Equine Lumbar (Back) Pain

My horse has a sore back!

The diagnosis or symptoms of back pain in the horse is a commonly reported problem. Symptoms can be many or varied. Commonly reported symptoms of “back pain” include:
• Reactivity to palpation (touch/pressure) in the lumbar region
• Resentment to saddle/girth
• Resentment to work, especially higher intensity work (i.e. speed/turning/jumping/ground work)
• Gait abnormalities/lameness, especially in the hind limbs
• Reduced mobility and flexion in the lumbar/sacro-iliac/pelvic region
Commonly there is a history of recent prolonged or high intensity/impact work
So does back pain really exist?
The most important thing to remember is that “back pain” in the horse is often a symptom of anothernon “back” related issue, rather than a primary musculo-skeletal problem originating in the lumbar region. The commonly misdiagnosed “kissing spine” – a condition resulting in inflammation between dorsal vertebral processes in the back is actually very rare, and can only reliably be diagnosed via diagnostic nerve blocks and/or scintigraphy (bone scan).
So what are the causes of the “symptoms” of back pain? These include, but are not restricted to:
• Secondary musculoskeletal pain/inflammation/ from:
o Hock (tarsal) issues (e.g. inflammation/arthritis)
o Sacro-iliac (SI) issues
o Stifle issues
o Hind-leg hoof issues or imbalance
• Abdominal discomfort (e.g. ulcers)
• Primary back pain (inflammation, muscular tears, arthritis)
o Ill-fitting saddle
o Kissing spine
o Arthritis/”wear-and-tear”
o Excessive weight
o Excessive/high-impact work load (e.g. jumping)
• Nerve issues
• Other underlying systemic issues
The diagnosis of the factors causing “back pain” in your animal can be easy or complex, and require a thorough history. The work-up will likely also involve a full lameness examination (which can include gait assessment (walk/trot/lunge/canter), diagnostic nerve blocks, ultrasound examination, x-rays, MRI, CT, referral to a hospital, etc). 
Treatment(s) will vary with relative cause(s). They may include:
• Conservative treatments such as:
o Rest 
o Non-steroidal anti-inflammatories (e.g. phenylbutazone/”bute”)
o Refitting a saddle
o Corrective farriery
o Strengthening exercises (low-level hill work, water work, stepping over obstacles, cavalettis, etc.)
o Massage
o Acupuncture
o Joint protective/general anti-inflammatory treatments (Pentosan/HA/4Cyte)
o Joint supplements
o Shock-wave therapy
• More intensive/invasive treatments are often necessary, and may include:
o Joint injections (cortico-steroids(cortisone)/HA/IRAP/PRP)
o Surgery
o Treatments of other underlying systemic causes
Sometimes treatment can result in immediate improvement and allow a resumption of your horse/pony’s work, however sometimes diagnosis and treatment can take considerable time, effort and rehabilitation.
If at any time you are worried about your horse/pony’s condition, or if you have any further questions, please contact the Main Ridge Veterinary Clinic on (03) 5989 6232