I am often called to look at horses that are exhibiting back pain and performance problems. The difficulty is that the symptoms are not always consistent, and may not always be easily re-created when I am there to watch the horse go. Hence a good history of the problems that you are seeing is very helpful.

I always suggest a thorough physical exam of the horse before we focus on the back. A basic overview of the horse, including opthamalogical, neurological and dental exams, and observation of the horse in the stall at rest as well as in motion can offer important clues. I palpate the legs as well as the back, looking for swellings, heat, point tenderness and muscle soreness, and pain in muscle groups that may not be directly involved with the horse’s back. I look at hoof balance and observe the horse’s hoof landing when he is walked. I try to speak with the farrier who has been shoeing the horse to determine if he has been working on correcting any hoof balance issues or abnormal wear.

I will want to see the horse go in a round pen or on the lunge, and then under saddle. I like to watch the horse in the soft footing of the ring and also trotting on a hard surface. I look for obvious lameness issues such as head bobbing or toe dragging, and do a general gait evaluation consistent with the level of the horse’s schooling and balance. I note discrepancies in stride, such as a horse that has a shorter forward or rearward phase of the flight of the leg. Many back sore horses also have hock and stifle issues that cause abnormalities in gait and can aggravate back problems. Basic full leg flexion tests of all legs should be done, and any leg that shows lameness or soreness should be flexed joint by joint. I have seen many cases of horses that are sore in two or more legs. This can be very difficult to see, because often the characteristic ‘head bob’ that makes it easy to spot a lameness can be cancelled out as the horse ‘ouches’ on two or more legs. Nerve blocks and x-rays may be indicated if leg lameness is suspected as being part of the picture.

There are many diagnostic tools available that can help us pinpoint the problem. I often start with a thermography camera that allows me to see heat patterns on the horse’s body. Inflamed areas show up extremely well, and this can help me pinpoint saddle pressure problems as well as muscle damage and joints that heat up. It is sometimes very hard to sort out saddle fitting problems and training issues from medical problems. I look for asymmetrical patterns, comparing patterns on both sides of the horse, and make careful note of ‘hot spots’. It is helpful to do the thermographic imaging both before and after the horse is worked to look for changes in heat patterns.

If I suspect trauma or degeneration of the bony spine, I take radiographs. I am now using a computerized digital system that allows me to enhance the x-rays on a computer for much better viewing. In the past, spinal x-rays were very difficult to do out in the field, and sometimes didn’t always come out very well. If bony degeneration is identified, the condition may respond well to anti-inflammatories and it is sometimes appropriate to inject cortisone into the affected joints. Muscle problems, (which often go along with bony problems) can respond to muscle relaxants such as Robaxin, and injectable drugs such as ‘Sarapin’. Please note that many of these drugs are illegal to use on a horse in competition. Treatment with poly-sulfated glycosamines, such as ‘Adequan’ and ‘Legend’ has been proven very beneficial in treating arthritic conditions, and many horse owners are finding success with the feed supplements that target joint health.

 Nuclear Scintigraphy is another imaging modality that can be very helpful in diagnosis of elusive problems. This procedure must be done at a facility that is set up to deal with the radioactive isotopes that are injected into the horse. Areas that are ‘hot’ will show an increased uptake of the isotopes.

I do blood screens to identify indications of electrolyte imbalances, potassium level alterations, and elevated muscle enzymes. The blood work can give an indication of whether it is appropriate to consider muscle biopsies to identify glycogen storage disease, which can be responsible for muscle pain and weakness.

A dental exam will identify any teeth or mouth irregularities. Horses with mouth pain can hold their head and neck crooked, which can translate into stiffness and discomfort throughout the rest of the body. It is often necessary to sedate the horse in order to have a really thorough look. In addition to checking for sharp edges on the molars, I look for wolf teeth, and wolf teeth that have been broken off under the gum line.

Neurological exams address the possibilities of spinal impingement, EPM (equine protozoal myelitis) and an assortment of other diseases that affect the nervous system. There are some simple, but fairly specific tests, including tight circles, backing up, and foot placement that can identify abnormalities that may mandate further testing.

A reproductive exam can help identify problems in mares associated with their heat cycles. Low-grade uterine infections and hormone imbalances can make mares overly sensitive and very uncomfortable to carrying weight and saddle pressure. The use of estrus suppressing drugs can be helpful in some cases.

The bottom line is that back problems can be very tricky to diagnose and treat. It can often be an ongoing situation that requires constant monitoring and care. Once you have identified the problem, and done whatever treatment may be appropriate, then good fitness, strengthening exercises, and careful conditioning can go a long way to sustain the usefulness of horses with back pain issues.