09/08/2026
🐴 When a horse has back pain, is the back actually the problem?
Not always.
In a 10-year survey of equine back pain, Riccio et al. (2018) found an almost even split:
➡️ 46–50% of cases were primary back pain - where the source of the problem originated within the back itself.
➡️ 49–54% were secondary back pain - where another condition or influence was contributing to the pain experienced in the back.
And that distinction matters.
Primary back pain can arise from conditions such as overriding dorsal spinous processes (kissing spines), facet joint osteoarthritis, supraspinous or interspinous desmitis, congenital abnormalities, fractures, infection and other pathology of the vertebral column.
But when back pain is secondary, our investigation needs to extend much further.
We may need to consider:
🐎 Forelimb or hindlimb lameness
🐎 Ill-fitting tack
🐎 Hoof balance
🐎 Rider asymmetry
🐎 Posture and core strength
🐎 Training load and exercise progression
🐎 Extended stable rest
🐎 Working surfaces
🐎 Visceral pain
🐎 Metabolic or hormonal influences
🐎 Emotional stress
In other words, the painful area isn't necessarily the source of the problem.
Back pain can be a little red flag - an indication that something isn't right somewhere in the horse.
That is why recognising back pain should be the beginning of our investigation, rather than the end of it.
Where is the pain coming from? What else has changed? How is the horse moving? What does their tack look like? What is happening in their training, management and environment?
Sometimes treating the back is important.
But understanding why the back became painful in the first place is where we have the opportunity to make a much bigger difference.
📖 Want to dive deeper into the primary and secondary causes of equine back pain?
Comment EBP3 and we'll send you the link to read the full blog.
