Back Pain in Horses: Could It Be Affecting Your Horse’s Performance?

A horse that suddenly begins knocking rails, struggles to engage the hindquarters, becomes reluctant to go forward or simply feels “not quite right” may not have a training problem at all. In some horses, subtle changes in performance can be an indication of back pain.

Back pain is an important consideration in ridden horses because the back is involved in transferring force between the hindquarters and forehand while also supporting the weight and movement of the rider. Problems involving the muscles, vertebrae, ligaments, sacroiliac region or even poorly fitting tack can therefore affect both comfort and performance.

A 2025 study by Shokry, Ali and El-Sharkawy investigated the relationship between back pain and poor performance in 75 show jumping horses aged between eight and 23 years. All of the horses had histories suggesting back problems together with reduced competitive ability. The researchers identified several different causes of back pain, reinforcing that “a sore back” is not a single condition.

What Causes Back Pain in Horses?

In the Shokry et al. study, sacroiliac sprain or injury was the most commonly identified problem, accounting for 40% of cases. Muscular strain accounted for 24%, vertebral abnormalities such as crowding of the dorsal spinous processes and spondylosis accounted for just over 21%, while smaller numbers had conformational abnormalities or skin and tack-related problems.

This is important because back discomfort may originate from very different structures.

Potential causes can include:

• muscular strain or fatigue;

• injury or inflammation around the sacroiliac region;

• supraspinous or interspinous ligament injury;

• osteoarthritis involving spinal joints;

• impinging or overriding dorsal spinous processes, commonly called “kissing spines”;

• poor saddle fit or pressure from tack;

• underlying limb lameness that alters the way the horse moves; and

• inappropriate or excessive training load.

The researchers noted that incorrect saddle fit, rider or training factors, muscular strain and abnormalities involving the spinous processes and supporting ligaments were among the issues associated with back pain in the horses examined.

Signs of Back Pain Can Be Subtle

One of the challenges for owners is that back pain does not always present as obvious soreness.

A horse may instead begin showing changes such as:

• reduced willingness to go forward;

• difficulty engaging the hindquarters;

• loss of impulsion;

• reluctance or refusal at jumps;

• difficulty maintaining speed;

• reduced performance;

• resistance when being saddled or ridden;

• muscle loss or asymmetry through the back or hindquarters;

• stiffness when bending;

• sensitivity when the back is touched; or

• intermittent or shifting hindlimb lameness.

Shokry and colleagues reported that 70.6% of the horses in their study showed signs of hindlimb lameness, while 60% demonstrated an inability to elevate the trunk normally during spinal assessment.

This highlights an important point: what appears to be a behavioural or training issue may sometimes have a physical explanation.

A horse repeatedly refusing fences, struggling with transitions or becoming reluctant to work should therefore not automatically be labelled lazy, stubborn or difficult.

Diagnosing the Problem

Because there are so many possible causes, persistent back pain warrants veterinary investigation.

The 2025 study emphasised the importance of assessing the horse both standing and moving. Palpation, examination of muscle symmetry, spinal movement and reflexes, gait assessment and evaluation under exercise can all provide useful information. Depending on the suspected problem, diagnostic imaging such as ultrasonography or radiography and diagnostic local anaesthetic blocks may also be required.

Saddle fit should also be considered. A horse can change shape considerably with age, workload, muscle development or loss, meaning a saddle that fitted previously may no longer distribute pressure appropriately.

Treatment then depends on the underlying diagnosis. In the Shokry study, management included periods of rest and controlled walking, correction of saddle-related problems, anti-inflammatory treatment and, in selected diagnosed cases, targeted veterinary injections.

Can Joint Supplements Help?

Joint and musculoskeletal supplements may be useful as supportive nutrition, particularly for performance horses, older horses or horses with diagnosed degenerative joint disease. However, they should not be viewed as a substitute for identifying the cause of back pain.

Some commonly used ingredients include:

MSM

Methylsulfonylmethane (MSM) is a sulphur-containing nutritional supplement widely used for joint and muscle support.

Interestingly, a 2025 equine study investigated MSM supplementation in adult Thoroughbred geldings undergoing exercise. Researchers found differences in exercise-responsive inflammatory gene activity within skeletal muscle in supplemented horses, although several circulating inflammatory and antioxidant measurements were unchanged. The findings suggest MSM may have a role in supporting the muscular response to exercise, but further research is still warranted.

For performance horses, this makes MSM particularly interesting because back discomfort can involve muscular strain as well as joints and ligaments.

Hyaluronic Acid

Hyaluronic acid (HA) is naturally present within synovial fluid and contributes to the environment in which joints move.

HA is used extensively in equine joint management, including veterinary-administered therapies. Oral HA is also commonly included in equine joint supplements, frequently alongside glucosamine, chondroitin and MSM.

Research into oral combination supplements containing HA has produced some encouraging findings, including changes in gait and biomarkers in some studies, but the evidence for individual oral ingredients remains variable.

Therefore, HA-containing products are best considered part of a broader joint-management program rather than a treatment for back pain itself.

Glucosamine and Chondroitin

Glucosamine and chondroitin are probably two of the best-known ingredients in equine joint supplements.

Some equine studies have reported improvements in stride characteristics following supplementation, while other research has failed to demonstrate meaningful improvements. Reviews of the equine literature have consequently concluded that the overall quality and consistency of evidence remains limited.

A more recent 2026 placebo-controlled study involving aged horses with chronic lameness also found no evidence that the particular oral joint supplement tested improved stride length, gait symmetry or lameness over six weeks.

This does not necessarily mean all glucosamine or chondroitin products are ineffective, but owners should be cautious of supplements making dramatic claims.

Collagen

Collagen and collagen peptides are another increasingly common addition to joint-support products.

A small equine study involving horses with naturally occurring osteoarthritis reported promising improvements following supplementation with specific bioactive collagen peptides, although the researchers also called for larger, well-controlled studies to confirm the findings.

Undenatured type II collagen, often called UC-II, has also produced promising results in an equine study involving arthritic horses.

Omega-3 Fatty Acids

Long-chain omega-3 fatty acids, particularly EPA and DHA, may also be worth considering when supporting joint health.

In an equine study investigating experimentally induced joint inflammation, supplementation increased EPA and DHA concentrations within blood and synovial fluid. Although it did not significantly alter several major inflammatory joint-fluid markers, researchers observed changes in one cartilage-degradation-related pathway and concluded that further investigation was justified.

When choosing an omega-3 supplement specifically for this purpose, look at the actual quantities of EPA and DHA supplied rather than simply the total amount of “omega-3”.

Supporting the Whole Horse

Perhaps the most important lesson is that maintaining a comfortable back involves much more than adding a joint supplement.

Appropriate conditioning, gradual increases in workload, regular saddle assessment, good farriery, maintaining an appropriate body condition and providing sufficient quality protein, vitamins and minerals all contribute to maintaining the musculoskeletal system.

Products containing MSM, hyaluronic acid, glucosamine, chondroitin, collagen or marine-derived EPA/DHA can be considered as part of a long-term joint-support program, particularly for horses in regular work or older horses. The scientific evidence behind individual ingredients varies, however, so supplements should support—not replace—good management and appropriate veterinary care.

Most importantly, pay attention to changes in your horse.

A loss of impulsion, unwillingness to jump, difficulty engaging, unusual sensitivity when grooming or a gradual deterioration in performance may be more than a schooling problem.

Sometimes your horse is not saying “I won't.”

They may be saying “I can't comfortably do this anymore.”

If your horse develops persistent back soreness, unexplained poor performance or lameness, speak with your veterinarian before attempting to manage the problem with supplements alone.

Reference

Shokry, M., Ali, L.B. & El-Sharkawy, M. (2025). Relationship between back pain and poor performance in show jumping athletic horses. Open Veterinary Journal, 15(3), 1480–1487. doi:10.5455/OVJ.2025.v15.i3.37.