Up and Over: Stop Horse Rears and Backward Falls

What should you do if your horse rears and flips over backward?and how can you prevent it?
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What should you do if your horse rears and flips over backward?and how can you prevent it?

It's time to clip your horse's ears, which is not his favorite grooming routine. As you reach up to start, he raises his head and steps backward, taking the slack out of the cross-ties?and in a flash, a complete disaster unfolds. His eyes widen as he feels his head restricted. He pulls against the ties. They hold, and he fights harder. He rears up and pulls back with everything he's got. Then his halter snaps. Suddenly released, he flips over backward and lands on his back, hitting the floor with a sickening thud. A horse who flips over backward can suffer fatal injuries or, conversely, stand up with nothing more than bruises. In this article I'll explain how injuries come about and what to do if your horse ever flips over. I'll also give you some tips for preventing these potentially catastrophic accidents.

An X-ray showing fractured dorsal spinous processes, which form the underlying framework of a horse's withers. | Courtesy, Midge Leitch, VMD/Practical Horseman

An X-ray showing fractured dorsal spinous processes, which form the underlying framework of a horse's withers. | Courtesy, Midge Leitch, VMD/Practical Horseman

A horse will rarely, if ever, fall over backward when he's at liberty. Horse flip-over injuries typically occur when a horse pulls back suddenly and feels his head restrained. The greater the force restraining him, the more he fights by pulling back. Then, when he finally breaks free, he flies back with tremendous force?and his momentum may carry him over.

How Bad Could It Be?
Bad, especially if the horse falls on a hard surface. The point of impact takes the brunt of the force and is most likely to be injured.

Poll. In the worst-case scenario, the horse flips completely over and strikes his poll with enough force to fracture his skull. The blow may kill him outright or cause blindness, incoordination or other severe neurological damage.

One possible result is internal bleeding?a hematoma?that compresses and damages delicate tissue in the brain stem, the lower part of the brain. The brain stem not only links the spinal cord to the higher brain but also controls essential body functions, including breathing and heart contraction. A rapidly expanding hematoma here can bring these functions to a halt.

A fractured skull also may damage other areas of the brain and cause the horse to bleed from his nose or ears. Or the horse may break the first few vertebrae of his neck. That puts pressure on his spinal cord and, depending on the degree of injury, may leave him paralyzed or severely incoordinated.

There is really nothing that can be done for the horse in these cases. Fortunately, this worst-case scenario isn't the most common. More often, the horse pulls back with somewhat less force and lands on his ...

Withers. The impact can fracture the dorsal spinous processes, the tall spines of bone that extend up from the vertebrae and form the underlying framework of the withers. This is painful but it's not fatal or, in most cases, career-ending. I've known a grand prix show jumper and a Maryland Hunt Cup winner who competed successfully after recovering from such injuries. (It's less common for a horse that flips backward to break his back. That happens more often when a horse flips forward?say, an event horse that doesn't clear a bank and plows headfirst into the ground. That impact can produce an upward arching of the back as well as compression from head to tail.)

Fractured withers rarely require surgery or other intervention. Healing does take time, though. The horse will be very sore at first, and the vet will probably give him anti-inflammatory medication. He may be unwilling to lower his head to eat or drink because doing so stretches the nuchal ligament, a large, strong band of connective tissue that provides support for the neck and is attached along the withers. Make sure his water and feed buckets are at chest height, and set up hay nets or a hayrack for him. After a few weeks he'll begin to be more comfortable, and in a couple of months lowering his head won't be an issue. But the area still needs time to heal, so don't rush him back to work. Plan to give him at least six months off, with turnout for exercise as he seems more comfortable. During turnout, be sure he's protected from harassment by other horses so that he can move about to the degree that's comfortable and not be required to defend himself.

The bony fragments usually do not heal back to each other but instead settle into a bed of fibrous scar tissue in the spot where they end up on one side or the other of the remainder of the spinous processes. Once they heal, the withers won't be painful, but they probably will be deformed. They usually end up flatter and wider than they were before the injury. This can be a saddle-fitting issue but seldom causes a problem that permanently sidelines the horse.

Tail and rump. A horse that goes back with even less force may not go all the way over. He may "sit" hard, landing on his rump, and break the base of his tail. (This can also happen when a horse is caught under something, like the butt bar of a trailer.) This is another injury that requires time rather than intervention. Most horses are uncomfortable at first, and the recovery period varies with the individual. You can use the horse's level of comfort as a yardstick to gradually increase turnout exercise and then return him to work. If he's not comfortable swishing his tail?which is likely at first?be sure to protect him from flies with an effective repellant.

A broken tail is painful, but it rarely leads to long-term problems. The tail may be crooked when it heals, or the horse may end up with a permanent bump or dimple at the base. But the nerves that control key working structures?like the hind legs and the rectum?leave the spinal cord above the base of the tail, so they're usually not affected.

Less often, the impact fractures the tip of the tuber ischii, the part of the hipbone that underlies the point of the horse's buttocks, on either side of the tail. Higher up, at the top of the croup, the horse can tear the ligaments that secure the top of the hip (the ileum) to the section of the spine called the sacrum. This injury, called a sacroiliac subluxation, is more a product of slipping than of falling?the horse loses his footing behind as he pulls back, his hind feet suddenly shoot forward under his body and his back is wrenched. (Sacroiliac injuries more typically occur in the pasture on mud or ice, when the horse is running and tries to stop short. Or they may be chronic, the result of wear and tear, especially in such occupations as jumping.)

Any of these injuries will make the horse sore and take time to heal; recovery time varies but is usually a period of months, not weeks. Given the time to heal, the injuries rarely lead to long-term problems.

What To?Do
Let's hope your horse never flips over. But if he does, the smartest thing you can do is to let him lie still for a minute. Clear the area around him, and stand out of the way. Let him sort it out. If he's going to die from a brain-stem injury, he will thrash violently in his last moments. You can't do anything to help him?and you could be seriously injured. If he rolls onto his chest and looks like he's preparing to get up, don't rush him. You don't want him to stand too soon and then collapse, perhaps on you. He'll stand on his own when he's ready.

You'll probably want to put a lead rope on him, since he broke whatever tie was securing him (and perhaps his halter) when he fell. But don't place yourself at risk to put it on. Stay back unless he's on his chest and looking calm and alert, not panicky or dazed and disoriented. If you're inside, shut the barn door to keep him from escaping when he gets up.

Standing is, of course, a very good sign; but it doesn't mean that you're entirely out of the woods. Head trauma doesn't always kill instantly or even produce clear signs immediately. Pressure from internal bleeding can build slowly, so you won't know initially how serious the injury is. I've seen horses suffer such injuries and show no obvious symptoms at first, only to die suddenly a few hours later.

To be safe, then, put the horse in his stall and leave him to rest quietly. This is not the time to go on with shoeing, clipping, mane pulling or whatever else you were doing when he flipped over. It's certainly not the time to ride. If swelling is building around his brain stem, signs should appear within six to 10 hours. Meanwhile, call your veterinarian. A veterinarian should always inspect a horse that flips over with force, takes time getting to his feet or seems uncomfortable after the fall. The vet can check for fractures and for subtle signs of neurological damage.

Depending on the site of the impact and the clinical signs, X-rays may be needed to identify a fracture. (The withers, neck, poll and tail can all be X-rayed, but some of these sites require digital equipment or a fixed unit at a referral clinic. The lumbar spine is more difficult to image.) And even if the horse hasn't suffered a head injury or fractured a bone, he's going to be sore and may benefit from anti-inflammatory medication, which the vet can prescribe?a non-steroidal anti-inflammatory such as phenyl-butazone for mild discomfort, perhaps, or stronger medication such as intravenous DMSO. While DMSO doesn't block pain directly, it's an excellent anti-inflammatory treatment for neurologic injuries and so would be appropriate for a horse that has flipped over and, say, banged his head, raising concern about potential neurologic dysfunction.

Prevention
While it's impossible to predict everything that horses will do, commonsense steps will prevent most flips. The basic rule is this: Avoid situations in which the horse will fight head restraint. Those situations come up frequently with young horses as they're introduced to handling, shoeing, shipping and other new experiences. But any horse can panic when he feels restricted. The most common trigger is tying?for grooming, shoeing or some other procedure. To tie safely and prevent accidents, follow the 10 steps listed in the box below.

Trailering also can lead to problems, typically when the horse fights loading or backs off the trailer in a rush. Getting him to load onto and back calmly off a trailer is a training issue, best tackled at home with lots of repetition. Feeding him on the trailer will generally help convince him that it's a good place and make him less anxious to rush off.

To unload safely, enlist a helper to work the butt bar while you take the horse's head. The helper must not drop the butt bar until you get a lead rope on the horse's halter, unclip the trailer tie, drop the chest bar and give the OK. Then back your horse out as slowly as possible. If he rushes backward anyway, go with him?trying to stop him will only increase his panic.

Other situations can provoke a horse to pull back and even rear. Jerking too hard on a lead shank, especially with the chain looped through the halter rings so that it passes under the horse's chin, is enough for some. If this happens, give him slack and move back with him, being careful to stay clear of his legs, or let him go. The worst thing you can do is to try to restrain him. He'll just pull harder?and before you know it, back and up will turn into up and over.

Midge Leitch, VMD, has traveled with the US Equestrian Team to multiple world championships and Olympic Games. A board-certified veterinary surgeon, she began her career at the University of Pennsylvania's New Bolton Center and then started a private practice, focusing on performance horses, in 1980. Now based in Cochranville, Pennsylvania, she rejoined the New Bolton staff in 2005 as a clinician in radiology.

This article originally appeared in the July 2007 issue of Practical Horseman magazine. Read more about getting your horse to stand still in cross-ties in the Here's How column in the October 2011 issue.