10/04/2026
Can't wait to host your seminars on November 14th and December 5th! https://bluewatersfarm.com/events/ 💕
"Pain Resolution vs. Structural Rehabilitation:
Why the Back Needs Both"
ALP Equine's Foundational Principle on Back Pain
"To truly resolve the physiological consequences of back pain, we must understand what happens physically inside the horse's body — this is the missing piece of successful rehabilitation." - Alisa Pitt
Back pain is one of the most prevalent and multifactorial conditions encountered in equine practice. Successful management requires not only the identification and correction of primary causative factors, but also a structured approach to physiological rehabilitation that addresses the downstream neuromuscular consequences of pain and compensatory movement patterns.
We are often effective at addressing the external causes of back pain — saddle fit, pathology, way of going. However, to truly resolve back pain, it is essential to understand what happens physically inside the horse's body when discomfort develops. This is frequently the missing piece in rehabilitation.
Equine back pain is rarely attributable to a single cause. The categories below represent the primary contributing factors that should be systematically evaluated. Importantly, radiographic pathology is not a prerequisite for clinically significant back pain. Horses may present with considerable discomfort in the absence of identifiable structural lesions on imaging.
Understanding the root cause is essential so that appropriate interventions can be made — whether a new saddle, veterinary support to break the pain cycle, or management of radiographic findings.
Equipment & Tack
Ill-fitting saddle (most common extrinsic cause)
Inappropriate girthing or rider imbalance
Structural & Pathological
Kissing spine / dorsal spinous impingement
Facet joint arthritis
Segmental hypo- or hypermobility
Acute traumatic injury
Soft Tissue & Myofascial
Muscular restriction or soreness
Fascial restriction in the thoracolumbar complex
Compensatory bracing patterns
Hindlimb & Distal Factors
Hock or stifle pathology
Altered loading and propulsion
Hoof imbalance affecting spinal alignment
Biomechanical & Training
Habitual patterns of improper movement
Training under tension or restriction
Asymmetrical epaxial muscle development
Idiopathic & Other
No single identifiable cause
Combination of low-grade contributing factors
Age-related cumulative change
Neuromuscular Pathophysiology
Understanding the neuromuscular consequences of back pain is critical to achieving a full and durable rehabilitation outcome. This component is frequently overlooked in standard clinical management. The back has two key muscles whose function is profoundly disrupted by pain:
Primary Stabilizer
Multifidus
The multifidus are small, segmental intervertebral muscles whose primary role is intersegmental vertebral stabilization. Under normal conditions they function continuously and independently of global musculature. In the presence of pain, these muscles are among the first to undergo inhibition and subsequent atrophy — with detectable loss occurring within as little as 7–14 days of unresolved pain onset. This leaves the spine vulnerable to segmental dysfunction.
Primary Mover
Longissimus Dorsi
The longissimus dorsi is the primary global mover of the equine back, responsible for dynamic spinal motion. When pain triggers protective splinting, the longissimus is secondarily recruited as a stabilizer — compensating for multifidus inhibition. It is now no longer performing its proper role. The result: restricted back mobility, hypertonic tissue, and a compensation pattern that persists even after the original pain source is resolved.
Gluteus Medius
The gluteus medius is one of the largest and most powerful muscles in the horse's body, and its influence on the back goes well beyond propulsion. It attaches broadly across the ilium and sacrum and inserts near the greater trochanter of the femur, putting it in direct mechanical relationship with the lumbosacral joint — the single most mobile junction between the spine and the pelvis, and the hinge point that transmits every stride's hind-end drive forward into the back. When the gluteus medius is tight, asymmetrically developed, or guarding, it can tilt or restrict the pelvis, altering the angle at which force enters the lumbosacral joint and cascading up through the longissimus dorsi and multifidus. A horse compensating for hind-end pain, hock or stifle discomfort, or an old injury will often shift load through this muscle to protect a more painful structure, and over time that protective pattern becomes its own source of strain — the gluteus medius itself grows chronically tense, the lumbosacral joint loses its normal shock-absorbing motion, and the back muscles above it stiffen to compensate further. Muscle moves bone, and few muscles move as much bone, with as much consequence for the back, as this one — which is exactly why hind-end and pelvic assessment belongs in every serious back-pain workup rather than being treated as a separate issue.
Thoracolumbar Fascial Complex
The thoracolumbar fascia is a broad, multi-layered connective tissue structure that overlies both the longissimus dorsi and the gluteus medius. Due to this anatomical relationship, dysfunction or restriction in one muscle directly influences the mechanical behaviour and comfort of the other. Effective rehabilitation must therefore consider the functional relationship between the lumbar spine, the gluteal musculature, and the fascial envelope that connects them.
Signs
Regional Atrophy
Adjacent Hypertrophy
Reduced Suppleness
Reluctance to Engage
Behavioral Changes
Rehabilitation Framework
Removing the causative factor alone is frequently insufficient for full resolution. A comprehensive approach addresses both the elimination of the pain source and the restoration of neuromuscular function. We need to release the longissimus dorsi and mobilize the multifidus to restore proper back strength and movement.
Pain Cycle Interruption & Cause Resolution
Veterinary assessment and pharmacological pain management where indicated.
Saddle fit assessment and correction
Farrier review for hoof balance
Veterinary management of structural pathology
Hindlimb joint assessment and treatment
Soft Tissue Release & Mobilization
Release of the longissimus dorsi to restore its role as a dynamic mover
Fascial release targeting the thoracolumbar complex
Mobilization of the gluteus medius given its functional interdependence
Progressive flexibility and range-of-motion exercises
Neuromuscular Reconditioning
Targeted exercises to re-engage and strengthen the deep intersegmental stabilizers
Intentional schooling to encourage proper thoracolumbar muscle recruitment
Progressive loading with attention to movement quality
Ongoing monitoring for recurrence or compensation
Functional Movement Method
A Deeper Approach to Resolving Back Pain
The Functional Movement Method provides a structured approach to the rehabilitation stages outlined above. No matter what the struggle — saddle fit, kissing spine, muscle soreness, hoof imbalance, joint maintenance or something else — taking a more in-depth approach to resolving back pain is a valuable tool to have in your toolkit. The method incorporates targeted fascial and soft tissue release, progressive flexibility and mobility work, and intentional schooling protocols designed to re-establish proper muscle recruitment patterns.
Release Fascia & Muscle
Restore Flexibility & Mobility
Rebuild Proper Muscle
Intentional Schooling
This document is an educational reference only and does not constitute veterinary advice, diagnosis, or a treatment prescription of any kind. The content is derived from observational practice and personal experience, developed to help educate people on understanding the underlying reasons behind back pain. It is not a substitute for veterinary medicine. Always consult your veterinarian prior to commencing any exercises or rehabilitation program.
ALP Equine strives to change the way of thinking about Back Wellness.
“Pain resolved” is not the same as “back restored.” Even brief episodes of back pain can trigger measurable muscular changes. Without a dedicated rehabilitation phase, the horse may return to work with reduced stability and reduced mobility — even though it is no longer painful.
If you are interested in learning more ALP Equine will be taking a Deep Dive into these approaches to understanding and managing Back Pain. November 14th 10:30am-12:30 PM Blue Waters Farm Chesapeake City MD. Visit https://bluewatersfarm.com/events/ for more information and registration.
"Understand the Pain. Resolve the Cause. Rebuild the Horse."
