15/03/2026
Here’s an uncomfortable truth: flexion tests don’t diagnose anything.
They provoke.
As rehabilitation therapists, movement assessment is central to what we do. Lameness assessment is part of that - but lameness itself is not a diagnosis. It’s a sign of pain and altered biomechanics.
And pain in horses rarely travels alone.
One primary issue shifts load. That shift creates muscular tension. Over time, that tension can progress into secondary joint or ligament irritation. If we miss it, structural change follows. Concurrent and compensatory lameness isn’t the exception - it’s common.
So when we apply a flexion test, what are we actually seeing?
We’re seeing a limb that is irritably load-sensitive today. Not a specific structure. Not a confirmed localisation.
Without a clear baseline at walk and trot - before manipulation - interpretation becomes guesswork.
And if we forget that approximately 95% of primary forelimb pain is at or below the carpus (with the hoof structures first suspect), or that around 80% of hindlimb lameness cases involve concurrent lumbosacral or sacroiliac pain, we risk building the wrong narrative from a single positive response.
Flexion tests are useful. But only in context.
Baseline first.
Pattern recognition second.
Collaboration always.
In this blog, we explore what flexion tests truly reveal - and what they don’t - including their limited sensitivity and specificity, the risk of false positives, and how to standardise them if you use them pre-referral.
Have you ever seen a flexion test over-interpreted without enough baseline evidence?
Comment BLOG below and we’ll send you the link.
