The Causes of Equine Back Pain

 Back pain is an extremely common problem among our equine population of athletes and pleasure horses. In researching the topic, I tried to find out just how many horses are affected by back pain, but could not find any research that provides an answer.

That being said, it is uncommon for us as Vetrehabbers to see patients who don’t have back pain. The back is somewhat of a barometer for the body – when there is pain in the back, we know that something is wrong somewhere. Back pain is the little red flag that the body waves, saying, ‘Something is wrong!’ 

Discussing the causes of back pain, therefore, is a lot like trying to compile a comprehensive list of all the things that could be wrong with our patients – a tall order, but let me give it a try! 

Primary or secondary

A survey performed by Riccio et al. (2018) over the course of ten years indicated that 46-50% of back pain was primary (originating in the back), while 49-54% of cases were secondary (originating from another condition).

Let us look at some of the primary, and a handful of the secondary causes of back pain (Riccio et al., 2018).

Primary causes

According to Riccio (2018), only 60-80% of primary back pain could be diagnosed, with the percentage increasing over the years as imaging techniques have improved. However, a diagnosis of primary back pain remains a challenge. According to Henson (Equine Back Pathology), some of the primary causes of equine back pain include:

• overriding dorsal spinous process, or kissing spines (the most common cause of primary back pain (Jeffcott, 1989)
• transitional vertebrae or other congenital malformations
• supraspinous desmitis
• interspinous desmitis
• articular facet joint osteoarthritis
• ventral vertebral spondylosis
• discospondylitis
• stress fractures of the vertebral laminae or pelvis
• infection of the vertebrae or intervertebral disk
• traumatic damage, including fracture of dorsal spinous processes, fracture of the thoracolumbar vertebral column and pelvic fractures.

Secondary causes

This is where things get really interesting. As I said, back pain is a common finding when we are treating almost anything physically wrong with the horse. The back can also become painful when the horse is under mental or emotional stress, especially over long periods, and during times of mares’ hormonal changes.

Some of the many causes of secondary back pain include:

• ill-fitting tack – either a saddle or a bit and bridle
• lameness in the fore or hind limbs
• poor posture
• weak core strength
• extended stable rest
• unbalanced or asymmetrical rider
• incorrect hoof balance
• poor conformation
• exercise in deep surfaces
• incorrect progression of exercise or training schedule (usually too fast)
• incorrect exercise regimen
• visceral pain from ovaries, kidneys, or stomach ulcers
• dietary imbalances
• metabolic conditions such as PSSM (polysaccharide storage myopathy) or EPM (equineprotozoal myeloencephalitis)
• hormonal imbalances
• emotional stress or imbalances

Identifying back pain as an owner

Since back pain has so many causes, the root cause of a specific instance can be challenging to identify. However, back pain remains a valuable indicator that investigation or intervention is called for.

We should regularly monitor the condition of our own horse’s back so that we know what ‘normal’ is for our horse, and when our horse starts to move out of ‘normal’ parameters.

Some of the ways in which you can identify back pain in your horse include:

• an unwillingness to work
• modified or changed jumping technique (or other skill)
• poor performance
• changes in behaviour
• loss of forwardness
• rushing
• poor posture – arching the back and raising the head
• unwilling to take up the contact
• difficulties with bend, or turning during ridden work
• unwilling to be saddled or mounted
• a tendency to kick at or object to the leg, perhaps nipping at the leg of the rider
• difficulty with the farrier
• areas of heat

Searching for back pain

You can learn to gently palpate your horse’s back for areas of pain  – a valuable skill to add to your horsemanship toolkit. It is possible to learn how to palpate your horse’s back from YouTube videos, but I recommend learning the skill directly from your Vetrehabber. This way you will be able to demonstrate what you have learnt, and receive specific and immediate corrections with regard to technique and pressure.

Prevention can be practised

Many of the causes listed above can be addressed or prevented through your horses management and exercise. You might pay attention to the following areas:

• Excellent nutrition
  Managing your horse’s nutrition and lifestyle will promote a balanced emotional and hormonal life, as well as prevent or manage certain muscular conditions. 

• Strength and posture
  Incorporating core strengthening and conditioning into your exercise routine and maintaining a strong focus on correct posture will help your horse develop a strong and resilient back, well able to withstand the onslaughts of daily life. It will also help to treat and possibly prevent the worsening of some of the primary causes of back pain, such as kissing spines or arthritis.

• Well-fitting tack
  Ensuring you have well-fitting tack is another way to ensure that your horse remains healthy and pain free, and continues to offer you the best possible performance.

If you are ever in doubt about how best to manage your horse’s back, especially if they have a pre-existing condition, chat to your Veterinary team about possible causes and challenges that your horse might be facing, and what interventions would be appropriate. If the back is kept healthy and strong, a whole host of other conditions may be prevented, too.

References:

1. Frances Henson, Equine Back Pathology
2. Impingement of the dorsal spinous processes in two hundred and fifteen horses: case selection, surgical technique and results;  P. Walmsley, H. Pettersson, F. Winberg, F. McEvoy
3. Two Multicenter Surveys on Equine Back-Pain 10 Years a Part Barbara Riccio¹, Claudia Fraschetto,  Justine Villanueva,  Federica Cantatore and Andrea Bertuglia