Cold-back syndrome in horses requires systematic investigation of multiple potential causes before any treatment is initiated, with pain identification and management being the welfare priority.
Cold-back investigation is a welfare priority that requires systematic rather than shotgun approaches. Addressing all potential causes simultaneously without diagnosis may resolve some cases while missing the primary driver and wasting owner resources. The investigation sequence prioritizes the most common causes: saddle fit assessment by a qualified fitter, veterinary assessment of the back including palpation and potentially imaging, and gastroscopy to rule out ulcers as a contributing factor. Only after identifying and addressing the physical causes should behavioral conditioning from previous pain be addressed through progressive remounting protocols. This systematic approach respects both horse welfare and the investigation evidence.