The Hyoid and First Rib Connection

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Before we get started, let’s establish some basics. What is the hyoid?  The hyoid apparatus is a collection of bones and muscles in the horse’s head and controls the balance, coordination, and movement of your horse. It’s suspended from the temporal bones, which are located just under the horse’s ears, and you can actually feel the horse’s hyoid in the soft hollow in the horse’s mandible.

Many people talk about the hyoid as the cause of an issue. The equine industry has established that the hyoid is connected not only directly to the tongue, forelimb, and poll but also indirectly to the hindquarter. Therefore, a restriction, pain or any dysfunction in the hyoid may have a direct impact on the mobility of the horse, leading to a shortened or stilted gait.

However, looking at this from a holistic perspective, it is also important to consider what else the hyoid is affected by. The prominent first rib misalignment, as we talk about so often here at Holistic Horseworks, will not only impact the front end of the horse but also bacl to the hind end and even all the way up to the hyoid. And so our vicious cycle ofimbalance and misalignment continues in a never ending feedback loop.

To understand how the hyoid works together with the rest of the body so that it can all be brought back into balance, let’s take a closer look at the three important connections.

The sternohyoid muscle is the first connection: it connects the horse’s tongue & mouth to the chest of the horse. From here the fascia connections and muscular connections carry through the pectoral muscles along the lower inside of the horse, together with the abdominal muscles, and into the pelvis. This is often referred to as the bottom connection of the horse.

The omohyoid muscle is the second connection: it connects to the shoulder joint, linking into the fascial connection that runs from the head, along the lower inside of the neck, middle of the shoulder, and all the way to the toe on the hindlimb.

The occipitohyoid muscle is the third connection: it connects the hyoid to the poll, creating a direct connection from the shoulder through the hyoid to the poll, and from there through the nuchal ligament, the dorsal muscular connection. Back to the hindquarters. This is commonly known as the top line of the horse.

At Holistic Horseworks, all of our students understand the impact of the first rib on the totality of the horse, and with Equine Musculoskeletal Unwinding we learn how to release the first rib. With all of this information, we can also understand the impact of a misaligned first rib on the hyoid, its connection, and linkages.

When a misaligned first rib impedes the movement of the shoulder and through the second connection the omohyoid, then it also extends to affect all three connections including the sternohyoid and the occipitohyoid. 

It is important to take a holistic view to treat the entire body as it is all interconnected from the hind to the front and tongue through the top line and the bottom line and all those all so intricate connections.

In Holistic Horseworks classes from level 1 all the way through to level 3 we teach our students how to address all aspects impacting on the Hyoid. And ultimately your horse’s ability to perform at its best and in total comfort with joy and ease up into its 30’s. A horse should not need joint injections or be retired early if everything in the horse’s body is working correctly and efficiently. We invite you to join us in learning all about this at our next hands-on horse bodywork clinic. 



Holistic Horseworks has a team of global instructors who teach hands-on horse bodywork clinics all over the world! Head on over to our schedule page to see the Level 1: Equine Musculoskeletal Unwinding, Level 2: Cranio Sacral Unwinding and Advanced Applied Kinesiology, and Level 3: Equine Cranial Decompression clinics coming soon.  

Author and Holistic Horseworks Instructor
Marisa Levitt
Magic Hands Horseworks

Horse rider since childhood. Had a break from horses. When I came back to horses in 2013, I bought a little mare that was in trouble. She stole my heart. She is the reason I went down the equine practitioner path. Once I was introduced to the Holistic Horseworks Level one workshop there was no stopping. I went on to qualify in the human side of things too as I soon realised through my own experience that the rider and the horse can impact the balance of each other.

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