There are numerous causes of back pain in horses. The cause of pain can range from saddle fit to impingement of dorsal spinous processes (kissing spines). Sometimes, horses do not have either of these causes of back pain and we find that the pain is compensatory from the neck or sacroiliac region. Other reasons can include osteoarthritis of thoracic or lumbar articular facets which can be diagnosed by ultrasound.

How do I know if my horse has back pain?

Often, the primary complaint of horses with back pain is bucking under saddle. Sometimes the signs are more subtle and include inability to perform lead changes, difficulty moving to the canter, or difficulty moving from the canter to the trot. Back pain can be diagnosed by careful palpation of the dorsal spinous process, thoracolumbar epaxial muscles, and sacroiliac region. If warranted, a lameness exam and/or ridden exam may be performed.

Why is my horses’ topline missing?

Horses presenting with back pain may have atrophy and/or spasms of the epaxial muscles that stabilize the back. Over time, extended muscle spasms lead to the visual presentation of muscle atrophy. It is possible that the muscles are just “tensed up” and need pain relief to re-expand. This means that over time, the muscle cells are constantly depolarizing and become hyperexcitable and contract creating a constant spasm. These key differences in atrophy vs. spasm are especially important to have examined if topline is a concern for your horse.

How does shockwave treat back muscle pain?

A recent target for rehabilitation is the spinalis multifidus muscle which is a deep spinal stabilizer. Atrophy of this muscle on the SAME side as bony changes/pathology make this muscle an ideal target for treatment with shockwave. Shockwave treatments two weeks apart decrease the pain response threshold, known as the minimum nociceptive threshold. Shockwave also increases capillary formation, decreases harmful inflammatory mediators, and improves tissue fibers in soft tissues. This is important in horses that have injuries of the supraspinous or interspinous ligaments associated with back pain and kissing spines.

How does shockwave treat kissing spines?

The use of shockwave won’t cure kissing spines or improve the radiographic findings. However, the use of shockwave for back pain is multimodal because treats affected muscles, ligaments, and bony remodeling that is involved in kissing spine. As mentioned before, Shockwave treats the musculature that stabilizes the spine which plays a huge role in managing kissing spine pain. Additionally, shockwave targets the bone by activating osteogenic (bone) factors. This stimulates chondroprotective cell surface mediators (beta-1 integrin) and decreasing harmful cytokines and interleukin cells (TNF alpha and IL-10). In other words, shockwave promotes protective barriers to the bone while inhibiting harmful inflammatory mediators that break bone down.

How long will shockwave last to treat my horses back pain?

Our observations find that 80% of horses with back pain and/or kissing spine treated with shockwave respond favorably for 6 months to a year. 20% of horses with kissing spines treated with shockwave will need adjunct treatments that can include injection.

One study concluded that three consecutive treatments of back pain relating to either caudal thoracic arthropathy, supraspinous ligament strains, non-specific soft tissue pain, or dorsal spinous process pain provided analgesia for up to 5 months. Another study showed 89% improvement in horses treated for back pain with 30% of patients improving for 2-4 months, 28% of patients improving for 4-6 months, and 31% of patients improving for >6 months.


If you would like to consult about a case or have your horse evaluated for back pain please email us or call at:

561-515-2685 ext. 2

Call Us Text Us
Skip to content