Oh, My Aching Back!

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By Jennifer Dunlap, DVM

Back injuries are, unfortunately, not uncommon in horses. However, they differ from human back injuries in that horses don’t herniate discs in their backs due to the strength of the structures in their backs. The part of the horse’s back that we can palpate is the dorsal spinous processes which poke up from the actual spine of the horse.  A horse can sustain a soft tissue (muscle, tendon/ligament, bursa) injury or bony injury to the back and, just like back injuries in people, these injuries can be very painful. Back problems tend to cause poor performance and behavioral issues long before “lameness” is seen; so signs may be subtle and it is critical to know what’s normal for your horse and what isn’t, so changes in behavior and performance can be addressed quickly.

One of the most common back pain issues we see is pain due to an ill-fitting saddle. Your horse may start biting you when the girth is tightened or become resistant to saddling all together, buck, rear or display other behavioral problems. These issues should be addressed immediately to eliminate the pain and decrease the risk to horse and rider. Even the best saddle pad cannot make a badly fitting saddle fit well and, in fact, the more padding added, the more a saddle can rock back and forth creating pressure points.

Saddle fit is extremely important and not all saddles will fit all horses, though more and more saddles are coming with adjustable trees and shims to help a saddle fit more than one horse well. A saddle should sit level on a horse’s back, not tilting downward towards the withers or tilting back towards the lumbar (lower back) area of the spine.  There should be good clearance for the withers and the center of the back.  These areas should have no pressure on them.  If your saddle is leaving dry spots when the rest of the back is sweaty, then your saddle is pinching.  Those white hairs on an otherwise dark coat sometimes seen on withers and the back? Though sometimes due to a freak injury, they are more likely due to a badly fitting saddle at some point in that horse’s career.  You can check with a reputable saddle fitter if you are concerned that your saddle is not fitting well. Also check with the saddle’s manufacturer if in doubt about whether adjustments can be made. When shopping for a saddle, it is a good idea to get tracings of your horse’s back to send in to the saddle fitter or manufacturer to make sure you are getting the saddle your horse needs.

Another serious issue seen with backs is fistulous withers (drainage from a wound in the withers.)  This should be distinguished from a wound from a poorly fitting saddle. It is generally easy to do so because fistulous withers usually involves a marked amount of swelling and a draining tract into the withers. This involves infection of the structures of the withers, including the ligaments, bursa (fluid filled sac) and bone.  It can be caused by blunt force trauma such as a hard bite from another horse, which can cause injury and infection, or it can sometimes crop up due to brucellosis, a serious bacteria. Whenever a fistulous withers is diagnosed, it is very important to test the drainage for brucellosis because the bacteria can cause serious human health issues, as well.  Fistulous withers can be difficult to treat and can be life threatening and often require high powered antibiotics and aggressive surgical debridement, with removal of all affected tissue (even bone) to give the affected horse a good chance of recovery.  Depending on how much tissue has to be removed, future riding may not be an option or may require a special cut back saddle and pad.

Horses involved in accidents, such as rearing and flipping over backwards and trailer accidents, are at high risk for a blunt force trauma back injury.  I have responded to a lot of trailer accidents and nearly all of the horses have some wound/heavy bruising over the withers and backs, either due to falling in the trailer against a partition or becoming pinned against or under a partition or central post. Care must be taken to pad the back and immediately remove pressure. A slit pool noodle works extremely well to cover the bottom of a partition or a side of a central post.  These accidents can often involve human injury as well, in the case of a rider being on the horse when he flips or in a trailer wreck. Careful and coordinated efforts must be made between veterinarians and first responders to make sure everyone gets taken care of. 

In the case of back injury to the withers from flipping over, the tops of the dorsal spinous processes of the withers are commonly fractured and sometimes open wounds are seen.  Good assessment is critical to make sure this is the only injury a horse has sustained because head injuries to the back of the skull are also common when a horse flips over.  Radiographs, anti-inflammatories are advised treatments, and if a wound is present, good wound care and antibiotics are needed.  Rarely will surgery have to be done to remove bony fragments, but if draining tracts develop due to dead bone then surgical debridement (removal of dead tissue) will be required.  Any time a horse flips over and falls backwards, a veterinary visit is warranted to check for neurologic damage and fractures, even if your horse gets up and “shakes it off.”

We’ve all heard the expression short coupled or short backed vs. long backed, and I do tend to see more “kissing spines” in long backed show jumpers.  Kissing spines occur when the dorsal spinous processes lose the space between one another and become compressed (DSP impingement.)  This occurs most commonly in the thoracic spine where the rider sits. This can cause significant pain and impair performance. Treatment is aimed at relieving pain and stretching the soft tissue around the back.  Injections into the area can be very beneficial when coupled with making sure the tack fits properly and doing physical therapy in the form of long and low riding, stretching and bending exercises.  Sometimes massage and acupuncture can also be beneficial.

Horses, just like people, need to have their backs taken care of so there are a few things that we as riders can do to help ensure that our horses’ backs stay strong and healthy. 1. Make sure your tack fits properly. This includes even making sure you are using the right bit.  If a horse constantly sucks back and hollows his back to avoid bit contact, back pain from muscle strain can result. 2. Even if your youngster seems big in height and overall size, remember that a young horse is still skeletally immature, so only work a baby once he is of the age he can handle work, and lightly until he is fit enough for work. A horse will hollow out the back to avoid pressure and when fatigued and this can lead to muscle spasms, pelvic tilting, and sacroiliac joint pain. 3. Always warm a horse up long and low and cool down long and low to encourage stretching of the topline and ensuring good blood flow to warm up the muscles and to carry away lactic acid built up from work at the end of a ride. 4. Pay attention to behavioral changes or performance changes and get them checked out before a greater issue results. Keeping these things in mind can help ensure your horse is a happy riding partner for years to come.

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