Soreness and Back Pain in Horses

Updated June 29, 2023
view of a horses back topline

Nothing frustrates horse owners and veterinarians like back pain in horses. Because of the wide variety of causes—as well as the variety of clinical signs and therapeutic options—back soreness 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 gain a better understanding of horse back pain from them.

Causes of Back Pain in Horses

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 (overriding dorsal spinous processes)
  • spondylosis (ossification, or bone formation, of vertebral joints)
  • arthritis of the articular facets between vertebrae
  • fracture of bony structures in the spine

    picture of kissing spine in horse with x-ray showing narrowed spacing and bone remodeling.
    In this radiograph of a horse who has been diagnosed with kissing spines by his veterinarian, you can note the impinged areas with narrowed spacing and bony remodeling.

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 a diagnosis and treatment can be.

Recognizing Signs of Soreness and Pain

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
  • Resisting work
  • Displaying abnormal tail swishing
  • Initiating uncharacteristic behavior (such as bolting or running away)

Getting to the Root of Back Pain

Identifying a change in your horse’s performance or personality and then pinpointing the primary cause of back pain can be a veterinary diagnostic challenge. First, the vet must obtain 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 it. Next, they will perform a comprehensive physical examination that includes visual inspection, palpation, and assessment of the horse’s flexibility and ranges of motion.

Then, the veterinarian will perform a lameness examination in motion. That is, they will evaluate the horse’s soundness and way of going while being walked and jogged in hand, lunged, and/or 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.

Treating Back Pain in Horses

A veterinarian administering shockwave therapy to a horse's back.
Dr. Andy Kaneps administering shockwave therapy to a horse's back.

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
  • Muscle relaxants
  • Mesotherapy (a pain-dampening technique of injections that stimulate the mesoderm, the middle layer of the skin)
  • Chiropractic and acupuncture
  • 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.

Video on How to Help a Horse with a Sore Back

Rehabilitation and Prevention

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 (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. 

SmartPak strongly encourages you to consult your veterinarian regarding specific questions about your horse's health. This information is not intended to diagnose or treat any disease, and is purely educational.