Vet Insight: Equine Back Pain

David Blakey BVetMed CertAVP(EM) MRCVS started playing polo with The Wilton Hunt Pony Club at the age of 10 and went on to both play and groom in South Africa and the U.K, before setting off for The Royal Veterinary College. He graduated in 2010, and currently works at Waterlane Equine Vets in Gloucestershire, the practice that looks after the Polo Times string. He deals with everything from miniature Shetlands to performance sport horses, although he does have a particular interest in anesthesia and older horse management. David regularly plays polo at Edgeworth’s Wednesday evening chukkas and once held a 1 goal handicap, but lack of time and money has curtailed his polo habit

Back pain in horses, as in human medicine, is a complicated issue to satisfactorily diagnose and treat. It should be born in mind, it is more of a clinical sign than a diagnosis in itself, and there are many conditions and reasons why a horse may display signs of back pain – both related to specific structures in the back, and to other areas (e.g. gastric ulcers).

One of the more straight forward conditions to diagnose is kissing spines, a topic which has been covered by Mark Emerson MRCVS in the April 2014 issue of Polo Times. Radiographic (X-ray) changes in association with clinical signs can be enough to diagnose the condition, and the treatment of keyhole surgery or local medication are relatively straight forward. However, it has been shown that what is critical to over coming this condition is rehabilitation to relax and retrain spasming muscles that contributed to the formation of the problem in the first place.

So, how do these muscles start spasming? It could be the horse’s conformation (short or hollow backed) contributed, a poorly

Equine Back Pain

How back pain can hide in plain sight

Kissing spines can be treated through keyhole surgery

Photography courtesy of Polo Times

Case Study

Celine was always a lethargic and sluggish youngster, unwilling to fully engage and not particularly forward going. Initially this was attributed to a relaxed character, but in later months into pre-season preparations her behaviour changed and she became more cold backed and would buck and appear generally uncomfortable when ridden. After a visit from the vet, she was diagnosed with kissing spines and booked in for keyhole surgery.

Post-surgery, Celine seemed to feel much better in herself and after rehabilitation including stretching and lunging she was given six months off from polo in order to let the spine fully heal without being ridden.

The following year, when starting to stick and ball again she seemed slow on the turn and tight in her rear action, David assessed Celine and noticed an additional toe drag of the hind limbs and recommended a steroid injection into the small hock joint in order to address the issues. Since the medication of the hocks, Celine’s performance has improved dramatically and she has reached her full playing form.

fitting saddle, or dare we say it, rider conformation or ability. However, by far the biggest contribution, in my opinion, would be orthopaedic pain – lameness.

Now, most people associate lameness with an obvious head nod indicating one specific limb is lame. The problem is that most lameness in performance horses is bilateral – i.e. both front legs (e.g. navicular syndrome) or hind legs (e.g. hock arthritis). With polo ponies of Thoroughbred blood, front foot pain can be a recurrent problem due to poor foot structure. And the twisting, turning and rapid stops of polo can easily cause stress and strains on the small hock joints which weren’t really designed for the purpose which leads to arthritis (horse evolved to eat, and then run away in a straight line, not pirouette on their hind legs).

A horse that is lame in both limbs may just look short striding (for front limbs) or for hind limbs, may start struggling to maintain a canter lead on tight circle, not perform flying changes or struggle to engage their hind limbs in a stop. In hindsight many of my teenage polo ponies I played in Pony Club fitted that bill. This can lead to changes in the way the horses moves as a compensation – if you wear a bad pair of shoes, you can end up with back pain.

So, where am I going with this article. If we diagnose a horse with back pain, and specifically kissing spines, treat it and then expect it to perform intense rehab on painful limbs, our outcomes are likely to be poor. My approach to these cases is that if I find back pain, I go looking for the bilateral lameness. Hopefully it’s a simple as medication of the hocks, but equally it may be more involved with conditions like high suspensory disease, or navicular syndrome in the front feet. There is little point treating the back pain and expecting it to stay treated if the initially driving force (for instance bilateral lameness) is still present.

Waterlane Equine Vets Tel: 01452 770268 www.waterlaneequinevets.co.uk waterlaneequine@gmail.com

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