Backpain and SI problems in horses

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Back pain in horses and especially in the ‘lower’ back, the sacral region is common. How do you find out if your horse is also affected by this? How does the treatment and rehabilitation work and what can you do to prevent this?

From vague lameness to final diagnosis of SI problems, including inflamed SI joints, it is quite common.

The SI joint connects the pelvis and the spine and is used at every step. With this the action of the hind legs is passed on to the back and the force is converted into forward movement. The power in the hind legs is needed for example when jumping, galloping, collecting and lengtening, turning etc.

About how problems begin

SI problems can occur after a fall of the horse or being stuck in the box, something that can lead to an unnoticed injury with eventually possible osteoarthritis formation as the cartilage wears and the bone changes. However, wear and / or misuse of the horse’s back (due to incorrect riding / training) can also cause the ligaments to stretch or the joint itself to become inflamed.

What to pay attention to?

Complaints for back or SI problems are often vague and often do not manifest themselves immediately in lameness, but rather in behavioral change and resistance in the horse.

Many riders think that their horse is simply “annoying and needs to be handeld more”.

Some problems can be seen in hand or during lunging, but often the signals are worse when the horse is being ridden and sometimes these signals are only felt by the rider. If you recognize 4 or more of the symptoms below, chances are that your horse will have back and especially problems in the sacral area:

  • lingering movement of the horse on one side or difficult movement in a bend or on a circle on one side
  • the horse resists transitions, throws the head up and pushes the back away when canter or more hindquarters action is requested
  • cross-firing in canter
  • ‘bunny hop’, the hind legs move in canter almost simultaneously
  • the horse pushes its back away when more collection is required in combination with a reduced bend

  • the horse generally keeps its back stiff and difficult to maintain. The back can also be sensitive to touch
  • the horse tends to ‘swing’ one hind leg below the hindquarters, especially with turns
  • bucks when a little more activity, forward movement is requested or refuses / has trouble jumping

  • when it is difficult to develop muscles in the hindquarters, in particular the croup, in combination with short steps of the hind legs
  • alternating lameness and a shorter step of the diagonal foreleg
  • wagging the tail under the saddle, especially in warming up
  • drags with the toe of the hindleg in walk and has a short step

  • possible presence of the “hunters bump”, bump on the sacral vertebrae (highest point of the hindquarters)
  • difficulty for the blacksmith, especially when the horse has to lean on one hind leg
  • discomfort and “shaking” of the hindleg in question. For example when it is lifted for hoof care.
  • often there is some improvement after chiropractic treatment, but no long-term improvement
  • asymmetrical musculature of the hindquarters
  • in hand, the horse can show a weird gait on a hard surface (for example, ‘hanetred’) with the hind legs and has trouble placing the hind feet properly on a circle.


Of course, the above issues are purely indicative that something may be wrong and it is very important to then seek expert advice from a good veterinarian who has experience with these types of complaints. Often there are several physical problems at the same time (as a result of which it is often the case that the diagnosis is not made correctly) and what cause and what effect must be figured out by the veterinarian.

Problems in the sacral area are difficult to ascertain because this area is covered with substantial layers of muscle and fat, so you cannot directly see or feel it (although a good osteopath can often assess / feel whether there may be a blockage or pain in the sacral area) This makes X-rays and injections in the joint difficult. Often the diagnosis for a problem in the sacral area is only revealed when all other causes of lameness are excluded in the hindquarters.

Since a few years there is a method called Scintigraphy that makes it possible to find out SI problems faster. With this method the diagnosis has also been made on my stable mate’s horse.


The required treatment is tailor-made and must be adjusted (by the veterinarian) on the horse. Often it will first be aimed at reducing the inflammation (eg with injection although this is often the question if this helps) and reducing the pain. Secondly, there will probably be a period of work interruption and relative rest. More and more often the advice seems to be not to keep a stable rest, but to place the horse in a smaller environment (paddock) with a good surface and let it move.

Rehabilitation and exercises

After the “treatment” it is advisable to have the veterinarian (possibly in combination with other experts) check the horse again in any case to see whether there is green light to rehabilitate the horse. Resting too long and just putting the horse on the pasture is not beneficial because it is important to train the back muscles and the associated ligaments so that they become supple and stronger again.


  • daily short walks with the horse in hand (not in the step mill and do not set the horse free in a riding arena or meadow)
  • massage the horse in the sacral region before moving on each side for 1-2 minutes.
  • allow the horse to walk 5 steps backwards daily to be able to stretch the sacroiliac ligaments (2-3 weeks)

  • let the horse walk over poles in hand. Use 3 poles and place them one behind the other with 3 large footsteps between them. Then walk 4-5 times a large figure 8. This helps to stretch and stretch the sacral and pelvic region every time the horse lifts a leg and walks over the poles. This can ultimately also be used as a warm-up for riding, but must be done first in hand. Later on, it is wise to continuously incorporate exercises with poles into your training schedule!
  • work the horse in hand especially in shoulderin. Later this exercise can also be used well under the saddle to do a few zig zags
  • use stretching exercises several times a week for at least 6 weeks. Continued use is even better. Click here for a detailed explanation of the range of stretching exercises

  • pay attention to the horse’s reactions. If the horse has difficulty or no longer wants to cooperate, you probably have to take a step back
  • use cross training. So alternate with groundwork, outdoor rides (slope training), walking tours and training with cavaletti so that there is no constant load on the joints
  • be careful with activities that are harmful to the sacral region such as: jumping, abrupt transitions, short turns and small cirkels.

  • not too many cirkels in general
  • possibly add a supplement with vit. A, E, zinc, copper and magnesium for strengthening of the ligaments
  • check the corner of the rear hooves. In proportion, the rear hooves must have a sharper angle, shorter toe and higher heels than the front hooves
  • seek professional guidance during the rehabilitation process. A reliable and good address is 4DimensionDressage (veterinarian, rehabilitation expert and classic rider)
  • assimilate good exercises in your training program see: Exercises back and abs horse

Prevention of back pain and si problems

A fall, being stuck in the box etc. is unfortunate and not always preventable. Wrong use and (early) wear of the horse can often be prevented.

Pay good attention to your horse and its natural needs and meet his standards as well as possible. The horse is also not made for riding. So don’t start riding too early. And carefully handle the overall training and riding of the horse.

On this website I will give you as much information as I can to help you with that.

Used sources:


Leste-Lasserre, C. (2017). Sacroilliac Joint Pain in Horses. The Horse, article 37575

Identify and Treat Equine Sacroiliac Problems,
Auteur: Elaine Pascoe met Kevin K. Haussler, DVM, DC, PhD;

Auteur: Dr. John Kohnke BVSc RDA

Categories: Training

1 Comment

Ha Arlem · January 4, 2021 at 2:57 am

Hello. Happy New Year. While I’m reading I feel so distress because of this content many years ago that I have a horse problem. Thanks for this very informative content. God bless!

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