The type of treatment used for a back problem depends on the nature of the injury. Muscle or ligament strain is treated differently than an arthritic condition with bony proliferative changes or erosive changes.
For a horse that’s functioning poorly because of back pain, the goal is to treat the horse so that he’s comfortable enough to work and get fit again.
“We try to relieve pain and increase motion and mobility,” said Richard D. Mitchell, D.V.M., Fairfield Equine Associates, Newtown, Conn. “If we can get these horses comfortable and working again, they may be able to function in such a way that they can maintain mobility of these joints. We may inject the neck or lumbar facet joints with corticosteroids, under ultrasonic guidance to put the medication directly into the joint. This will relieve the inflammation and then we try to get the horse on a program of exercise to encourage better carriage of the body.”
If there is a lot of inflammation and trauma, the horse may need time off in addition to injections to allow the structures to heal a little.
“We can inject locally between the affected vertebrae to relieve inflammation and sore- ness, to try to improve the horse’s mobility and get him to raise his back, if he can. Until you relieve the pain, it feels like he has a knife in his back all the time,” Mitchell said.
Many horses continue to compete in spite of sacroiliac problems. They periodically need treatment, but they might have a chance to heal more completely and get over the injuries – such as damage to the ligaments that support the joint – if they had some time off.
The use of NSAIDs such as Bute, Banamine and Ketoprofen can be helpful.
“Some of the newer ones like Equioxx are beneficial because they are kind to the gut, especially if the horse has had ulcers,’ Mitchell said. “We’ve found that some horses respond very well to certain types of regional injections. Horses with caudal sacral soreness may respond to caudal epidural injections of corticosteroids. Local injections are another technique that may be beneficial.”
Shock wave therapy and acupuncture can also be useful for lower degrees of discomfort and to support and improve what is being accomplished with direct medical therapy.
“Mesotherapy, used for pain, is also beneficial. This involves use of very small intradermal needles to inject local anesthetic and corticosteroids in small doses into dermal layers of the skin in multiple spots along the back. This affects the pain reflex and helps reduce pain locally and get the horse’s back to relax. The combination of corticosteroids and anesthetic rapidly reduces sensitivity of these areas and breaks the pain cycle, and the horse becomes very comfortable, very quickly,” he said.
The new drug Tildren can be effective in reducing the pain of degenerative arthritis, he said. The drug was developed for navicular disease but seems to help when there are bony changes in the back and neck, he said.
Many physical therapy tools can be used in combination with medicines to give the horse relief. Ice packs can help with immediate injuries, and later on, moist heat can reduce chronic pain; pulsating magnetic therapy devices, magnetic blankets and heat blankets may help with chronic muscle or ligament soreness and help get the horse loosened up and feeling better.