Your horse’s back is a complex structure, built of nerve and muscle, tendon and ligament, cartilage and bone. At the core of the system, encased safely in the protective fortress of the vertebrae, runs the spinal cord, the superhighway of the nervous system. Every step, every turn, every movement a horse makes, from his poll to his tail, originates in the nerves of the spine, and every muscular action from his feet to his ears interconnects in some way with the muscles and tendons of his back and neck.

It’s no wonder then that pain originating in any structure of the back can have effects throughout a horse’s body. And vice versa: Any injury in the body can affect how the horse uses his back, which in turn can lead to aches, strains and spasms there as well. And, as you undoubtedly know if you’ve ever been troubled by injury to your own back, pain will inhibit a horse’s movements, limit his ability to perform and affect his attitude toward work.

“All the performance horses I work with, despite being in different disciplines, push from behind,” says Jenny Johnson, VMD, of Oakhill Shockwave and Veterinary Chiropractic in Calabasas, California. “They must be able to engage their hind end. If a horse has back pain, he is unable to do this very effectively; the pain makes him reluctant to fully use his body.”

And yet the signs that a horse is experiencing back pain can be easy to overlook. Learning to distinguish evidence of discomfort emanating from his topline is the first step; once you do it is important to get your veterinarian on the case early to address smaller issues before they grow into more serious problems. The good news is that veterinarians today have a range of reliable treatment options that can help keep your horse working pain-free for a lifetime.

Recognizing equine back pain

In some cases, the effects of back pain are unmistakable. A horse in severe discomfort from crushed withers, for example—splintering of the spinal processes that can occur when he rears and falls over backward—might be unwilling to walk or lower his head to graze.

But more often, the signs are subtle. He might object to saddling or be difficult to shoe. He might resist moving out when asked or have a generally sour attitude toward being handled and ridden. He might flinch while being groomed or even if you simply run your hand down his back. “Back pain may present as a performance issue,” says Johnson. “The horse may not push from behind the way he used to, may not round over jumps, may not come through in a dressage movement, or may not sit down on the haunches to stop and turn, the way he needs to.”

A number of issues can cause pain. One of the most common is ill-fitting tack, which creates pressure points that lead to muscle soreness. And even when the tack fits well, rider asymmetry can place uneven pressures on a back. Other sources can include traumatic injury, from a fall or accident, or overuse, which can lead to muscle strains and sprains as well as, in time, arthritic changes in the vertebrae.

Finding a problem in a horse’s back can require some detective work on the part of your veterinarian. “Sometimes the source of back pain is elusive,” says Bruce Connally, DVM, of Wyoming Equine, an equine sports medicine practice in Berthoud, Colorado. “The problem might be in a foot or leg; the back pain is secondary to the lameness, and we have to find the cause of lameness. On the other hand, we might do a flexion test on a hind leg and the horse tests positive so we think it’s the leg. But flexion tests also put a twist on the back. It can be challenging to arrive at an accurate diagnosis.”

And the signs can lead to a dead end. “Sometimes what we think might be back pain is actually something else,” says Tia Nelson, DVM, of Valley Veterinary Hospital in Helena, Montana. “So we usually start with a complete lameness evaluation to make sure the feet are in good shape and comfortable, because if the feet hurt, there are compensatory issues in the neck or back. If there is something obviously wrong with a foot and you block it out and the pain is resolved, we assume it’s not a back problem.”

A history may also yield significant clues. Your veterinarian may ask when you first noticed an issue and when the signs occur—for example, if the horse is generally comfortable moving laterally to the left but not to the right, or if he resists only when you ask him to collect himself or back up. Tail wringing is another sign that may indicate pain: If you notice your horse doing this consistently at certain points in your ride—when you ask for certain gait or lead changes, for example—your veterinarian will want to know.

A visual examination might also yield clues, such as swelling, atrophy or crookedness. “If you stand behind and above some of these horses, you might detect a crooked spine,” Connally says. Your veterinarian will also likely want to watch your horse in motion. “It’s important to watch the horse on a lead shank and a longe line, and also under saddle,” Johnson says. “Frequently you won’t be able to see what the problem is until the horse is doing what he’s supposed to be doing for his job.”

The next step in the diagnostic process might be a hands-on examination that includes manually pressing on the horse’s back along the spine. “Many horses with back pain respond to touch or pressure along the back if you palpate the lumbar muscles,” Connally adds. “These horses will either tense up to try to protect themselves from that touch, or sink downward to try to get away from it. Some will tense upward if you touch the tips of the spines of the vertebrae.”

Investigating the cause

Once a veterinarian has identified a particular region of the back that seems to be causing more pain, he might try injecting the area with a local anesthetic to see if the horse improves. He might also call for x-rays—but the images need to be interpreted with caution. Even if an x-ray shows arthritic changes or other abnormalities in the vertebrae, it doesn’t necessarily mean that the bones are the source of the pain. Many horses can have serious-looking changes on x-rays—such as “kissing” spines, a condition in which the dorsal (upright) processes of the vertebrae come into contact with each other—but never experience any ill effects. “Just because the horse has kissing spines doesn’t necessarily mean they are making the horse hurt,” says Connally. “This complicates the diagnosis because pain may be coming from something else. If we use the x-rays to make a diagnosis of kissing spines, we should also use local anesthetic to try to block that area, to make sure the block makes the horse hurt less.”

Another difficulty with x-rays is getting clear views of the sacroiliac region, where the last lumbar vertebra meets the pelvis. Unlike other joints along the spinal vertebrae, which have little range of motion, the lumbosacral joint rotates almost 30 degrees, which enables the horse to pull his hind legs up under him. Strains and injuries to this area are common to horses involved in many athletic endeavors.

Other imaging technologies may also be helpful. Nuclear scintigraphy, for example, involves injecting the horse with a radioactive tracer that accumulates in metabolically active “hot spots” in bone tissue—which might indicate inflammation or injury. If a problem in the neck is suspected, magnetic resonance imaging (MRI) or computed tomography (CT) scans may be used to obtain detailed, three-dimensional images of the vertebrae. Thermography, which records the heat emanating from body tissues, can pinpoint spots where soft-tissue injuries are generating extra heat due to inflammation. Ultrasound can be useful to identify changes in soft tissue as well as lesions in the bone.

Even with the best diagnostic technology, however, in some cases the specific source of a horse’s pain might remain a mystery. “Sometimes we never do figure out exactly why the horse is sore,” Nelson says. “It’s challenging because the horse can’t talk and tell us.”

Treatment options

The best course of action for a back injury depends, of course, on your veterinarian’s findings.

In some cases, finding the most effective treatment may take some trial and error—and in the end, your veterinarian may need to administer or prescribe several together. Here are some of the options he might consider:

• Rest and medications. Even just a day or two off from work may be enough to ease muscle pain in a horse’s back. “If it’s an overuse injury, rest is often beneficial, and maybe some anti-inflammatory medication, as for any overused body part,” says Connally. “If the owner/rider is in a hurry to continue with shows/competitions, they won’t like that suggestion, but rest is sometimes the best treatment—just to give the horse time off from work to see if the injury and pain resolves.”

If the pain results from an acute injury, icing, poulticing or other efforts to reduce localized pain and inflammation will help. “In those cases sometimes we alternate heat and ice, to resolve local inflammation and ease pain,” says Nelson. “Sometimes we use nonsteroidal anti-inflammatory medications like bute and Banamine. We may also use a topical anti-inflammatory medication like Surpass, or liniments. I don’t load a horse up with pain medications just to be treating, but I also don’t hesitate to treat pain.” Pain causes the horse stress, which in turn can affect his movements and inhibit healing, so pain management is important for good healing.

In addition, a veterinarian might prescribe a muscle relaxant to ease spasms at the site of an injury or as a result of overuse. “I sometimes use a muscle relaxant called methocarbamol, which works nicely in humans for back pain,” Nelson says. “It depends on whether it is an acute injury or a chronic condition.”

Rest alone, however, is not recommended for many types of back pain. For one, too much time away from training can lead to loss of muscle tone, which can exacerbate an injury and complicate the horse’s return to work. So veterinarians may often suggest more aggressive treatments to ease a horse’s pain.

• Injections. One common treatment for back pain is to inject corticosteroids or local anesthetics directly into the affected area to control pain and inflammation. “Cortisone can be injected into the sacroiliac joints,” says Connally. “But this takes some experience—if we get that injection off target it can block the nerve to where the horse can’t use the hind legs for a while. If you use a local anesthetic along with the cortisone it may even knock the horse clear down for several hours and he can’t get up.”

Another approach, called mesotherapy, is useful to treat soft-tissue pain along the length of the back. “Mesotherapy involves using tiny needles and injecting small amounts of medication just under the skin in the painful area,” Connally says. The injections are placed just under the skin in long rows extending along both sides of the horse’s topline, from the withers to the hindquarters.

• Shockwave therapy. Extracorporeal shockwave therapy (ESWT) involves sending tightly focused, very high-energy pressure waves through body tissue to ease pain and stimulate healing. Exactly how ESWT affects the targeted tissues is not fully understood, but the treatment has been shown to relieve pain almost immediately, and it also stimulates improved circulation, which supports healing. Additionally, says Johnson, “shockwave therapy will stimulate migration of naturally occurring stem cells to the site that is treated. Shockwave therapy, in essence, serves to stimulate the body’s healing mechanism.” ESWT has numerous applications in veterinary medicine, including treating tendon, ligament and bone injuries. In the back, ESWT might be used to ease pain resulting from osteoarthritis in the vertebrae along with muscular or soft-tissue pain.

“I’ve had some success with shockwave therapy,” says Connally. “It may treat some of the disease processes, or it may just treat inflammation. It may help some horses more than others. I have used shockwave on my own neck, and it made a huge difference.”

Shockwave therapy needs to be performed by a veterinarian, typically after x-rays or other imaging technologies have pinpointed the specific areas where osteoarthritic changes in the spine are causing the horse pain. ESWT can be administered in most clinics, especially those that specialize in sport horses. Some veterinarians may have portable devices that can be used while a horse is standing sedated in his stall.

• Massage and stretching. Massage—manually rubbing or manipulating the muscles—is widely practiced on racehorses and other sport horses. Proponents claim that the practice relaxes tense muscles, increases circulation to reduce localized pain and swelling in the area, and relaxes the horse’s general attitude. Scientific research into massage therapy has been limited, but some studies have shown that it can increase the range of motion in a horse’s limbs and improve overall performance, and anecdotal reports of its usefulness are widespread.

Stretching exercises—which involve motions such as lifting and manipulating the limbs as well as “carrot stretches,” asking the horse to bend his neck to reach treats held at different points—can also help to ease tense muscles and improve circulation.

Both massage and stretching can be done routinely, as part of a horse’s fitness regimen, to help him stay more flexible and balanced. But the exercises must be done carefully to avoid causing injury. Both forms of therapy can help a horse recover from back pain, but this is best done under the supervision of a veterinarian—beginning the treatment too soon or performing it too aggressively can aggravate an acute injury. Talk to your veterinarian before beginning a massage or stretching program with your horse, and if it’s applicable, ask for recommendations for a qualified practitioner in your area.

• Chiropractic. Another method of manipulating the musculoskeletal system is chiropractic care, which focuses primarily on the vertebrae. The goal is to correct “subluxations,” shifts in individual vertebrae that might be impinging upon and interfering with the function of muscles and nerve cells. Limited studies have shown that chiropractic manipulations may improve how a horse moves, but in-depth research on the practice has not been done. Nevertheless, chiropractic care is widely used, with many people reporting good results.

Johnson, who has been an equine veterinarian for 28 years but for the past eight has specialized in shockwave therapy and chiropractic care, says that the practice can make a huge difference in a horse: “Because I spend so much time with my hands on the horse doing chiropractic care, I know these horses’ backs intimately. I am feeling every vertebral joint and evaluating the motion—side to side and up and down. I have a more complete picture of that horse than I did when I was just doing lameness work, and I can frequently identify areas that are consistently sore, particularly sore muscles.”

She often finds problems in the lumbar area of the back. “This is where the horse has to flex, and it is through this area that all of the energy that is generated from the engagement of the hind end must pass. I’ll find restriction in a horse who is not necessarily painful but sensitive when a person is brushing the back, or maybe he’s just a little cranky. When I make adjustments, a lot of times the horse achieves fairly immediate relief. Some people tell me they have a totally different horse the next day,” Johnson says. “This is rewarding for me. These are things that cannot be addressed any other way. Back pain can be related to a lot of different things, but some issues will be missed if the horse does not have chiropractic care.”

• Acupuncture. Acupuncture is a component of traditional Chinese medicine that has become well established in the West. The technique involves inserting very thin stainless steel needles into the body at specific points. Variations of the traditional technique include stimulating the needles with heat or electricity, treating the acupuncture points with heat or a cold laser without breaking the skin, or injecting small amounts of various substances into the points. “There are various ways to use acupuncture including injections via the needles, using anything from cortisone to B complex vitamins to some iodine-type irritation injections,” Connally says.

Chinese tradition talks of using acupuncture to “increase energy flow,” but a more modern approach allows that the technique is stimulating muscles and nerves to cause relaxation and ease pain. “Science has shown that acupuncture causes endorphin release in the brain, so it does ease pain,” Connally says.

Acupuncture is never intended to be a primary treatment for an injury, but veterinarians might suggest it as a way to help ease pain in conjunction with traditional Western approaches. “In the right circumstances, both acupuncture and chiropractic can make a horse feel better, treating the pain and/or muscle spasms,” says Connally. “If there is a disease process like a pinched nerve, however, that problem can’t be helped with acupuncture.”

Nelson will sometimes use acupuncture before performing chiropractic adjustments: “Then the adjustments go a lot quicker and easier. The out-of-place areas go into place again much easier. I don’t know if the acupuncture relaxes the muscles around the joints that are in trouble, but it seems to help.”

When it comes to protecting your horse’s back, start by making sure your saddle fits. Beyond that, the same measures that can protect soundness will also reduce a horse’s risk of developing a sore back. Before workouts, spend 10 to 15 minutes warming him up with straight lines, then serpentines and circles. Also, avoid repeating the same maneuvers more than a few times in each session, and be particularly careful about repetitions of sliding stops, sharp turns and other movements that can strain fatigued muscles.

Varying your riding routine by alternating arena workouts with trail rides or other types of exercise will help to keep your horse mentally engaged as well as physically sound. Finally, give your horse as much turnout time as possible. Moving about and grazing gives him the opportunity to stretch out and relax all of his muscles as he goes about his business.

Of course there are no guarantees, but the time and energy you devote to protecting your horse’s back is likely to keep your horse happier and make him more fun to ride. Besides, says Johnson, you owe it to him. “Horses do so much for us that I think we have a responsibility to make sure they are comfortable doing what we ask,” she says. “They are unbelievably generous to us. As their keepers and riders it is our responsibility to take care of them.”

This article first appeared in EQUUS issue #452

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