Clinical experience continues to expand our understanding of the pathophysiology of pain and injury within the carpal joints. The anatomical and physiological capacity of the equine carpus to neutralise loading stress plays a significant role in the prevention of carpal injury. The ability of joint surfaces to dissipate axial force by transfer to the interosseous ligaments is the principal means by which carpal injury is avoided. In the medial aspect of the intercarpal joint and the dorsal aspect of the radial carpal joint, however, the effects of chronic maximal stress and isolated acute supraphysiological loads cannot be neutralised. Progressive osseous remodelling and stress induced changes within the bone, which outstrip its ability to accommodate increasing loads, lead to the loss of structural integrity and fracture in horses in training.