Behind every sound athlete is precision care — discover the science and feel of equine physiotherapy with Håkan Crantz.

For more than twenty-five years, Swedish equine physiotherapist Håkan Crantz has been working with some of the world’s best horses and riders. From Olympic arenas to quiet training yards, he has seen firsthand how small details in a horse’s body can make the difference between soundness and peak performance. His own path into physiotherapy began in an unusual way, and his reflections reveal not only deep expertise but also a lifelong passion for horses.

How did you first get into physiotherapy, and why did you choose horses over humans? 

“I was a farrier for thirteen years, but then I developed back problems. My physiotherapist at the time suggested that I might want to consider stopping horseback riding. I told him I didn’t know what else to do, and he said: Why don’t you become a physiotherapist? That’s how the idea started.

At first, I planned to work with both horses and riders, but I got too many horses to do. And honestly, I preferred horses in front of humans. My background as a rider and with racehorses and shoeing made it quite natural to start working with horses instead.”

You’ve been part of the Swedish Olympic team for many years now. What has that journey been like? 

“Since 2012, I’ve worked as a physiotherapist for the Swedish eventing team. I’ve done four Olympics, three World Championships, and seven European Championships for the eventers. For one year, I even worked across all disciplines. It’s been a fantastic journey.”

What kinds of therapy methods do you use most often? 

“There are so many ways to treat the horse’s body. But if you want to be good, you have to choose a couple of methods - you can’t do everything. I work with hands, electricity and ultrasound. 

How can ultrasound be used in physiotherapy for horses?

“There are two kinds of ultrasound,” Håkan explains:

• “One is scanning ultrasound, which is used to create images, for example, when examining tendons in a horse. The sound waves travel into the body, reflect differently depending on the tissue, and then form an image on the screen. 

• The other is therapeutic ultrasound. In this case, stronger waves are sent into the body—not to produce an image, but to create a treatment effect in the tissues. So I’m using a therapeutic ultrasound.”

  
  

What kind of problems do horse owners most commonly bring their horses to you for? 

“85% of the horses I see are sound. They pass veterinary inspection without any complaints. I don’t treat sick animals; I treat sound athletes. My role is to make it a little easier for the horse and a little easier for the rider. For example: 

• It's not that the horse is lame, but maybe it's a little bit more difficult to go on the left circle than on the right,

• maybe they have a little bit less power in the right canter than in the left canter, 

• maybe the horse is jumping a little bit to the left,

• maybe they lose a little bit of momentum and power in the extended trot. 

These are the kinds of issues I work with. At the clinic, where I work one day a week, I sometimes see lame horses together with the vet, but most of the time I work with sound horses.”

I think it’s very similar to humans. Everyone has some muscle tightness, but for top athletes, those little things matter. Håkan agrees. “Exactly. If you’re just jogging in the woods, those problems don’t matter. But if you’re throwing the javelin when competing, then you won't be allowed to have that little problem. Because that little problem can make the throw that much less. And then suddenly you place #6 instead of #1. It all depends on what you are doing. The same goes for horses: if a horse just goes out into the woods a few times a week for walking and trotting, there is no real problem. But if that same horse is expected to jump 1.60 meters and has tension in its muscles, then it becomes a serious issue. Everything depends on the level of work the horse is asked to perform.”

How much does a horse’s progress depend on what the rider does at home? 

“A lot. Sometimes I don’t make any real difference myself; sometimes I improve the horse, but quite often I just give the rider the opportunity to improve the horse with correct riding. It’s very important that the rider can ride in the right way, because that’s what makes the horse better.”

I add that I’ve heard of riders who seem to ‘heal’ horses through correct riding. Håkan nods but adds, “It depends on the problem. If there’s a chip in the fetlock, you can’t ride that away. But if it’s tightness in a muscle, then yes, correct riding can make a big difference.”

What are the most common mistakes owners make during recovery? 

“They don’t give the horse the chance to recover. Horses don’t get better just by resting, but they also don’t get better if you only push, push, push. They need work to build strength, but they also need easy days to recover—both body and mind.”

When you observe a horse, what do you pay attention to? Do you have a system? 

“Yes, I always go through the horse in the same way. Usually, I don’t want to know what the rider feels, because that can bias me. If the rider says the horse has a problem in the right canter, I might focus only there and miss something else. So I just want to know the horse’s age, condition, and if it’s safe to stand behind it. Then I feel through the body. If what I find matches the rider’s impression, that’s great. If not, I go back and check again.

I have many different tests, and I could spend half a day on one horse. But I can’t do every test every time—that would make it unaffordable. So I have a basic system, and then add more checks if needed.”

How does a horse tell you something hurts? 

“Mostly through what I feel. After around 38,000 treatments, I know how a muscle should feel under my fingers. If I find tension, swelling, heat, or restricted movement, that tells me something. Sometimes the horse reacts with a muscle spasm or puts its ears back when I touch a sore spot. But I don’t rely much on facial expressions or so-called ‘pain faces.’ For me, it’s about feel and movement. I wish I were that good - to be able to scan a picture and immediately see whether the horse feels at ease or not.”

We agree that, just like people, horses sometimes look tense even when they’re not in pain. “Exactly,” Håkan says. “Some horses get angry easily, some are always relaxed. Personality plays a role. But if a horse accepts touch everywhere except one place, that tells me something is wrong.”

What signs should owners look for to catch problems early? 

“Feel your horse every day. Run your hands along the body, the back, the legs. If you do that every day, you’ll immediately notice when something changes—like a swollen fetlock on the very first day. Too often, people don’t realize until weeks later. In big stables, one horse may have ten different grooms, but ideally, one person should feel the same horse every day. That’s how you build awareness.”  

“Some people put their heads in the sand and pretend the signs don’t exist. Others react from day one, saying that something must be wrong if the horse doesn’t seem normal. Personally, I don’t think that way — I want the horse to feel off for a couple of days before I consider it a real problem that needs to be managed. But even then, it should make you alert if the horse isn’t feeling well. That’s why it’s actually good to have the same rider the next day. If you switch riders and the new one says, ‘I don’t feel anything,’ then it becomes much harder to identify the problem.”

I’ve also heard that sometimes the horse’s stress level depends on how many different people work with it. Håkan agrees, “It makes sense. For example, older people who need daily help can also get stressed when too many strangers come to assist them. My wife’s parents are quite old now, and yesterday seven different people visited to help them — all new faces they hadn’t seen before. That was stressful for them, and of course, it must be similar for a horse. If every day a new person comes to take care of it, one after another, that naturally causes stress.

Also, remember, horses can have bad days just like us. If a horse feels wrong one day, that’s okay. But if it feels wrong five days in a row, then there’s probably something that needs attention.”

How often should a horse see a physiotherapist if there’s no obvious issue?

“It depends on many factors:

• For a healthy horse living a fairly normal life, I believe it is a good practice to have a check-up twice a year. Horses that spend time out in the paddock and live as naturally as possible are, of course, still at risk of injury. However, the signs of such injuries may not appear immediately - sometimes they only become visible months later. Regular check-ups with a physiotherapist, for example, every six months, can help detect these issues early and prevent them from developing into more serious problems.

• For horses competing at the highest level, check-ups should naturally be more frequent. These horses are doing intense work, and if something is wrong, the combination of heavy training and competition increases the risk of a minor issue developing into something much more serious. Some of these horses may need to be seen once or even twice a month during the peak of the competition season.

It is, in the end, highly individual.”

Can physiotherapy change a horse’s personality? 

“Yes, absolutely. If a horse is asked to work in pain, it won’t be very happy. Remove the pain, and suddenly it’s more positive and willing. The personality changes in proportion to the pain level. Some horses hide discomfort well, others become grumpy. But once they’re comfortable, you see the difference.”

How much of your work is science, and how much is intuition or feel? 

“That’s a very good question. Science gives you the tools, but to use them, you need feeling. There have been big studies—like in France—where horses were treated with different methods: chiropractic, laser, massage, and electricity. Riders were asked to rate their horses afterwards. Almost all horses were reported as better, no matter what treatment they had—or even if they had no treatment at all.

That shows the placebo effect. Not in the horse, but in the rider. If the rider believes the horse is better, they ride differently, and that alone can make the horse go better. Sometimes that’s not a bad thing—it can even help. But it shows how much of this work is about both science and feeling.”

What is the best piece of advice you’ve received in your career?

When I was studying in England with Mary Bromiley (the best horsewoman I have ever met), she gave me advice that has stayed with me ever since. She once told me, “Don’t think you can treat all horses the same way. You must first find the real problem, and only then choose the right tool from your toolbox. That advice has stayed with me always.”

What is your vision for the future of equine physiotherapy? 

“My personal vision is retirement,” he laughs. “But for the field in general, I hope we get more scientific proof for what we’re doing. I believe we’re doing a lot of good, but more science would give us clearer answers.”

What three words would you use to describe good equine therapy?

“You need to be a good communicator—with the owner, the vet, everyone. You need to be a problem-solver, able to find solutions. And you need to have a feel.”

Finally, what simple advice would you give to every horse owner?

“I would like to push on this again, “feel through the horses every day”. Feel the muscles in the neck, back, and legs. The more you do that, the sooner you’ll find out if something is wrong. Top grooms know every little detail about their horses, and sometimes they can even sense something is amiss before looking into the stall. That’s how close the connection should be. If more people did this, horses would be better understood and cared for.”

Triinu: “Thank you, Håkan, for this exciting interview. I was happy to share a passion for horses with you!”

Håkan smiles and says: “I usually avoid giving interviews, but this time I felt surprisingly comfortable and enjoyed it. Thank you!”