Equine Back Pain: It’s Not All Kissing Spines! A Farriery Perspective

Introduction

Back pain in horses is one of the most commonly reported performance-limiting problems encountered across disciplines, from elite sport horses to everyday leisure mounts (Dyson, 2021). Yet, despite its prevalence, the root causes are often misunderstood or oversimplified. The term kissing spines (dorsal spinous process impingement) has become somewhat of a catch-all diagnosis whenever a horse exhibits resistance, poor performance, or behavioural changes under saddle (Stubbs et al., 2019). While kissing spines are undoubtedly real and can be profoundly painful, the farrier’s experience tells a more complex story: many cases of back pain originate, or are perpetuated, from the ground up through the feet, limbs, and posture (Hobbs and Clayton, 2013).

As farriers, we are in a unique position to observe the biomechanical chain that links the hoof to the back. Every imbalance in the foot affects limb loading, joint angles, and ultimately, the musculature and comfort of the horse’s spine (O’Grady, 2020). A holistic understanding of equine back pain, therefore, requires a collaborative approach combining farriery, veterinary input, saddle fitting, physiotherapy, and rider awareness (Greve and Dyson, 2015).

Altered posture arsing from back pain and inadequate hoof balance.

The Biomechanical Connection Between the Hoof and the Back

To understand how farriery influences the horse’s back, we must appreciate the horse as a kinetic chain. Each structure, from hoof capsule to poll, functions as part of an integrated system designed for efficient locomotion. When one link in this chain falters, compensatory adjustments ripple throughout the body (Clayton and Hobbs, 2017).

The hoof plays a critical role in shock absorption and load distribution. During locomotion, ground reaction forces travel up the limb, through the joints, tendons, and ligaments, and into the axial skeleton (Hobbs et al., 2020). Subtle distortions in hoof balance such as mediolateral imbalance, long toes, under-run heels, or collapsed frogs alter how these forces are transmitted. Over time, these imbalances create asymmetric loading patterns in the limbs, leading to uneven pelvic movement, altered stride length, and muscle tension in the thoracolumbar region (Greve and Dyson, 2018).

For example:

• A long toe–low heel conformation delays breakover, increasing strain on the deep digital flexor tendon and the back of the limb. This tension can manifest as stiffness in the lumbar and sacral regions (O’Grady, 2020).

• Mediolateral imbalance (e.g., one heel higher than the other) tilts the distal limb, causing uneven pelvic rotation. The horse may develop unilateral muscle hypertrophy or soreness in the gluteals and longissimus dorsi (Hobbs and Clayton, 2013).

• Collapsed digital cushion or frog reduces shock absorption, forcing the back muscles to compensate for the lack of distal damping (Dyson, 2021).

From a farrier’s viewpoint, these biomechanical distortions are often the hidden culprits behind chronic back discomfort—long before any spinal impingement is visible radiographically (Greve and Dyson, 2015).

Collapsed heels putting strain on the upper body.

Recognising Hoof-Related Indicators of Back Pain

The horse’s feet often tell a story of how it is using its body. A farrier who reads that story carefully can spot early signs of compensation that suggest developing back or hindquarter discomfort. Typical hoof indicators of back-associated issues include:

• Uneven heel wear or growth: Suggests the horse is loading one side of the limb more heavily, often due to pelvic or sacroiliac asymmetry (Clayton et al., 2020).

• Flaring or distortion: A long toe on one side may correspond with restricted stride or reduced limb protraction (Hobbs et al., 2020).

• Flat soles and under-run heels: Common in horses that move with tension through the back, shortening stride and reducing heel-first landing (Dyson, 2021).

• Asymmetric frog pressure: Indicates altered weight-bearing, which may relate to compensatory posture or uneven propulsion (Greve and Dyson, 2018).

  
  

By noting these changes and communicating them to veterinarians or therapists, farriers can help identify biomechanical issues long before overt back pain develops. This early warning role is a crucial part of holistic equine care (O’Grady, 2020).

An example of medio-lateral imbalance

The Influence of Hoof Balance on Posture and Core Stability

A horse’s ability to carry itself correctly, to lift its back, engage the core, and move freely begins at the ground. Balanced, symmetrical feet allow the horse to distribute weight evenly across both sides of the body (Clayton and Hobbs, 2017). Conversely, unbalanced feet can force compensatory patterns that inhibit correct posture.

Example: A horse with a low left heel and a high right heel may consistently track shorter on the left hind. This asymmetry leads to rotation in the pelvis, uneven development of the longissimus muscles, and tension along one side of the back (Hobbs et al., 2020). Over time, this horse may resist bending one way, struggle to pick up a particular canter lead, or show behavioural signs under saddle.

By restoring mediolateral balance through careful trimming and shoeing, the farrier can improve pelvic symmetry, enabling the horse to engage its back more evenly. This mechanical correction often reduces tension patterns that bodyworkers observe during palpation or soft tissue treatment (Dyson, 2021).

Farriery Interventions That Support the Back

Farriery is both an art and a science. The aim in managing back pain is not only to correct the feet but to influence the horse’s posture and comfort through precise mechanical support (O’Grady, 2020). Below are several common farriery strategies that can contribute to relieving or preventing back pain.

1. Optimising Dorso-palmar Balance. A correct hoof-pastern axis ensures that load is evenly transmitted through the limb. Horses with a broken-back hoof-pastern axis often experience delayed breakover and excessive strain up the limb and into the back. Shortening the toe, raising the heels (where appropriate), or selecting shoes with rolled toes can restore a smoother gait and reduce compensatory muscle use (Hobbs and Clayton, 2013).

2. Supporting Heel Engagement. Encouraging heel-first landings promotes shock absorption and enhances digital cushion function. Wedged frog support pads may be used temporarily in horses with under-run heels or collapsed frogs to encourage more natural engagement of the back part of the foot, improving comfort higher up the kinetic chain (Clayton et al., 2020).

3. Correcting Mediolateral Imbalance. Asymmetric foot balance leads to rotational forces through the hock and pelvis. Careful trimming to equalise medial and lateral wall height, often combined with feedback from gait analysis or pressure mapping, can significantly improve spinal symmetry and reduce tension-related back issues (Greve and Dyson, 2018).

4. Managing Hoof Conformation in the Hindlimbs. The hind feet play a central role in propulsion and back engagement. Horses with long toes and low heels behind often compensate by hollowing the back and trailing the hindlimbs (Dyson, 2021). Re-establishing proper heel support behind allows the horse to step under its body more effectively, activating the core muscles and relieving lumbar strain (Hobbs et al., 2020).

5. Considering the Barefoot vs. Shod Debate. While some horses benefit from barefoot management, others require mechanical assistance through shoeing to maintain balance and comfort. The farrier’s decision should always be guided by the individual horse’s workload, environment, and hoof quality—not by ideology (O’Grady, 2020). The goal remains the same: functional, balanced feet that support a healthy back.

   
   

Collaboration with Animal Therapists and Veterinarians

Back pain is rarely an isolated problem. The farrier’s work intersects with that of equine physiotherapists, osteopaths, chiropractors, and veterinarians (Greve and Dyson, 2015). A collaborative approach ensures that interventions are synergistic rather than contradictory.

Veterinarians provide diagnostic imaging, nerve blocks, and medical treatment for underlying pathology. Therapists help release muscular tension, improve flexibility, and restore correct neuromuscular patterns. Farriers adjust mechanical forces through trimming and shoeing, reducing strain that perpetuates pain.

Regular communication between these professionals enables a 360° understanding of each case. For instance, if a physiotherapist notes persistent tension on one side of the back, the farrier can re-examine the corresponding limb and hoof for imbalance.

Similarly, if radiographs reveal uneven joint space in the hocks or stifles, shoeing can be adapted to support better alignment (Clayton and Hobbs, 2017).

Collaboration with physiotherapists and therapists is critical for a successful outcome.

Saddle Fit and Farriery: Interdependent Factors

It’s impossible to discuss back pain without acknowledging saddle fit. Poorly fitting saddles can create focal pressure, restrict shoulder freedom, and cause muscle wastage along the thoracolumbar region (Greve and Dyson, 2015). However, it’s equally important to recognise that hoof imbalance can cause saddle fit to deteriorate.

A horse that stands or moves crookedly due to foot imbalance alters its thoracic shape (Hobbs et al., 2020). One shoulder becomes more developed than the other, the back hollows unevenly, and the saddle begins to slip or rock. The rider then compensates with uneven weight distribution, further compounding the problem.

By addressing the issue from both ends—the feet and the saddle—we can restore the biomechanical harmony necessary for comfortable performance. A farrier working in conjunction with a qualified saddle fitter can ensure that both the base and top of the kinetic chain are optimised (Dyson, 2021).

Recognising When Back Pain is Secondary to Foot Pain

One of the farrier’s most important contributions to equine welfare is recognising when apparent back pain is secondary to primary foot pathology. Many horses labelled as having cold backs or behavioural issues are, in fact, compensating for undiagnosed hoof pain (Greve and Dyson, 2018).

Common examples include:

• Chronic sole bruising leading to shortened stride and lumbar tension.

• Subclinical laminitis creating reluctance to engage the hindquarters.

• Navicular or heel pain resulting in a hollowed back posture and inverted muscle patterns (Hobbs et al., 2020).

Addressing these primary causes through corrective farriery often results in dramatic improvement in the horse’s back comfort, confirming the interconnected nature of these structures (Dyson, 2021).

The Role of Environment, Surfaces, and Management

A holistic farrier also considers environmental influences on back comfort. Horses kept on hard, uneven, or excessively soft ground may develop postural adaptations that affect the entire musculoskeletal system (Clayton et al., 2020). Similarly, inadequate exercise, obesity, or poor fitness can all contribute to back dysfunction.

Farriers can advise owners on:

• Appropriate exercise surfaces: Avoiding constant work on deep or slippery footing that increases lumbar strain.

• Turnout management: Encouraging natural movement promotes hoof health and spinal flexibility.

• Conditioning and fitness: Gradual strengthening of the topline helps maintain spinal alignment and reduces reliance on farriery correction alone (Greve and Dyson, 2015).

These environmental insights, though often overlooked, are key components of holistic back pain prevention.

The Psychological and Ethical Dimension

Equine back pain often leads to frustration, both for the horse and the humans around it. Behavioural signs such as bucking, reluctance to move forward, or resistance to saddling are frequently misinterpreted as disobedience rather than discomfort (Dyson, 2021). As professionals, we have an ethical duty to approach such cases with empathy and curiosity rather than blame.

Farriers, spending regular one-on-one time with each horse, are in a privileged position to observe subtle changes in demeanour or movement. Sharing these observations respectfully with owners and the wider care team ensures early intervention and prevents escalation into chronic pain syndromes (Hobbs et al., 2020).

Beyond the Forge: Education and Prevention

The farrier’s role in preventing back pain extends beyond the workshop. Educating owners and riders about the importance of regular hoof maintenance, correct training, and postural awareness is vital (Greve and Dyson, 2018). Horses benefit when their caregivers understand how every decision—from feeding to footing—affects the integrity of their movement and the comfort of their spine.

Workshops, yard demonstrations, and collaborative talks with therapists and veterinarians foster a culture of whole-horse thinking. The more connected our professions become, the more effectively we can safeguard the welfare and performance of the horses in our care (Clayton et al., 2020).

Conclusion

Equine back pain is not synonymous with kissing spines. While spinal impingement can be a factor, the majority of back discomfort encountered in horses is multifactorial, involving a complex interplay between hoof balance, posture, muscular compensation, and management (Dyson, 2021).

From a farriery perspective, the key lies in mechanical harmony. Balanced feet create balanced movement; balanced movement creates a healthy back. When combined with veterinary diagnostics, therapeutic interventions, and informed management, farriery becomes a cornerstone of holistic back care (O’Grady, 2020).

The old saying that “no foot, no horse” remains profoundly true, but perhaps it should be extended: “No balanced foot, no balanced back.”

By recognising our shared responsibility across professions, we can move closer to the ultimate goal—horses that are comfortable, functional, and free from pain, from hoof to poll (Clayton and Hobbs, 2017).

References

Clayton, H.M. and Hobbs, S.J. (2017) The role of biomechanical analysis in equine locomotion and training. Equine Veterinary Education, 29(6), pp. 321–331.

Clayton, H.M., Hobbs, S.J. and Crevier-Denoix, N. (2020) Biomechanics of the equine back: implications for performance and welfare. The Veterinary Journal, 262, 105509.

Dyson, S.J. (2021) Diagnosis and management of equine back pain: clinical perspectives. Equine Veterinary Education, 33(3), pp. 135–147.

Greve, L. and Dyson, S.J. (2015) The horse–saddle–rider interaction: implications for equine back pain. Equine Veterinary Journal, 47(4), pp. 437–447.

Greve, L. and Dyson, S.J. (2018) The relationship between saddle fit and equine back pain. Journal of Equine Veterinary Science, 68, pp. 1–8.

Hobbs, S.J. and Clayton, H.M. (2013) A review of locomotor biomechanics of the equine thoracolumbar region: implications for physical therapy and performance. Equine Veterinary Education, 25(10), pp. 497–507.

Hobbs, S.J., Richards, J., Back, W. and Clayton, H.M. (2020) The effect of hoof balance on limb loading and equine spinal kinematics. The Veterinary Journal, 262, 105507.

O’Grady, S.E. (2020) The farrier’s role in maintaining soundness through functional hoof balance. Veterinary Clinics of North America: Equine Practice, 36(2), pp. 203–220.