An ethogram is a series of behaviours each with strict definitions. The Ridden Horse Pain Ethogram (RHpE) comprises 24 behaviours, the majority of which are at least 10 times more likely to be seen in horses with musculoskeletal pain compared with non-lame horses. The display of ≥ 8 behaviours of the RHpE is highly likely to reflect the presence of musculoskeletal pain, although some lame horses score < 8. The median score for non-lame horses has ranged from 2 to 3 in a variety of studies. Diagnostic anaesthesia which abolishes lameness results in an immediate substantial reduction in the RHpE score. Persistence of ≥ 8 behaviours is likely to reflect an additional problem, such as a poorly fitting saddle. The RHpE can be uses to assist in recognising pain-related poor performance and at pre-purchase examinations. Correct application of the RHpE, like any clinical tool, requires appropriate training and practice.