Back pain can arise from a number of causes, including lameness and dental problems, as well as conditions affecting the vertebral column and associated soft tissues.

Effective treatment relies upon accurate diagnosis, so that appropriate medical or surgical therapies can be prescribed, as well as relieving more general muscle stiffness and discomfort.

Horses that have back pain secondary to dental disease, lameness or an ill-fitting saddle must have these primary complaints addressed.

While simply treating the back may bring relief from symptoms associated with accompanying muscle and soft tissue discomfort, this is usually only temporary in nature unless the underlying cause is dealt with.

Those with primary back conditions – such as impinging or kissing spines, inflammation of the supraspinous ligament, arthritis of the joints between vertebrae, and damage to the sacroiliac joints – will require specific treatment. This usually involves direct injection of anti-inflammatory agents.

Corticosteroids, such as triamcinolone (Adcortyl) and methyl prednisolone (Depo-Medrone), are most commonly used for the medication of these injuries or degenerative diseases.

Ultrasound imaging may be necessary to accurately place the needles used to administer these steroids, especially when injecting intervertebral articulations and the sacroiliac joints.

Other pain-relieving agents may also be administered, including sarapin, which contains extracts of pitcher plants that are commonly used in the treatment of back pain in humans, and the homeopathic anti-inflammatory traumeel.

Oral or intravenous non-steroid anti-inflammatory drugs may also provide benefit, especially in horses where there has been an acute traumatic injury to the back. Such cases include horses that been cast in the stable, fallen when jumping, or injured themselves in a trailer or horsebox.

Longer term treatment with Equipalazone (‘bute’) or Danilon may also be effective in providing symptomatic pain relief in horses with chronic back pain.

The anti-arthritis drug, Tildren, has also been proven to reduce pain and improve back mobility in horses with osteoarthritis of the joints between vertebrae.

Other veterinary therapies are directed at relieving muscle pain and spasm. Those horses that have discomfort in the deep lumbar muscles, often as a result of jumping injuries, will benefit from injection of these muscles with anti-inflammatory and spasm-relieving agents.

Multiple injections of local anaesthetic and steroid anti-inflammatory under the saddle area – using a technique called mesotherapy – can also be of help in horses with general stiffness in this region.

Extracorporeal shock wave therapy has also been shown to be effective in treating a variety of back disorders. It is unclear, however, whether its benefits are due to it simply providing pain relief as opposed to modifying any underlying disease.

Application of ice, or cold therapy using a refrigerated unit like the Zamar, may be indicated if there is localised muscle damage or inflammation, especially in the early stages. Later, as the muscle heals, hot packs or warming gels may improve circulation and muscle function. A veterinary equivalent of Ralgex, called Compagel, has recently been launched in the UK for use on inflammatory swellings and bruising.

The role that physiotherapy, acupuncture and manipulative therapies, such as osteopathy, chiropractic and shiatsu, play in the relief and long-term management of equine back pain cannot be overstated.

The key is finding a suitable practitioner and technique that enables your horse to return to a full and competitive life.

A useful introduction to the range of therapies available can be found at www.natural-animal-health.co.uk.

The fact that a large number of therapists make a living from treating horses with back pain bears testament to the complexity of back problems and the reality that there is no single solution for all cases.

Chances of success are greatest, in my opinion, when the back practitioner works closely with the vet to deliver an effective treatment programme and schedule of rehabilitation.

If you are using an animal physiotherapist, check that he or she is a member of ACPAT (Association of Chartered Physiotherapists in Animal Therapy). This means that they are fully qualified, have professional and public liability insurance and adhere to the association’s regulations and standards, including the requirement to liaise with vets, farriers and other healthcare professionals involved with the case.

Physiotherapists will use techniques like ultrasound, laser and pulsating magnetic field therapies, as well as manipulation and massage, to address both the primary condition and any associated muscle or soft tissue damage.

There is no statutory regulation of other therapists, or even physiotherapists that do not belong to ACPAT, but there are professional or trade bodies with which they may register. Just because someone promotes themselves as a ‘back man’, it doesn’t mean that they have appropriate training, suitable qualification, or the protection of insurance if things were to go wrong.

Under UK law, it is illegal for anyone other than a veterinary surgeon to give acupuncture treatment to an animal. This is because the use of needles is regarded as an invasive procedure. Vets that perform acupuncture are usually members of the Association of British Veterinary Acupuncture.

Many equine osteopaths are registered with the General Osteopathic Council and have undertaken a postgraduate diploma in animal osteopathy.

With regards to chiropractic, look for practitioners that have undertaken the McTimoney training or attended either the Oxford College of Equine Physical Therapy or the International Academy of Veterinary Chiropractic. The Equine Sports Massage Association also maintains a list of registered equine body workers.

It is also worth checking that your insurance policy covers fees for non-veterinary or alternative treatments, and whether they stipulate that the practitioner should be a member of ACPAT or another professional organisation.

Therapeutic programmes usually commence with frequent sessions, say twice a week for three to six weeks, followed by a gradual increase in the interval between therapies until the problem is resolved or the horse needs only the occasional treatment.

Your vet and therapists should agree upon a work schedule, usually commencing with lunging and followed by gradual introduction of ridden exercise, with periodic re-assessments.

Through this process many clients become aware of the contribution that therapists can make to ensuring that the horse remains supple, free moving and happy in his or her work. Just like shoeing, a manipulation or massage session becomes a permanent component of the horse’s maintenance programme.

At this stage, it is also imperative to prevent any recurrence of the back problem. Horses with front foot pain, bone spavin or chronic suspensory ligament injuries may require on-going treatment.

Regular dental and saddle-fitting checks are essential, even if these were not the cause of the initial problem. Any kissing spines, osteoarthritis, or sacroiliac disease may also periodic medication.

Finally, there are a number of products on the market that can help in the prevention and management of back pain, ranging from magnetic rugs to massage pads and systems like the Equilibrium Products massage pad or equissage. These are designed to promote blood flow, relieve tension and improve mobility, and are best used on a daily basis.

Last year, my daughter’s younger horse started to get tense before a lesson or competition and, while the back was not overtly painful, the muscles were tense and tight. She would fidget when being tacked up and took a long time to settle in the warm-up arena.

Her teeth and saddle fitting were duly checked and there was no sign of underlying lameness. Someone suggested it might be my driving of the horsebox, but she would do the same when ridden at home.

The issues resolved completely with the purchase of a relatively inexpensive massage pad, which Molly now wears for 30 minutes while being groomed or in the lorry on the way to an event. It helps relax her, tacking up is no longer a struggle and she works calmly from the minute she is mounted. If only all horse and rider problems were that easily fixed!