Back pain is highly prevalent in ridden horses but often goes unrecognized. Advances in pain assessment tools are helping riders and vets identify and address this important welfare issue.
Back pain in horses is frequently misidentified as training resistance or behavioral problems, leading to escalating pressure rather than veterinary investigation. The RHpE allows non-veterinarians to systematically observe behavioral pain indicators. Once pain is identified, treatment may include veterinary injections, physiotherapy, saddle refitting, and changes to training loads. Rider asymmetry can also cause or worsen back pain. The equine welfare field increasingly recognizes that performance problems are often pain problems, and addressing the horse's physical comfort must come first.