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Diagnosing and Treating Neck Pain in Horses

By Alexandra Beckstett

While we often think of limb lameness as the most common cause of poor performance in horses, neck pain can be just as debilitating. Affected horses might be unwilling to work, stiff, resistant to certain head positions, and show signs of forelimb lameness or hind-limb ataxia (incoordination).

Elizabeth Davidson, DVM, Dipl. ACVS, ACVSMR, associate professor of sports medicine at the University of Pennsylvania School of Veterinary Medicine’s New Bolton Center, in Kennett Square, described how to diagnose and treat this performance-limiting condition during the 2018 British Equine Veterinary Association Congress, held Sept. 12-15, in Birmingham, U.K.

The Physical Exam

When examining neck pain in horses, she said veterinarians should first perform a big-picture visual assessment looking for abnormalities such as:

  • Inconsistent muscle development in the neck versus the rest of the body;
  • Neck asymmetries;
  • Abnormal sites of sweating;
  • Muscle atrophy (wasting); and
  • Unusual neck posture, stance, or conformation.

Then, “look at neck flexibility via baited stretching exercises, side to side and up and down,” Davidson said, followed by a traditional lameness exam to assess the horse’s gait.

“Examine the horse on the longe and, if indicated, while ridden, implementing different things that might affect different parts of the neck,” such as a bridle, side reins, a rider, etc., she said. Common rider complaints might include difficulty bending one direction, jerky head and neck movements, and neck stiffness.

If the horse shows signs of ataxia, stumbling, or proprioceptive issues (lack of awareness where he’s placing his limbs), the veterinarian should also perform a neurologic exam, she said.

Diagnostic Imaging
Diagnostic imaging options and usefulness in this region of the horse’s body vary. Radiographs must be interpreted with care, as bone remodeling and variations in the cervical articular process joints (neck vertebrae) are fairly common (seen in about 50% of normal horses), particularly in older horses and Warmbloods, said Davidson.

“There’s no statistical association between clinical signs and radiographic grade,” she said.

Veterinarians can use nuclear scintigraphy to look for active bone remodeling. “Again, there are areas—particularly high-movement areas—that show this normally,” she said, adding that it’s important to compare left and right lateral images.

Ultrasonography is useful for identifying soft tissue and muscle problems, as well as ligament abnormalities and bursitis (inflammation of the bursa, or fluid-filled sacs, cushioning the joints).

Computed tomography (CT) has enhanced practitioners’ detection of both soft tissue and bone pathology in the neck, said Davidson. “Standing CT can provide tremendous insight and value as to what we’re seeing on X ray,” she said.

Other diagnostics include MRI, cervical vertebral canal endoscopy (using an endoscope, or a tube with a camera to view the affected area), arthroscopy (using an endoscope to examine and treat joint damage), and diagnostic analgesia, which Davidson said is key to assessing how clinically relevant neck abnormalities found on imaging are.

Imaging, however, does not provide all the answers, she added: “Don’t forget to look at the whole horse.”


Treating neck pain in horses remains challenging, said Davidson, and includes systemic non-steroidal anti-inflammatory administration, rest, and intra-articular (in the joint) injections. Results, unfortunately, aren’t all that promising, she said, and typically only have short-lived effects (one to six months in one study).

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