"The more people mess with their horses, the more they need their vet."
This observation was made by a friend and colleague who practices in Minnesota, and he noticed that the number of calls he gets in a day is directly related to the weather. When it's cold out, people just throw hay at their horses and run inside, not noticing the big laceration inside the hind leg. Then, when the weather warms up for a few days, folks want to start riding a bit, and then they notice that laceration all of a sudden, or how their horse feels lame.
The quotation can be extrapolated to the wider horse world, too. Those who show successfully on the “A” circuit tend to manage their horses under a microscope. They do this in part because the horses are so valuable, but also because it's very competitive out there, and no stone gets left unturned when there's a chance to win a class. The more they mess with their horses, the more they need their vet.
This drive to extract every ounce of effort out of a horse combined with recent advances in veterinary medicine have opened up new avenues of diagnostics and, subsequently, therapeutics. It’s been widely accepted that 90 percent of lameness is from the carpus (knee) and below.
This is a historical underestimation in my opinion. I'd be willing to place a bet that if you did a tally of all the horses seen in a year by traditional "western" equine practitioners, that the adult horses probably end up with a carpus-down diagnosis more like 98 percent of the time.
Just Not Quite Right
What's interesting to me, is in spite of this statistic, how infrequently I'm asked to look at a "lame" horse in my sports medicine practice, versus how often I'm asked to give an opinion on a horse with a performance complaint that doesn't involve limping. Now to be fair, many times I do find a subtle lameness that contributes to the problem. But more often than not, the "complaint" is a result of back pain or, nearly as frequently, neck pain.
Does that mean that horses don't come up lame at big horse shows? Nope, they do it all the time unfortunately. But it's a minority of my work. Most of my work is created by trainers who have noticed a subtle change in performance and want to stay ahead of the 8-ball. It’s their sophistication that’s led us to push the diagnostic envelope in efforts to help the horses perform at their very best.
So why does back pain matter? Two reasons: 1. Ability to use the body at its most efficient and effective, and 2. Willingness to work.
I've seen horses with severe back (and, less frequently, neck) pain do everything from rear, buck, spin and try to throw themselves down, to biting their rider's foot when asked to canter. There is no other body area in my experience where pain is so quick to elicit misbehavior in the horse, including ulcers and sore front feet.
I’ve written about misbehavior, and its relationship to pain in the horse.  There are horses that are stoic enough to live their lives with significant pain and are still willing to get out of bed and do their jobs every day without a complaint. They are wonderful animals, and we are indebted to them. Other horses lack that Protestant work ethic, and when they get a little sore, they aren't afraid to show you their "social finger" once in a while. This can lead to rapid deterioration in the value of the animal, as most working horses have a job where their brain is way more important than their body. So we need to do everything we can to keep those horses comfortable that are fortitude deficient.
The back is used to balance the animal and initiate locomotion. When functioning properly, the back is engineered to manufacture tremendous forward propulsion with the least amount of energy consumption. It is the veritable "engine" of the entire horse. When it isn't firing on all cylinders, the horse is limited in its ability to do its work, and perhaps even worse, starts overusing other body parts, which can lead to lameness. "No foot, no horse?" I say, "Bad back, bad horse."
In future articles I will get into specifics about how exactly the back is engineered to create forward propulsion, how back (and neck) pain arises, how it affects and is affected by other sources of pain, how we diagnose it, and how we manage it.
Alex G. Emerson, DVM, provides sports medicine services for Rood and Riddle Equine Hospital in Lexington, Ky. and Wellington, Fla. Views expressed here do not necessarily reflect those of other veterinarians at RREH. Read his older blogs on the  Sidelines  website.