Decoding Back Pain in Horses: What Imaging Findings Are Clinically Relevant?

This article originally appeared in the Fall 2026 issue of EquiManagement. Sign up here for a FREE subscription to EquiManagement’s quarterly digital or print magazine and any special issues.

Primary back pain can stem from bone, joint, ligament, tendon, muscle, or any combination of these structures anywhere along the length of the horse’s body. As such, it’s a complicated condition to diagnose and manage. Additionally, clinical signs of back pain can be highly variable and nonspecific, including “poor performance” and “behavior problems.” Other reported clinical signs of back pain include:

• Bruxism.
• Tail swishing/altered tail carriage.
• Altered gait such as bunny hopping or lameness.
• Difficulty sliding/stopping, holding canter leads, bending.
• Missing lead changes.
• Unwilling to go forward and refusing jumps.
• Loss of topline/muscle atrophy.

Radiology and ultrasonography are commonly the first diagnostic tools practitioners reach for upon suspicion of back pain. Additional modalities might include nuclear scintigraphy, thermography, and computed tomography (CT) based on availability, owner’s financial ability, and practitioner’s preference.