Page 86 - April 2016

“Horses with back pain often present as avoidance behavior or a performance problem. The horse is trying to avoid what you want him to do because it hurts him,” says Allen.
horse, the present complaint and clinical signs, physical findings, lameness exam, and an accumu- lation of all the reactive diagnostic acupuncture points,” explains Holt. “We put this all together to help us focus on the area(s) of concern.”
There may be painful areas due to restricted motion in a certain joint or joints. The back has several sections, with different types of vertebrae in each section. There are 18 vertebral bodies in the thoracic area, for instance. “Each of those has 12 different facet joints. Thus, there are about 360 small joints in the horse’s back,” Holt says. It’s no wonder the horse suf- fers back pain at times.
“In my examination, I try to isolate joints in the back that are not moving correctly. If there is even one joint that is not moving, the one in front of it and the one behind it have to work overtime to compensate. Then, the muscles around it get sore. My job is to find that spot and try to stimu- late that joint to move correctly,” says Holt.
Bruce Connolly, DVM, Equine Sports Medicine in Berthoud, Colorado, says it’s not always easy to determine the cause of back pain, or whether the pain is actually due to a back injury or is secondary to a problem some- where else in the body. Back pain may also be mistaken for lameness if the horse is moving differently because of the pain.
“Sometimes, the problem might be in a foot or leg and the back pain is secondary to the lameness. Or, we 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 sometime be a challenge to get an accurate diagnosis with back pain,” he says.
Bruce Connolly, DVM of Equine Sports Medicine in Colorado, says back pain may be due to many things, including lameness or problems somewhere else in the body.
“Many horses with back pain will respond to touch/pressure along the back if you palpate the lumbar muscles. 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. This might be indicative of kissing spines, where the spines of the vertebrae are bumping against each other,” says Connolly.
“Sometimes we take x-rays. On some of those horses you can see the spines touch-
ing each other but can’t find any sign of pain caused by it. Just because the horse has kissing spines doesn’t necessarily mean this is making the horse hurt. This complicates the diagnosis because pain may be coming from something else. If we just look at the x-rays and assume we’ve found the problem, we may be wrong.
If we make a diagnosis of kissing spines, we should use local anesthetic to try to block that area to make sure the block makes the horse hurt less and that the x-ray is appropriate.”
The back pain is often due to something we can’t see anatomically, while in some cases it is obvious, such as if the horse has a hump in his back or a crooked back. “If you stand behind and above some of these horses, you might be able to detect a crooked spine,” he says. If there is no obvious abnormality, however, this makes it harder to diagnose.
Many back injuries in humans involve herniated disks, pinched nerves, etc. “We don’t see as much of these issues in horses, possibly because they have a horizontal backbone,” he says. There is more strain/stress on the human
back with upright posture. We can’t always assume that horses have the same kind of back problems humans do.
“Today we are more able to diagnose sacroiliac joint issues with bone scans or use injections into that area to control pain and the horse gets better,” says Connolly.
TreaTing Back Pain
Nelson uses a variety of treatments for backs, including chiropractic manipulations and acupuncture. “There are some sore-backed horses whose owners ask me to do chiropractic or acupuncture on them, that I know are sore from feet issues.” For these horses, she tries to address the hoof imbalances before she works on the back and upper body problems.
“I probably use chiropractic methods more often than acupuncture. I do motion palpation along the back and identify spots that are not moving the way they are supposed to move. Then, I bring the joints into some tension and give a thrust and adjust the back. It’s amazing how much difference this can make for the horse. Sometimes it takes more than one visit, depending on how much is wrong,” she says.
She uses acupuncture mainly when there is muscle pain rather than a bone/joint problem. “If when I am palpating and I feel that it’s a muscle problem, acupuncture seems to help,” says Nelson.
“Sometimes, I also use non-steroidal anti- inflammatory drugs on a back injury (to help relieve swelling, inflammation and pain) and sometimes I use steroids. It’s important to iden- tify the problem and figure out if it’s an acute injury or a chronic problem. With some horses, it can be difficult to resolve an old chronic injury. After a time, however, it may be possible to make the horse more comfortable. I discuss this with the client and try to determine what we can actually expect for that horse,” she says.
Holt does a lot of physical therapy, acu- puncture and chiropractic work on some of these horses to try to rehabilitate them back into training. It’s impossible to pop and manip- ulate a horse’s back and get the joints back into place like a chiropractor does with humans because the horse is so much larger with thicker and stronger back muscles.
“Instead, I work on each individual muscle and each individual joint within the vertebral bodies. I am not working on the whole back,
I take it at each segment, a little part here and there that needs some help,” Holt explains.
Unless a horse has an obvious hump in his back, or if by standing above and behind the horse you can see that his back is crooked, it can be hard to determine what is causing the back pain. Thermography, however, can allow you to view areas of the back that may be inflamed.
84 SPEEDHORSE, April 2016
equine health