What to do about your horse’s sore back

A wide ar­ray of ther­a­peu­tic op­tions can help ease equine back pain.

EQUUS - - Contents - By Heather Smith Thomas

A wide ar­ray of ther­a­peu­tic op­tions can help ease equine back pain.

Your horse’s back is a com­plex struc­ture, built of nerve and mus­cle, ten­don and lig­a­ment, car­ti­lage and bone. At the core of the sys­tem, en­cased safely in the pro­tec­tive fortress of the ver­te­brae, runs the spinal cord, the su­per­high­way of the ner­vous sys­tem. Ev­ery step, ev­ery turn, ev­ery move­ment a horse makes, from his poll to his tail, orig­i­nates in the nerves of the spine, and ev­ery mus­cu­lar ac­tion from his feet to his ears in­ter­con­nects in some way with th the mus­cles and ten­dons of his bbac back and neck.

It’s no won­der then that pain o orig­i­nat­ing in any struc­ture of the back can have ef­fects through­out a horse’s horse’s body. And vice versa: Any in­jury in the body can af­fect how the horse uses his back, which in turn can lead to aches, strains and spasms there as well. And, ass as you un­doubt­edly know if you’ve ever beeen been trou­bled by in­jury to your own back, pain will in­hibit a horse’s move­ments, limit his abil­ity to per­form and af­fect his at­ti­tude to­ward work.

“All the per­for­mance horses I work with, de­spite be­ing in dif­fer­ent dis­ci­plines, push from be­hind,” says Jenny John­son, VMD, of Oakhill Shock­wave and Ve­teri­nary Chi­ro­prac­tic in Cal­abasas, Cal­i­for­nia. “They must be able to en­gage their hind end. If a horse has back pain, he is un­able to do this very ef­fec­tively; the pain makes him re­luc­tant to fully use his body.”

And yet the signs that a horse is ex­pe­ri­enc­ing back pain can be easy to over­look. Learn­ing to dis­tin­guish ev­i­dence of dis­com­fort em­a­nat­ing from his topline is the first step; once you do it is im­por­tant to get your vet­eri­nar­ian on the case early to ad­dress smaller is­sues be­fore they grow into more se­ri­ous prob­lems. The good news is that vet­eri­nar­i­ans to­day have a range of re­li­able treat­ment op­tions that can help keep your horse work­ing pain-free for a life­time.

IDEN­TI­FY­ING THE PROB­LEM

In some cases, the ef­fects of back pain are un­mis­tak­able. A horse in se­vere dis­com­fort from crushed with­ers, for ex­am­ple---splin­ter­ing of the spinal pro­cesses that can oc­cur when he rears and falls over back­ward---might be un­will­ing to walk or lower his head to graze.

But more of­ten, the signs are sub­tle. He might ob­ject to sad­dling or be dif­fi­cult to shoe. He might re­sist mov­ing out when asked or have a gen­er­ally sour at­ti­tude to­ward be­ing han­dled and rid­den. He might flinch while be­ing groomed or even if you sim­ply run your hand down his back. “Back pain may present as a per­for­mance is­sue,” says John­son. “The horse may not push from be­hind the way he used to, may not round over jumps, may not come through in a dres­sage move­ment, or may not sit down on the haunches to stop and turn, the way he needs to.”

A num­ber of is­sues can cause pain. One of the most com­mon is ill-fit­ting tack, which cre­ates pres­sure points that lead to mus­cle sore­ness. And even when the tack fits well, rider asym­me­try can place un­even pres­sures on a back. Other sources can in­clude trau­matic in­jury, from a fall or ac­ci­dent, or overuse, which can lead to mus­cle strains and sprains as well as, in time, arthritic changes in the ver­te­brae.

Find­ing a prob­lem in a horse’s back can re­quire some de­tec­tive work on the part of your vet­eri­nar­ian. “Some­times the source of back pain is elu­sive,” says Bruce Con­nally, DVM, of Wy­oming Equine, an equine sports medicine prac­tice in Berthoud, Colorado. “The prob­lem might be in a foot or leg; the back pain is sec­ondary to the lame­ness, and we have to find the cause of lame­ness. On the other hand, we might do a flex­ion test on a hind leg and the horse tests pos­i­tive so we think it’s the leg. But flex­ion tests also put a twist on the back. It can be chal­leng­ing to ar­rive at an ac­cu­rate di­ag­no­sis.”

And the signs can lead to a dead end. “Some­times what we think might be back pain is ac­tu­ally some­thing else,” says Tia Nel­son, DVM, of Val­ley Ve­teri­nary Hospi­tal in He­lena, Mon­tana. “So we usu­ally start with a com­plete lame­ness eval­u­a­tion to make sure the feet are in good shape and com­fort­able, be­cause if the feet hurt, there are com­pen­satory is­sues in the neck or back. If there is some­thing ob­vi­ously wrong with a foot and you block it

Signs of back pain are of­ten sub­tle. He might ob­ject to sad­dling or be dif­fi­cult to shoe. He might re­sist mov­ing out when asked or have a gen­er­ally sour at­ti­tude to­ward be­ing han­dled and rid­den.

out and the pain is re­solved, we as­sume it’s not a back prob­lem.”

A his­tory may also yield sig­nif­i­cant clues. Your vet­eri­nar­ian may ask when you first no­ticed an is­sue and when the signs oc­cur---for ex­am­ple, if the horse is gen­er­ally com­fort­able mov­ing lat­er­ally to the left but not to the right, or if he re­sists only when you ask him to col­lect him­self or back up. Tail wring­ing is an­other sign that may in­di­cate pain: If you no­tice your horse do­ing this con­sis­tently at cer­tain points in your ride--when you ask for cer­tain gait or lead changes, for ex­am­ple---your vet­eri­nar­ian will want to know.

A vis­ual ex­am­i­na­tion might also yield clues, such as swelling, at­ro­phy or crooked­ness. “If you stand be­hind and above some of these horses, you might de­tect a crooked spine,” Con­nally says. Your vet­eri­nar­ian will also likely want to watch your horse in mo­tion. “It’s im­por­tant to watch the horse on a lead shank and a longe line, and also un­der sad­dle,” John­son says. “Fre­quently you won’t be able to see what the prob­lem is un­til the horse is do­ing what he’s sup­posed to be do­ing for his job.”

The next step in the di­ag­nos­tic process might be a hands-on ex­am­i­na­tion that in­cludes man­u­ally press­ing on the horse’s back along the spine. “Many horses with back pain re­spond to touch or pres­sure along the back if you pal­pate the lum­bar mus­cles,” Con­nally adds. “These horses will ei­ther tense up to try to pro­tect them­selves from that touch, or sink down­ward to try to get away from it. Some will tense up­ward if you touch the tips of the spines of the ver­te­brae.”

FUR­THER IN­VES­TI­GA­TION

Once a vet­eri­nar­ian has iden­ti­fied a par­tic­u­lar re­gion of the back that seems to be caus­ing more pain, he might try in­ject­ing the area with a lo­cal anes­thetic to see if the horse im­proves. He might also call for x-rays--but the im­ages need to be in­ter­preted with cau­tion. Even if an x-ray shows arthritic changes or other ab­nor­mal­i­ties in the ver­te­brae, it doesn’t nec­es­sar­ily mean that the bones are the source of the pain. Many horses can have se­ri­ous-look­ing changes on x-rays--such as “kiss­ing” spines, a con­di­tion in which the dor­sal (up­right) pro­cesses of the ver­te­brae come into con­tact with each other---but never ex­pe­ri­ence any ill ef­fects. “Just be­cause

the horse has kiss­ing spines doesn’t nec­es­sar­ily mean they are mak­ing the horse hurt,” says Con­nally. “This com­pli­cates the di­ag­no­sis be­cause pain may be com­ing from some­thing else. If we use the x-rays to make a di­ag­no­sis of kiss­ing spines, we should also use lo­cal anes­thetic to try to block that area, to make sure the block makes the horse hurt less.”

An­other dif­fi­culty with x-rays is get­ting clear views of the sacroil­iac re­gion, where the last lum­bar ver­te­bra meets the pelvis. Un­like other joints along the spinal ver­te­brae, which have lit­tle range of mo­tion, the lum­bosacral joint ro­tates al­most 30 de­grees, which en­ables the horse to pull his hind legs up un­der him. Strains and in­juries to this area are com­mon to horses in­volved in many ath­letic en­deav­ors.

Other imag­ing tech­nolo­gies may also be help­ful. Nu­clear scintig­ra­phy, for ex­am­ple, in­volves in­ject­ing the horse with a ra­dioac­tive tracer that ac­cu­mu­lates in metabol­i­cally ac­tive “hot spots” in bone tis­sue---which might in­di­cate in­flam­ma­tion or in­jury. If a prob­lem in the neck is sus­pected, mag­netic res­o­nance imag­ing

(MRI)

or com­puted to­mog­ra­phy (CT) scans may be used to ob­tain de­tailed, three­d­i­men­sional im­ages of the ver­te­brae. Ther­mog­ra­phy, which records the heat em­a­nat­ing from body tis­sues, can pin­point spots where soft-tis­sue in­juries are gen­er­at­ing ex­tra heat due to in­flam­ma­tion. Ul­tra­sound can be use­ful to iden­tify changes in soft tis­sue as well as le­sions in the bone.

Even with the best di­ag­nos­tic tech­nol­ogy, how­ever, in some cases the spe­cific source of a horse’s pain might re­main a mys­tery. “Some­times we never do fig­ure out ex­actly why the horse is sore,” Nel­son says. “It’s chal­leng­ing be­cause the horse can’t talk and tell us.”

TREAT­MENT OP­TIONS

The best course of ac­tion for a back in­jury de­pends, of course, on your vet­eri­nar­ian’s find­ings.

In some cases, find­ing the most ef­fec­tive treat­ment may take some trial and er­ror---and in the end, your

vet­eri­nar­ian may need to ad­min­is­ter or pre­scribe sev­eral to­gether. Here are some of the op­tions he might con­sider:

• Rest and med­i­ca­tions. Even just a day or two off from work may be enough to ease mus­cle pain in a horse’s back. “If it’s an overuse in­jury, rest is of­ten ben­e­fi­cial, and maybe some an­ti­in­flam­ma­tory med­i­ca­tion, as for any overused body part,” says Con­nally. “If the owner/rider is in a hurry to con­tinue with shows/com­pe­ti­tions, they won’t like that sug­ges­tion, but rest is some­times the best treat­ment---just to give the horse time off from work to see if the in­jury and pain re­solves.”

If the pain re­sults from an acute in­jury, ic­ing, poul­tic­ing or other ef­forts to re­duce lo­cal­ized pain and in­flam­ma­tion will help. “In those cases some­times we al­ter­nate heat and ice, to re­solve lo­cal in­flam­ma­tion and ease pain,” says Nel­son. “Some­times we use non­s­teroidal anti-in­flam­ma­tory med­i­ca­tions like bute0 and Banamine0. We may also use a top­i­cal an­ti­in­flam­ma­tory med­i­ca­tion like Sur­pass, or lin­i­ments. I don’t load a horse up with pain med­i­ca­tions just to be treat­ing, but I also don’t hes­i­tate to treat pain.” Pain causes the horse stress, which in turn can af­fect his move­ments and in­hibit heal­ing, so pain man­age­ment is im­por­tant for good heal­ing.

In ad­di­tion, a vet­eri­nar­ian might pre­scribe a mus­cle re­lax­ant to ease spasms at the site of an in­jury or as a re­sult of overuse. “I some­times use a mus­cle re­lax­ant called metho­car­bamol, which works nicely in hu­mans for back pain,” Nel­son says. “It de­pends on whether it is an acute in­jury or a chronic con­di­tion.”

Rest alone, how­ever, is not rec­om­mended for many types of back pain. For one, too much time away from train­ing can lead to loss of mus­cle tone, which can ex­ac­er­bate an in­jury and com­pli­cate the horse’s re­turn to work. So vet­eri­nar­i­ans may of­ten sug­gest more ag­gres­sive treat­ments to ease a horse’s pain.

• In­jec­tions. One com­mon treat­ment for back pain is to in­ject cor­ti­cos­teroids or lo­cal anes­thet­ics di­rectly into the af­fected area to con­trol pain and in­flam­ma­tion. “Cor­ti­sone can be in­jected into the sacroil­iac joints,” says Con­nally. “But this takes some ex­pe­ri­ence---if we get that in­jec­tion off tar­get it can block the nerve to where the horse can’t use the hind legs for a while. If you use a lo­cal anes­thetic along with the cor­ti­sone it may even knock the horse clear down for sev­eral hours and he can’t get up.”

An­other ap­proach, called mesother­apy, is use­ful to treat soft-tis­sue pain along the length of the back. “Mesother­apy in­volves us­ing tiny nee­dles and in­ject­ing small amounts of med­i­ca­tion just un­der the skin in the painful area,” Con­nally says. The in­jec­tions are placed just un­der the skin in long rows ex­tend­ing along both sides of the horse’s topline, from the with­ers to the hindquar­ters.

• Shock­wave ther­apy. Ex­tra­cor­po­real shock­wave ther­apy (ESWT) in­volves send­ing tightly fo­cused, very high-en­ergy pres­sure waves through body tis­sue to ease pain and

stim­u­late heal­ing. Ex­actly how ESWT af­fects the tar­geted tis­sues is not fully un­der­stood, but the treat­ment has been shown to re­lieve pain al­most im­me­di­ately, and it also stim­u­lates im­proved cir­cu­la­tion, which sup­ports heal­ing. Ad­di­tion­ally, says John­son, “shock­wave ther­apy will stim­u­late mi­gra­tion of nat­u­rally oc­cur­ring stem cells to the site that is treated. Shock­wave ther­apy, in essence, serves to stim­u­late the body’s heal­ing mech­a­nism.” ESWT has nu­mer­ous ap­pli­ca­tions in ve­teri­nary medicine, in­clud­ing treat­ing ten­don, lig­a­ment and bone in­juries. In the back, ESWT might be used to ease pain re­sult­ing from os­teoarthri­tis in the ver­te­brae along with mus­cu­lar or soft-tis­sue pain.

“I’ve had some suc­cess with shock­wave ther­apy,” says Con­nally. “It may treat some of the dis­ease pro­cesses, or it may just treat in­flam­ma­tion. It may help some horses more than oth­ers. I have used shock­wave on my own neck, and it made a huge dif­fer­ence.”

Shock­wave ther­apy needs to be per­formed by a vet­eri­nar­ian, typ­i­cally af­ter x-rays or other imag­ing tech­nolo­gies have pin­pointed the spe­cific ar­eas where os­teoarthrit­ic changes in the spine are caus­ing the horse pain. ESWT can be ad­min­is­tered in most clin­ics, es­pe­cially those that spe­cial­ize in sport horses. Some vet­eri­nar­i­ans may have por­ta­ble de­vices that can be used while a horse is stand­ing se­dated in his stall.

• Mas­sage and stretch­ing. Mas­sage---man­u­ally rub­bing or ma­nip­u­lat­ing the mus­cles---is widely prac­ticed on race­horses and other sport horses. Pro­po­nents claim that the prac­tice re­laxes tense mus­cles, in­creases cir­cu­la­tion to re­duce lo­cal­ized pain and swelling in the area, and re­laxes the horse’s gen­eral at­ti­tude. Sci­en­tific re­search into mas­sage ther­apy has been lim­ited, but some stud­ies have shown that it can in­crease the range of mo­tion in a horse’s limbs and im­prove over­all per­for­mance, and anec­do­tal re­ports of its use­ful­ness are wide­spread.

Stretch­ing ex­er­cises---which in­volve mo­tions such as lift­ing and ma­nip­u­lat­ing the limbs as well as “car­rot stretches,” ask­ing the horse to bend his neck to reach treats held at dif­fer­ent points--can also help to ease tense mus­cles and im­prove cir­cu­la­tion.

Both mas­sage and stretch­ing can be done rou­tinely, as part of a horse’s fit­ness reg­i­men, to help him stay more flex­i­ble and bal­anced. But the ex­er­cises must be done care­fully to avoid caus­ing in­jury. Both forms of ther­apy can help a horse re­cover from back pain, but this is best done un­der the su­per­vi­sion of a vet­eri­nar­ian---be­gin­ning the treat­ment too soon or per­form­ing it too ag­gres­sively can ag­gra­vate an acute in­jury. Talk to your vet­eri­nar­ian be­fore be­gin­ning a mas­sage or stretch­ing pro­gram with your horse, and if it’s ap­pli­ca­ble, ask for rec­om­men­da­tions for a qual­i­fied prac­ti­tioner in your area.

• Chi­ro­prac­tic. An­other method of ma­nip­u­lat­ing the mus­cu­loskele­tal sys­tem is chi­ro­prac­tic care, which fo­cuses pri­mar­ily on the ver­te­brae. The goal is to cor­rect “sub­lux­a­tions,” shifts in in­di­vid­ual ver­te­brae that might be im­ping­ing upon and in­ter­fer­ing with the func­tion of mus­cles and nerve cells. Lim­ited stud­ies have

shown that chi­ro­prac­tic ma­nip­u­la­tions may im­prove how a horse moves, but in­depth re­search on the prac­tice has not been done. Nev­er­the­less, chi­ro­prac­tic care is widely used, with many peo­ple re­port­ing good re­sults.

John­son, who has been an equine vet­eri­nar­ian for 28 years but for the past eight has spe­cial­ized in shock­wave ther­apy and chi­ro­prac­tic care, says that the prac­tice can make a huge dif­fer­ence in a horse: “Be­cause I spend so much time with my hands on the horse do­ing chi­ro­prac­tic care, I know these horses’ backs in­ti­mately. I am feel­ing ev­ery ver­te­bral joint and eval­u­at­ing the mo­tion---side to side and up and down. I have a more com­plete pic­ture of that

horse than I did when I was just do­ing lame­ness work, and I can fre­quently iden­tify ar­eas that are con­sis­tently sore, par­tic­u­larly sore mus­cles.”

She of­ten finds prob­lems in the lum­bar area of the back. “This is where the horse has to flex, and it is through this area that all of the en­ergy that is gen­er­ated from the en­gage­ment of the hind

end must pass. I’ll find re­stric­tion in a horse who is not nec­es­sar­ily painful but sen­si­tive when a per­son is brush­ing the back, or maybe he’s just a lit­tle cranky. When I make ad­just­ments, a lot of times the horse achieves fairly im­me­di­ate re­lief. Some peo­ple tell me they have a to­tally dif­fer­ent horse the next day,” John­son says. “This is re­ward­ing for me. These are things that can­not be ad­dressed any other way. Back pain can be re­lated to a lot of dif­fer­ent things, but some is­sues will be missed if the horse does not have chi­ro­prac­tic care.”

• Acupunc­ture. Acupunc­ture is a com­po­nent of tra­di­tional Chi­nese medicine that has be­come well es­tab­lished in the West. The tech­nique in­volves in­sert­ing very thin stain­less steel nee­dles into the body at spe­cific points. Vari­a­tions of the tra­di­tional tech­nique in­clude stim­u­lat­ing the nee­dles with heat or elec­tric­ity, treat­ing the acupunc­ture points with heat or a cold laser with­out break­ing the skin, or in­ject­ing

small amounts of var­i­ous sub­stances into the points. “There are var­i­ous ways to use acupunc­ture in­clud­ing in­jec­tions via the nee­dles, us­ing any­thing from cor­ti­sone to B com­plex vi­ta­mins to some io­dine-type ir­ri­ta­tion in­jec­tions,” Con­nally says.

Chi­nese tra­di­tion talks of us­ing acupunc­ture to “in­crease en­ergy flow,” but a more mod­ern ap­proach al­lows that the tech­nique is stim­u­lat­ing mus­cles and nerves to cause re­lax­ation and ease pain. “Sci­ence has shown that acupunc­ture causes en­dor­phin re­lease in the brain, so it does ease pain,” Con­nally says.

Acupunc­ture is never in­tended to be a pri­mary treat­ment for an in­jury, but vet­eri­nar­i­ans might sug­gest it as a way to help ease pain in con­junc­tion with tra­di­tional Western ap­proaches. “In the right cir­cum­stances, both acupunc­ture and chi­ro­prac­tic can make a horse feel bet­ter, treat­ing the pain and/or mus­cle spasms,” says Con­nally. “If there is a dis­ease process like a pinched nerve, how­ever, that prob­lem can’t be helped with acupunc­ture.”

Nel­son will some­times use acupunc­ture be­fore per­form­ing chi­ro­prac­tic ad­just­ments: “Then the ad­just­ments go a lot quicker and eas­ier. The out-of-place ar­eas go into place again much eas­ier. I don’t know if the acupunc­ture re­laxes the mus­cles around the joints that are in trou­ble, but it seems to help.”

When it comes to pro­tect­ing your horse’s back, start by mak­ing sure your sad­dle fits (see “Sad­dle Fit and Asym­me­tries, page 46). Beyond that, the same mea­sures that can pro­tect sound­ness will also re­duce a horse’s risk of de­vel­op­ing a sore back. Be­fore work­outs, spend 10 to 15 min­utes warm­ing him up with straight lines, then ser­pen­tines and cir­cles. Also, avoid re­peat­ing the same ma­neu­vers more than a few times in each ses­sion, and be par­tic­u­larly care­ful about rep­e­ti­tions of slid­ing stops, sharp turns and other move­ments that can strain fa­tigued mus­cles.

Vary­ing your rid­ing rou­tine by al­ter­nat­ing arena work­outs with trail rides or other types of ex­er­cise will help to keep your horse men­tally en­gaged as well as phys­i­cally sound. Fi­nally, give your horse as much turnout time as pos­si­ble. Mov­ing about and graz­ing gives him the op­por­tu­nity to stretch out and re­lax all of his mus­cles as he goes about his busi­ness.

Of course there are no guar­an­tees, but the time and en­ergy you de­vote to pro­tect­ing your horse’s back is likely to keep your horse hap­pier and make him more fun to ride. Be­sides, says John­son, you owe it to him. “Horses do so much for us that I think we have a re­spon­si­bil­ity to make sure they are com­fort­able do­ing what we ask,” she says. “They are un­be­liev­ably gen­er­ous to us. As their keep­ers and rid­ers it is our re­spon­si­bil­ity to take care of them.”

In­ject­ing cor­ti­cos­teroids or lo­cal anes­thet­ics di­rectly into the sore area of the back can help con­trol pain and in­flam­ma­tion. Soft-tis­sue in­jury may call for mesother­apy, the use of tiny nee­dles to in­ject small amounts of med­i­ca­tion just un­der the skin in the sore area.

ACUPUNC­TURECHI­RO­PRAC­TIC

MAS­SAGE AND STRETCH­ING

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