The Straw That Broke the Horse’s Back: Is Lower Back Pain Self-limiting in Equestrians?

Lower back pain is a complex, multi-factorial problem⁽¹⁾. There has been a significant rise in diagnostic and treatment options, but current treatments have paradoxically increased the severity and chronicity of low back pain⁽²⁾. Horse riders have considerably high incidences of lower back pain⁽³⁾. For example, researchers from Germany surveyed 508 riders with an average age of 33,5 and found that 73% had incidences of lower back pain⁽³⁾. Furthermore, their VAS score was also higher in the rider group at ±3.4 than at ±0.7  in the control group⁽³⁾.

However, there is no conclusive MRI evidence to suggest that horse riding accelerates spinal degeneration⁽³⁾. To add more complexity, MRI and X-ray are largely unhelpful in identifying the root cause of an individual’s pain, and incidental morphology findings in asymptomatic individuals are fairly common⁽⁴⁾. It is unknown if the high incidence is due to the kinematics of horseback riding or other factors.

In the puzzle to understand why horse riders seem to have such high incidences of back pain, practitioners must look at how the rider interacts with the horse. The relationship between the horse and the rider is known as the horse-rider dyad. There are multiple equestrian disciplines, such as show jumping and dressage—these two are most popular globally (see figure 1 and 2). However, regarding horse-rider kinematics, the principles are similar across most types of riding.