14/02/2026
𝗛𝗲𝗮𝗱 𝗦𝗵𝗮𝗸𝗶𝗻𝗴 >>𝘄𝗵𝗲𝗻 𝘁𝗵𝗲 𝗵𝗲𝗮𝗱 𝗶𝘀 𝗻𝗼𝘁 𝘁𝗵𝗲 𝗽𝗿𝗼𝗯𝗹𝗲𝗺......
Olive is a grey mare with a long history of head shaking.
She has been thoroughly investigated by her veterinary team, including advanced imaging. A CT scan revealed no structural pathology that could explain her symptoms. Electroacupuncture had also been trialled, without meaningful improvement.
The owner described a clear seasonal pattern: Olive is significantly worse in winter, particularly with wind and rain. There was also an important historical detail – when Olive was first backed, she would retract her tongue so far back that she appeared close to choking, and a tongue tie was introduced to manage this behaviour.
So for me often the question is not “what is wrong with her head?”
It was “what is her head responding to?”
🐎 𝗪𝗵𝗮𝘁 𝗜 𝗳𝗼𝘂𝗻𝗱
Assessment revealed restriction at the cervico-occipital (CO) junction, held in extension with a slight sidebending pattern to the left. This transitional region between skull and spine has a strong influence on neurological tone and is highly sensitive to strain.
The left ear was notably reactive to touch including specific sutures. The distribution of sensitivity corresponded with recognised sensory territories of cranial nerves VII (facial), IX (glossopharyngeal) and X (vagus), alongside contribution from the CO/C1 spinal nerves. This immediately suggested a cranial nerve involvement rather than a localised ear issue.
The jaw and cranial base provided further clarity.
The left mandible was held in an ascending pattern, with cramping through the left masseter. The hyoid apparatus was drawn forward and left. The temporalis bones were asymmetrical, with the left held in endorotation and the right in exorotation.
Within our osteopathic training, this is clinically significant: endorotation of the temporal bone is associated with vascular compromise, while exorotation is associated with neural tension or potential neural entrapment.
In Olive’s case, the left temporal endorotation may subtly influence venous and arterial flow in the cranial base, particularly the internal jugular vein and internal carotid artery, contributing to local congestion. Here we can also start to consider CN V11, & CN V111, as possibly involved.
The right temporal exorotation reflects compensatory neural strain (more on this and froamen lacerum further down). This pattern is further influenced by environmental factors like wind, rain, and cold, which can accentuate vascular and neural tension.
These cranial base patterns link directly to hyoid, jaw, and tongue mechanics, influencing head carriage, swallowing, and airway dynamics.
𝗢𝗔𝗔 (𝗢𝗰𝗰𝗶𝗽𝘂𝘁-𝗔𝘁𝗹𝗮𝘀-𝗔𝘅𝗶𝘀) 𝗖𝗼𝗺𝗽𝗹𝗲𝘅:
The trigeminal nerve’s sensory nucleus extends into the dorsal horn of the upper cervical spinal cord (C1–C3). Dysfunction or "blockages" at the OAA can create abnormal sensory "noise" or tension that the brain interprets as facial pain.
𝗠𝘂𝘀𝗰𝘂𝗹𝗮𝗿 & 𝗙𝗮𝘀𝗰𝗶𝗮𝗹 𝗧𝗲𝗻𝘀𝗶𝗼𝗻:
The muscles of mastication (masseter, temporalis, pterygoids) are directly innervated by the mandibular branch (V3) of the trigeminal nerve. Chronic jaw tension or TMJ dysfunction can cause these muscles to shorten/contract, potentially tugging on the facial fascia and putting pressure on the nerve as it exits various skull openings.
𝗘𝘅𝗼>𝗘𝗻𝗱𝗼 𝗼𝗳 𝗧𝗲𝗺𝗽𝗼𝗿𝗮𝗹𝗲 𝗕𝗼𝗻𝗲𝘀:
The foramen lacerum region, functionally, involves CN IX (glossopharyngeal), X (vagus), XI (accessory), and V3 (mandibular branch of trigeminal), affecting sensory, motor, and autonomic functions to the head and hyoid/tongue complex.
The tongue was not incidental
The historical tongue retraction suddenly became anatomically coherent.
The tongue is a highly organised muscular structure with a strong central core, intimately linked to the hyoid apparatus, mandible, soft palate, and upper airway. Its coordination depends on balanced input from cranial nerves IX (glossopharyngeal), X (vagus), and XII (hypoglossal).
When tone within this system is disrupted, (TMJS, OAA complex, sphenoid, SSB, Temporales)......the tongue may draw caudally and dorsally as a protective response, narrowing the airway and interfering with normal swallowing–breathing coordination.
In Olive’s case, the tongue behaviour appears not as a training issue, but as a compensatory pattern within a strained cranial–Tmj-hyoid–neurological system.
The palatine bones, forming part of the roof of the mouth and boundary of the nasopharynx, are also relevant in such presentations. Restriction here can further affect tongue position and airway comfort. Any internal assessment or treatment of this area would appropriately require veterinary or dental involvement, with a gag in place.
𝗧𝗵𝗲 𝗯𝗼𝗱𝘆 𝘄𝗮𝘀 𝗶𝗻𝘃𝗼𝗹𝘃𝗲𝗱 𝘁𝗼𝗼......𝗪𝗛𝗢𝗟𝗘 🐎
𝘛𝘩𝘪𝘴 𝘸𝘢𝘴 𝘯𝘰𝘵 𝘢 𝘩𝘦𝘢𝘥-𝘰𝘯𝘭𝘺 𝘱𝘢𝘵𝘵𝘦𝘳𝘯.
The diaphragm was restricted in an inspiratory state. The mid-thoracic spine showed right sidebending, and the pelvis demonstrated asymmetry, with the right ilium held in dorsal inflare and the sacrum organised around an oblique axis pattern.
The lumbar spine showed mixed compensations rather than a clean biomechanical response, indicating reduced adaptability within the system.
From an osteopathic standpoint, this matters deeply. In many of my posts I talk about how the dura mater forms a continuous tension system from the sacrum to the occiput. Pelvic and sacral strain does not remain local>> it is transmitted cranially, influencing the cranial base and the neurological structures housed there.
In this context, Olive’s head was not misbehaving.
It was responding intelligently to the demands placed upon it by the rest of her body.
𝗪𝗵𝘆 𝘁𝗵𝗶𝘀 𝗺𝗮𝘁𝘁𝗲𝗿𝘀:
These cases highlight how functional restriction, particularly involving the diaphragm, pelvis, and cranial base, can produce significant neurological and sensory symptoms without leaving a structural footprint on imaging.
𝗘𝗾𝘂𝗶𝗻𝗲 𝗼𝘀𝘁𝗲𝗼𝗽𝗮𝘁𝗵𝘆 𝗶𝘀 𝗻𝗼𝘁 𝗮𝗯𝗼𝘂𝘁 𝗰𝗵𝗮𝘀𝗶𝗻𝗴 𝘀𝘆𝗺𝗽𝘁𝗼𝗺𝘀.
It is about understanding relationships.
And when the anatomy is allowed to tell its story, the horse often makes perfect sense.
Image: Found on google, the asterisk mark the foramen lacerum > https://www.equus-soma.com/apollo-part-five/
Shared with permission of owner.
