Put Your Back Into It
Dr. Tom Daniel has been practicing equine veterinary medicine for 27 years in Southern Pines, N.C., and may have more clients with driving horses and ponies than almost any other area of the country.
“While a lot of attention is paid to injuries of the legs,” says Dr. Daniel, “We need to remember, as veterinarians, that there is a lot of horse above the elbow and stifle.” When clients call with concerns that their horse is having a problem, veterinarians often consider the unsoundness to come from the limbs and don’t investigate the rest of the body.”
Next to the legs, problems with the back can be significant, performance robbing issues. “With driving horses you have to be very careful because riding horses will usually show you their back problems when you get on them,” explains Daniel. “You will know they have a back problem when you get on by the way they feel.” Since many drivers don’t ride their horses, they can miss clues that indicate their horses may have soreness in their backs. Drivers need to know how to check for problems in other ways.
How common are back problems in driving horses? “The issue is not so much as what we see, but what we don’t see. Sometimes it is more prevalent than we know, because we aren’t looking for it.”
“Look at what they do,” says Daniel, “– at what they pull – at the physics being applied to that animal. Backs are under a lot of stress driving. I think more than we know. ‘Got to put your back into it.’ There is a reason for that phrase. That is what we are asking that horse to do.”
Daniel says that driving horses are disadvantaged in another way in the development of core strength. “It isn’t any different than with human athletes. Your core strength has a lot to do with back issues. If you have a weak core, you have a back that is susceptible to strains and stresses and therefore injury. The stronger your core is, the more protected your back is.”
The work the driving horse does when he is pulling a carriage does not build core strength. Other disciplines are able to develop core strength. Hunters, jumpers, and dressage horses have to lift through their backs in order to perform correctly. What these horses do to work their backs is fundamentally different conditioning and strengthening than in driving horses. So driving horses are susceptible to chronic, low-grade, performance robbing back issues that may fly under the radar.
Riding your driving horse is a very good way to strengthen its core. Many upper level drivers either ride, or have someone ride, their horses. It also breaks up the monotony for them as well as helping to condition their backs.
“Veterinarians have a lot of tools to understand the source of the back pain and therefore what the therapeutic options might be,” says Daniel. “We have palpation, observation, and quite frequently the muscling of the back will tell us where the problems are.”
Drivers should be familiar with their horse’s topline. “If you look at their backs often enough you will see changes in the musculature along the topline that will indicate back problems. If you don’t use these muscles, they will atrophy, same as in humans.” They cannot use certain portions of their back and have segmental atrophy, it’s not the whole topline but parts of the topline. You can see it, and you can feel it. Palpating the back should be a routine part of examining your horse as well as visually inspecting his topline – maybe not every day, but frequently. “Look for trends, not a specific day with a back problem, but trends and patterns.” Look for repeated sensitivity over a period of time. The withers are always sensitive to some degree. Notice if it worsens.
Daniel recommends checking the back before work, as usually they will get better as they loosen up. Some problems get worse with work, but generally back problems loosen up, so it is better to examine your horse cold, when taken out of the stall.
Symptoms of back problems include evasion of pain. This can be felt just by palpating. Ask your veterinarian, to show you his technique for palpating the back and localizing the source of the pain, using both light and deep touch. The longissimus muscle that runs on either side of the back is the major working muscle of the back and what you are usually palpating.
A back issue isn’t something that can necessarily be seen while driving. The horse won’t be lame, but you might sense that something is not quite right. You probably won’t see the back not flexing or contracting, or him guarding it. “It’s pretty easy to tell with a riding horse. You can see a difference in their performance.”
Good dressage judges may notice something in your dressage test and make a comment – “not relaxed in the back.” There is an extension and flexion of the back that happens in movement. “At the trot, this is a passive flexion and extension. The epaxial muscles – the skeletal muscles – are not engaged at the trot in the back. It’s the weight of the abdomen that is creating the flexion and extension of the back. And as such it is painful for the horse. The horse is not using its muscles so he’s going to stiffen and guard those muscles and not allow the movement to happen. At the trot you get this very stiff moving back. The judges will notice this. With good judges, you’ll know if your horse has a bad back, because they will see it.”
The canter actively engages those muscles and warms them up. “If a horse’s discipline involves riding and he has a sore back we prefer that they warm up in two-point canter before asking for the trot. Don’t go from a walk to a trot to a canter with a sore-backed horse. Two point canter – then to the trot. Then he is warmed up and he can take that passive flexion and extension at the trot. This is a way to get a horse prepared that is a little sore-backed – canter then back him down” says Daniel.
There are specific exercises to help strengthen the core. Driving alone won’t do it, just as with humans, jogging will not strengthen a bad back.
Riding is one way to help. There are also some exercises that can be done with the horse standing in the barn aisle. If you work with chiropractors, they will show you core strengthening exercises. You come up underneath them and ask them to lift up their backs. It’s a little like doing a plank exercise in yoga.
Daniel believes you can’t fix a back problem – you manage it. If you don’t manage it well, you will run out of options, just like in humans. Surgical intervention options aren’t available to horses as they are in humans.
An underlying pathology such as arthritis in the back can cause pain. This is very common in people. Arthritis of the facets – the bony proliferation – puts pressure on the nerve root. That creates radiating nerve pain, but it is usually less in the horse, according to Daniel. The muscles around the back go into spasms creating problems with normal movement.
There are numerous problems that can be identified in the back, specific pathologies, but the two most common ones are the over-riding vertebrae or “kissing spines” – a misunderstood phrase Daniel doesn’t like. “Generally it is a problem of the dorsal processes of the vertebrae – the fins that stick off the top. A bony protuberance like a fin coming up off the main body. They are very long in the wither and ligaments attach them to each other.
There is a ligament that runs between the spinous processes of each vertebrae and one that connects all of them through the length of the spine. It frequently is a ligament issue if they strain the ligament between the dorsal processes that can create problems too. Because the ligaments are attached to the bone the problem may also lead to boney changes if that attachment is involved. You can generally see that on a radiograph and you can see it very well. Radiographs are a little more difficult to obtain in the lower back and in more heavily muscled horses.
The second most problematic area is in the joints between the vertebrae, which are also known as the facets. In that case, the imaging that shows those problems is a bone scan. A bone scan shows any back problems, so it is the best imaging modality for a back. Radiographs are best for the dorsal processes and the neck. Good images are possible because you don’t have the muscle mass. The rest, particularly the facets can be imaged with ultrasound. Not all veterinarians are qualified to diagnose that kind of back problem, so a good ultrasonographer is required. Dr. Daniel works with a radiologist who does that for his clients. Some vets certainly are more capable with training.
Another example of ultrasound guided injection of the back is of the sacro-iliac joint, also referred to as an SI injection. The illustrations demonstrate the ability to see the needle placement during the injection. The models used in the pictures show this with the muscle removed.
For an issue with the facets, the treatment is the same as for humans – steroid injection into the joint capsule to alleviate the pain. “Then you have to manage it, because you can’t rely on the steroid injection alone. We are limited in terms of how often and how long we can do that without ruining the horse’s back.” Managing may include riding and doing the ground exercises mentioned above.
Shock wave therapy is another therapy frequently used in backs. This can be used for a non-specific issue and can be done without a whole lot of work-up.
Miso-therapy is another therapy. “It’s a little complicated to explain. It is simple looking – intradermal injections along sections of the back that work with the nervous system to affectively block the pain. You are not addressing any specific underlying problem you are simply blocking the pain, similar to blocking a horse’s sore heel. It is a short-term emergency band-aid and not something that should be done on a regular basis. If you have consistent back pain you need to diagnose it and specifically address it.”
Massage, chiropractic, acupuncture are therapies that we have that can help manage a horse with back issues. If you address the right problem, these therapies will be beneficial and you’ll get your money’s worth.