# How to Help a Down Horse Get Up and Tying-Up Care A down horse needs a calm, planned approach, not a tug-of-war. Call your veterinarian first, keep the horse quiet and supported, and only attempt to help it rise when it is safe for both of you. This article explains how to help a downed horse get up, when it is an emergency, and what tying-up recovery involves. This article is educational and is not a substitute for veterinary diagnosis or treatment. ## Quick Answer - Call your veterinarian immediately if your horse has been down for more than 30 minutes, is struggling, or cannot lift its head. - Never pull on the tail, ears, or legs to force a horse up. You can injure the horse and yourself. - Keep the horse warm, dry, and on a non-slip surface, and remove obstacles so it has room to roll and rise. - Offer water and hay within reach if the horse is alert and swallowing normally. - Tying-up recovery means controlled exercise, diet changes, and monitoring for relapse, all guided by your veterinarian. ## What Does It Mean When a Horse Is Down? A down horse is one that is lying flat and cannot or will not rise. Horses can lie down normally to rest and sleep, and a healthy horse can usually get back up within a short time. A horse that stays down for hours, or that tries and fails to stand, is a medical concern. Prolonged recumbency, meaning a horse that stays down for an extended period, causes its own problems. These include muscle damage, nerve compression, pressure sores, and reduced blood flow to the limbs. Managing a down horse means treating the original illness while also preventing these secondary complications [1]. That is why time matters so much. ## Signs Owners Notice Owners often spot a problem before it becomes a full down episode. Watch for: - A horse that is reluctant to move, stiff, or sweating after exercise - Firm, painful hindquarter muscles, especially after work - A horse that lies down more than usual or struggles to rise - Paddling, trembling, or a blank stare - A horse that goes down and cannot get its legs under itself For a horse with tying-up, the classic picture is a horse that ties up during or after exercise with hard, tense hindquarter muscles, reluctance to move, and sometimes dark urine. For a down horse, the picture is more serious. If your horse is down and cannot rise, treat it as an emergency. ## Causes and Risk Factors ### Tying-Up (Exertional Rhabdomyolysis) Tying-up is muscle damage triggered by exercise. It happens when muscle cells break down and release their contents into the bloodstream. Some horses have a genetic form, and others tie up after hard work, dehydration, or electrolyte problems. Diet and conditioning play a role. ### Other Causes of Recumbency A horse can go down for many reasons. These include severe colic, neurological disease, exhaustion, metabolic problems, and, rarely, tumors affecting the spinal cord. One report described a young horse that arrived recumbent and was later found to have a tumor pressing on the spinal cord [2]. Spinal cord tumors in horses are rare and often carry a poor outlook because of how hard they are to diagnose and treat in such a large patient [2]. ### Risk Factors for an Old Horse Older horses lose muscle mass and joint flexibility. Arthritis, hoof pain, and weakness make rising harder. Cold, wet weather and slippery footing add to the problem. If you care for a senior horse, see our [Senior Horse Care Guide](/knowledge/veterinary-medicine/equine-care/senior-horse-care) for ways to reduce these risks. ## How Veterinarians Diagnose the Problem Your veterinarian starts with a physical exam and a history. They will ask when the horse went down, what it was doing before, and whether it has tied up before. Blood work is the main tool for tying-up. Muscle enzymes rise in the blood after muscle damage. Your veterinarian may also check electrolytes, kidney values, and hydration status. For a down horse, the exam focuses on why it cannot rise. Your veterinarian checks nerve reflexes, pain response, heart rate, and breathing. Imaging may be recommended, but a large horse can be hard to image, and some causes are only found after death [2]. If the horse needs anesthesia for a procedure, your veterinarian will plan the recovery carefully, since the period right after anesthesia is a high-risk time for horses [3]. ## How to Help a Downed Horse Get Up This is the section most owners search for, so read it before you need it. ### First, Make the Area Safe - Clear away buckets, feeders, and anything the horse could hit. - Put non-slip mats or bedding under the horse if you can do it safely. - Keep other horses calm and away from the area. - Dim harsh lights and lower noise. ### Support, Do Not Drag Do not pull the horse by the tail, mane, ears, or legs. Do not use a tractor or truck to drag a down horse. These moves cause injuries and rarely work. If your veterinarian is present or guiding you by phone, they may direct you to: - Position the horse so its legs are folded under its body in a normal resting position. - Use a wide strap or rope as a sling under the chest and hindquarters, with at least two strong people, only if your veterinarian says it is safe. - Give the horse a quiet moment, then encourage it to rise on its own. A horse that is truly trying to rise will usually rock forward, push with its front legs, and swing its hindquarters up. Your job is to give it room, grip, and calm. ### Help an Old Horse Get Up For an older horse, the problem is often strength and footing. Provide deep, clean bedding and rubber mats. Keep the stall large enough for the horse to lie down and adjust its position, since stall space affects rest and welfare [4]. Trim hooves regularly so the horse can balance. If your horse is down more than usual, call your veterinarian to check for pain or weakness. ### When Not to Force It If the horse is thrashing, has a racing heart, is sweating heavily, or cannot hold its head up, stop. Wait for your veterinarian. Forcing a struggling horse to rise can cause fractures and muscle damage. ## Tying-Up Recovery for Horses Tying-up recovery is a slow, staged process. The goal is to let damaged muscle heal without triggering another episode. ### The First Days Your veterinarian will set the plan. In general, the horse needs rest, water, and a calm environment. Severe cases may need intravenous fluids and pain control. Your veterinarian calculates any drug dose from your horse's weight and health, so never guess a dose on your own. ### Returning to Exercise Controlled exercise is often part of recovery. This usually means walking, not trotting or cantering, and building up slowly over days to weeks. Your veterinarian will tell you when to increase work. Pushing too fast is a common cause of relapse. ### Diet and Management Diet changes often help. Your veterinarian may adjust grain, fat, and electrolyte intake based on your horse's type of tying-up. Some horses do better on a low-starch diet with added fat. Others need specific electrolyte support. There is no single diet that fits every horse, so follow your veterinarian's plan. ### Monitoring at Home Watch for stiffness, sweating, reluctance to move, and dark urine. Check your horse's attitude and appetite daily. Keep a simple log of exercise, feed, and any symptoms. This helps your veterinarian adjust the plan. | Stage | What You Do | What to Watch For | |---|---|---| | Acute (first 24 to 48 hours) | Rest, water, veterinary care, pain control as prescribed | Dark urine, severe pain, inability to stand | | Early recovery (days to weeks) | Hand walking or light controlled exercise as directed | Stiffness after work, reluctance to move | | Reconditioning (weeks to months) | Gradual increase in work, diet adjusted by your veterinarian | Relapse signs, poor recovery after exercise | | Long-term | Consistent turnout, diet, and exercise routine | Repeated episodes, weight loss, poor performance | ## Recovery, Outlook, and Long-Term Management The outlook depends on the cause. Mild tying-up often resolves with rest and management. Severe tying-up can cause kidney damage and muscle loss, and some horses do not survive. For a down horse, the outlook depends on why it went down and how long it has been down. Prolonged recumbency itself causes complications, so early care matters [1]. Some causes, like spinal cord tumors, carry a grave outlook [2]. Long-term, most tying-up horses need a consistent routine. That means regular turnout, a set feeding schedule, and a warm-up before hard work. Cold weather can make muscle problems worse, so read our guide to [Caring for a Horse in Winter](/knowledge/veterinary-medicine/equine-care/horse-winter-care) for practical tips. ## Prevention You cannot prevent every cause of recumbency, but you can lower the risk. - Warm up and cool down your horse around hard exercise. - Keep water and electrolytes available, especially in hot weather. - Feed a balanced diet and avoid sudden grain increases. - Keep hooves trimmed and footing safe. - Provide enough stall space for your horse to lie down and shift position [4]. - Watch older horses closely for stiffness and weakness. If your horse has tied up before, work with your veterinarian on a prevention plan. Keep a first aid kit ready, and see our [First Aid for Horses: An Owner's Guide](/knowledge/veterinary-medicine/equine-care/horse-first-aid) for what to stock. ## Limitations and When to Contact a Veterinarian No article can replace an exam. Individual cases need a veterinarian who can see your horse, run tests, and set a treatment plan. Call your veterinarian the same day if your horse: - Is stiff or sore after exercise - Has firm, painful hindquarter muscles - Is reluctant to move or lying down more than usual - Has dark or discolored urine Call immediately, as an emergency, if your horse: - Has been down more than 30 minutes - Is thrashing, sweating heavily, or breathing hard - Cannot lift its head or has a blank stare - Tries to rise and fails repeatedly - Has severe pain or a swollen, hard muscle group For a routine visit, call if your older horse is slowing down, struggling to rise, or losing weight. Early checks are easier than emergency calls. ## Frequently Asked Questions ### How long can a horse safely stay down? A healthy horse can rest lying down for short periods, but prolonged recumbency causes real harm. Muscle damage, nerve pressure, and pressure sores build up over hours. If your horse has been down for more than 30 minutes and cannot rise, call your veterinarian right away. ### Can I use a sling to lift my horse myself? No. A sling needs proper placement, strong equipment, and at least two trained people, and it should only be used under veterinary direction. A poorly placed sling can injure the horse and anyone helping. Wait for guidance before you try anything. ### What should I feed a horse recovering from tying-up? Your veterinarian will set the diet based on your horse's type of tying-up. Many horses do well with less starch and more fat, plus balanced electrolytes. Do not change feed suddenly on your own, since diet shifts can trigger another episode. ### Will my horse fully recover from tying-up? Many horses return to work with careful management, but recovery varies. Mild cases often improve within days to weeks with rest and a controlled return to exercise. Severe cases can leave lasting muscle damage, so follow your veterinarian's plan closely. ### Is a down horse always an emergency? Not always, but you cannot tell the difference on your own. A horse that lies down briefly and rises normally is usually fine. A horse that stays down, struggles, or seems distressed needs a veterinarian now. When in doubt, call. If you are also caring for other animals, our article on [How to Help Your Senior Cat Get Up and Down from High Places Safely](/knowledge/veterinary-medicine/senior-and-chronic-care/help-senior-cat-high-places-safely) covers similar mobility support for cats. ## Related Articles - [Horse Blanketing: When and How](/knowledge/veterinary-medicine/equine-care/horse-blanketing-guide) - [Senior Horse Care Guide](/knowledge/veterinary-medicine/equine-care/senior-horse-care) - [How to Help Your Senior Cat Get Up and Down from High Places Safely](/knowledge/veterinary-medicine/senior-and-chronic-care/help-senior-cat-high-places-safely) - [First Aid for Horses: An Owner's Guide](/knowledge/veterinary-medicine/equine-care/horse-first-aid) - [Caring for a Horse in Winter](/knowledge/veterinary-medicine/equine-care/horse-winter-care) - [Horse Hoof Care: Anatomy, Trimming, and Common Problems](/knowledge/veterinary-medicine/equine-care/horse-hoof-care-anatomy-trimming-and-common-problems) ## References 1. [Complications of the Recumbent Horse: Diagnosis and Management](https://pubmed.ncbi.nlm.nih.gov/41033903/). The Veterinary clinics of North America. Equine practice, 2025. 2. [Cervical extradural mast cell tumour in a 2-year-old Irish Sport Horse colt](https://pubmed.ncbi.nlm.nih.gov/41880795/). Journal of comparative pathology, 2026. 3. [Effects of flow-controlled expiration on oxygenation and early recovery in horses undergoing general anaesthesia](https://pubmed.ncbi.nlm.nih.gov/42392997/). Equine veterinary journal, 2026. 4. [Evaluation of Short-Term Stall Size Housing on the Behavior and Welfare of Domestic Horses (Equus caballus)](https://pubmed.ncbi.nlm.nih.gov/42014105/). Journal of the American Association for Laboratory Animal Science : JAALAS, 2026. ## Further Reading - [American Veterinary Medical Association: First Aid Tips for Pet Owners](https://www.avma.org/resources-tools/pet-owners/emergencycare/first-aid-tips-pet-owners) - [Merck Veterinary Manual: Horse Owners](https://www.merckvetmanual.com/horse-owners)