Back problems in horses
By Doug Thal, DVM
Back problems have been recognized and poorly understood in horses for hundreds of
years. There continues to be lots of misconception in the horse world about the equine
back and back pain.
Back pain is poorly understood in human medicine. Equine back pain is even more
difficult to comprehend and diagnose. Start with an animal who can’t tell you where or
how it is experiencing pain. Then make that animal so large that you only have access to
the very “shallow” layers by touch and even with most x-ray and other diagnostic
equipment. Then introduce tack, a rider and the owner’s own interpretation of the
problem. All of these factors make back pain in horses a complicated and difficult
problem.
This article will be the first of two on back pain. Its purpose is to give the reader a very
brief introduction to the concepts and complexity of back pain in horses. I will start by
discussing the common signs of back pain. I will make a few basic points on back
anatomy and function, which then will lead to a very basic discussion on veterinary
diagnosis, tack fit, and treatment.
Common Signs of back pain
The signs of back pain are usually subtle and are often confused with those caused by
other problems, including behavior. Some horses are more sensitive to back pain than
others, or respond differently to it, and so show more obvious signs.

The most common sign associated with back pain is some reduction in
performance at whatever discipline the horse is involved in.

Behavioral problems such as rearing or bucking can relate to back pain.

In some cases, the rider’s main concern is apparent soreness to touch or
pressure on the back. Responses to back pressure and manipulation differ
among horses, Just because a horse reacts does not necessarily mean he has
significant back pain.

Horses with back pain may resist saddling or be difficult to shoe. Again, the
challenge here is to separate true soreness from primary behavioral problems.
Anatomy and Function
The most important thing to know about the anatomy of the back is that it is very
complicated. There are hundreds of joint surfaces and small stabilizing ligaments. There
are massive muscles which attach the spine to itself, to the skull and to the legs. There
are sheets of stabilizing, thick connective tissue surrounding the spine. Nerve roots exit
from the spinal cord through small spaces between and in the vertebrae.
Vertebrae have spines of bone that project upward or outward and to which the back
muscles attach. Only the very tips of these spines can be felt along the horse’s back.
The spinal cord is much deeper in the back than most horse people think.
The vertebrae (the individual back bones) are essentially cube-shaped bones separated
by joints. There are four distinct regions that each have uniquely shaped bones and
joints. In each region, unique vertebral design, joint design and support and muscle
attachment allows for more or less flexibility side to side, up and down and in rotation.
The basic form and function of the equine back is a critical piece in understanding back
pain and the causes and treatments for that pain. Sound back conformation is very
important for an animal that is expected to perform athletically with the weight of a rider
on its back
Diagnosis
Veterinary examination of the back is difficult because the muscles are so heavy and
thick that it is difficult to appreciate the deeper structures that might be involved. That
said, a thorough physical examination at rest and in movement is still the cornerstone of
diagnosis.

Muscles, ligaments and bones are palpated and evaluated for pain.

Joints are evaluated for range of motion.

Movement is evaluated both with and without a rider.

Tack fit is evaluated.
Additional diagnostics

Imaging the back with x-ray is difficult because of the inability to penetrate the
mass of tissue. The neck and withers are x-rayed routinely but the spine through
the trunk of the horse can only be imaged with the most powerful x-ray
equipment.

Ultrasound is used to visualize the soft tissues of the back. It too has limitations.
Ultrasound is not good at seeing deep structures and cannot penetrate through
bone.

Scintigraphy or bone scan is used to find inflamed areas in the back. It is costly
and only offered by a few clinics.

Practitioners of chiropractic and acupuncture use specific diagnostic techniques
to help define problem areas. There is controversy regarding the effectiveness of
these diagnostics in horses.
The causes of back pain
Generally, the causes of back pain can be broken down into primary and secondary
groups.
Primary back pain
Back pain can result from lesions of the skin, muscle, connective tissue, nerves, joints
and bones of the back. These are usually a result of traumatic injury. Poor tack fit can
contribute to or cause these problems. Rider technique can result in or worsen these
problems.
Different types of primary back problems affect horses of different types, from different
disciplines, and of different conformation.
Secondary back pain
Back soreness is often a result of, or “secondary to” underlying lameness. Hind limb
lameness (especially hock pain) is more frequently associated with back pain, but any
lameness can result in secondary back pain. The back and limbs are linked in function. If
one is not functioning properly, there will likely be consequences for the other.
Poor saddle and tack fit causes back soreness.
The idea of good saddle fit is that the force bearing surfaces of the saddle conform well
to the horse’s back, and that there are not focal areas of pressure. The saddle should be
level, front to back, and sit in such a position that it favors the free movement of the
horse and reduces discomfort. A saddle that fits right should put the rider in a position
where he or she is balanced, not thrown forward or backward. Imagine a photo of horse
and rider taken from the side. A good generality is that if the horse is removed from the
photo, and the rider’s feet were shown to touch the ground, the rider would be able to
balance.
Improperly adjusted or fitting bridles or bits can cause a horse to resist the bit, which
then indirectly causes the horse to flatten or hollow his back. This reduces the ability to
perform and can lead to secondary back soreness.
Treatment for back problems
Veterinary treatment for back problems involves diagnosing and treating primary
contributing factors like lameness, tack fit and riding technique. Veterinary treatments for
back pain depend on the specific nature of the injury and may involve combinations of
the use of anti-inflammatory drugs, direct injection of affected muscles, ligaments and
joint, therapeutic ultrasound, shock wave therapy, physical therapy, massage,
application of heat and cold, and many others, often used in combination.
Conventional western medicine does not have all the answers for back problems. As for
any medical problem for which there is not a satisfactory solution available, people will
try anything to find relief for themselves or their animals. Human patients and horse
owners alike resort to chiropractic, massage, acupuncture and many other “alternative
therapies” to try to deal with these often chronic, debilitating and frustrating problems.
The use of these techniques in horses is controversial.
The back will likely remain a mystery, even with technologic advances in diagnostics and
treatment. Your equine veterinarian remains the best place to start if you feel that your
horse is having a back problem. Many vets now have more knowledge and interest in
this area, and some have advanced training in alternative therapies, which they combine
with more conventional treatments. In the next article, we will discuss more about
specific back problems, diagnostics, treatment and conformation and the controversy
regarding alternative therapies and back treatment.
© Thal Equine, LLC