Equines depend on normal cervical motion to aid in locomotion, balance, gait efficiency, respiration and to adjust load on the limbs. Cervical pain in horses, therefore, is associated with changes in gait and decreased performance. Presenting signs may include: resistance to turning, lameness not localized to the distal limb, poor performance, abnormal gait, loss of power, incoordination and ataxia. While there have been an increasing number of studies on the equine neck, none have addressed changes in muscle mass or range of motion with cervical pain. Studies in humans have looked at these parameters and demonstrated that neck pain alters neuromuscular control and decreases muscle mass and range of motion. These changes leave the spine vulnerable to injury. Treatments include anti-inflammatory drugs, facet injection, acupuncture and targeted exercise. This review will explore normal cervical movement and function in the equine, the effect of neck pain on range of motion, muscle mass, neuromuscular control and treatment of cervical pain.