Managing Your Horse’s Back Pain

Two veterinarians share how they diagnose, treat, and rehab back-sore horses.
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Managing Your Horse
Your regular veterinarian knows your horse better than any other vet, and with your help and possibly that of other local equine specialists, he or she has the best potential for relieving your horse's pain. | Photo: Kevin Thompson/The Horse

Two veterinarians share how they diagnose, treat, and rehab back-sore horses

Yesterday you led your horse out of his stall and into the crossties, ready to enjoy some time in the saddle. When you brushed his back, he flinched. When you tightened the girth, he swung his head to the side, clearly annoyed. Your red-flag radar told you something wasn’t right. And as soon as you swung lightly into the saddle and felt his back sink, you knew your normally happy, easygoing mount was hurting. Recognizing the signs of back pain but not knowing just what the problem was, you dejectedly untacked him and called your veterinarian.

Because your horse can’t verbalize where exactly his back hurts or how and when it all began, how does your veterinarian go about pinpointing the problem and forming a treatment plan to eliminate, or at least minimize, the source of his pain? Read on to learn how veterinarians know what diagnostic path to pursue and how to manage your horse’s short- or long-term back pain.

Choose Your Team

Your regular veterinarian knows your horse better than any other vet, and with your help and possibly that of other local equine specialists, he or she has the best potential for relieving your horse’s pain.

Sometimes, however, another opinion or approach might be helpful. Melinda Story, DVM, Dipl. ACVS, ACVSMR, an assistant professor of equine sports medicine and rehabilitation at Colorado State University’s College of Veterinary Medicine and Biomedical Sciences, in Fort Collins, says that even if you’re not near a specialist or a veterinary teaching hospital or school, finding a veterinarian who’s open to an integrative approach—working with multiple modalities and professionals—is important.

Review Possible Causes

It can be a chicken-or-egg-type scenario: Did the back pain result from discomfort somewhere else in the body, or is it truly the root of your horse’s problem?  

Back pain can stem from one or more of a long list of causes—some preventable and some not. Your veterinarian can help you determine if there’s a rider- or management-based reason for your horse’s pain. Common causes include:


Your veterinarian can advise you on your horse’s suitability for a particular discipline; some horses simply aren’t built for the movement required in a specific activity. It’s helpful to determine this during the prepurchase exam and not well into your ownership of the horse.  


Grace Buchanan, DVM, of Buchanan Mobile Veterinary Services, a satellite of Teigland, Franklin, and Brokken, DVMs, PA, based out of Rutherfordton, North Carolina, says improper ­shoeing can create trigger points (muscle spasms) that can lead to back discomfort. This is especially true in horses with “clubby” feet, long toes and low heels, or underrun heels.  

Rider position and posture

“If back pain is consistently recurring or not resolving like I think it should, I look at rider position to see if they’re riding in a way that’s causing pressure over time,” says Buchanan.

Training methods and conditioning

Improper approaches can lead to muscle strains and injury. Make sure you ­condition your horse sufficiently and work the appropriate muscle groups to withstand workouts in your discipline.  

Tack fit

“If I’m finding a lot of pain at the withers, I’ll be suspicious of saddle fit,” says Buchanan. “Usually I’ll have the horse’s owner put the saddle on with no saddle pad (and no rider) and insert three fingers between the pommel and the withers. If they can fit more than three fingers, the saddle is too narrow and sitting too high; if less than three fingers, it’s too wide and sitting too low. This isn’t a 100% perfect science, but it’s a good guideline.

“Another thing I look for is bridging,” she adds. “The saddle’s panels should lie smoothly all along the horse, with no areas that aren’t touching the horse’s back. Areas without contact mean other areas are getting too much pressure.

“A third test is to ride in a clean saddle pad, and after you’ve ridden, check the pad for dry spots that indicate uneven pressure,” she adds. “Then if there are more significant tack-related problems, I’ll refer the client to a saddle fitter.”

Have an expert saddle fitter evaluate saddle fit frequently. “If a horse has underlying pathology, he’ll lose some musculature, so a saddle that fit before may not fit anymore,” says Story. “Check fit at least a few times a year or after any significant change in work or time off.”

Muscle and/or ligament strains or tightening

A back injury can cause pain at the place of insult. Or, an injury in one area—­including soft-tissue injuries such as wounds and resulting scars—can cause a horse to compensate, or move other body parts abnormally in an effort to minimize the pain, resulting in injury of other muscles, joints, or ligaments.  


This progressive and painful degenerative disease process can occur in the joints along the spine.

Acute trauma from falling

Do all you can to eliminate the risk of falls. Keep turnouts and stalls free of objects such as rocks that could cause your horse to trip and/or injure him if he falls. If possible, exercise your horse indoors when the ground outside is slick or icy. Even without a fall, says Story, your horse can strain his back muscles by slipping and sliding on icy or wet footing.

Kissing spines

Veterinarians see this overriding or impinging of the spinous processes most commonly in middle-aged horses involved in racing, jumping, and performance events. “In the case of kissing spines, we can assess using radiographs,” says Story. “In most horses, however, because of the large muscle mass, it’s difficult to penetrate and obtain clear images of the facet joint (small stabilizing joint of the spine) regions.”  

Sleuth a Diagnosis

Your veterinarian will follow a fairly standard protocol looking for clues to help pinpoint your horse’s problem.  

Manual examination

The practitioner will run his or her hands over your horse, feeling for muscle tension or heat that might indicate inflammation.  

Equine back exam
The back exam begins with a manual evaluation for muscle tension or heat. | Photo: Alexandra Beckstett/The Horse

Postural analysis

This simply involves standing back to see if your horse is standing square. “Horses with pelvic or low back pain will often stand with hind feet separated, one foot up underneath and one foot out behind,” says Buchanan.

Passive and active mobilization

Your veterinarian might physically move your horse’s joints and muscles (called passive motion) to determine tolerance for movement in the neck, thoracic, and lumbar regions. He or she will also observe reactions to active mobilization: How well your horse is moving in a straight line and a circle, with a surcingle or a saddle, and with and without a rider. Also, Buchanan says hooking a few fingers around your horse’s tail and wiggling it gently from side to side or asking the horse to flex and extend his back can reveal signs of pain (e.g., biting, kicking, tail swishing, trying to move away).

Acupuncture exam

By running his or her hands over acupuncture points and gauging the horse’s reactions, your veterinarian can find painful trigger points not evident in a conventional exam.  

Nuclear scintigraphy (bone scan)

Usually performed at referral clinics, scintigraphy involves injecting radioisotopes (radioactive molecules) intravenously that settle in areas of active bone remodeling, and then scanning the body area. Although the resulting images are not as clear as radiographs, they can help the veterinarian localize problem areas to know which region to focus on or perform further imaging on.  


Your veterinarian will likely take radiographs if he or she feels they will shed light on the cause of the pain or rule out some conditions. Again, radiographs have their limitations for assessing a horse’s back, but most field units can penetrate enough to see the spinous processes in the thoracic and thoracolumbar regions, says Story, adding that “if the field unit does not have the capability to penetrate the muscle mass, the horse may have to travel to a referral center with larger, more powerful ­equipment.”  

Build a Treatment Plan

Ideally with acute injuries, proper diagnosis, specific treatments, and careful rehabilitation lead to a positive outcome. For rider- and ­management-based causes, your intervention can facilitate healing and prevent ­recurrence.  

Sometimes, despite best efforts, the ­issue stumps veterinarians, says Story, and treatment then focuses on managing pain rather than solving ­problems.  

She adds that back treatment focuses on three goals: decreasing pain, increasing strength, and increasing mobility. To achieve the best recovery, virtually all horses with back pain need to undergo some degree of rehab involving exercises that develop the muscles to support the entire spine and enable them to use their backs comfortably and properly.  

Here’s what your veterinarian will likely do for the horse that’s suffering from chronic or acute back pain, subject to re-evaluation and redirection along the way, depending on response to each method.  

Acute pain relief

Your horse might be experiencing too much pain to allow him to perform rehab exercises right away.  

“If the horse is so reactive that he’s kicking or acting out and you can’t touch his back, the nervous system is firing too quickly, and in trying to protect himself from the pain, the horse may brace against the exercise and never develop the muscles that rehab would target,” Story says. “In the very painful or reactive cases, I might start with systemic or local medications such as anti-­inflammatories, muscle relaxers, or medications to target the nervous system, to quiet those responses before even getting to rehab exercises. Once the horse is more comfortable, rehabilitation exercises, chiropractic, and acupuncture care can then be initiated.”

Rehab exercises

Following a ­veterinarian-prescribed rehab program can make a huge difference in a horse’s recovery. “Fitness is also critical,” Story says. “Sometimes horses with back pain might be put into the ‘rest’ category, but standing in the stall frequently is the worst thing for them. Building core strength and muscle is imperative. They need to be able to move and stretch; you have to make them strong and keep them strong so they’re at less risk for injury. This is sometimes difficult because some horses will run and play too hard if out in a pasture. Finding the balance of careful motion without re-injury is essential.”


If your horse has a chronic injury or lameness, chiropractic care can help correct abnormal proprioception (the body’s unconscious perception of position and movement) and retrain the nerve pathways to help prevent back re-injury or soreness, says Buchanan.  


When your veterinarian inserts needles in acupuncture points, it triggers endorphin release and sends signals to the nervous system to calm the area, dissipate spasms, and bring blood flow to stimulate healing.  

Shock wave therapy
Shock wave therapy helps stimulate healing and might break up some muscle fibrosis. | Photo: Alexandra Beckstett/The Horse

Extracorporeal shock wave therapy

This noninvasive modality sends a pressure wave into the target tissue that stimulates increases in blood flow and new blood vessel formation, essentially helping the body heal from the inside. It might also break up some of the fibrosis (scarring) of tight, shortened muscles.  


To relieve the pain of kissing spines, veterinarians might surgically remove the tips of every other overriding spinous process or cut the ligament between the processes. “This is purely a last resort, however, and I encourage owners to seek out all other possibilities first,” says Story. “These surgical options can only help a small percentage of horses that present with back pain.”

Sadly, she says, some horses just don’t recover from back problems, and she emphasizes that it’s important for owners to know they’re not alone if their horse reaches the stage where spinal abnormalities prevent them from returning to their previous level of performance.

Take-Home Message

With proper management and therapy, most horses with back pain can be rehabbed back to normal use. Working with your ­veterinarian—and possibly a team of veterinary and other professionals—is your best option for determining the cause of your horse’s pain, ensuring the most complete recovery, and minimizing the possibility of recurrence.


Written by:

Diane Rice earned her bachelor’s degree in agricultural journalism from the University of Wisconsin, then married her education with her lifelong passion for horses by working in editorial positions at Appaloosa Journal for 12 years. She has also served on the American Horse Publications’ board of directors. She now freelances in writing, editing, and proofreading. She lives in Middleton, Idaho, and spends her spare time gardening, reading, serving in her church, and spending time with her daughters, their families, and a myriad of her own and other people’s pets.

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