Riding Out Back Pain

Chances are, you know someone at your barn with back problems or pain. Maybe you even have first-hand experience. With seemingly so many riders dealing with back issues, do riding and back pain go hand in hand?

Not necessarily. There are ways to help prevent back problems, and even riders currently experiencing back pain can find ways to alleviate it and ride in comfort.

A Common Malady

According to an article published by the Mayo Clinic, four out of five adults experience at least one bout of back pain during their lifetime, and low back pain is the fifth leading cause of doctor visits in the United States.

Back pain is a common complaint that sends a lot of riders to Dr. Craig Ferrell, M.D., team physician for the United States Equestrian Team, and Wendy Murdoch, from Washington, Va., a riding instructor who teaches from a science-based, biomechanical standpoint.

“At least 30 percent of my clients come to me because of their back pain,” Wendy says. Before helping others manage their pain, Wendy had to learn to work through her own. In 1984 a horse she was riding reared up and fell on her. With a broken hip socket and a pelvis broken in two places, she began the long process of regaining her mobility—and ability to ride. Her explorations led her to study with Sally Swift, creator of Centered Riding, and Linda Tellington-Jones, creator of TTEAM and TTOUCH work with horses.

Dr. Ferrell sees high-level equestrian competitors and recreational riders alike in his practice, The Bone and Joint Clinic in Franklin, Tenn., and as team doctor for the USET since 1995. No matter their aspirations, a common theme among patients is that they want to find a way to keep riding. “There are many reasons for back pain, which is why it’s essential to have a medical diagnosis of the cause,” Dr. Ferrell explains. Once the cause is determined, the doctor can provide an individualized treatment plan.

As a riding instructor, Wendy follows the same approach. “If the doctor approves continued riding, there are ways that are more comfortable based on what is biomechanically correct for the riders’ backs.”

The Healthy Back: A Wonderful Design

Our backs are marvelously complex structures that permit, in the absence of injury or abnormality, a wide range of movement. It is this flexibility and movement that allows us to sit a trot or canter, stick to a cutting horse or jump 5-foot oxers without inhibiting our horses’ natural abilities.

Wendy says, “Once we stop thinking of the back as one big muscle with a rigid rod propping it up, we can start seeing it as an instrument that we can learn to play much like a piano. We can use a tiny effort, a little more effort, or a larger effort to match the intensity of the aid we want to give.

“With the small movements possible in the back, we can learn to refine our seat aids,” Wendy continues. “Subtle changes in the use of the back can create changes in the horse’s balance, speed and stride length.”

Common Causes of Back Problems

Not everyone is blessed with a perfect spine. In addition to obvious injury, riders’ back problems can be brought on by structural issues that predispose them to back pain.

Structural Issues
“There are a number of problems that we see pretty frequently in riders, even with riders at the Olympic level,” Dr. Ferrell says. “The most common affliction in riders is disc-related problems, called discogenic low back pain.”

Older riders have a higher incidence of disc problems. “Where the disc is inflamed and how badly it’s inflamed dictate how difficult it is to manage from an orthopedic standpoint,” Dr. Ferrell says.

“With back pain, some people start with a relatively normal back and then develop problems. Others are born with abnormalities in their backs, which sometimes predispose them to certain injuries or problems. Spondylolisthesis, known as ‘slippage of the spine,’ and ‘transitional syndrome,’ in which the back joins with the sacrum or the pelvis abnormally, are two common abnormalities,” he says.

Soft-Tissue Issues
When pain doesn’t originate from bone, it can occur from the soft tissues alone (muscles, ligaments and tendons) that support the spine. In addition, nerve issues can cause back pain.

Other Issues
“Not all back pain comes from the back,” Dr. Ferrell says. “For example, it’s not uncommon for prostate problems in men and endometriosis in women to present as back pain. Once again, considering all the possible causes of back pain and taking a good history of the problem are important parts of making an accurate diagnosis.”

Treatment Options
Depending on the cause of the problem, there are a variety of methods that can help lessen back pain.

Medical Treatments
Beyond the initial pain associated with discogenic issues, the second phase occurs if the disc ruptures and hits a nerve and pinches that nerve. The rider can then develop leg numbness or weakness.

“These cases are sometimes managed with an operation and sometimes with epidural steroids, where cortisone is injected around the nerves in the back. Depending on the situation and the circumstances, I’ve successfully done both for Olympic-caliber riders at various points in their careers,” Dr. Ferrell says.

Physical Therapy
Formerly team physician for the U.S. swim team, Dr. Ferrell believes that swimming can be very beneficial for riders who have developed back problems. He says that the swimming motion provides gentle rotation to the back, and it uses the same trunk muscles and balance muscles needed for riding. Also, because you’re lying flat in the water, the discs are not loaded or under pressure.

“I think many times taking up a swimming program as an adjunct to riding can be very beneficial to riders who have chronic, disc-related problems in their backs,” Dr. Ferrell says.

Other Treatments
A lot of riders use various treatments with their horses, such as acupuncture, chiropractic, ultrasound, heat and ice packs, massage and so on. “Any of these modalities have a place at some point in the treatment of [human] back pain once a diagnosis has been made,” Dr. Ferrell says. “For certain issues, some of these treatments can be very helpful; for other problems, they can be a waste of time. Again, it depends on making a very accurate diagnosis.”

Wendy Murdoch suggests adding Feldenkrais work (a method to increase body awareness). “In terms of resolving pain issues, I like this as a solution because its focus is on awareness through movement. The whole idea is that each person listens to where it’s most comfortable for his or her body and learns other possible ways to move that are comfortable rather than just moving in the same pattern all the time, which can cause the discomfort.”

Ways to Ward Off Back Problems

Riders can take an active role in preventing back pain or problems by following some simple steps.

Unfortunately, many riders—especially if they have no existing back issues—don’t pay much attention to their overall fitness and use riding as their only conditioning activity. Riders should commit to a well-rounded fitness program, including strengthening, stretching, warming up and body awareness, that can help keep back problems at bay.

Core Strength
“One of the key things riders can do as preventive maintenance is to develop their abdominal muscles and core muscles for riding,” Dr. Ferrell says. “This helps with your balance, your strength and your back.”

“While strengthening the abdominal muscles is important, it’s also crucial to work on overall organization. The back muscles need to work in concert with the rest of the body,” Wendy Murdoch says. “The abdominal muscles are important, but riders don’t necessarily need to have six-pack abs. It is important to work on coordination and use of the entire self, not simply one part of the body, in order to utilize the entire musculoskeletal system.”

Flexibility
“Flexibility is a big benefit to a rider, especially hamstring flexibility,” Dr. Ferrell says. “If a rider doesn’t have a back problem, it’s less of an issue, but if a person has any discogenic back problems and tight hamstrings, it’s worth committing to a program to regain as much flexibility as possible.”

Body Awareness
Exercises or activities that increase a rider’s body awareness are beneficial. Some popular methods are Pilates, yoga, tai chi, Feldenkrais, martial arts and the Alexander Technique (a method that works to change movement habits, improve freedom of movement, balance and coordination, and release unnecessary tension).

Be Back Friendly by Riding Right

“As in any sport, proper technique tends to decrease the load that’s focused on any one area of your body. So a lot of times, problems—whether back problems, shoulder strains or any other orthopedic complaint—are sometimes because you’re taking too much of the load in one place and not distributing it over your body,” Dr. Ferrell says.

He suggests working with a riding coach. “Get someone on the ground to make sure you’re riding properly for your back, and you’re doing it with proper mechanics. It’s important for riders to work on their seat and their equitation. All riders are less likely to have problems if they use proper technique than if they just go out and get on a horse and see what they can do.”

Wendy Murdoch has taught students who have fusions, slipped discs, rods in their backs, scoliosis and other issues, who come to her clinics with their doctors’ approval. Wendy believes that the arched-back posture of some riders can cause muscle-related back pain. “Some riders may perceive they are riding with a ‘straight’ back, but their backs are actually arched. This can cause the back muscles to contract, which can cause pain. When the rider can find a position where the back is straight, but the muscles are not overly contracted, the rider is usually much more comfortable, and this position can alleviate a lot of the pain.

“Their pelvis and seat bones should align underneath them, so the seat bones are pointing straight down rather than being ahead of or out behind the pelvis. When the pelvis is underneath the rider, it and the rest of the skeleton can support the rider without relying on overuse of muscles to stay on the horse,” Wendy says.

Happy Trails, Happy Back

Dr. Ferrell has seen a lot of back injuries in his practice, including Olympic-level riders with spinal fractures. “There are some back injuries where you might not recommend riding again. However, even with significant injuries to the back, if the injuries heal properly, you can usually—with permission from your physician—get back to riding again.”