Back pain in horses has become a common diagnosis for horses with performance problems. Despite the frequency of this diagnosis, pain from the deeper bony and joint structures is poorly understood with the possible exception of muscle inflammation of the back. This does include vertebral impingement, iliosacral and other joint subluxations or misalignments, and degeneration of the intravertebral joints. This article reviews the current state of our knowledge of normal anatomy and acquired pain of the lower back of horses.

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In nearly every large performance barn across the country there are horses that have been diagnosed with problems of the lower back and pelvis that are performance limiting. These horses fall into these groups:

• Obvious gait deficits
• Recent history of decreased performance
• Recent history of sourness, that may intensify under saddle
• Horse not reaching its expected potential
• Abnormal findings on routine exam of an animal without any predefined problems.

Frequently, on the basis of the physical exam, a specific diagnosis is opined and specific treatment recommended. The following diagnoses are common:

• vertebral dorsal spinous impingement (kissing spines)
• iliosacral and other joint subluxations or misalignments
• degeneration of the intravertebral joints