into the multifidus muscle. These findings should be taken into account to avoid false interpretation.
Possible causes of back pain
Underlying causes for back pain can be grouped into three main categories: Pathology-causing primary back pain; pathology causing secondary back pain; and rider/tack-inflicted back pain. Furthermore, problems such as sacroiliac joint region pain, neck pain or rib fractures may result in clinical symptoms similar to the ones of back pain.
Pathology causing primary back pain
• Impinging dorsal spinous processes (‘kissing spines’)
• Arthropathy of the articular process joints in the thoracolumbar spine
• Ventral spondylosis
• Desmopathy of the supra- and intraspinous ligament
Pathology causing secondary back pain
• Lameness (particularly hindlimb lameness)
Rider or tack-inflicted back pain
• Poor saddle fit
• Unsuitable riding or training techniques (eg. rollkur, overuse of draw reins)
• Poor riding skills (novice, unbalanced riders)
• Lack of fitness/strength of the horse
• Excessive rider weight
An important part of successfully treating back pain is to include physiotherapy in the rehabilitation and to establish a suitable exercise programme depending on the individual case and underlying cause.
There are a number of conservative and surgical treatment options available for primary conditions of back pain. Corticosteroid injections can be employed by infiltrating areas of DSP impingement or by ultrasound-guided periarticular injection of the articular process joints. Other treatment options such as acupuncture, mesotherapy, bisphosphonate medication and extracorporeal shockwave therapy may be considered by some practitioners. Surgical treatment options such as DSP resection or interspinous ligament desmotomy have been described and are available to treat ‘kissing spine’ syndrome.
If lameness has been identified, it is important to diagnose and treat the lameness prior to treating the back in order to achieve successful and long-lasting results.