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Nothing frustrates horse owners and veterinarians like back pain in horses. Because of the wide variety of causes—as well as the wide variety of clinical signs and therapeutic options—back soreness in horses can be a diagnostic challenge and a treatment dilemma. Fortunately there are a few veterinarians who seem to be able to successfully navigate these waters so let’s launch a better understanding of horse back pain from them.
What causes it?
According to Phillipe Benoit, DVM, a former French show jumping team veterinarian, the majority of back problems are bony in nature but are always combined with soft tissue damage. While ligament or muscle soreness may be the primary culprit in some cases, causes of the more common bone pain include “kissing spines,” arthritis of the articular facets between vertebrae, spondylosis (ossification, or bone formation, of vertebral joints), and fracture of bony structures in the spine.
Some veterinarians say that back pain due to hock lameness, poor saddle fit, and behavioral issues are all myths. Others insist that certain disciplines, rider imbalance, ill-fitting tack, poor conformation, unsatisfactory shoeing, lack of conditioning and even poorly fitting blankets can all lead to soreness in the back, proving just how challenging diagnosis and treatment can be.
What does it look like?
Dr. Joyce Harman of Harmany Equine Clinic lists the following as signs of back pain in horses:
Objecting to being saddled
Being slow to warm up
Becoming difficult to shoe
Developing a bad attitude
Displaying abnormal tail swishing
Initiating uncharacteristic behavior (such as bolting or running away)
Specific signs pointing to “kissing spines” (aka overriding dorsal spinous processes) are back stiffness, reduced jumping ability, resistance to work, change of temperament, and resentment of grooming or picking up the hind feet.
According to Jean-Marie Denoix, DVM, PhD, an expert in equine biomechanics, “kissing spines” occurs most often in young thoroughbreds or thoroughbred-crosses with short backs used primarily for jumping. Show jumpers appear to be the most commonly affected, although eventers and hunters suffer from this condition as well.
How is it diagnosed?
Identifying a change in performance or personality as back pain then pinpointing the primary cause of this back pain can be a veterinary diagnostic challenge. Step one is obtaining a detailed history from the owner and/or rider that includes when a problem was first noticed, exactly what the problem is, and what has already been done to try and resolve the problem. Step two is a comprehensive physical examination that includes visual inspection, palpation, and assessment of the horse’s flexibility and ranges of motion. Next, the veterinarian will perform a lameness examination in motion. That is, he or she will evaluate the horse’s soundness and way of going while being walked and jogged in hand, being lunged, and being ridden. Depending on the results of this initial work-up, the veterinarian may recommend diagnostic imaging such as X-rays, ultrasound, bone scan (nuclear scintigraphy), and/or thermography.
What are some of the treatment choices?
According to Dr. Kent Allen, Official Veterinary Coordinator the Olympic Games and the World Equestrian Games, the ideal treatment is one that addresses both bone and soft tissue, lasts four to six months, and is relatively inexpensive. Examples of various treatments include:
Injecting corticosteroids into painful joints
NSAIDs to decrease inflammation
Mesotherapy (a pain-dampening technique of injections that stimulate the mesoderm, the middle layer of the skin)
Chiropractics, acupuncture, and therapeutic ultrasound
Ensuring proper saddle fit
Estrone sulfate to help improve muscle tone
Extracorporeal shock wave therapy (ESWT)
Time off from performance in the case of trauma
Unfortunately, any time there are this many treatment methods available it means that nothing works consistently. The key thing to remember is that when treating back injury, owners are not only dealing with inflammation but also pain. Therefore treatment must break the pain/spasm cycle and motion must be restored--rest alone does the horse no favors.
Successful therapy involves rehabilitation of the back and re-evaluation within four to six weeks then again within three to four months. Research by Dr. Hilary Clayton and Narelle Stubbs at the McPhail Equine Performance Center at the Michigan State University College of Veterinary Medicine has shown that performing baited stretches (ie carrot stretches) regularly over a three-month period can activate and strengthen the muscles that support and stabilize the horse’s back. These dynamic mobilization exercises can be used to restore musculoskeletal function following injury, return the horse to maximal performance, and reduce the risk of further injury in the future.
The good news is that in the hands of qualified sports medicine practitioners, the majority of horses with back pain returned to their previous level of exercise when diagnosed properly and treated aggressively.