|Summary The Ridden Horse Pain Ethogram (RHpE) comprises 24 behaviours, the majority of which are at least 10 times more likely to be seen in lame horses compared with non-lame horses. The observation of >=8/24 behaviours is likely to reflect the presence of musculoskeletal pain, although some lame horses score <8/24 behaviours. A marked reduction in RHpE scores after resolution of lameness using diagnostic anaesthesia proves a causal relationship between pain and RHpE scores. Horses should be assessed for approximately 10?min in walk, trot (including 10?m diameter circles), canter and transitions. The validity of the RHpE has been verified for use in horses which perform dressage-type movements, and which have been trained to work with the front of the head in a vertical position. It has not, as yet, been used in horses while jumping, racehorses, western performance or endurance horses. The RHpE provides a valuable tool for riders, trainers, veterinarians and other equine professionals to recognise the presence of musculoskeletal pain, even if overt lameness cannot be recognised. Riders with a higher skill-level may improve gait quality, but cannot obscure behavioural signs of pain, although specific behaviours may change. Tight saddle tree points, the rider sitting on the caudal third of the saddle and rider weight may influence RHpE scores. Accurate application of the RHpE requires training and practice. The RHpE is a powerful tool for the assessment of ridden horses and the identification of likely musculoskeletal pain. Such pain merits further investigation and treatment, to improve equine welfare and performance. The RHpE provides an additional means of evaluating the response to diagnostic anaesthesia. It provides a mechanism for client education and a diplomatic way of communicating with clients about equine discomfort related to saddle-fit, rider size, their position in the saddle and ability to ride in balance.