shock wave
Building upon diagnostic strategies from her first presentation at the 2022 Veterinary Meeting and Expo (VMX) held in Orlando, Florida, Sarah Waxman, DVM, MS, Dipl. ACVS, a clinician in the Equine Community Practice department at Purdue University, in West Lafayette, Indiana, devoted a second session to treating and rehabilitating neck and back pain.

After establishing that not all back problems can be traced back to lameness and discussing diagnostic options, Waxman delved into specific conditions responsible for primary back pain:

  • Overriding dorsal spinous processes (aka kissing spines). This condition most commonly affects thoracic vertebrae T10-T18 and lumbar vertebrae L1-L6 and might include severe sclerosis (formation of new or excessive bone, often in response to continued trauma/stress) and osteolysis (bone resorption/destruction). Horses’ pain tolerance levels vary greatly, and not all kissing spines cases are clinically significant.
  • Articular process joint (APJ) arthritis. Resulting from either malformation, injury, or wear and tear, APJ arthritis can lead to periarticular (surrounding the joint) bone formation, sclerosis, lysis, capsulitis (joint capsule inflammation), and synovitis (inflammation of the joint lining). Veterinarians treat this form of arthritis much like any other form.
  • Intervertebral disc disease (IVDD) and spondylosis. A rare condition, IVDD causes painful disc degeneration and collapse of intervertebral disc space. Treatment involves providing both local and systemic pain relief, but the quality of life of many affected horses degenerates quickly.
  • Lumbosacral disease. Injury to this region can consist of joint degeneration from wear and tear or from acute trauma such as a dislocation or fracture.
  • Soft tissue injuries. Differential diagnoses include nuchal ligament or supraspinal ligament desmitis and muscle tears or abscesses.

Waxman briefly touched on the therapeutic options practitioners have available when addressing neck and back problems:

  • Chiropractic care
  • Acupuncture
  • Physiotherapy, including kinesiology taping
  • Extracorporeal shock wave therapy
  • Pulsed electromagnetic field (PEMF) therapy
  • Therapeutic laser
  • Therapeutic ultrasound
  • Mesotherapy
  • Joint injections, either with steroids or regenerative therapies such as platelet rich plasma (PRP) or interleukin-1 receptor antagonist protein (IRAP)
  • Surgery, consisting of spinous process resection/desmotomy in kissing spine cases
  • Medical therapy, usually in the form of non-steroidal anti-inflammatory drugs (NSAIDs) or off-label use of the bisphosphonate drugs Osphos and Tildren.

“Rehabilitation is just as important as the treatment itself,” Waxman emphasized. “Mobilization exercises help the horse relearn how to lift and flex his spine. Water treadmill or swimming sessions are valuable assets to rebuild the strength of the back without adding stress to the joints.”

When it comes to under-saddle work, Waxman said she’s a big proponent of working up and down hills, which helps build coordination and strength and conditions the gluteal and iliopsoas muscles that support the pelvis. In the ring, she said she values the judicious use of a Pessoa training aid or similar systems to promote “long and low” movement, encouraging stretching and elongation of the topline.

After discussing anatomy, diagnostics, specific conditions, and their treatments, Waxman ended by stressing the importance of physiotherapy and exercise management when addressing conditions related to neck and back pain. “These are two crucial components for a successful comeback,” she said. “Ultimately, the rider must listen to their horse and adapt the training regimen to accommodate individual progress and tolerance.”

Editor’s note: This is a continuation of a series on neck and back problems in the horse. See last week’s story about diagnosing these issues.