Back pain, two (of the 72 trillion) words that stir fear in the horse owner…
What causes equine back pain and why can it be difficult to eliminate?
Is there anything that can be done to prevent it and how can it be managed long term?
All relevant questions horse owners ask in their pursuit to keep their four legged friend as comfortable as possible.
Back pain is not uncommon in humans. This means we know how miserable it can be and how significantly it can vary between patient to patient. Therefore, we can assume similar for the horse. However, there are two very important differences; firstly, we sit on top of the area where the pain might be presenting, no doubt making it even more uncomfortable, and secondly, horses have no way of directly telling us that they are suffering. This means that we have to look out for potential clues, which can be difficult as each horse is an individual- not only will each be able to tolerate different levels of pain before displaying any signs, the signs displayed vary from horse to horse. To make this even more difficult, horses are very good at hiding their discomfort and making compensatory adaptations as this is what they would have had to have originally done in the wild to limit the danger of becoming the target of a predator. Monitoring your horse and knowing what is ‘normal’ for them is key in identifying back pain early so that it can be addressed.
Signs of back pain
This list is not exhaustive and it is important to remember that every horse is an individual meaning that just because one horse shows certain signs it doesn’t necessarily mean that this will be the same for another. Again, this is why it is important to know what is normal for your horse. The following signs could be an indication of back pain:
• Reduced performance
• Reluctance to jump
• Extension or ‘hollowing’ of the back
• Avoidance of the saddle, being girthed or rugged
• Avoidance of being mounted
• Discomfort when being groomed over the back
• Pain in palpation
• Reluctance to carry out baited stretches
• Dull or depressed behaviour
• Reduction in muscle mass over the back
• Bucking or rearing
What causes back pain in horses?
Equine back pain can be caused by a number of issues. It could be as simple as an isolated strain from taking a jump wrong or slipping in the field- similar to us if we pick up something too heavy. A horse’s conformation could be a contributing factor. For example, it is believed that horses with longer backs or with lordotic (dipped) backs are more predisposed to back pain. Other causes can be lack of muscle mass and strength. This can often be the case for young horses who have not yet had the time to develop the stabilising muscles required to support the vertebrae or for older horses whose muscle mass is beginning to reduce through age. Over training can result in pain through fatigue and structures not having enough time to recover between sessions. Ill fitting tack can also play a role, especially if it pinches or squashes muscles, which will then not be recruited and as a result will reduce in size and strength over time. Of course, in some cases there may be some pathology which is causing the initial pain, though this doesn’t necessarily need to be present in the back; pathology in other areas, such as the hind limbs, forelimbs or neck, can alter how a horse moves and result in compensatory pain in the back.
A continuous cycle
Research into human back pain tells us that pain in the lower back reduces the function of spinal stabilising muscles, resulting in a loss of their preparatory stabilising function. These muscles become inactive and reduce in size and do not resume normal activity, even when the pain has resolved. It can be presumed that back pain in the horse follows a similar pattern. Therefore, once pain becomes present, the following cycle often begins:
Breaking the cycle
The first stage of breaking the cycle of equine back pain is to make the horse comfortable again which usually means reducing the inflammation and helping the muscles which are in spasm to relax. A couple of weeks of rest may be enough to achieve this, however in more severe cases or where back pain has been more longstanding intervention from either a vet or veterinary physiotherapist may be required. If you’re concerned that your horse is suffering from back pain, seeking advice from your vet about the best form of treatment is a good idea. They will not only be able to assess how severe the pain is, they will also be able to help establish the cause, which is important for long term recovery. Your vet may simply advise rest in the first instance to see whether this is enough to reduce the inflammation and through this the pain. In more severe cases, they may recommend treatment from a veterinary physiotherapist, who can use therapy such as massage, laser or INDIBA (radio frequency therapy) to help reduce inflammation and relax muscles in spasm. In some cases, vets might treat the pain themselves with muscle relaxants or steroid injections, again to reduce inflammation. Of course, if your vet suspects the initial cause of the back pain is related to a specific pathology (which remember could be in the back or elsewhere in the body with the back presenting compensatory pain) they will be able to carry out further investigation. This is why it is important for an initial examination by your vet so that you are able to make sure your horse is receiving the correct treatment from the beginning, hopefully resulting in quicker recovery.
Once the pain and inflammation have resolved, strength then needs to be reestablished to prevent the pain reoccurring. This is something your veterinary physiotherapist will be able to help you with. They will be able to advise you on a rehabilitation program to rebuild strength in the mutifidus muscles so that they are able to carry out their role in stabilising the vertebrae and therefore preventing any further build of inflammation through micro movement. Baited stretches in particular have been evidenced to increase the cross sectional area of these muscles and are therefore an important exercise for rehabilitation and long term maintenance. They will also be able to advise on exercises to improve posture and core strength, as well as those which re-establish and improve limb movement patterns to ensure that your horse is moving in a way which supports longer term back health. Along side all of this, they will be able to monitor your horse’s progress and treat any signs of muscle fatigue as strength is developed. This is important because strength is built through increasing challenge, which can sometimes lead to short term muscle fatigue. This needs to be managed along the way to ensure the cycle of pain is not given the opportunity to redevelop.
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