What To Do If Your Horse Is Down and Cannot Get Up

By Dr Duncan Houston

A horse lying down is not automatically an emergency.

A horse that cannot get up is.

That difference matters. Healthy horses do lie down to rest and enter REM sleep. They usually do this in short sessions, often at night, and then rise again normally. But when a horse stays down, struggles repeatedly, becomes trapped, cannot coordinate the limbs, or is too weak or painful to stand, the situation can become dangerous quickly.

A recumbent horse is one of the hardest emergencies in equine practice. The original cause may be colic, trauma, fracture, laminitis, neurological disease, exhaustion, dehydration, muscle disease, foaling complications, toxic disease, or entrapment. But once the horse is down for a prolonged period, the recumbency itself starts creating new problems: muscle damage, pressure injury, breathing compromise, dehydration, electrolyte changes, kidney stress, and injury from repeated struggling.

The safest mindset is simple: if your horse is down and cannot rise normally, call your vet immediately.

Quick Answer

If your horse is lying down and cannot get up, treat it as an emergency. Healthy adult horses usually lie down in short rest periods, but a horse that remains down, struggles, is trapped, is weak, painful, breathing abnormally, sweating, colicking, or unable to stand needs urgent veterinary assessment. Do not try to drag the horse by the head, neck, tail, or limbs. Keep the area quiet and safe, check whether the horse is trapped, take photos or video if safe, and call your vet or emergency rescue support. Horses can injure themselves and rescuers during attempts to rise, so lifting or rolling should be planned carefully. (Chaire bien-être animal)

Is It Normal for Horses To Lie Down?

Yes. Horses lie down as part of normal rest and sleep.

Horses can do some rest and slow-wave sleep while standing because of the stay apparatus, but they need to lie down for REM sleep. UC Davis notes that horses sleep in short periods across the day, can do slow-wave sleep standing, and usually need about 20 to 30 minutes of REM sleep within a 24-hour period, which requires lying down. (compneuro.vetmed.ucdavis.edu)

Normal recumbency is usually short and broken into sessions, not one long stretch. Chaire Bien-être animal reports that horses usually spend an estimated 30 minutes to 2 hours lying down across 24 hours, but they generally do not stay still for long, with an average uninterrupted lying period of around 20 minutes. (Chaire bien-être animal)

So the concern is not simply “my horse is lying down.”

The concern is:

• The horse cannot rise.

• The horse tries and fails.

• The horse is trapped or cast.

• The horse is sweating, painful, weak, or distressed.

• The horse has been down far longer than normal.

• The horse rises but immediately collapses again.

• The horse is lying in an abnormal posture.

• The horse is breathing abnormally or looks systemically unwell.

That is when this becomes a veterinary emergency.

What Is a Recumbent Horse?

A recumbent horse is a horse lying down. Clinically, the concern is usually a horse that is unable or unwilling to rise.

There are two main positions:

Position	What it looks like	Why it matters
Sternal recumbency	Horse lies on the chest or sternum, legs tucked or partly tucked	Usually safer than lateral recumbency because breathing and circulation are generally less compromised
Lateral recumbency	Horse lies flat on the side	More concerning if prolonged because the horse’s body weight can compress muscles, lungs, nerves, and internal structures

A horse that is resting quietly in sternal recumbency and rises normally when approached is very different from a horse lying flat, sweating, unable to coordinate the legs, or repeatedly thrashing.

Why Prolonged Recumbency Is Dangerous

The original disease or injury may put the horse down.

Then being down makes the horse worse.

Prolonged recumbency can cause:

• Muscle compression

• Reduced blood flow to large muscle groups

• Muscle damage

• Nerve compression

• Pressure sores

• Poor lung expansion

• Dehydration

• Electrolyte imbalance

• Myoglobin release from damaged muscle

• Kidney stress or acute kidney injury

• Hyperkalemia in severe muscle damage

• Exhaustion from repeated attempts to rise

• Secondary trauma from struggling

A review chapter on the recumbent horse describes these cases as one of the greatest challenges faced by equine veterinarians and notes that many disease processes can result in recumbency, including neurological disease, neuromuscular disease such as botulism, systemic disease such as severe sepsis, muscular disease such as rhabdomyolysis, and musculoskeletal disease such as laminitis. (Illinois Experts)

The longer the horse is down, the more the emergency becomes about both the cause and the consequences.

What Happens to the Muscles?

Large horses place enormous pressure on the muscles underneath them when they are down.

That pressure can reduce blood flow, reduce oxygen delivery, and damage muscle cells. When muscle cells are damaged, they can release enzymes and pigments into the bloodstream, including CK, AST, potassium, and myoglobin.

Myoglobin is especially important because it can damage the kidneys, particularly if the horse is dehydrated. Merck Veterinary Manual notes that severe rhabdomyolysis can lead to renal compromise because of ischemia, myoglobinuria, dehydration, and other factors, and that horses with myoglobinuria need aggressive fluid support and monitoring of kidney values. (Merck Veterinary Manual)

This is why a down horse may need bloodwork even after standing.

The horse may be upright, but the damage from being down can continue.

What Happens to the Lungs?

When a horse is down for too long, especially flat on one side, the lower lung can be compressed. This can reduce ventilation, worsen oxygen exchange, and contribute to respiratory compromise.

Breathing difficulty becomes more concerning if the horse is:

• Lying flat on the side

• Obese or heavily muscled

• Colicking

• Bloated

• Weak from neurological disease

• Exhausted from repeated struggling

• Sedated

• Trapped in an awkward position

• Down on a slope, against a wall, or in a confined space

A horse that is down and breathing hard, flaring nostrils, sweating, or extending the neck needs urgent veterinary attention.

What Happens to the Heart and Electrolytes?

Severe muscle damage, dehydration, shock, kidney compromise, and acidosis can all disturb electrolytes.

Potassium is one of the major concerns. Potassium is mostly stored inside cells. When muscle cells are badly damaged, potassium can move into the bloodstream. High potassium can interfere with heart rhythm.

Not every recumbent horse develops dangerous hyperkalemia, but it is one reason bloodwork and monitoring matter in prolonged cases.

A down horse that is weak, collapsed, sweating, breathing abnormally, or has abnormal heart rhythm should be treated as critical.

How Long Is Too Long for a Horse To Be Down?

There is no single safe cutoff.

A horse trapped under a fence for 20 minutes may be an emergency.

A horse resting normally for 20 minutes may be fine.

A horse down for several hours, even if quiet, is concerning because pressure-related muscle, lung, nerve, and circulation problems become more likely. Chaire Bien-être animal notes that horses generally do not lie still for long because prolonged recumbency can compress organs and create circulatory, respiratory, and other disorders. (Chaire bien-être animal)

Use this practical rule:

If the horse does not rise normally, call the vet. Do not wait for an exact number of hours.

Timing helps judge risk, but the horse’s ability to rise matters more.

How Worried Should You Be?

Low Concern

This is more likely when:

• The horse is lying quietly.

• The horse is in a normal resting position.

• The horse is breathing normally.

• The horse is bright and aware.

• The horse rises normally when approached or encouraged.

• There is no sweating, distress, colic, lameness, weakness, or injury.

• The horse has not been down for an unusually long time.

Action: monitor. Lying down itself is normal. Make a note if the horse is lying down much more than usual, especially if they seem dull, painful, or reluctant to rise.

Moderate Concern

This is more likely when:

• The horse is lying down more than normal.

• The horse is slow to rise but can stand.

• The horse gets up but appears weak, stiff, or painful.

• The horse is mildly sweaty or dull.

• The horse has mild colic signs.

• The horse is older, arthritic, or recovering from illness.

• The horse has repeated short episodes of lying down and rising.

Action: call your vet for advice the same day. The horse may need examination, pain assessment, bloodwork, or management changes.

High Concern

This is more likely when:

• The horse tries to rise and fails.

• The horse is cast against a wall or fence.

• The horse is trapped.

• The horse is sweating, trembling, colicking, or distressed.

• The horse is breathing hard.

• The horse is severely lame after rising.

• The horse lies down again soon after standing.

• The horse has been down longer than a normal rest period.

• The horse is weak, wobbly, or uncoordinated.

Action: call your vet urgently. Keep the area quiet and safe. Do not attempt a dangerous rescue alone.

Critical

Treat this as an emergency if:

• The horse cannot rise.

• The horse is recumbent for a prolonged period.

• The horse is flat out and weak.

• The horse is thrashing or repeatedly struggling.

• The horse is trapped under fencing, in a ditch, trailer, stall, or ravine.

• The horse has severe colic signs.

• The horse has severe laminitis or cannot bear weight.

• The horse has neurological signs.

• The horse has difficulty breathing.

• The horse has dark urine.

• The horse has a suspected fracture.

• The horse collapses again after standing.

Action: call your vet immediately and request emergency support. If entrapment or lifting is needed, technical rescue assistance may be required.

When Is This an Emergency?

A horse that is down and cannot get up is an emergency.

Call your vet immediately if your horse:

• Cannot rise

• Tries to rise and fails

• Is trapped or cast

• Is sweating, painful, or distressed

• Has colic signs

• Is breathing abnormally

• Is weak, wobbly, or ataxic

• Is severely lame

• Has a suspected fracture

• Has laminitis and cannot stand comfortably

• Has dark urine

• Has severe muscle stiffness

• Has fever, depression, or signs of sepsis

• Has been down for longer than normal rest

• Gets up but collapses again

Do not wait to “see if they get up later.”

If the horse cannot rise normally, the emergency has already started.

What Causes a Horse To Become Recumbent?

There are many possible causes, and several are serious.

Colic

Severe abdominal pain can cause a horse to lie down, roll, or become exhausted. A colic horse may lie down repeatedly, look at the flank, paw, sweat, roll, or stop passing manure.

A severe colic horse that becomes recumbent needs urgent veterinary care.

Trauma or Fracture

A horse may be unable to rise after:

• A fall

• Kick

• Collision

• Trailer accident

• Pelvic fracture

• Limb fracture

• Spinal trauma

• Tendon or ligament rupture

If fracture or spinal injury is possible, do not force the horse up.

Severe Laminitis

Laminitis can make standing extremely painful. Some horses lie down to take pressure off the feet and may be reluctant or unable to rise.

A laminitic horse that cannot stand comfortably is an emergency.

Neurological Disease

Neurological problems can cause weakness, poor coordination, collapse, or inability to rise.

Possible causes include:

• EPM

• Cervical vertebral compressive myelopathy

• Trauma

• Botulism

• Viral neurological disease

• Toxic disease

• Severe metabolic disturbance

The recumbent horse chapter from Illinois notes that neurological and neuromuscular diseases are common causes of prolonged recumbency, including botulism. (Illinois Experts)

Exhaustion, Dehydration and Electrolyte Imbalance

Hot weather, prolonged struggling, endurance events, colic, transport stress, or severe illness can leave a horse too weak to rise.

DVM360 notes that dehydration and electrolyte imbalance can cause profound muscle weakness and make a horse unable to stand, and that fluid and electrolyte correction may need to begin while a rescue plan is being developed. (dvm360)

Muscle Disease or Rhabdomyolysis

Severe muscle disease can make a horse stiff, painful, weak, or recumbent.

Possible signs include:

• Firm painful muscles

• Sweating

• Reluctance to move

• Dark urine

• High CK and AST on bloodwork

• Weakness or collapse

Merck notes that severe exertional rhabdomyolysis can range to muscle necrosis with recumbency and myoglobinuric renal failure. (Merck Veterinary Manual)

Entrapment or Casting

A horse may be physically unable to rise because they are:

• Cast against a stall wall

• Stuck under fencing

• Trapped in a trailer

• Down in a ditch

• Stuck in mud

• Stranded on a slope

• Wedged in a confined space

Emergency rescue literature notes that entrapped or recumbent horses can injure themselves struggling to rise, and rescuers can also be injured if rescue is not planned carefully. (MDPI)

Foaling or Reproductive Emergencies

A mare may become recumbent because of:

• Dystocia

• Uterine rupture

• Severe haemorrhage

• Metabolic collapse

• Exhaustion after foaling

• Postpartum colic

• Hypocalcemia in some cases

These are urgent.

Systemic Illness or Sepsis

A very sick horse may be too weak to stand. Severe infection, endotoxemia, pneumonia, diarrhoea, or shock can all cause collapse.

What Else Can Look Like a Recumbency Emergency?

Some situations are less dangerous, but still need attention if abnormal.

Normal Sleep

A resting horse may lie quietly and rise normally. They should be bright, breathing normally, and not distressed.

REM Sleep Deprivation Collapse

Some horses collapse because they are sleep deprived and enter REM sleep while standing. UC Davis notes that sleep deprivation is often confused with narcolepsy and occurs when horses do not get adequate recumbent sleep. (compneuro.vetmed.ucdavis.edu)

These horses may be found with abrasions on the knees, fetlocks, or face from collapsing, but they may appear normal between episodes.

Narcolepsy

Rare true narcolepsy can cause sudden sleep attacks or collapse, but sleep deprivation must be ruled out first.

Painful Rising in Older Horses

Older horses with arthritis may lie down and struggle to rise, especially on slippery or hard surfaces. This is still important because repeated difficulty rising can become an emergency.

Sedation or Anaesthesia Recovery

Horses recovering from sedation or anaesthesia may be recumbent temporarily. This should be monitored by veterinary professionals.

What Should You Do Right Now?

1. Call Your Vet Immediately

If the horse cannot rise, call your vet before trying anything risky.

Tell them:

• How long the horse has been down

• Whether the horse is trapped

• Whether the horse has tried to rise

• Whether they are sweating, colicking, or breathing abnormally

• Whether there was trauma

• Whether the horse can move all limbs

• Whether there is dark urine

• Whether the horse has known laminitis, neurological disease, colic, or injury

2. Stay Safe

A down horse can kick, thrash, roll, or lunge forward suddenly.

Do not stand near the legs.

Do not sit near the head.

Do not put yourself between the horse and a wall, fence, trailer side, or gate.

3. Check Whether the Horse Is Trapped

Look for:

• Legs under a fence

• Halter caught

• Foot trapped in a gate

• Horse cast against a wall

• Horse wedged in a trailer

• Horse down in mud, ditch, or slope

• Head or neck trapped under an object

Only free the horse if it is safe to do so. If the horse is trapped in a dangerous way, you may need firefighters, technical rescue, experienced equine handlers, or veterinary guidance.

4. Keep the Area Quiet

Reduce noise, dogs, crowds, shouting, and unnecessary movement.

A panicked horse wastes energy and may injure themselves.

5. Provide Shade and Soft Ground if Possible

If safe, protect the horse from heat, sun, cold, rain, or hard surfaces. Do not attempt major movement without a plan.

6. Take Photos or Video

If safe, take a short video for your vet showing:

• The horse’s position

• Breathing

• limb placement

• Attempts to rise

• Any obvious injury

• The surrounding area

This can help your vet advise before arrival.

7. Do Not Pull on the Head, Neck, Tail, or Limbs

Emergency rescue literature warns that secondary injury can occur from struggling and from attempted rescue by pulling on the head or limbs. (MDPI)

Improvised pulling can cause catastrophic injury to the horse and serious injury to people.

8. Do Not Force Repeated Attempts To Stand

A horse that keeps failing to rise becomes exhausted and may worsen muscle damage.

Your vet may decide the horse needs fluids, pain relief, sedation, repositioning, lifting equipment, rescue straps, or referral.

How Vets Assess a Recumbent Horse

A recumbent horse exam is difficult, but the priorities are clear.

Your vet may assess:

• Heart rate

• Respiratory rate

• Temperature

• Mucous membrane colour

• Hydration

• Gut sounds

• Pain level

• Limb movement

• Neurological status

• Signs of fracture

• Signs of colic

• Signs of laminitis

• Muscle pain or swelling

• Bloodwork

• Electrolytes

• Kidney values

• CK and AST muscle enzymes

• Lactate

• Urine colour

• ECG in selected cases

• Ultrasound or radiographs where possible

DVM360 emphasises that even when examination is difficult, physical examination is the first and most important starting point in a down horse rescue, and correction of dehydration and electrolyte loss may need to begin while the rescue plan is being formulated. (dvm360)

Treatment: What Happens Next?

Treatment depends on the cause and whether the horse can safely stand.

Possible interventions include:

• Pain relief

• Sedation if needed for safety

• IV fluids

• Electrolyte correction

• Dextrose or energy support in selected cases

• Treatment for colic

• Treatment for laminitis

• Treatment for neurological disease

• Treatment for rhabdomyolysis

• Oxygen support where available

• Antibiotics if infection is suspected

• Bloodwork monitoring

• Urinary catheterisation in selected cases

• Repositioning

• Assisted rolling from lateral to sternal

• Hoisting or sling support

• Referral to an equine hospital

• Euthanasia in severe, nonrecoverable cases

A recumbent horse chapter notes that care may need to continue 24 hours per day and potentially for days to weeks depending on the cause. (Illinois Experts)

That is why prolonged recumbency is so challenging. Standing the horse up is only one part of the case.

When Is Lifting or Slinging Needed?

Lifting may be considered when the horse:

• Wants to rise but cannot

• Is physically trapped

• Can bear weight once standing

• Needs repositioning

• Is at risk from prolonged pressure

• Is otherwise stable enough for an attempt

Rescue techniques may include:

• Rolling the horse from lateral to sternal recumbency

• Dragging or sliding only with proper equipment

• Assisting the front or hind end

• Vertical lift with suitable straps or slings

• Full-body sling support

• Technical rescue using trained personnel

The MDPI equine rescue paper describes methods for rolling, dragging, and vertical lifting recumbent horses using strap systems, and emphasises that rescue must reduce injury to both the horse and rescuers. (MDPI)

This is not a job for random ropes and five people pulling in different directions.

What Should Not Be Done?

Avoid these common mistakes:

• Do not wait hours before calling the vet.

• Do not assume the horse is just sleeping if they cannot rise.

• Do not drag the horse by the head, neck, tail, or limbs.

• Do not force repeated attempts to stand.

• Do not stand near the legs of a struggling horse.

• Do not crowd the horse with people.

• Do not give human medication.

• Do not give oral fluids or feed to a weak horse that may choke.

• Do not trailer a horse that cannot stand safely unless directed by a vet and rescue team.

• Do not roll or lift without a plan if fracture, spinal injury, or severe colic is possible.

• Do not ignore a horse that stands after prolonged recumbency. They may still need bloodwork and monitoring.

The biggest mistake is treating the moment the horse stands as the end of the emergency. Sometimes it is only the start of the monitoring phase.

What Happens After the Horse Stands?

If the horse gets up, they still need close monitoring.

Watch for:

• Repeated collapse

• Weakness

• Staggering

• Severe lameness

• Dark urine

• Muscle swelling or pain

• Rapid breathing

• Sweating

• Colic signs

• Depression

• Reduced appetite

• Reduced manure or urine

• Fever

• Pressure sores

• Limb swelling

Your vet may recommend bloodwork to check:

• CK

• AST

• Creatinine

• BUN

• Electrolytes

• Lactate

• Hydration status

• Myoglobinuria

• Acid-base status if available

A horse that was down long enough to damage muscle may look better standing but still be at risk of kidney and electrolyte complications.

Prevention: Reducing Recumbency Risk

You cannot prevent every down-horse emergency, but you can reduce risk.

Practical steps include:

• Provide safe fencing.

• Remove wire hazards.

• Avoid narrow gaps where horses can become trapped.

• Use safe stall design with enough space to rise.

• Use adequate bedding for older or arthritic horses.

• Monitor horses with severe arthritis, laminitis, neurological disease, or previous difficulty rising.

• Treat colic signs early.

• Manage laminitis aggressively.

• Maintain regular farrier care.

• Provide turnout surfaces with good traction.

• Avoid deep mud and unsafe slopes.

• Use safe trailer loading and transport practices.

• Monitor foaling mares closely.

• Support hydration and electrolytes in hot weather and endurance work.

• Have an emergency plan for lifting or rescue.

• Know whether local fire or rescue services have large animal rescue capability.

If you own horses, especially seniors, laminitic horses, neurological horses, or horses with previous casting problems, plan before the emergency. The best time to find out who can help lift a horse is not while the horse is already down.

Common Mistakes Owners Make

Waiting Too Long

A horse that cannot rise should not be watched for several hours. Call early.

Assuming Calm Means Safe

A down horse may look calm because they are exhausted, weak, in shock, or too painful to struggle.

Pulling on the Wrong Structures

Dragging by the head, neck, tail, or limbs can injure the horse. Use trained rescue help.

Forgetting About People Safety

A struggling horse can seriously injure handlers. Safety is part of treatment.

Not Checking for Entrapment

A horse may be unable to rise because a leg, halter, rug, or body position is trapped.

Missing Laminitis or Colic

A horse lying down repeatedly or refusing to rise may be showing severe pain, not weakness.

Stopping Monitoring After the Horse Stands

Muscle damage, kidney stress, dehydration, and recurrence can still occur.

Myth vs Reality

Myth	Reality
Horses never lie down unless they are sick.	Healthy horses do lie down for rest and REM sleep.
If a horse is quiet while down, it is probably fine.	A quiet down horse may be exhausted, painful, weak, or systemically unwell.
You should pull a down horse up with ropes.	Improper pulling can injure the horse and rescuers. Rescue needs planning and correct equipment.
The danger only starts after many hours.	A trapped, painful, colicking, neurologic, or fractured horse is an emergency immediately.
Once the horse stands, the crisis is over.	The horse may still need monitoring for muscle damage, kidney stress, dehydration, and relapse.
Slings fix the problem.	Slings can help selected horses stand, but the underlying disease still needs diagnosis and treatment.

FAQs About Recumbent Horses

How long can a horse safely lie down?

There is no exact safe number. Healthy horses normally lie down in relatively short sessions and rise normally. A horse that cannot rise, is trapped, distressed, painful, breathing abnormally, or down much longer than normal should be treated as urgent. (Chaire bien-être animal)

Should I try to make my horse stand?

You can calmly encourage a normal resting horse to rise, but do not force repeated attempts if the horse fails, is trapped, is severely painful, or may have a fracture or neurological problem. Call your vet first.

Can a down horse recover?

Yes, some horses recover well, especially if the cause is treatable and they are assisted early. Prognosis depends on why the horse went down, how long they were down, whether they can bear weight, whether muscle and kidney damage occurred, and whether rescue can be performed safely.

What is the biggest danger in prolonged recumbency?

The major dangers are pressure-related muscle damage, breathing compromise, dehydration, electrolyte problems, kidney stress from muscle breakdown, and injuries from repeated struggling. Severe muscle damage can release myoglobin, which may contribute to kidney injury. (Merck Veterinary Manual)

When should I call the vet?

Call immediately if the horse cannot get up, tries and fails to rise, is trapped, has colic signs, is sweating, breathing abnormally, weak, neurologic, severely lame, or has been down longer than a normal rest period.

The Bottom Line

A horse lying down is normal.

A horse unable to get up is an emergency.

The danger is not only the original problem that put the horse down. Prolonged recumbency can create its own life-threatening complications, including muscle damage, breathing compromise, dehydration, electrolyte imbalance, kidney stress, and further injury from repeated struggling.

The safest approach is:

• Call your vet early.

• Keep people safe.

• Check whether the horse is trapped.

• Keep the area quiet.

• Do not drag by the head, neck, tail, or limbs.

• Do not force repeated failed attempts to rise.

• Use trained rescue help when lifting or rolling is needed.

• Monitor closely even after the horse stands.

With a down horse, time matters. But calm, organised action matters just as much.

The goal is not just to get the horse upright. The goal is to get the horse upright safely, diagnose why they went down, and prevent the complications that can follow.

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If your horse is down, struggling to rise, trapped, weak, colicking, or breathing abnormally, contact your local veterinarian or emergency service immediately. If you need help organising the signs, timing, photos, and key details while you wait for hands-on care, ASK A VET™ can help you prepare the right information quickly.