A pain in the back; SI problems, neck stiffness and generalized back pain. Back issues and complaints in the horse are quite common, leading to lost work, poor attitudes and overall moderate difficulty in management. Current therapies are often unrewarding, especially long term, as the main cause or root is often overlooked. Through a better understanding of both anatomy, physiology and contributors, management becomes easier and the horse more responsive without the long term need for medications or injections.
The horse is not much different from you or I, in regards to back anatomy with the exception of a few extra ribs and vertebrae here and there. The back in the horse is broken up into 3 main sections; neck (cervical), chest region (thoracic) and abdominal region (lumbar). The lumbar vertebrae then join up with the sacrum which helps to make up the pelvic region, then finally we have the tail bones or coccygeal vertebrae. The pelvis itself, is actually a box like structure, containing the distal colon/rectum, reproductive organs and outflow for the urinary tract. There are three main bones, mirrored on each side, that make up the pelvis which include the ileum, ischium and pubis. There is a right and left side, which are joined on the bottom and then again at the top via the sacrum. Not too dissimilar to human anatomy. The ileum is the large wing bone on each side of the pelvis and joins up to the sacrum via the sacro-iliac joint (SI joint). This SI joint moves as the horse moves. It is not locked in position through a union, but is a functioning joint, having both a right and left side.
Along the back, we have vertebrae, which make up the spinal column. Each vertebrae has side wings, a dorsal projection (spinous process), a body and a central hole through which the spinal cord travels down the back. The vertebrae are aligned one after the other, moving from cervical to the lumbar region. They butt up to one another, forming a joint, cushioned by a intervertebral disk, that acts to cushion movement.
Pain and discomfort in the back can originate in any one of these areas from cervival to coccygeal vertebrae, although primary tail or coccygeal pain is not that common unless there is an injury to that region. The main regions that we deal with back pain are the cervical, thoracic and lumbar region.
Common Back Problems
Primary trauma: Trauma can impact any section of the back from neck to pelvic region, usually a result due to a kick or other trauma leading to injury, predisposing to arthritis, ligament and muscle damage, and even neurological impairment.
Wobbler: (cervical stenotic vertebral myelopathy) This is a genetic condition in which the spinal canal or whole within each vertebrae is narrowed in certain sections of the cervical spinal section, which results in pinching to the spinal cord and variable neurological signs. The condition is usually most apparent in younger horses, <4 years of age, and can result in weakness or uncoordination either intermittently or constantly, dependent on degree of pinching present. Many are clinical only upon flexion of the neck, while others are present at all times, not positionally related. It often results in weakness of the limbs, usually rear limbs first and most prominant. Diagnosis is sometimes difficult and requires specialized x-rays and dye studies to demonstrate the impignment of the spinal cord. Therapies include non-steroidal anti-inflammatories, steroids and surgery when needed. Prognosis is highly variable.
Kissing Spine: Kissing spine lesions are essentially areas of arthritis that have formed when certain areas of adjoining vertebrae run against one another over time. In normal situations, each vertebrae should be seperate from one another, only linked via the joint present between them. Over time, due to injury, poor conformation and other factors, tissue break down and the vertebrae can become closer to one another, making contact possible. In most cases, it is the dorsal spinous processes that are in contact, rubbing against one another as the horse moves, creating pain and discomfort. Traditonal therapy for these lesions are routine injections of corticosteroids to help resolve pain along with non-steroidal anti-inflammatories. Long term prognosis is guarded, dependent on the extent of the lesion and formed arthritis.
Generalized Arthritis: Arthritis is a disease of joints and therefore can and does occur anywhere along the vertebral or spinal column. It can happen primarily, but also secondary to other conditions such as trauma, kissing spine and even wobbler syndrome. Like other cases of arthritis, we often see variable bone degeneration, new bone formation (spurs), limited movement and pain. All are a result of inflammation, secondary to increased stress upon the impacted region for various reasons.
Back Soreness/Muscle Pain: Muscle pain and soreness are common and can happen as a result of many causes from overtraining, poor saddle fit, improper rider balance, nutrition factors, conformation flaws and even hoof or foot imbalance. In many cases, the muscle pain or tightness is the main condition we are dealing with in most patients. In other cases, the muscle pain or tightness can be secondary to a primary problem, such as kissing spine or arthritis. The muscles will often tense up due to pain and compensation, resulting in clinical signs.
SI Pain (saccroiliac disease): This condition is commonly diagnosed and presents in a variety of ways and different degrees of progression or damage. In these cases, the junction or joint of the ileum and sacrum is stressed, resulting not just in pain but deterioration of that joint over time. It can occur on one side of both, really dependent on the contributing factors present.
Contributing Factors and Causes:
All of these conditions have one main common factor, which is inflammation. The process of inflammation is a cellular event, a signaling event, that can change cell function resulting in changes such as bone spurs, bone loss and remodeling. Through this process, range of movement is impaired and pain is the end result. The inflammation can be a primary cause or secondary, but is always present. That is a key point no matter the problem! In a situation such as wobbler syndrome, we may have a genetic predisposition to the condition, but the end result is inflammation (secondary), which results in tissue changes, bone changes and dysfunction on various levels.
Putting Wobbler syndrome to the side, in my personal experience all other back problems are secondary to some other cause or contributor. They often are not primary problems by themselves and this is evident due to the high level of unsuccessful attempts to manage through various injections or medications. These approaches can assist in the very short term, but often require repetitive use with diminishing success over time. Some of the main contributors include poor saddle fit, improper rider balance, conformational issues, poor conditioning,improper nutritiion and hoof imbalance. All of these are important and need to be evaluated in each and every back patient. If we ignore these contributors, our success rate will plummet. If we approach the horse as a complete unit, a whole horse, looking at other variables, correcting or improving them, our success will improve greatly.
One big issue is foot imbalance and conformation. Issues such as straight in the hocks/stifles will lead to improper load bearing, resulting in excessive load upon other joints including the SI joint and vetebral joints. Over time, this excessive stress will take its toll, resulting in early muscular tightness and pain, then bone deterioration and arthritis. Along these lines, hoof imbalance is a common problem but often overlooked. It is not uncommon, again in my experience, to have a horse with back pain but also unmatched hind or even fore feet. We have two different angles present, sometimes overgrown toes, under-run heels and generalized imbalance. This is critical to understand and see. If we look at us, as humans, if we walk around in a high heel shoe on one foot and a tennis shoe on the other, over time, we will feel that pain in our hip and likely back region. Hoof imbalance and conformational flaws often go hand in hand, so when we have one, sometimes we have the other. We need to assess the feet, often as our first line of therapy, making corrections when we can and then assess for the impact.
Better Management Options for Success!
We all want a 'cure' for what ails us or our horse, but this is not always possible. However, improvements and easier management are within grasp. One key area, as mentioned above, is to look for contributors and correct them. Most back problems are secondary, despite there being clinical arthritis or other problem present on x-rays. If we just direct our attention to the problem that is most evident, our success rate is usually much lower. If we address the evident problem, but also identify and correct other factor, our success rate climbs. Don't forget about contributoring factors!
Putting those obvious contributors aside, we have one factor that is not always obvious but is present and that is inflammation. If we have pain, we have inflammation. However, even when we don't have pain, inflammation is usually still a moderate factor. That inflammatory event is usually primary, meaning it is causing the damage present, but in other cases it is secondary. In either case, it needs to be addressed and if we address it more fully, more completely, the results will often follow. However, one has to keep in mind the extent of damage present. The longer we wait, the more damage. We can't reverse that damage, so much better to prevent it and control it in the early stages. All too often, I encounter the owner that has done repetitive SI or back injections over months or even years, with progressive damage present. Then, due to traditional therapies no longer providing results, they begin to seek other options. It would be far better to put these modalities into play earlier in the game, even alongside of traditional therapies, to help curb the process and likely improve the outcome.
Inflammation is traditionally managed with corticosteroid injections and oral non-steroidal anti-inflammatory medications. So, what's wrong with that? Well, we have to look at success rates to answer that question. In the short term, those medications may provide good results and improvement for the patient, but in the long term what we see is repeated use of these treatments and continued deterioration of the condition. In a nut shell, they are not the fix. We have to manage that inflammation from a wider, broader perspective in order to maximize results and potentially slow the degenerative process. The other factor is that this inflammation is not generally just localized to that back region. As a case in point, it is not uncommon to have a horse with back problems present as a perceived primary problem, when in fact they also have concurrent hock issues with arthritis and maybe foot imbalance. Is the back the primary problem or secondary? I'd guess secondary, but we are making it primary. The inflammation is now present in all 3 locations, when actually it likely started in the foot several years prior, moving up the leg due to compensation. As this inflammation builds and moves, more locations are impacted and more damage is done. Instead of just one area of concern, now we have 3.
I choose to approach the inflammatory process through the use of herbs and nutrition. Why? First, medications and injections are not the answer as noted above. Second, through the use of proper herbal formulas and dietary approaches, we can manage the inflammation more completely, at a higher level and on an internal level.
Diet is one area I look at heavily. Diet can be a friend or foe. We need proper nutrition to help the body to build, strenghten, maintain and recover. This does not come in the form of a synthetic vitamin/mineral supplement, processed grains and lower quality hay. We need proper nutrition, without the loads of preservatives, additives, sweeteners and other chemicals. Many times, the modern equine diet is contributing to the inflammatory process, more so than resolving it. This is why so many continue to have problems, despite attempts to add this or that to the supplement regimen. We are far better served to put our money into high quality hay, full of nutriition, and whole grains. This will end up serving us better and in the long term providing better results.
Herbal therapy is also critical, in almost every equine patient. The proper herbal formula can assist us in managing inflammation on a higher level than any medication or injection. Useful herbs include Curcumin, Boswellia, Dandelion, Marshmallow, Parsley and numerous others. We can also gain much nutritional value from many herbs, including spirulina and alfalfa as examples. The one key is that these herbs are used in combination and often much higher doses than anticipated. We are managing a horse after all, not a gerbil. Combination and dose is key. Results will often follow quickly when the right approach is taken and expenditures on medications will be reduced.
Formulas that we find helpful in management of these cases include Cur-OST EQ Plus, Cur-OST EQ Pure and Cur-OST EQ Total Support. Which formula is dependent on that patient, how they present and other variables involved. An easy keeper with back issues is often linked back to gastrointestinal dyfunction, while a more lean race horse is usually stress and other joint related. They can all have similar underlying factors, including conformation and hoof imbalance, but each reacts differently to those situations.
Other formulas that we find helpful, dependent on dietary status and needs are the Cur-OST EQ Nourish and Cur-OST EQ Rejuvenate. Both of these formulas help to provide added nutrition, including protein, to assist not only in muscle health and recovery, but also bone health. Bones need nutrition too!
In the end, all issues are better prevented than they are treated. Through the use of proper herbal therapy, dietary evaluation and correction of other contributing factors, most 'back' equine patients can be helped tremendously. We just have to see the big picture, instead of just of focusing on the evident problem at hand. You can do it and we are here to help! Catch them early, manage them better in an early stage and results will follow.
Author: Tom Schell, D.V.M., CVCH
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