The work is the first comprehensive analysis of equine pathological changes from the Polish territory. The research material was collected from 20 archaeological sites, mainly early medieval settlements, such as strongholds, settlements, towns and horse graves. In the material examined, 186 cases of lesions were found. Of these, 26.9% were lesions of the spine, 39.8% lesions of the limb skeleton and 31.7% lesions of the head including dental pathologies. Most of the lesions in the limbs involved their distal segments. The vast majority of pathological cases can be linked to animal use. It was found that horses in which pathological lesions were observed were used under cover. In one case, the observed cranial trauma was the cause of death associated with injury to the nasal auricles and large vessels and consequent blood loss and possible shock. It was found that, in some of the cases, the horses started to be used early which affected their organs of motion and spine.