Back pain

A sore back or poor performance because of back pain is a very common complaint, however, can be very difficult to diagnose. True back problems are relatively uncommon and all these cases must be assumed to suffer from another problem, i.e. lameness in another leg, until proven otherwise.

Signs of back pain

The signs of back pain include stiffness in walk or trot, resentment of being saddled, reduced performance or inability to jump, head-shaking, tail-swishing, altered behaviour and difficulty lying down. As the signs of back pain can be very subtle a very careful examination must be carried out by the vet.

Examination of the horse with back pain

  1. Examination at rest: The vet will first look at your horse’s conformation, evidence of any muscle wastage, symmetry of the hindquarters and how squarely the horse stands.
  2. Palpation: By gently palpating the muscles along the back, areas of pain or muscle spasm may be found.
  3. Manipulation: The horse’s spine can be manipulated to assess how it flexes up, down and to both sides and to see if there is any pain associated with this. The tail and neck can also be manipulated to assess any area of pain.
  4. Exercise: Many horses with back pain will show a restricted hindlimb action with poor hock flexion and a tendency to drag the toes. The horse may have either a close (plaiting) or wide (straddling) gait behind. Flexion test should be carried out to rule out common hindlimb lameness due to bone spavin. The horse should be turned in tight circles, walked backwards and placed on the lunge. The vet may wish to see the horse ridden and maybe even jumping. At this stage the tack should be carefully checked to see if it may be causing discomfort.
  5. X-rays: Powerful equipment is needed to obtain pictures of soma parts of the spine and to gain good images of the pelvis region a general anaesthetic may be required.
  6. Bone scanning: This can be used to find ‘hot spots’ of active bone along the spine.
  7. Local anaesthetic can be injected into the spaces between spinous processes of areas that are thought to be a problem and the horse re-assessed afterwards.
  8. A blood sample can be taken to rule out other conditions that cause poor performance and occasionally assess muscle damage.

Conditions causing back pain

Certain conditions need to be ruled out before proving a back problem. These include temperamental problems, poor schooling, badly fitting tack, lameness in both front legs (e.g. navicular) and lameness in both hind legs (e.g. hock and stifle problems, esp spavin).

Muscle strain

This is the most common back injury and is usually caused during exercise, especially after a trip or fall. Muscle spasms can also develop over a period of time after compensating for a lameness elsewhere. Horses with muscular injuries

Sacroiliac syndrome

The sacroiliac region is between the ileum of the pelvis and the sacrum (i.e. just in front of the tail head). The joint between the two structures is normally immovable due to strong ligaments that support it. Problems in this region occur when the rigid support of this joint is lost either suddenly after a slip of fall (acute) or due to repetitive low grade injury (chromic). After an acute injury horses will show obvious pain in the sacroiliac region and be stiff at the walk. These horses require rest and and will hopefully resolve when the joint has fibrosed back into a stable position. In chronic cases the signs can be very slight and the only treatment is to try an manage the horse with the occasional use of anti-inflammatory drugs such as phenylbutazone (‘bute’) and keeping the horse fit and well muscled.

Overriding dorsal spinous processes (kissing spine)

In this condition back pain is caused by spinous processes, the upward extensions of bone from the spine, from two neighbouring spinal segments overlapping and impinging. Local anaesthetic can be injected between two spinous processes that appear to be impinging on x-rays and the horse assessed afterwards to see if there is an improvement. The spinous process that is causing a problem can be removed surgically under a general anaesthetic.

Back ‘put out’

Many people will claim that one of the horse’s vertebrae has been displaced and is causing back pain. This is completely impossible and is most likely that what is being seen is caused by muscle spasms on either the left or right side of the back, causing a slight curvature in the horse’s spine. Manipulation by a chiropractor can temporarily result in equal muscle tone on both sides of the back, however, if there is an underlying problem causing the muscle spasm the relief may only be temporary as it treats one of the signs rather than the cause of the condition. In a study of 825 horses, thought to have back problems 12% had no abnormalities, 17% had problems away from the back, 14% had sacroiliac problems, 28% had kissing spines and 33% had muscle strains.