The author of a study looking into rider weight and equine back pain hopes to find out whether there is a correlation between the two, and help inform future research.

Elysia Jones, who is studying equine sports coaching at Hartpury University, is asking as many riders as possible to complete her study, which will inform her dissertation.

She hopes to secure 1,000 responses to her questionnaire, which investigates how UK horse owners perceive the causes of back problems in their horses.

“This will help create an understanding of the factors that create back pain, how significantly rider weight influences back pain, and how owners recognise the cause of the problem,” she said. “Hopefully, this research can act as a platform for future studies to grasp a better understanding of how back pain is established and the impact of rider weight in true circumstances.”

Complete the questionnaire here

Elysia told H&H the topic of rider weight and its effect on horses is a taboo one, and one that interests her.

“It’s not something people like to go into too much, it’s very controversial,” she said.

The survey asks about respondents’ horses, and themselves, including questions on rider experience, saddle fit and the horse’s work, to investigate a range of different causes of back pain.

Continues below…

Excess rider weight can cause back pain in horses

Heavier riders and unsuitable saddles can cause muscle tension and pain in horses according to a study by Dr Sue

‘It’s not fat-shaming, it’s horse welfare’: saddle fitter’s warning on damaging effects of excess rider weight

“These people are often good riders who do everything for their horses, except the one thing that would truly help

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“I’ve had about 120 responses so far and it’s an even split on whether people get their saddles fitted just to the horse, or to themselves as well, which is a big issue,” she said.

“My objectives are to find out the prevalence of back pain in UK horses, to find out what owners think causes it and to find out if there’s a correlation between rider weight and equine back pain.

“In my own view, up to a certain weight ratio, rider experience comes into play too but if a rider’s too heavy, you can’t change that; other studies have shown horses’ backs don’t work in the right way [under a too-heavy rider]. But I’m not saying rider weight is causing more back pain; I want to see what the results tell me.”

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Applying traction to a horse’s tail is a widely-used therapy believed to help relieve back pain, but does recent research support its efficacy? Dr Peter Green explains...

EQUINE physical therapies vary: some are similar to human medical physiotherapy, while others are more akin to human alternative therapies. Whichever school of therapy the practitioner uses, traction is a common tool.

The tail pull is a widely used traction therapy, where the practitioner pulls steadily backwards on the tail for a short time and then repeats the procedure. It is claimed to relieve back pain.

Researchers used a group of 32 horses referred to a veterinary hospital in New Zealand for apparent back pain to assess the efficacy of the technique.

Their findings, recently published in the Journal of Equine Veterinary Science, suggest that the claim may be justified.

Researchers assessed the horses for tenderness in the back muscles using an algometer. This medical instrument increases pressure point stimulation of soft tissues, to measure the threshold at which the pressure becomes unpleasant.

The response to pressure was measured at eight points along the backs of the horses, either side of the spine, from the back of the rib cage to the pelvis. A small digital weighing scale was then hooked into the plaited tail of each horse. A steady pull of 4.5kg was applied for 20 seconds, followed by a 10 second rest, then repeated twice more. The algometer measurements were taken once again.

After the tail pull therapy, the back muscles were much less tender. There could be several explanations for this effect, but we know that there are structural links between the tail and other regions of the back.

More research is under way.

Further reading: Journal of Equine Veterinary Science 93: tail pull traction

H&H 29 October 2020

You may also be interested in…

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Excess rider weight can cause back pain in horses

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Our chartered physiotherapist investigates back pain in horses and how to recognise if your horse is suffering from it

How to recognise pain in horses from their facial expressions *H&H VIP*

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British dressage rider Spencer Wilton has undergone surgery in Sydney for a ruptured disc in his lower back, having been admitted to hospital while in Australia on a teaching trip.

The multi-medalled Olympian suffered with the back injury during 2018, blighting his preparations for the World Equestrian Games (WEG) in September — though he and Super Nova II still helped Britain achieve team bronze in Tryon.

A relapse while in Australia meant he was admitted to the Prince Charles Hospital in Sydney, and needed an operation before he could return to the UK. He underwent the surgery on Saturday morning (8 June).

“I’m feeling much better and extremely relieved,” said Spencer. “If all goes well I’ll stay in hospital until Wednesday then have a few days resting up and hopefully fly home next weekend.

“[It wasn’t] quite the end to a fabulous trip teaching in Australia that I was expecting. Having had a bit of a sore back on arrival it quickly got rather uncomfortable, to the point that I was needing assistance to get dressed!

“Without getting too mushy I want to say that being in this situation, on the other side of the world, has been quite an experience, but all the messages of support that I have received have really humbled me. So thank you all from the bottom of my heart.”

Continues below…

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Spencer and “Neville” have been members of the British senior team for the past three consecutive years, winning team silver at the Rio Olympics and helping Britain finish fourth at the 2017 European Championships in Gothenburg, Sweden.

The pair made their comeback after the best part of a year out in 2018, winning bronze at WEG, but Spencer recently announced that he will not be campaigning the 17-year-old De Niro gelding for this year’s European Championship team, instead saving him for a tilt at the Tokyo Olympics in 2020.

For all the latest news analysis, competition reports, interviews, features and much more, don’t miss Horse & Hound magazine, on sale every Thursday.

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Equine back pain is not uncommon and horses are often referred to physiotherapy for assessment and treatment. There are a multitude of reasons as to why a horse may experience back pain and likewise a variety of presenting signs and signs.

Back pain can be caused by dysfunction in a variety of anatomical tissues (e.g. bone, joint, muscle, ligament, nerve). Pain that originates in the spinal region can be deemed as primary back pain. Back pain can also be a secondary sign of physiological dysfunction elsewhere e.g. hindlimb lameness. In some instances, it can be difficult to establish whether back pain is primary or secondary in nature.

Horses are prey animals and will therefore often not show signs of pain until it is truly significant because this would be a sign of weakness to a predator. Horses may demonstrate pain in a variety of ways including a decline in performance and/or a change in behaviour.

Horse owners often describe some of the following signs from horses experiencing back pain:

● Reluctance to being tacked up

● Loss of enthusiasm for work

● Reduced ability or reluctance to jump

● Appearing ‘cold backed’ or ‘hollowing’ through the back

● Tail swishing

● Reluctance to bend on a circle

● Appearing uncomfortable, stiff or lame behind

Possible contributing factors to consider:

● Conformation – certain conformation traits may predispose a horse to back pain, in particular horses that are excessively long backed, short backed or with a lordotic (hollow-backed) posture.

● Tack – studies have shown that having a saddle on the horse’s back increases the amount of spinal extension or ‘hollowing’, which can contribute to injury. Ensuring optimum saddle fit is an important factor in minimising the risk of back pain and optimising performance.

● Rider – a rider who is unbalanced or who has an asymmetric position (e.g. due to pain, weakness or stiffness themselves) may influence the horse’s comfort and could be a contributing factor to equine back pain. It is often beneficial for the rider to be assessed and if required, physiotherapy input can support improvements to the rider’s comfort and position on the horse too.

● Head and neck position – the horse’s head and neck position influences spinal biomechanics. Ensuring that training encourages the horse to vary its head and neck position (rather than a fixed head carriage) by working the horse through from behind may help support improvements in comfort — both through the horse’s neck and back.

● Underlying pathology – Most back pain will improve with physiotherapy, however if it doesn’t, a veterinarian can investigate further as to whether there is underlying pathology.

A simple way for owners to monitor how comfortable their horse is through the back is to carry out the following palpation techniques:

1. Slowly run your finger tips down the long spinal muscles either side of the horse’s spine from the wither region to the tail.

2. Slowly run your fingertips across the spinal muscle fibres towards the spine and carry this out sequentially along the horses back.

Continued below…

Like this? You might also enjoy reading these:

Nina Wareham’s physiotherapy blog: Factors to consider in optimising horse performance and welfare

Nina Wareham’s physiotherapy blog: 4 key stretches to improve your horse’s core stability

Nina Wareham’s physiotherapy blog: engagement and core strength — why they are important for your horse

Feel for lumps, bumps, heat, and hair changes/chaffing. Signs of discomfort may include, the horse dipping away from your hand, the muscles appearing to tighten or clamp down, muscle fasciculation (appearing to ‘flicker’ under the pressure). Also watch for behavioural signs such as tail swishing or the horse pinning its ears back.

N.b Horses can be unpredictable especially if in pain. Any person carrying out the above technique must do so at his or her own risk. Seek professional advice if you are unsure.

If you are concerned that your horse may have back pain, a vet and/or physiotherapist (following veterinary referral) can further assess and help to establish a likely cause.

Nina

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A horse’s mid-section must serve as a sturdy, central link if he is to fulfil his athletic potential and avoid injury. Rachel Murray MRCVS discusses the importance of core strength and stability

As humans, we stand with our spine near to vertical so that gravity compresses our spinal column. Unlike us, a horse’s spine is near horizontal. His weighty abdominal and chest organs are pulled down by gravity, effectively hanging from the spine, and his heavy head is held out in front on the end of a long neck.

We then ask him to be an athlete, creating power through his body to connect the hindlimbs to the forelimbs, and finally we add the weight of a rider to the equation. Supporting these body parts and coordinating these levers — while all the time maintaining balance and energy — is a complex procedure for the horse, involving a range of muscles and nerves.

We are now more aware of the importance of core muscle development in providing the strong, stable base needed for correct movement and to prevent injury.

Power and lift

During each stride a horse’s back moves in flexion and extension, from side to side and in slight rotation.

The bigger the horse’s action — whether dressage or jumping — the more the body moves and the wider this range of movement. To prevent overstraining of any areas of the body, movement must be controlled and stabilised. A stable platform is vital so that the additional weight of the rider does not cause the back to overextend during the stride.

The horse uses both large and small core muscles to maintain this stability and move athletically.

Extension of the back occurs when the large muscles on the top of the back are contracted. The large muscles underneath the spine enable flexion of the back, support the rider and help counteract the pull of the abdominal contents. These are assisted by the muscles that flex the lumbosacral joint behind the saddle, including the iliopsoas muscles.

In addition to controlling the movement of the spine, the core muscles are important for raising the thorax (chest) of the horse relative to the floor — literally lifting the withers. Because the horse does not have a collarbone, the muscles that attach his forelimbs to his trunk must contract to create lift.

The stronger he is through his core, the more easily he can transfer power from his limbs through his body to perform movements or generate lift.

Creating stability

Poor core strength can result in a number of problems.

A very flexible young horse usually starts with a wide range of motion, giving a very elastic appearance. The more extravagant the action, the more critical core muscle development becomes to stabilise movement and protect the horse from injury.

Likewise, the less balanced the rider or the heavier they sit, the greater the risk to a horse with a very mobile and unstable back. If the back is extended too far, the dorsal spinous processes can impact on each other and form kissing spines.

Although we can see evidence of large muscle development through a good topline and a tight abdomen, the small muscles lying close to the spine are less visible. These include the multifidus muscles — vital for managing subtle movement.

When a horse is working correctly, the multifidus muscles become well developed because they are in constant use. When back pain occurs, however, the multifidus muscles are used less and tend to atrophy — becoming small and scarred, rather than functional.

Control of subtle movement for stability then decreases and the larger, less effective muscles are used. These become tense and can spasm, which can be felt by palpating the horse’s back.

Getting physical

Development of core muscle strength can be assisted by correct day-to-day management.

Encouraging the horse to have his head down and his back in flexion will stretch his topline and use core muscles. Simply feeding his hay and hard feed from the floor in his stable and encouraging turnout will help.

Stable-based exercises are useful for horses in work, following the principles of core muscle development. These include a range of baited (carrot) stretches, lifts, flexions and tail pulls, and are generally safest to do when a horse is already warmed up.

Groundwork exercises are particularly effective in switching on the correct muscle patterns without the strain and complication of a rider. These could include pole work at walk, exercise on a water treadmill or with a training aid such as a Pessoa. The maximum benefit is likely to be obtained by developing these exercises under the direction of a physiotherapist with an interest in core muscle development.

Ridden exercise with the horse’s back flexed and his head down will encourage correct posture and core muscle use, as will correctly performed downward transitions and half halts, pole work and gridwork. If the rider or saddle restricts the horse from lifting his back, however, he will be unable to perform the exercise correctly and will use the wrong muscles.

Tactile stimulators can be used under the direction of a physiotherapist to “remind” a horse to use certain muscle groups during exercise. Proprioceptive tape placed on the skin over selected muscle groups, or elasticated bands around the abdomen or quarters, can assist with switching on the right muscle groups.

Functional electric stimulation, under veterinary and physiotherapy direction, has been used effectively to improve patterns of core muscle use in some horses with back pain.

Ref: Horse & Hound; 15 October 2015

New research into sacroiliac (SI) joint region pain in horses has shown that nerve blocking the joint can help pinpoint the source of the pain, while assessing the horse under saddle is also vital.

The research, published last month (20 May), gives guidance for both vets and owners on the clinical signs of SI joint region pain and how best to examine it.

Signs of SI joint region pain include canter quality that is worse than trot, and bucking and kicking out, especially in canter.

A stilted or bunny-hopping type canter, being on the forehand and croup high, changing legs behind, spontaneously breaking from canter to trot and being reluctant to canter were also commonly observed, as well as the tendency to come above the bit.

Benefits of nerve blocking

The study highlighted that for horses showing these signs, blocking the SI joint in a diagnostic investigation could provide crucial answers.

It found that nuclear scintigraphy alone is unreliable for the diagnosis of SI joint pain — only 42% of horses that had a positive response to an SI block and underwent nuclear scintigraphy had abnormal radiopharmaceutical uptake (RU).

However, the use of ultrasonography and scintigraphy in conjunction with an SI block can provide additional information in some horses.

“Assessing the effect of treatment of the SI joints is not an effective method of diagnosis; the use of nerve blocks is much more reliable,” said Dr Sue Dyson.

Importance of ridden assessment

The majority of horses in the study had SI joint region pain and hindlimb lameness.

Although clear improvement in lameness in-hand was seen in some horses after removing the source of pain in the lame limb, ridden exercise highlighted the persistence of another source of pain, which was sometimes worse after abolishing the lameness.

This emphasised the importance of ridden exercise in both trot and canter when assessing lameness and poor performance.

The Animal Health Trust

The study is the first large-scale study of its kind and was conducted at the veterinary charity The Animal Health Trust (AHT) by Dr Sue Dyson, head of clinical orthopaedics at the AHT, and Amy Barstow, a previous AHT intern.

The research analysed 295 past cases of horses treated by the charity and builds on previous AHT research that recognised SI joint region pain as a contributor to poor performance and/or hindlimb lameness.

“The Animal Health Trust’s Equine Clinic is experienced in diagnosing and treating SI joint region pain in horses and offers a fully comprehensive referral service,” said a spokesman for the AHT.

“If you are concerned that your horse is showing signs suggestive of SI joint region pain, speak to your vet and ask for a referral.”

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Have you ever stopped to think how a horse’s back works underneath you? It might seem complex, but if you don’t understand, you can’t train your horse correctly. These are the five sections you need to know about:

1. Cervical vertebrae

These start behind the poll and run through the middle of the neck. Muscle sits on the top.

“The reason these vertebrae are so low is because the head is heavy and horses need to be able to lift it up,” explains sports and remedial therapist Gillian Higgins of Horses Inside Out.

Most movement happens at the base of a horse’s neck. However, quite a lot of movement happens at the second vertebrae behind the skull too. This is what enables a horse to nod, and look left and right.

If the horse’s head is too high, the first vertebrae locks and they can’t flex left or right. The same happens if a horse over-flexes.

2. Thoracic vertebrae

There are 18 thoracic vertebrae, which start at the withers and connect to the ribcage. You can feel the bony projections, which are called spiny processes, at the top of the horse’s back. The first three vertebrae are hidden under the shoulder. This area also consists of muscle to enable the head to lift, plus carry its weight and that of the neck.

The spinal cord runs along the bottom of these vertebrae.

“The spinal cord is a central motorway for messages through the body to the brain and back again. It’s much lower down than most people think,” adds Gillian.

3. Lumbar vertebrae

Six lumbar vertebrae run on from the thoracic vertebrae. The lumbar vertebrae stick out to the side, as well as the top, because they do not connect to any ribs.

“If a horse is very thin you can feel the lumbar vertebrae, but you don’t want to be able to and in most horses you can’t,” says Gillian.

There is limited rotation or flexion between the lumbar vertebrae, because nodules hold them together and reduce the range of movement. It is also very important that the saddle doesn’t finish here, because that would cause a pressure point. “The way to find the first lumbar vertebrate is to feel for the top of the last rib and run your finger up to the top. That’s it,” adds Gillian.

4. Sacrum

Next comes the sacrum. Spiny processes in the lumbar vertebrae face forward towards the head, whereas those in the sacrum face the tail. Consequently, there is a V shape where they meet. That is known as the lumbar/sacral junction, which is what enables a horse to bring its hindleg under its body.

Flexion and extension happens at this junction — that is why a riding coach refers to a horse needing to lift its back. Unless it does, the range of movement in this area is restricted and the horse cannot engage its hindleg.

Next to this is the sacroiliac joint, where the sacrum vertebrae meet the ilial at the top of the pelvis.

“There is very little movement in the sacroiliac joint, whereas the lumbar/sacral junction moves a lot. That makes this a complex area and it’s why so many problems stem from here,” explains Gillian.

5. Tail vertebrae

There are between 18 and 22 tail vertebrae, which run to the end of the dock. The spinal cord stops after the sacrum, but muscle and ligament continues to the end of the dock. This means the tail can reveal a lot about the horse’s back.

For example, a horse who is clamping its tail down or holding it to the side probably has something going on elsewhere in the back. Make sure you are familiar with how your horse naturally holds his tail — any sudden change is an early sign to call for expert advice.

Thank you to XLEquine, www.xlequine.co.uk, Scarsdale Vets Equine Practice and Horses Inside Out for their help with this feature.

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The range of practitioners available to help keep equine athletes in tip-top condition is staggering. But who should you turn to first and how can you check their credentials?

Here we find out what to expect and what to look out for when using equine biomechanists.

What do they do?

Equine biomechanists specialise in the mechanics of the horse, particularly the measurement and analysis of movement.

By using video or sensors and analysing a horse’s movement mathematically, they can work out what is going on internally. This can help to identify such problems as tendon and ligament strains and analysing the spinal, joint and muscle forces involved in a specific movement.

When might you use one?

Biomechanists do not diagnose or treat horses, so are not therapists. They are employed to analyse a movement problem or monitor rehabilitation. They might answer a question such as, “Are this horse’s kissing spines improving?” Biomechanists do not provide treatment — they merely quantify or predict change.

Qualification check

Biomechanists train in both anatomy and engineering and so need a degree, PhD and further post-graduate guidance. But the horseworld has no accreditation for clinical scientists or engineers, so anyone can call themselves a biomechanist, despite having little or no training.

To find out about other equine practitioners, inclusing physiotherapist and osteopaths, see 1 November issue of H&H

Read more about back problems

Read more about joint problems

The range of practitioners available to help keep equine athletes in tip-top condition is staggering. But who should you turn to first and how can you check their credentials?

Here we find out what to expect and what to look out for when using equine osteopaths.

What do they do?

Like physiotherapists and chiropractors, manual osteopaths use a combination of techniques to address problems in the musculoskeletal system. From an osteopathic perspective, however, these problems stem not just from the spine but from issues found within the bones, joints, muscles and related nerves, blood or lymph transport.

When might you need one?

Anecdotal evidence and clinical experience suggest that the manipulation used by osteopaths is a helpful addition to the treatment of some musculoskeletal-related disorders in horses, such as joint pain or restricted motion.

Problems treated in the horse by osteopaths extend from joint disorders to digestive issues.

Note that, compared with chiropractic and physiotherapy, human osteopathy has very little research supporting it so far.

Qualification check

“Osteopath” is a protected title and registration and can only be used by members of the General Osteopathic Council.

A three-year undergraduate course is usually followed by a further post-graduate course to specialise in animals. However, osteopaths can specialise in animals and register with the Society of Osteopaths in Animal Practice straight away, without having undergone any animal or equine-specific training.

To find out about other equine practitioners, including physiotherapists and chiropractors, see 1 November issue of H&H

Read more about back problems

Read more about joint problems

The range of practitioners available to help keep equine athletes in tip-top condition is staggering. But who should you turn to first and how can you check their credentials?

Here we find out what to expect and what to look out for when using equine body worker and massage therapists.

What do they do?

Massage therapy involves moving the skin and underlying soft tissue by hand or with a machine such as a vibrating pad or rug.

Techniques include well-known methods such as Swedish massage, sports massage, lymphatic drainage and acupressure. Equine body workers are massage therapists who use whole body massage techniques, but also include stretching exercises.

When might you need one?

Massage and soft-tissue mobilisation is believed to increase blood flow, promote muscle and mental relaxation and increase suppleness. Equine massage has been used to reduce stress levels, improve lymph drainage and enhance pain tolerance in an existing back injury.

There are many anecdotal reports of the benefits of massage on equine performance, but scientific evidence is still lacking.

Qualification check

Although there is a qualification for equine body workers and an International Equine Body Worker Association (IEBWA) that qualified members can join, there is no regulatory body for massage therapy as a whole and no accreditation exists. Without proper qualifications, insurers may not not be willing to accept such treatments.

To find out about other equine practitioners, including physiotherapists and osteopaths, see 1 November issue of H&H

Read more about back problems

Read more about joint problems

The range of practitioners available to help keep equine athletes in tip-top condition is staggering. But who should you turn to first and how can you check their credentials?

Here we find out what to expect and what to look out for when using an equine chiropractor.

What do they do?

A chiropractor focuses on the spine of the horse and its effect on the nervous system. Chiropractic treatment involves the application of high-velocity, low-amplitude thrusts to induce relief in joints, muscles and reflexes. Chiropractors believe that a healthy spine and nerves are essential for the health of the whole body.

When might you need one?

Chiropractors are particularly useful where joint motion is reduced or pain is apparent, for example arthritic joints and back pain.

Randomised-control trials published in the journal Spine have shown that spinal manipulation can reduce back pain, improve flexibility and reduce muscle tension in horses.

Qualification check

The title “chiropractor” can only be used by members of the General Chiropractic Council. Practitioners must first train and qualify as human chiropractors before specialising.

The McTimoney College of Chiropractic teaches a branch of human care that is recognised by the General Chiropractic Council, however students of their animal manipulation course are not trained in chiropractic therapy and may not call themselves chiropractors.

Confusingly, this means that there are McTimoney chiropractors, who may specialise in horses, and McTimoney animal manipulators, who may not practise chiropractic.

To find out about other equine practitioners, inclusing physiotherapist and osteopaths, see 1 November issue of H&H

Read more about back problems

Read more about joint problems

The range of practitioners available to help keep equine athletes in tip-top condition is staggering. But who should you turn to first and how can you check their credentials?

Here we find out what to expect and what to look out for when using an equine physiotherapist.

What do they do?

Physiotherapists treat a wide variety of musculoskeletal problems.

They manipulate and mobilise joints and soft tissue, use electrotherapies such as ultrasound and laser therapy, and prescribe exercise regimes.

These practitioners use a hands-on approach to promote passive stretching, weight-shifting and the activation of spinal reflexes — exercises that are also helpful for post-operative rehabilitation.

Many of the techniques and exercises physiotherapists use are also thought to help to increase flexibility and strengthen core muscles.

When might you need one?

Injuries that can benefit from physiotherapy include back pain, arthritis and muscle or ligament strain. Many of the problems a physiotherapist addresses may be man-made, for example an asymmetric rider or a badly fitting saddle.

There is a growing research base behind human physiotherapy and, although this has not yet translated into the equine specialism, physiotherapy is becoming a widely recognised equine treatment.

Qualification check

Although courses in “veterinary physiotherapy” exist, the only route to becoming a chartered (accredited) physiotherapist is through a three- to four-year course in human physiotherapy, followed by in-practice experience and specialisation in animals via another two-year course.

The Association of Chartered Physiotherapists in Animal Therapy (www.acpat.org) lists accredited physiotherapists.

To find out about other equine practitioners, including chiropractors and osteopaths, see the current issue of H&H (1 Novemeber)

Read more about back problems

Read more about joint problems

Global veterinary health company Ceva Animal Health has launched a leaflet underlining the basic principles of equine back pain to help educate owners.

The leaflet, which offers information on the cause, diagnosis and management of equine back pain, complements Ceva’s series of waiting room leaflets aimed at horse owners.

A spokesman for Ceva said, “The leaflet ‘Understanding Back Pain’ explains the anatomy of the back, as well as the clinical signs of back pain and how it is diagnosed, including the treatment options and the general prognosis.”

Back pain can be a challenge for both vets and owners, but diagnosing conditions early is beneficial to a more favourable outcome.

Copies of the leaflet are available free of charge to vet practices.

For more information visit www.ceva.uk.

Stay in touch with all the news in the run-up to and throughout the major shows and events during 2026 and beyond with a Horse & Hound subscription. Subscribe today for all you need to know ahead of these major events, plus online reports on the action as it happens from our expert team of reporters and in-depth analysis in our special commemorative magazines. Have a subscription already? Set up your unlimited website access now

The majority of lumps that spring up on a horse’s back are not serious. The challenge is deciding what they are and what you can about them.

Case study

Kathy Carter has owned Badger, a six-year-old Irish draught-thoroughbred, for about nine months.

When she first tried him, Kathy noticed a small, marble-sized lump on his back.

“The saddle didn’t touch it and I was assured by the owner that it hadn’t bothered him, or changed in size since it appeared when he was a yearling,” said Kathy.

The vetting, which Badger passed, detailed the lump as a melanoma.

“That did worry me, but I spoke with my vets before I signed the cheque and on their advice, decided to take the risk and buy him with a view to having the lump removed when I got him home.

“The consensus was that the problem was more likely to be a cyst than a melanoma, which was a relief to hear.

“Although some people advised me to leave it well alone, I was worried about rugs rubbing it or fly bites causing it to swell. I thought it was better to remove it.”

Badger underwent a straightforward operation under local anaesthetic. The lump turned out to be a benign developmental dermoid cyst, which was easily removed. The wound healed well and within a few weeks Kathy was riding again.

“I spent time on in-hand and lunge work, but three months on the area had healed completely. There is now no evidence of the surgery.”

To read the full veterinary feature on mystery back lump see the current issue of H&H (24 May 2012)

Do you want to read more about back problems?

Find out more about back problems in horses

The sacroiliac joint comprises the sacrum (a bone made up of five fused sacral vertebrae forming the lower part of the spine) and the ilium (part of the pelvis).

The sacrum is wedged between the two halves of the pelvis.

There is no movement in the joint; its main function is to provide stability.

Five signs of sacroiliac pain

• Loss of topline musculature
• Poor impulsion and reluctance to engage the hindlimbs when ridden, especially in canter
• Bucking or kicking out with one hindleg
• Reluctance to go forward
• Hindlimb lameness

For the full veterinary article on dealing with sacroiliac problems, see the current issue of Horse & Hound (8 September)

Read more about back problems in horses

More articles on back problems in horses

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H&H explains the construction of a horse’s back and the problems with diagnosing injury

The equine spine comprises seven cervical vertebrae in the neck, 18 thoracic vertebrae, six lumbar vertebrae and five fused sacral vertebrae in the sacrum, plus more than 15 coccygeal vertebrae in the tail.

The spinal cord is well protected as it runs through the spinal canal, which passes through each individual backbone from the top of the neck to the sacral region.

Fractures and subluxations (dislocation) of a lumbar vertebra can unfortunately result in neurological abnormalities to the extent that the horse may be paralysed.

Rotational falls are high risk, as horses are not designed to somersault. The neck and lower end of the back are able to bend, but there is very little flexibility in the mid-back region.

Enormous pressure is applied to the spine when a horse somersaults. The central section of the horse’s back is firmly anchored by muscles, ligaments and rib attachments — this is the area that is most likely to break when bent.

Difficult to diagnose

Injuries involving the horse’s spine are a challenge to investigate as the equine back is a large area covered by thick muscles. Pinpointing the cause of the damage can be difficult.

Until the precise problem has been identified, specific treatment is difficult. Sometimes it can be hard to differentiate between bone damage, muscle pain or a horse that has tied-up with muscle cramps.

Initially, any treatment should involve removing pain and making the horse as comfortable as possible before it can start to exercise again and regain its lost muscle function and strength.

For the full veterinary article on broken backs, see the current issue of Horse & Hound (22 July, ’10)

Looking for more articles on back problems in horses?

Find an equine vet near you

Back problems are sometimes blamed for low-grade lameness in horses when in fact the back pain develops secondary to the lameness.

British Equestrian Federation (BEF) physiotherapist Vicky Spalding explains: “When a horse is lame in one leg, he attempts to reduce the loading on this limb by lifting the trunk of his body when the affected leg hits the ground. Back pain can occur when the lumbar and pelvic muscles are overused as a result of this.”

It is always worth looking to the foot as the cause of lameness until proven otherwise.

Horses with chronic foot pain will rapidly develop secondary back problems as a consequence of their bilateral and short-striding shuffling action.

Hock lameness can also cause discomfort along the back muscles, which usually vanishes when the hocks are pain-free.

It can be hard to believe that a single nerve-block in a hock joint will cure back pain, but if the primary lameness can be resolved, then the compensatory pain should reduce too.

“This is one reason why it is so important that a qualified practitioner is used to treat your horse’s back — it is essential that underlying lameness is not missed,” explains Vicky.

But even when the underlying injury and the associated back pain have been identified and treated, the story may not be over.

“Studies show that in the human spine, when back pain resolves, the core stabilising muscles may not regenerate fully unless stimulated to do so by specific rehabilitation exercises,” Vicky says.

“This may be significant in horses with compensatory back pain and it indicates a need for rehabilitation and re-education of movement following an episode of lameness.”

But remember, back pain can be a problem of its own, for instance in a horse with kissing spines.

For the full article on compensatory injuries, see Horse & Hound (10 December, ’09)

The “back man” has a mythical status in many yards. Everyone knows someone (or, at the very least, someone’s instructor’s sister’s friend) who was on the verge of having a horse put down when the back man pulled off a miracle.

“Anyone can say they’re a horse back manipulator and set themselves up in business,” says Yorkshire-based vet Mike Jones, who specialises in equine physiotherapy.

“There are enough people doing that with no qualifications and no experience. Some of them can certainly do some good. Most of the time, they’re relatively benign and employing them is simply a waste of time, money and effort.

“I have seen one or two catastrophic cases where a horse was actually suffering from a fractured pelvis and a so-called back man picked up its hind leg and waggled it around.”

Are you breaking the law?

It is an offence for anyone, other than the owner, to treat an animal without the permission of the vet. This is to ensure that a proper diagnosis is made and any medical or complementary treatment is appropriate.

The Protection of Animals Act means that owners who allow an animal to be treated without veterinary consent are themselves liable to prosecution. Similarly, indemnity insurance held by any practitioner would be invalid if permission had not been sought and received.

This law refers only to the manipulative therapies, which are, anyway, those most commonly used when a horse has a back problem.

These include:

• osteopathy, intended to work on areas of tension and inflammation in the muscles, ligaments and joints
• chiropractic, which focuses on the musculoskeletal system and mainly the neck, back and pelvis
• physiotherapy, which can utilise lasers and electrotherapy as well as manipulation and stretches
• equine sports massage, which concentrates on the soft tissue and can provide pain relief.
  Other possible treatments such as acupuncture and homeopathy can only ever be carried out by a specially trained vet.Is your vet helping?
  “Historically, I think the veterinary profession has shot itself in the foot,” he admits. “When I was training, I was taught that the only things that go wrong with a horse’s back are fractures and the only option is to put the horse down,” says Mike Jones.Attitudes are changing. The natural suspicion of doctors for anything that can’t be comprehensively backed by statistics and science is slowly being overcome as college courses improve and dissertations and research provide more detailed information.“Back problems are still under-diagnosed,” admits Mike. “It’s a very difficult area of the horse to deal with. It’s covered by muscles, you can’t really see what’s going on, and it’s not an area you can readily take X-rays of.“Vets need to work closely with people who are qualified in this field to dispel the myth and try to sort out rational treatment.”Who is really qualified?
  Anyone using the word McTimoney in a description of their work has to have trained at the college, which will provide a list of qualified practitioners (tel: 01235 523336; www.mctimoney-college.ac.uk).To call themselves a chiropractor, people must also have a human chiropractic qualification and be a member of the General Chiropractic Council.The Association of Chartered Physiotherapists in Animal Therapy (ACPAT; www.acpat.org.uk) runs a postgraduate diploma or MSc in veterinary physiotherapy, in collaboration with the Royal Veterinary College. Only ACPAT members with this qualification can use the title “veterinary physiotherapist”.The term physiotherapist itself is not protected, meaning that anyone can use it, but a “chartered physiotherapist” does have a high level of academic and practical training in human physiotherapy. ACPAT recommends that all owners choose a practitioner with the letters SRP (State Registered Physiotherapist) after their name.There are several different animal massage courses and qualifications, but the entry requirements and length of training vary wildly.Members of the Equine Sports Massage Association have completed a nine-month diploma after finishing a human course and showing extensive equestrian experience. Registered members (listed at www.equinemassageassociation.co.uk) are insured and are also required to do a set amount of training each year to keep them up-to-date with developing techniques.So where should you start?
  “I am very wary, especially of people who lay on hands and say they know what’s wrong,” says Mike Jones.“There can always be underlying medical conditions that must be ruled out by a qualified vet. Fractures and muscle or bone damage can be severely aggravated by the manipulation that goes on.”If your vet can find no such problem but is unhelpful about referral, Mike recommends contacting a qualified physiotherapist direct.“They will then discuss any objections and ask for access to the horse’s medical records. It would be borderline unprofessional for a vet to refuse to hand over information,” he says.“Some of the techniques that have been developed do a lot of good in cases where veterinary medicine has no answers.”Is it a back problem?
  These are all indications that a horse may benefit from one of the manipulative therapies provided by most “back men”:
• Reduced performance
• Head-shaking or a changed head carriage
• Stiffness or one-sidedness
• Reluctance to collect or engage quarters
• Clamping the tail or holding it to one side
• Reluctance to canter on one lead
• Being cold-backed
• Bucking
• Stepping short or dragging a foot
• Excessive rolling
• Uneven muscle development
• Suddenly refusing fences
• Unexplained loss of condition
  It is also worth asking your vet for a referral if the horse has been cast, suffered a fall or other trauma or shows any significant change in behaviour.What should you expect?
• Any McTimoney practitioner, and most other osteopaths, chiropractors and physiotherapists, will want to assess the whole horse and the situation.
• An initial session is likely to last 45min to 1hr, with subsequent visits usually slightly shorter.
• The number of sessions needed depends entirely on the specific case, but practitioners do recommend preventative check-ups every six months, ideally at the beginning and end of the competitive season.
• They will also be able to show you techniques you can use yourself in the meantime.
• Fees vary but expect a session to cost in the region of £40.

This article first appeared in H&H (8 July)

Written by Sue Dyson MA, Vet MB, PhD, DEO, FRCVS

The anatomy of the pelvic region in the horse is fairly complex, and because of the huge overlying muscles comprising the hindquarters, most of the bony elements cannot be seen or felt, and are inaccessible to routine X-ray techniques.

To understand what can go wrong, the anatomy of the area requires explanation. The three pelvic bones – the ilium, ischium and pubis – are all fused and form a ring on the left and right sides, joined in the middle by an immovable joint called a symphysis.

The tops of the left and right ilial wings are called the tubera sacrale [see box, right], and form the most prominent region of the hindquarters, the so-called jumper’s bump. The ilia are curved bones that, at their widest point, form the so-called hipbones. This is a misnomer, because the real hip joint is positioned much further back, and their correct name is the tubera coxae.

These bony prominences are susceptible to direct trauma if a horse falls over, or crashes against a stable door or gatepost, and this may result in a fracture, a so-called “knocked down hip”.

Part of each ilial wing forms a joint with the sacrum, which is part of the horse’s backbone. This is the sacroiliac joint. This joint is different to typical joints because there is negligible movement and the cartilage between the bones is unusual.

There is very little or no joint fluid. The joint is supported by huge, very strong ligaments – the ventral sacroiliac ligaments. These are quite separate from the dorsal sacroiliac ligaments, which, confusingly, have nothing to do with the sacroiliac joints. The dorsal sacroiliac ligaments are much smaller structures that run lengthways along the horse’s back from the jumper’s bump region backwards to the top parts of the sacrum.

In a fit, lean horse the jumper’s bump region may appear unusually prominent, but this is just normal anatomy not masked by excessive fat. It doesn’t mean that the horse has a problem.

Sometimes the tubera sacrale appear asymmetrical, and this can also be seen in clinically normal horses. Historically, it was attributed to misalignment of the sacroiliac joint, but there is very little evidence to suggest that this can happen.

So what can cause this apparent asymmetry? The most likely reason is difference in thickness of the overlying soft tissues, possibly the result of previous injury.

Alternatively, it could be due to a previous fracture of the ilium, so that one tuber sacrale slipped downwards. It can be a cause for concern when a horse is examined for purchase if the discrepancy in height is large.

Ilial fractures

Fractures of the ilial wing usually occur in young racehorses and are stress-related injuries. Repetitive overstress of the bone through exercise results in a series of microfractures, which may not affect performance. Ultimately, there may be a more complete large fracture, causing severe lameness and pain. The horse may suffer a lot of pain if pressure is applied over the jumper’s bump region, and one side may look lower than the other.

In some horses, a fracture can be confirmed using an ultrasound scan, looking through the hindquarter muscle mass to the upper surface of the ilium. If the fracture is incomplete or only affects the lower surface of the ilium, a bone scan may be required for definitive diagnosis. Although many of these fractures heal without difficulty, some are very close to the sacroiliac joint, and may partially destabilise it and cause long-term problems.

Ligament injury

Diagnosis of injury to the ventral sacroiliac ligaments or the sacroiliac joints themselves is much more challenging. The hindquarter muscle mass completely surrounds the top parts of the sacroiliac joints, so it is impossible to feel the joints. An extremely limited part of the lower aspect of the joints can be felt through the rectal wall, but because of the normal irregular bony contours in this area, identifying any abnormality is extraordinarily difficult.

Unlike lower limb joints, which can be flexed to see if extreme motion causes pain, the sacroiliac joints cannot be directly manipulated. Increased stress can be placed on the joints by certain manoeuvres.

Holding one hind limb up fully flexed places an abnormal load on the opposite joint and may cause pain. Some horses with sacroiliac joint pain become difficult to shoe, because they object to standing on one hind limb for prolonged periods.

Diagnosis

The problem with diagnosing sacroiliac pain is the inaccessibility of the joints. Joint pain is normally diagnosed either by identification of obvious pain and swelling, and intensification of lameness by flexion of the joint, or by injecting local anaesthetic solution into the joint and then seeing improvement in lameness. The joint can then be X-rayed to see if any bony abnormalities can be identified.

The deep location of the sacroiliac joint and its tight structure mean that we cannot feel the joint, nor can we inject local anaesthetic into it.

We cannot assess heat in the joint manually, or by using thermography, because this technique only measures surface temperatures. The joint cannot be X-rayed in a standing horse, and only limited views of the joint can be obtained if the horse is anaesthetised.

Bone scans can be helpful in identifying abnormal bone activity in the region, but interpretation is not easy because there is a lot of variability in normal horses, partly reflecting the shape of their pelvis, the thickness of the overlying muscle and also age effects.

Although local anaesthetic cannot be injected into the sacroiliac joints, it is possible, using very long needles, to infiltrate it around the joints. Improvement in action may reflect joint pain, but the local anaesthetic could also influence nearby structures, such as the ventral sacroiliac ligaments, or local nerve roots, or spread to affect the lumbar joints themselves.

It is therefore extremely difficult to be sure of a diagnosis of sacroiliac joint pain, although we know from post mortem studies that arthritis of these joints does occur. It remains a huge diagnostic challenge, aided by methodical elimination of the many possible causes of loss of hind limb action, and using a jigsaw of information gained from examinations.

Treatment

As diagnosis is difficult, treatment recommendations are usually symptomatic, and include corticosteroids, chiropractic manipulation, acupuncture for pain relief, and modification of the work programme. Unfortunately, long-term follow-up suggests that the prognosis for horses with sacroiliac injury is poor for return to the previous level of activity. As such, it is frustrating for horse owners and vets alike.

Key Points

A recent study by the author and Rachel Murray MRCVS of 74 cases of sacroiliac joint disease showed:

• Dressage and showjumping horses appeared to be at particular risk
• There was no correlation between conformation and the presence of sacroiliac joint pain
• In all horses, restricted hind limb impulsion was the predominant feature; this was most obvious when the horse was ridden. Stiffness, unwillingness to work on the bit and poor-quality canter were common
• 99% of the horses had abnormalities of the sacroiliac joint region identified using nuclear scintigraphy (bone scanning).

A horse’s neck comprises seven vertebrae that are positioned in the lower part of the neck, just above the jugular furrow. The vertebrae connect with each other by paired joints on the left and right sides — the facet joints — and by joints between the vertebral bodies. The spinal cord passes through each vertebra and nerve roots emerge between each vertebra.

Above and below the vertebrae are large muscles responsible for neck and head movement along with forward movement of the forelimbs. The crest region is formed by the nuchal ligament, which attaches to the back of the head and runs along the top of the neck to the withers.

Most movement in the neck occurs at its base and it is common to see changes in the facet joints between the fifth and sixth and the sixth and seventh cervical vertebrae in X-rays of middle-aged and older horses. These arthritic changes are generally of no clinical significance unless joint enlargement results in nerve root impingement or joint pain develops.

All anatomical structures within the horse’s neck are potentially vulnerable to injury, which is often the result of trauma. For example, a horse that falls on its neck while jumping may develop bruising, muscle damage or a fracture to a vertebra, while a horse which pulls back while tied up may damage the poll region or the joint between the first two vertebrae. Overstretching can also cause muscle strain.

The muscle most commonly affected is the brachiocephalicus, which runs along both sides of the neck from the forelimb to the back of the head. Damage to one of these muscles can result in lameness, whereas most neck injuries cause stiffness and possibly a restricted forelimb gait.

Other signs of neck pain include the horse standing with its neck in an usually low position and being reluctant to move the head and neck through the full range of normal movement. If there is pain at the base of the neck, the horse may straddle its forelimbs to eat off the ground.

Establishing the cause

If neck pain is suspected, the following techniques can be used to assess the cause:

X-rays are most useful for identifying bone or joint damage. X-rays of the base of the neck near the shoulder require relatively high exposures, so the horse may need to be examined at a specilist clinic as a portable X-ray machine may not be powerful enough.

Ultrasonography can be used to assess muscle and ligament structure, but it must be remembered that a strain causing pain is not necessarily associated with detectable structural damage.

Scintigraphy (bone scanning) is useful if a bone injury is suspected but cannot be identified on X-ray, such as a very recent non-displaced fracture.

More recently, three-dimensional images of the bone and soft tissue structure have been obtained while the horse is under anaesthesia, using either computed tomography (CT) or magnetic resonancing imaging (MRI).

The management of neck pain depends on the nature of the injury. Primary muscle injuries require a team approach between a vet and physiotherapist to ensure than pain is reduced and normal function restored.

Neck fractures normally heal satisfactorily with conservative treatment of box rest, with the horse fed and watered at head height to minimise any un-necessary movement.

Chiropractic manipulation of the neck, while the horse is under general anaesthesia or heavy sedation, can help treat non-specific gait abnormalities thought to arise from nerve problems associated with subtle displacement of neck vertebrae, however this type of neck manipulation is not a cure-all.

• This feature was original published in full in Horse & Hound

Q: My instructor says my horse could be suffering from a cold back. The vet is due to examine him in the next few days. In the meantime, can you explain exactly what cold-backed means?

Chartered physiotherapist Vicky Spalding replies:

The term cold-backed is really a description of the symptoms that a horse witha painful back exhibits.

Typical symptoms are dipping away or putting the back up as a response to saddle pressure.

A cold-backed horse will often show symptoms when the saddle is put on initially, or when mounted and walking off for the first few steps, but will then work normally as the affected muscles warm up, lengthen and become accustomed to the pressure of the saddle/rider.

Many people think that symptoms of a cold back do not indicate pain and that this is their horse’s normal reaction to tacking up or mounting – this is most definitely not the case.

The acute reaction seen in cold-backed horses is caused by stimulation of sensitive nerve endings. This may be due to pressure from a badly fitting saddle or stretching of immobile or injured tissue. Back pain may also develop as a consequence of underlying lameness, as the horse adjusts his posture to avoid bearing weight on the affected limb.

If your horse is showing symptoms of a cold back, the first course of action will be to identify the cause.

Your vet, physiotherapist and saddler may need to work together to do this. Once a cause has been established, an appropriate course of treatment may be given.

Practical tips to help minimise cold-backed symptoms include:

• Regular (at least annual) saddle and physiotherapy checks to identify problems before they become established. Note that veterinary permission will need to be obtained prior to input from a physiotherapist, osteopath or chiropractor – even for a routine check.
• Walk your horse round the yard for a few minutes once tacked up before mounting to allow the back muscles to warm up and start to stretch.
• Always mount using a mounting block.
• Warm up and cool down at the beginning and end of all exercise sessions.

Vicky Spalding MCSP SRP is a chartered physiotherapist. She runs the Physiotherapy Practice based at the Yorkshire Equine Clinic in Leeds.

State-of-the-art technology and one of the oldest methods of healing known to man are being combined to notable effect by a Surrey-based American vet to help horses suffering from back pain.

Dietrich von Schweinitz, who has successfully treated many top horses including Pippa Funnell’s Supreme Rock, uses infrared thermographic scanning as a diagnostic tool, backed up by a range of treatments involving both conventional and alternative therapies, particularly his speciality, acupuncture.

Bad backs

As many of us know, having a “bad back” can cause much distress.A horse suffering pain or discomfort “talks” through behaviour or movement.

His language can range from over-sensitivity to being groomed or saddled, to bucking or other violent behaviour when being ridden.

He can show varying degrees of lameness without obvious cause, stilted or uneven action or postural faults, or reluctance to co-operate in athletic endeavour.

Thermography

the manifestation of problems in the horse often emanates from the spine. The sympathetic nervous system is part of the autonomic (control) system that governs the processes such as blood flow responses to muscular activity and body surface heat.

This is a vital part of the whole nervous system and a major component of the spinal cord. It undergoes extensive interaction with other nerves, including those transmitting sensations and motor control.

Thermography – plotting a temperature map of the body – shows up abnormalities and, again in common with well-documented human cases, pain does not necessarily have its source in areas of increased temperature, the obvious “hot spots” which might indicate inflammation.

“Cold areas”, where blood flow is restricted, are as – if not more – relevant in the search for a reason for chronic pain. The key is to identify variations in temperature from the norm.

At Dietrich’s clinic, the focus is on horses with poor performance syndromes, back and neck pain, chronic lameness and locomotor complaints, all of varying degrees of subtlety.

His patients are largely competition horses, particularly prone to neuromuscular and musculoskeletal faults. Rehabilitation treatment and services are not restricted to acupuncture; there aremost modern facilities practice, but the emphasis is on a holistic approach.

Thermographic scanning – an easy, non-invasive procedure -gives an overview of the horse’s physiological status and assists in plotting the sympathetic nervous system’s responses to acupuncture and other therapies.

Nervous system

It is one of Dietrich’s regrets that more attention is not given to neuro-physiology (working of the nervous system) in veterinary training.

“There is tremendous integration of the nerves involved in the micro-trauma of a needle insertion, because of where it is happening. The acupuncture points, all over the body, are slight hollows – you can feel them, for example, along the meridian which runs onboth sides of the spine on the edge of the longissimus muscle.

“They also frequently happen to be sites where neurovascular bundles [bundles of nerves and blood vessels] come out from the deeper tissue to innervate that area.”

Q: I bought my nine-year-old 16hh Irish gelding from a dealer who had brought him over from Ireland. He has a large scar on his off hind pastern which I was told happened in the field when he was a youngster.

I ride him six days a week, which includes two schooling sessions and the rest hacking.

I have show jumped him and done some cross-country before he started to have back problems. It has been suggested the problem – and his scarring – could stem from a fall while out hunting. He has had physiotherapy, including some ultrasound, and three months off overthe winter before being brought slowly back into work .

Recently, he has started to square his shoes at the back although he showed no signs of discomfort.

He now has physio and magnetic therapy. Will the problem always come back? And is there anything else I could do for my horse?

Jo Holmes MRCVS replies: You have not mentioned any veterinary input into your horse’s medical history, so I will highlight areas where it would be required.

If you had him vetted at purchase and he passed, the large scar on his right hind pastern is unlikely, in itself, to be causing him problems now. However, its acquisition may have been in a previous fall of some sort, which also injured his back.

The soft tissue damage in his back may never have fully disappeared, only becoming apparent when he is worked hard. A physiotherapist may well be the best person to keep this in shape.

Many back problems develop because of pain lower down the hind legs and cannot be cured without solving the primary problem. Asymmetry of muscle mass is not necessarily cause for alarm (unless accompanied by lameness) but illustrates an underlying rotated pelvis, which he may have acquired when young and has since stabilised.

Veterinary advice is vital to decide if the problem is acute or chronic and if the pelvic area has suffered any fracture or merely muscle or ligament strain. Physiotherapy will help muscle strain and can then build muscle back up correctly once inflammation has gone down. However, physiotherapy might not have been a priority in the first instance – box rest may have been a more suitable treatment for him.

Ensure that your physiotherapist works under the guidance ofa vet and only once a diagnosis has been made. Also, check he or she is a member of the ACPAT (Association of Chartered Physiotherapists for Animal Treatment, (tel: 01962 844 390).

An osteopath or chiropractor might help in other ways, depending on the problem.

You noticed your horse is squaring the toes of his hind shoes. This is an indication of many types of hind limb lameness, not just a bad back. If both legs are toe dragging, a common bilateral problem is possible such as spavins (arthritis of the hock joints). Veterinary advice must be sought.

There is no doubt that pain associated with the thoracolumbar region does exist, both as a primary problem and as muscular painsecondary to a forelimb or hindlimb lameness.

But, given the complex anatomy of the horses back, it is not surprising that identifying the cause is difficult.

Causes

• Primary back pain may be caused by an ill-fitting saddle. Horses can change their shape and a saddle which fitted when the horse was unfit and overweight may be totally unsuitable when the horse is fitter and leaner.
• Don’t rely on pads and numnahs to readjust the fitting.
• A rider who sits heavily or is thrown behind the rhythm because the saddle fits the horse but not the rider will inevitably cause back soreness.
• A rider who himself experiences physical problems and tends to sit crookedly may also induce back pain.
• Intense, painful back muscle spasm may be induced by the horse moving abnormally, perhaps jumping extravagantly or awkwardly.
• Back pain can also be the result of structural abnormalities such as impinging dorsal spinous processes (kissing spines), arthritis, spondylosis, herniation of intervertebral disks causing nerve root compression and, less commonly, fractures.

What to look for

To the rider, back pain can become evident with a change in the horses behaviour when first tacked up or mounted (cold-backed behaviour), a sudden onset of bucking or rearing, reluctance to go forward, resistance, shortness of stride, stiffness, unwillingness to jump or reduced performance.

But it is important to recognise that the majority of these signs are not specific to back pain. They could be shown, for example, by a horse with early arthritis in both hocks and bilateral hindlimb stiffness, a difficult horse or even one with a schooling problem.

A comprehensive evaluation of the whole horse should be made to detect any underlying problem which may cause back pain.

In some cases it is difficult to determine whether the primary problem is pain induced, or whether it reflects the horsesdifficult temperament.

In these horses, treatment with relatively high doses of painkilling drugs for two to three weeks can be invaluable to see what difference this makes.

Pain thresholds

Horses, just like people, have different pain thresholds. A similar level of discomfort may be well tolerated in one horse, but cause a marked decline in performance in another.

Pain that was tolerated when the horse was being ridden in an undemanding way may become clinically apparent when athletic demands increase.

Managing back pain

The successful long-term relief of back pain often requires a team effort: a combination of rider and trainer, the vet, the physiotherapist or chiropracter and the saddle fitter.

Precise treatments will obviously depend on the primary problem, which emphasises the need for an accurate diagnosis.

While manipulation may relieve muscle spasm, and therefore pain, and acupuncture may alleviate it, if there is an underlying structural bony abnormality then clinical signs are likely to recur.

Pain associated with kissing spines may be relieved by injecting a number of drugs between and around the offending bones, but this is likely to have to be repeated every three to four months and, in selected cases, surgery may be the best long-term solution.

It is also vital to recognise that many horses with suspected back pain actually have a primary problem elsewhere and, if the response to any treatment is short-lived, you should seek expert veterinary advice early on.

Back pain in horses can originate from:

• the skin (eg saddle sore)
• ligaments (eg sacroiliac strain)
• vertebrae (eg overriding dorsal spinous process or “kissing spine“)

Good conformation is paramount. Long-backed horses are prone to muscle and ligament strains, while those with excessively short backs are susceptible to vertebrae problems. Dip or sway backed (abnormal sunken back) horses have a weakness, while those with roach backs (humped) typically lack suppleness.

Common causes of back pain in horses

• incorrectly fitting or poorly maintained saddle
• pain elsewhere, causing the horse to alter its action, so putting abnormal stresses on the back
• falling, slipping up
• twisting, turning abruptly
• jumping awkwardly

Detailed examination

View the back from both sides, particularly from behind, with the horse standing square, noting: skin lesions; lumps, rubs, chaffs and saddle sores; areas of asymmetry; localised muscle swelling or wasting; curving of the spine.

Run your hands from the withers to the tail on either side of the spine. Gradually increase the pressure, remembering that it is normal for a horse to dip its back when the loins are reached and to hump as you pass over the quarters.

Signs of problems include:

• areas of heat
• rigidity or resentment at a particular “hot spot” (eg moving away, lashing out).

Push the horse backwards for a few strides as some with back pain object to this.

Finally, check your saddle.

If you suspect a problem, call your vet. He will repeat many of the tests in detail and try to establish whether there is a problem elsewhere. Many horses with suspected back pain are chronically lame behind, and a full lameness examination, including flexion tests of the hindleg, may be necessary.

Your vet will check your saddle and may also want to see that the horse:

• walked and trotted up in-hand on the flat and up and down a slope
• lunged on the circle at all gaits, on both soft and hard surfaces
• led and then ridden under saddle by the usual rider

Further investigation in equine back pain

Other investigative work that the vet may recommend include:

• Blood sampling: pre- and post-exercise to test for muscle damage
• X-rays: will show up fractures or osteoarthritis, but are limited by the thickness of the surrounding soft tissue.
• Gamma scintigraphy: bone scanning is helpful in detecting bony “hot spots”, but is limited in highlighting soft tissue problems.
• Ultrasonography: being increasingly used, although vets disagree about interpreting ultrasonographic changes.
• Electrical stimulation of back muscles: eg Faradism to detect areas of soft tissue pain.

Treatment for back pain in horses

Rest is essential, ranging from weeks to months. More specific treatment will depend on the diagnosis and includes:

• painkiller, eg bute
• physiotherapy, eg heat,ultrasound, Faradism, manipulation, infiltration into area of pain, eg. anti-inflammatories
• surgery in cases of painful “kissing spines” and some fractures
• controlled exercise
• acupuncture

Prevention of equine back pain

Back pain in horses can be notoriously difficult to isolate and treat. Many horses with chronic soft tissue injuries have recurrent problems and the prognosis can be bleak.

Ensure your saddle fits correctly. A well-fitted saddle should disperse the pressure of its rider over a uniform area. It is advisable to use a qualified saddle fitter, but you can try to assess a saddle’s suitability by sprinkling talcum powder on your horse’s back, put the saddle on, press down firmly, and remove it.

Study the lining: traces of powder should be distributed over a wide area – concentrated residues indicate damaging pressure points.

Your horse’s back may change shape during the year, due to weight or fitness

• Beware of dirty, sweaty saddle linings, and wet, muddy backs: all can cause chaffing and sores
• A slight rub dealt with early can prevent a full-blown sore requiring a longer time off work. Make sure your horse is fit for the work being asked of him
• Do not breed from your horse if the back conformation is poor