in the pelvis or the back, usually from having the hind end overloaded in relation to the front end. This overloading and resulting muscle tightness/soreness can cause horses to struggle lifting the hind leg up or to ‘play-up’ for the farrier.

Another hint that a horse is compensating can be detected when, as well as the cow-hocked stance, the hind feet have flares, bruising, long toes, underrun heels or a medial-lateral imbalance.

Fascia lines in the flank area are also a sign for an overloading of the hind end. The other test is to pick the leg up as shown in the photo and let it hang loosely. When you can see a straight bone structure with a twisted hoof capsule that can be adjusted using a slight pressure, we are likely dealing with a compensation pattern that can be changed.

Pelvis angle

A horse needs a functional pelvis to be able to develop propulsion, no matter it’s a dressage horse, a campdrafter a show jumper or a trail pony.

If sore, the horse can sometimes change its pelvis angle, either making it steeper or flatter depending on the way the horse is compensating. This leads to reduced mobility in the pelvis, which changes the way the horse can use itself and causes a lot of sacroiliac (SI) joint problems.

It is not always a problem in the hind-end that causes the horse to change the pelvis angle, more often than not it is actually coming from a pain issue in the front of the horse and the change in pelvis angle is the way of compensating. Another sign of a compensation issue in the pelvis area is a tucked tail. This often happens in combination with a change in pelvis angle and can be a sign your horse is sore.

Roached lumbar spine

If your horse gets very tight over the lumbar spine (the part between the last rib and the sacroiliac joint), or the spine has a convex shape (roach) in that area, it is likely that your horse is dealing with some pain issues.

Some people believe that a roached back is a structural fault but I haven’t seen a horse yet whose roached back was a true conformation fault.

The lumbar spine is a very common area for a compensation pattern to show up.

These horses don’t always show soreness in the back; sometimes they are so locked up that they don’t show any signs of pain when you push on their backs.

Importantly, the pain and underlying problem can be a long distance away from the site of compensation.

In summary…

These are a few examples from an endless list of compensation patterns that can be wrongly condemned as conformation faults.

The best way to look at the horse’s body is to see if you find pain or soreness anywhere and also if the horse is having trouble with some parts of its training.

Always remember that horses are masters at hiding pain so if in doubt, ask a certified practitioner in your area.

And, most importantly, if you think something is not right, it probably isn’t. You are your horse’s voice so make sure that everyone can hear it!

Dr Lena Clifford, BVSc, PhD, Member IVCA

Trained as a veterinarian in Germany, where she completed a PhD, Dr Clifford is based in Queensland and now specialises in animal acupuncture, Chinese herbal medicine and animal biomechanics. She is a Member of the International Veterinary Chiropractic Association (IVCA).

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  1. This was a very interesting read and has made me think more about the conformation of some of the school horses I work with, especially of a little grey mare with a very inverted neck and high head carriage. As you mentioned, her head carriage is likely the reason she is so aroused and can be spooky (a king her hard to handle and ride at times).
    Perhaps she is hiding pain that no one has been able to identify. She has never been lame in the time I have known her but it may be because she is so go at hiding it.


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