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Back and Neck-Related Soft Tissue Pain, Nerve Pain, and Stiffness

Dr. Jen Dulin, DVM MS DACVS-LA


Rehabilitation of back pain/injury is related to decreasing or eliminating pain, improving awareness of body and limb placement (proprioception), improving flexibility, and improving endurance and strength.

Steps often progress from treating the inciting cause (whether lameness in an unrelated area of the body, or in the neck/back), to passive exercises, to active exercises, to ground work, to ridden exercise.

Treatment of sacroiliac (SI) pain depends on if the pain is related to the SI joint or the dorsal sacral ligament (DSL).  Ultrasound and/or bone scan can help with this diagnosis.  Soft tissue DSL injury can take up to 6 months for recovery, while joint pain rehabilitation often lasts 3-6 weeks following joint injection to decrease inflammation.  The following schedule is a general guideline for rehabilitating DSL injury and SI pain, but can also be useful for generalized back and neck discomfort.  If SI joint pain has been diagnosed, this schedule can be condensed into weeks instead of months.

  1. 1-2 months of hand-walking, emphasizing serpentine work and ground exercises (see below)
  2. 1-2 months of walking under saddle, emphasizing serpentine and circle work.  Always begin with larger diameter circles, spiraling in towards the center then back out, working to both directions equally.  This stretches the back and SI on the outside of the circle, while lowering the pelvis on the inside, improving flexibility.
  3. Once movement is symmetrical to either direction in all sizes of circle, do another 1-2 months of circles at the trot and then canter.  At the end of this period, working on acceleration and deceleration at the canter can help with hind end strength and rounding.

Preventive Measures

Preventive measures include exercises that strengthen and stretch the back, improving core strength and flexibility to decrease the likelihood of soft tissue injury or SI pain.  These exercises are also helpful during rehabilitation of injury or pain, when appropriate.

Pre-exercise stretching and long warm-ups

  • Protraction (bring the leg forward) of the hindlimbs, which rounds the back and croup
  • Leg yields from the ground
  • Encourage dorsal extension by lowering the head to the ground

Post-exercise cooling down

  • Tack walking on a loose rein, over ground poles and cavalettis or up/downhill
  • "Crunches" - stimulating the ventral midline so the belly tenses and the back rounds.  Hold for 10-30 seconds and repeat.  Gradually increase time each crunch is held and repetitions.
  • Turnout, not stall rest

Walking in deep snow, consistently working in a round frame, and early identification of other hindlimb lamenesses will also help prevent SI injury or other back issues.

Additional Treatments

Shockwave therapy: can help with impinged dorsal spinous processes (thoracic spine), SI pain, neck arthritis, and muscle pain.  For SI pain, typically at least 3 treatments are performed at 2 week intervals.  If there is significant improvement with treatment, it can be repeated at additional intervals such as once monthly.

Heat and massage: increases flexibility

Continued motion: stall rest increases stiffness

Saddle fit: improved saddle fit increases muscle mass in the back

Medications for back/neck pain

Robaxin: decreases muscle tension/stiffness, may also decrease anxiety.

Gabapentin: decreases nerve impulses/nerve pain. It may take 3-4 days to see results.  Gradually decrease dose when stopping.

Bute: may not be as effective for chronic pain, or pain related to nerve pain (pain that is not caused by inflammation).  

All of the above medications have withdrawal times or regulations regarding to showing or racing.  The above exercises may not be appropriate for all horses, and your veterinarian should be consulted prior to any treatment or rehabilitation regimen.  An accurate diagnosis of the cause of back or neck pain is essential for the correct treatment plan.  Please don't hesitate to contact  Vermont Large Animal Clinic with further questions regarding neck and back pain.