While the horse may seem to have been specifically made to carry us on his back, in reality we’re only there by chance.

The horse’s back is actually quite susceptible to injury, especially when we ask him to gallop, jump, collect and extend with the added weight of a rider and tack.

Consequently, the horse may suffer many types of back injuries, including repetitive injuries that can hinder a horse’s ability to perform. Richard D. Mitchell, DVM, of Fairfield Equine Associates, Newtown, Conn., works with performance horses and treats a variety of back problems.

“We see injuries in all breeds of horses, but often see more serious problems in horses that jump or do upper level dressage,” he said. “These injuries can occur in many disciplines, however, especially in horses that work off their hindquarters.”

A horse may exhibit back pain in a number of ways, including soreness when being groomed, resentment of the saddle, resistance to being saddled (cold backed), resentment of rider weight, irritability, bucking, not wanting to perform, continually changing leads, bulging out one way or the other rather than traveling straight, and so on.

Once a horse is recognized as having pain, the next step is to try to determine the origin of pain.

“Is this a lower limb problem that’s producing upper limb symptoms because of abnormal muscle use? Or is this a problem of primary nature in the back, such as muscle strain, strain of the sacroiliac joint and ligaments, strain of the superspinous ligament, facette or joint arthritis in the lumbar spine? All of these problems are fairly common. It could also stem from injury to the hip joint or some kind of trauma to the pelvis,” said Mitchell.

The horse owner and veterinarian should also consider the fact that low back pain can be a by-product of pain elsewhere in the horse’s leg.

“It was long thought by many people that most back problems were a by-product of lower limb pain,” said Mitchell. “I don’t believe this is true; there are plenty of problems that originate in the back itself. Some lower limb problems don’t produce back pain. It can go both ways, however.

You can also see lamenesses that appear to be unilateral [affecting just one limb] that are a product of a back abnormality. There’s a lot to sort out in diagnosing the root of the problem,” he explained.

So, What’s The Problem?

Diagnosing a back problem often takes a complete physical examination. At the start, it’s important to stand off and look at the horse and its overall symmetry–from front, rear and side views, and even a look down its spine from a slightly higher vantage point.

“When I initially look at the horse I also do a modified acupuncture examination. I go over it very thoroughly, palpating some specific areas that can give a clue as to potential areas for soreness,” said Mitchell. “Whether you believe in acupuncture or not, the palpation pattern that we use for evaluating these horses gives us a good insight into myofascial relationships [involving the fascia surrounding the muscle tissue]. If certain muscles are sore, it may be because the horse is carrying itself in a particular way.”

Muscular pain in the low back can be due to strain or irritation of the gluteal muscle. This long muscle starts at the last rib-bearing thoracic vertebra and goes all the way back over the horse’s croup to the top part of the femur, near where it attaches to the pelvis. This long “rump” muscle starts far forward, in front of the loin. Other muscles that can be strained include lumbar muscles and those on top of the spine. And sometimes they become sore from activity or due to poor saddle fit.

“It’s very common to see horses get sore gluteal muscles when they have a sore hock or chronic high suspensory problem,” said Mitchell. “You may also see this when a horse has a chronic sore stifle. Occasionally, a horse will be lame enough, long enough, that when you block the affected hock or suspensory the lameness improves greatly, but the nerve block doesn’t totally eliminate the lameness because there’s still significant muscle soreness in the back,” he said.

He also checks the horse’s neck mobility by doing “carrot stretches” and other similar tests. “It’s important to check the neck. In warmblood horses that do dressage and jumping, neck problems are very common. We see what the horse is capable of, and where it might not want to move or turn, etc., before we go ahead with a typical lameness examination,” he noted.

Sometimes the obvious areas of pain are not the true problem, but they can give an insight into the posture of the horse, how it carries itself, and how it’s working.

“How the horse interacts with the rider or trainer is important,” he added. “The veterinarian needs to listen to what the rider or trainer has to say about how the horse is working, and what they perceive to be difficulties in working with the horse–saddle fit, head carriage, whether or not it can engage its hind end and work from underneath itself, or if it’s strung out with a hollow back all the time.”

Mitchell also checks the horse’s teeth and history of dental care. If the horse has problems with the jaw or tossing his head, that may be a clue too. In addition, he asks about the horse’s shoeing routine and any recent lamenesses.

After examining the body and checking symmetry, Mitchell watches the horse move while being led at walk and trot. Then he does flexion tests on all the limbs to determine if there are issues there that might contribute to back pain. He then longes the horse on normal ring footing and then on firm footing (like a paved surface) to see if there are changes in the horse’s gaits.

“After gathering all of this information, we may have decided there’s a limb lameness associated with what’s perceived to be back pain,” he said. “In that instance we pursue further diagnostics with nerve blocks, radiographs, ultrasound, and so on.”

Mitchell also watches the horse while being ridden. Many lamenesses, particularly back related lamenesses, go undiagnosed because the examining veterinarian doesn’t put a rider on the horse.

“You have to do that, to be complete in the examination, unless the horse is unsafe to ride. In certain cases the horse may be unsafe to ride, not because of a neurological problem that impairs function, but because being ridden is painful and the horse may resist,” he said.

Once he sees the horse move, Mitchell may have a good indication of the problem. If he can’t determine there’s significant evidence of limb pain, or has enough information to tell him the problem is actually in the back, he may proceed to radiographic or ultrasonicgraphic evaluation of the neck and back or bone scan (nuclear scintigraphy).

The bottom line is that you have to look everywhere; back pain is often not simply back pain.

“Nuclear scintigraphy can guide us more specifically and let us know we need to radiograph a certain area–perhaps the withers or the neck. You can radiograph or ultrasound the problem area and see if it fits the pattern of the lameness you’re seeing. You may find an unusual looking sacroiliac on the bone scan, which would make you inclined to spend some time doing ultrasound on the pelvis,” he explained. “The bone scan is a great tool to guide you in the right direction and we use it frequently when we have somewhat obscure back issues.”

Treatment Options

The type of treatment used will depend in part on the nature of the injury. If it’s a muscle or ligament strain it may be treated differently than an arthritic condition with bony changes or erosive changes.

“Many modalities are being used in treatment. Things as simple as nonsteroidal anti-inflammatory drugs like Naproxen may help. Naproxen, given at about 4 grams per day to the average size show horse is fairly effective at helping control back pain. That, sometimes given in conjunction with methocarbamol–a muscle relaxant with minimal potency–may be very beneficial in relieving pain,” he said.

Some problems are easier to treat than others. “You’re not going to cure a degenerative arthritis with chiropractic methods or any of these other therapies by themselves,” Mitchell noted. “If we identify that a horse has significant degenerative arthritis in facette joints in the neck or back, these need to be addressed just like any other arthritic joints: relieve the pain and try to increase motion and mobility. We try to get these horses comfortable and working again, so they can function in such a way that they can maintain the mobility of these joints.

“Typically, with cervical [neck] facettes or the lumbar facettes we inject the joints with corticosteroids, under ultrasonagraphic guidance to put the medication directly into the joint. This will relieve the inflammation. Then we get the horse on a program of exercise to encourage better carriage of the body. This may mean a period of time with no rider, or a period of time with a lighter rider and doing different exercises,” he said.

Mitchell said sacroiliac strains sometimes require time off depending on the severity. “If a horse is quite lame with a fairly recent sacroiliac injury we may treat it with an intra- articular injection in the sacroiliac joint, but there may be enough trauma and inflammation in the surrounding ligaments that the horse needs some time to rest and let these structures heal. You may be looking at 30 to 90 days in which the horse needs a break from work,” he said.

In some instances, injections are also given between the spinous processes when there is impingement (kissing spines) and bony proliferative change between the vertebrae. “We can inject locally between the affected vertebrae to relieve inflammation and soreness, to try to improve the horse’s mobility and get him to raise his back, if he can. Until you relieve the pain, it feels like he has a knife in his back all the time,” said Mitchell.

There’s some question as to whether agents like Adequan® or Legend® might benefit back pain. “We don’t really know, but if these products are effective for arthritis in the limbs, they should also be effective for arthritis in the neck or back,” he said.

Many people believe extracorporeal shockwave therapy is effective in treating back pain too. Mitchell believes this treatment is worth trying in chronic, recurrent pain after a diagnosis has been established.

Pasture turnout or controlled turnout may be useful, but depending on the diagnosis, the horse may do more harm by running around. Some horses with milder strains are better off kept in light work to prevent later injuries from over exuberance. Turnout should be considered on an individual basis, and the owner or trainer needs to discuss this with the veterinarian.

Immediate pain or soreness from an accident or trauma can be relieved with ice packs applied soon after the injury. If you can reduce the inflammation with cold therapy and anti-inflammatory drugs like Banamine®, bute or ketoprofen, this can help.

“Ketoprofen is a wonderful drug for immediate back pain, such as acute spasm or injury–as when a horse has a fall, or his hind legs slip out behind him, or he has an awkward jumping round. A muscle relaxant such as methocarbamol or a tranquilizer–even acepromazine–might be of some benefit to bring about generalized relaxation. Take it easy with that horse for a little while so the tissues can begin to heal,” he said.

Many horses continue to compete, in spite of sacroiliac problems. They periodically need treatment, but it would be nice if we could let a lot of these horses have some time off; they might, in fact, have a chance to heal more completely and get over the injuries they’ve done to the back–such as damage to the ligaments that support the joint.

“Some horses are predisposed to sacroiliac problems because of their conformation, how they jump, or how they are ridden. So you will not eliminate all the problems just by giving them a rest period,” he explained.

Mesotherapy For Pain Relief

One technique Richard Mitchell, DVM, has been using for several years is called mesotherapy. It involves intradermal injections of corticosteroids and anesthetics, in very small doses, in a multitude of spots along the back. The combination of corticosteroids and anesthetic rapidly reduces sensitivity in these areas and seems to break the pain cycle–the pain reflex. Horses treated with this technique become comfortable quickly.

“I think it’s very useful, but you also need to treat the primary problem,” said Mitchell.

“Does the horse just have muscle soreness and strain? If so, you can merely do mesotherapy and relieve it. But if he has muscle strain or muscle tension that’s secondary to arthritis in his back, you’d better treat the arthritic spot in his back at the same time. [The same] if it’s an arthritic hock or stifle, or let him rest to recover from a chronic suspensory problem. Don’t forget that you have to put the whole puzzle together to deal with the whole picture.”

Back To Management

Sometimes alleviating a horse’s back pain is as simple as changing the horse’s training regimen or his management.

“Saddle fit is important but won’t solve a problem that’s of an [underlying pathologic] nature,” said Richard Mitchell, DVM. “Doing exercises that will strengthen the horse’s abdominal muscles [long and low types of work], getting the neck down and a little bit flexed, will raise the back, rather than hollow it.

“The rider should ask the horse to come forward from behind, work over cavaletti poles on the ground and ask him to extend through them,” he explained. “If the horse raises his back, it separates the spinous processes, and if you separate those, there’s less discomfort related to any potentially impinging spinous processes.”

There are also some physical therapy tools such as magnetic blankets, heat wraps and heat blankets, massage and chiropractic therapy that help the horse. These therapies alleviate muscular soreness and chronic ligament soreness. They also help loosen tight muscles, allowing the horse to feel better.

“If a horse has recurrent and consistent back pain, you may also want to check for gastric ulcers,” added Mitchell. “This should not be ignored in performance horses. Ulcers can mimic or cause back pain.”

If a horse has recurrent back pain you need to look at other possible causes as well. Look at the muscle physiology and make sure there’s not a problem with polysaccharide storage myopothy, for instance. Make sure the horse is on a proper level of vitamin E and selenium, since this can be a problem in some regions. Good nutrition is vital to muscle health.

“A good regular training schedule is important, with adequate warm up rather than taking the horse out and thrusting him right into work. The horse needs to warm up, especially if he’s had chronic problems,” said Mitchell.