Conservative Management of Back Problems in Horses

Introduction
Back problems are a common cause of loss of performance in athlete horses. The conservative management of affected horses may include local injection (performed under ultrasonographic guidance), mesotherapy over the painful areas and general medication with tiludronate (Tildren ND). An adequate management of the horse activity (warming up, rehabilitation, selected physical exercises, competition programme) is essential for maintaining the back flexibility and musculature and keeping the horse at work.

1- Tiludronate
Tiludronate (Tildren®) belongs to the bisphosphonate therapeutical class. Bisphosphonates are used to regulate bone metabolism via the inhibition of bone resorption. The introduction of bisphosphonates with high affinity for hydroxyapatite in bone represented an important advance in the treatment of a number of bone diseases in man. In horses, Tiludronate has gained popularity in the treatment of a number of orthopaedic conditions over the past few years. Randomised controlled clinical trials in horses have been published showing positive benefits of tiludronate in the treatment of navicular disease (Denoix et al. 2003) and in the management of pain associated with osteoarthritic lesions of the thoracolumbar vertebral column (Coudry et al. 2007).

2- Ultrasonographic guided injections
Being a simple technique, completely non-invasive and very well tolerated, ultrasonography is now used for several years in guiding the therapeutic medical or surgical procedures, in human and equine medicine. In horses, ultrasonographic guided injections (USGI) are used to improve the reliability of intra-synovial injections (joints or tendons sheaths), to control injections made in lesions (such as tendons lesions) or to control injections made in painful areas (such in the back and pelvis).  [...]