Ask The Vet

Provided By: Melissa McKee DVM

Back pain can be a very nebulous diagnosis in the horse as it is so difficult to sort out the multitude of factors that cause abnormal gait and lameness. When presented with a sore back I still like to perform a thorough lameness exam because compensation and altered body mechanics from chronic lower limb pain can cause significant secondary discomfort over the topline. For example, a horse with sore front feet or hocks can develop pain in the lumbar area as they protectively splint the back in compensation. Investigation of other medical issues such as tying up and gastric ulcers is also warranted as both can result in general muscular pain. “Cold backed” or “girthy” horses often have gastric ulcer syndrome that can create a very tender point on the brisket, so it hurts to have the girth tightened. I like to take a look at the saddle both on and off of the horse, since saddle fit plays a major role in back comfort. For deeper investigation of back pain, I like to see the horse perform in hand, on the lunge line, and with a surcingle or saddle on. I also perform a careful manual exam to detect painful points, range of motion, and abnormal sensation. Using a rectal ultrasound, we can examine the sciatic nerves, sacroiliac joins and lumbosacral joints, and several other structures. Radiography of the pelvis is nearly impossible and requires a general anesthetic, but we can image parts of the thoracic and lumbar spine if spondylosis or kissing spines are suspected. Further imaging of the pelvic area would require the use of nuclear scintigraphy, which can be very useful for the identification of injuries not accessible to the ultrasound. Treatment of course depends on the specific diagnosis but our most common therapies are ultrasound-guided injections of the sacroiliac and lumbosacral joints, shockwave therapy, and mesotherapy. Acupuncture and chiropractic therapy are also helpful additions to the management strategy. Occasionally we will use medications to promote muscle relaxation and reduce inflammation, and we always recommend adjunctive treatment of any lower limb lameness problems, medical issues, and shoeing imbalances.