Photo courtesy of Adam Christman, DVM, MBA

We knew what it felt like to sit in a lobby, heart pounding, waiting for news. We knew the helplessness of holding a trembling dog and the anxiety of coaxing a cat into a carrier. We have cried in exam rooms. We have questioned estimates. We have worried about outcomes.

Walk into any veterinary clinic on a busy Tuesday afternoon, and you will see what our profession has become: ringing phones, full schedules, emergencies, walk-ins, and exhausted teams moving at a sprint pace to keep up. In that whirlwind, the core of why we do this work gets buried under medical records, billing disputes, and endless to-do lists.

Here’s the truth that keeps me grounded: before we were veterinarians, technicians, managers, or receptionists, we were pet parents. That realization that we share the same love, fear, and hope as the people who walk through our doors may be the most powerful reminder we have when the weight of this profession feels unbearable.

I will never forget the day my first dachshund, Chelsea, deteriorated rapidly. Suddenly, I wasn’t Dr Christman with the letters after my name; I was Adam, scared out of my mind, staring at a consent form I did not want to sign but had to. I read DNR forms and prayed for a good outcome. In that moment, every lecture I had ever given about empathy and every note I had written about client communication came roaring back with crystal-clear intensity. I wasn’t thinking like a clinician. I was thinking like a dog dad. Will she walk again?

The veterinary team was incredible, and Chelsea fully recovered after a hemilaminectomy. I wanted reassurance. I wanted compassion. I wanted someone to tell me they would care for my baby girl like she was their own. And I needed to know she was going to be OK. That’s when it hit me: our clients want the exact same things we want, to know their pet is safe, loved, and seen, not just treated as a case but treasured as family.

Think back to the first time you said aloud, “I want to be a veterinarian,” or “I want to be a veterinary technician.” It probably wasn’t because you were fascinated by practice management or eager to navigate third-party payment options.

It wasn’t because you loved 12-hour shifts or wrangling online reviews. It was because of a pet—the childhood dog that got you through hard years, the stray cat that followed you home, the horse that taught you patience, or the rabbit that showed you gentleness. That human-animal bond was the spark. That was our why.

Somewhere between board exams, production goals, and burnout, we forget. It happens. The statistics do not lie. Burnout, compassion fatigue, and moral distress run rampant. The weight of being a healer, counselor, businessperson, and miracle worker all at once is crushing. Add the rising cost of veterinary care, client frustrations, and the grief we absorb every day, and it is no wonder many of us feel like we are drowning.

But here’s the lifeline: our why is still there. It has not left us. It is buried beneath the noise.

We do not get to choose how long our patients live. We do not always get to decide whether a client says yes to treatment. But we do get to choose how we show up—and how deeply we remember that we are in this together as professionals and as pet parents. I save every sympathy card, every thank-you note, and every Edible Arrangements delivery to help me know my why. I suspect you do the same. After you finish reading this, revisit those cards and notes and look at the great work you have accomplished and continue to accomplish.

Here is a perspective shift that changes everything:

When a client balks at an estimate, remember when you stared at a surgery bill and wondered how you would manage it.

When a client asks the same question 3 different ways, remember the time you clung to every word from your own clinician, desperate for reassurance.

When a client becomes emotional over “just a skin tag,” remember when your pet trembled and you wanted nothing more than to protect them.

It is not “us” vs “them.” It is “we.” It always has been and always will be. In the words of The Mandalorian, “This is the way.”

So how do we keep the spark alive when exhaustion threatens to snuff it out and we sit in our cars scrolling on our phones in the driveway before going inside? A few practical reminders:

Tell the stories. Share the moment your pet changed your life with your team. 

Ask them to pause for perspective. Before every appointment, imagine you are the client, not the clinician. What would you want to feel in that moment? This can be daunting during long shifts and in emergency medicine, but it is not impossible.

Lead with empathy. Empathy is not a script but a recognition: “I have been where you are. I know this is hard.”

Celebrate the wins. A wagging tail, a purr, a regular urine stream after cystotomy, a grateful smile—those are victories. Let them matter.

Give yourself grace. You cannot pour from an empty cup. Caring for yourself is part of caring for your patients. Be good to yourself, your family, and your friends.

Every profession has a purpose, but few carry the weight of love like ours. We are guardians of the bond between people and their animals. That is not just medicine; it is sacred.

When you are tired, when you are overwhelmed, when the noise feels deafening, come back to this truth:

Before we were veterinarians, we were pet parents.

Before we were healers, we were the ones praying for healing.

Before we carried the stethoscope, we carried the leash, the carrier, and the toy in the waiting room.

That is what unites us, not just as a profession but as people.

The next time you walk into an exam room, take a breath and look at the client sitting there. See yourself in them. Remember what it feels like to be on the other side of the table. Then remind yourself of your why.

At the end of the day, this is not about production or protocols. It is about love, about the bond that brought us here in the first place.

At the end of every shift, after the charts are closed and the lights go off, what stays with us is not the stress or the numbers but the memory of the lives we touched and the quiet reminder that every patient we heal could easily be our own.

Articles

From the CVO: Adam Christman, DVM, MBA, provides commentary about celebrating the professional wins. 

Before we were veterinary professionals, we were pet parents

This podcast episode is sponsored by IDEXX 

On this episode of The Vet Blast Podcast presented by dvm360, our host Adam Christman, DVM, MBA, welcomes Dana Connell, DVM, MPH, DACVIM (Oncology), and Zachary L. Neumann, DVM, MS, DACVIM (Oncology) to talk about the importance of early cancer detection in canine patients and how it can improve outcomes.

Throughout the episode, the trio takes a deep dive into how the IDEXX Cancer Dx testing works and can be incorporated into routine wellness panels or used for sick patients. By providing results within days, veterinary professionals can use this new test as a way to make timely decisions for patients. 

Below is a partial transcript, edited lightly for clarity. 

As a generalist, that's what's most important to me, too. Just, you know, tell me what works does the data show that it's representation of the population of patients that I see in day-to-day practice? And it certainly sounds like it is. Let's talk about this, because we know that as veterinarians, sometimes we have a hard time implementing something into process. You know, we go to the conferences. We hear about these things, we try to figure out the how and the why. So, you know, can you share some examples of how veterinarians are incorporating IDEXX Cancer Dx testing into their practice?

Zachary L. Neumann, DVM, MS, DACVIM (Oncology)

Dana Connell, DVM, MPH, DACVIM (Oncology)

: Never. Veterinarians in general are just not skeptics, right?

Rightfully so, right? I mean, you have to be skeptical of things when they're first released to be a good practitioner and a good scientist.

:  I would definitely agree with that. I think from the data that we can see this test has already been used in a myriad of these cases, which is really exciting. So I see some general practitioners who are incorporating this into every wellness panel for which it's appropriate meaning, and specifically in those at-risk breeds or in that at risk age range of 7 and above, to get additional insights. I mean, we have to remember that the most common result that you are going to receive in those healthy appearing patients is that that dog does not have lymphoma, has a result not consistent with lymphoma. 

Again, I'm going to go back to, you know, the mammography example, I would say most women come out of their mammograms yearly with a, you know, not consistent with cancer, no abnormalities, type diagnosis which gives everybody peace of mind. So I think there's a lot of value there. I have seen this used in patients who have enlarged lymph nodes, and potentially maybe other diagnostics are not feasible for whatever reason, whether that's because of finances, whether that's because we have some clients who are just not in favor of doing aspirates or other more what they would call invasive means of trying to find a diagnosis. We've seen that. We've seen it alongside pathology, so alongside cytology and histopathology to get additional information, or to maybe get information a little bit faster, since the turnaround time is so short. 

And we've also seen it in cases where we have some maybe nebulous signs that aren't really pointing slam dunk to lymphoma, maybe some nebulous GI signs or something like that. Do a IDEXX Cancer Dx testing, it comes back consistent with lymphoma. That makes the clinician say, hey, you know there's -I don't know -there's something maybe here with these, this is a sick patient, but it's not really, you know, your classic lymphoma look. Let's look a little bit deeper, and then they go on to later confirm lymphoma. 

So we've had a lot of different cases that we've seen for this, and I think that it's really helping to just give those initial insights in the in the field. We've heard really, really positive things from the field about the test since it's been out.

Lymphoma is a great master of disguise, I feel like. And that's where, when it's an aid and diagnosis type test that you have that available. It's super beneficial for lymphoma, specifically because it can be such a such a beast, and it can present and look like so many other things, and can be very difficult good diagnosis on.

Podcasts

Discover how early cancer detection through the Cancer DX test enhances canine patient outcomes in this episode of The Vet Blast Podcast presented by dvm360.

 Early Detection: Advancing Canine Cancer Care

Canine osteoarthritis (OA) is a progressive degenerative joint disease that transitions from intermittent discomfort to persistent pain as cartilage thins toward bone-on-bone contact. Dogs compensate with altered posture and gait, reduced range of motion, and activity avoidance. Over time, secondary effects include muscle atrophy, weight gain due to lower activity, and behavior changes such as reluctance to play. Overall, OA steadily erodes a dog’s ability to perform normal daily functions and diminishes quality of life for both patient and owner. This article will review surgical management options for terminal OA in the hip, stifle, and elbow joints.

All patients affected by OA benefit from medical management, including activity modulation, professional physical rehabilitation, weight optimization, and medication (including systemic and locally administered drugs). However, because OA is a degenerative process, the success associated with conservative management declines over time. When conservative management reaches its limit, total joint replacement offers a means to remove painful, diseased articular surfaces and reestablish functional biomechanics.

Across all 3 joints, arthroplasty aims to:

eliminate or substantially reduce pain from bone-on-bone contact;

restore a more normal range of motion and gait mechanics;

reduce reliance on long-term systemic analgesics; and

support a durable return to activity and improved quality of life.

Modern cementless systems rely on osteointegration over approximately 6 to 12 weeks for long-term fixation. This extends the longevity of implants compared with previous implant generations that used cement for fixation. As with any arthroplasty, risks include infection, luxation/instability, and peri-implant fissure or fracture during early healing. Case selection, meticulous soft tissue handling, and structured rehabilitation are central to outcome. Earlier intervention in appropriate candidates typically simplifies surgery and recovery.

Hip OA most often follows hip dysplasia with excessive joint laxity. Abnormal “pistoning” of the femoral head accelerates cartilage wear. As cartilage wear progresses to bone-on-bone contact, pain escalates, and dogs adopt compensations, such as a hip held in relative flexion, avoidance of extension, a tall stance through the tarsus, and abducted resting postures. Additionally, running and jumping become difficult or impossible.

Total hip replacement (THR) is a well-established procedure in dogs and has benefited from continuous improvements over the past decades. Historically, THR was reserved for end-stage OA in medium- to large-breed dogs. However, modern implant designs and materials have significantly improved longevity compared with earlier implants, thus supporting earlier interventions. Performing surgery early in life expedites recovery, reduces comorbidities, and minimizes procedural complexity, as the severity of bone stock and soft tissue alterations worsens over time with disease progression. Additionally, product line expansion now enables procedures in small dogs and cats, with expected recovery paralleling that of standard breeds.

Dogs are expected to use their operated leg within 24 hours of surgery, with continuous improvement in comfort levels, quality of life, and function over the following 6 to 12 weeks. The success rate of THR is estimated at 98%, and although serious complications are possible, most of them can be addressed successfully. Complications include luxation, implant-associated infection, aseptic loosening, implant failure, fracture, patellar luxation, neuropraxia, and thromboembolism. Complication rate varies significantly between reports (5%-22%),

 but surgery team proficiency and patient selection are considered the most influential factors in mitigating intra- and postoperative complications.

Figure 1: 3D modeling and templating of a total knee replacement in a dog that has a severe femoral deformity. The 3D templating allows for the creation of custom guides, as shown. (Image courtesy: Cartesian Medical; Laurent Guiot, DVM, DACVS-SA, DECVS)

Stifle (knee) disease drives most elective orthopedic procedures in dogs, such as tibial plateau leveling osteotomy, lateral suture, and patellar luxation stabilization. Although early outcomes are often rated good to excellent, long-term OA progression varies with chronicity and baseline joint health at the index procedure. Canine total knee replacement (TKR) has been commercially available for nearly 20 years but remains relatively infrequent. Surveys suggest less than 30% are primary procedures, implying many TKR cases are revisions after earlier interventions fail to meet functional goals.

Figure 2: Preoperative (left) and postoperative (right) radiographs of a 7-year-old Boxer before and after total knee replacement surgery. This dog originally had a TPLO surgery with the bone plate subsequently removed. Unfortunately, he developed severe osteoarthritis and was unable to exercise with persistent lameness. The TKR was successful and enable full return to normal activity with no additional complications.

Technique evolution (complication mitigation) changes in surgical approach, along with the development of patient-specific instrumentation (PSI) to improve surgical accuracy, have significantly reduced the risk associated with TKR. In addition, a change in alignment philosophy was made with emphasis on kinematic alignment (KA)—matching implant orientation to the dog’s native alignment and preserving mediolateral soft tissue balance—rather than imposing mechanical neutrality. Early single-institution experience over a consecutive series (approximately 15 cases) reported no collateral failures after adopting the modified approach and KA philosophy.

With refined indications, PSI, KA, and robust revision options, primary TKR can outperform standard elective procedures in selected dogs with moderate OA. Wider adoption will depend on formal training and a complete implant ecosystem (including off-the-shelf revision solutions).

Elbow OA often arises from elbow dysplasia, such as medial coronoid disease or trauma. Progressive cartilage loss produces painful crepitus, swelling, restricted range of motion, and lameness that typically waxes and wanes but trends worse over time, limiting daily function and activity.

Figure 3: Preoperative (left) and postoperative (right) radiographs of an 11-year-old dog with severe OA secondary to dysplasia. Postoperative images show the replaced elbow joint with the TATE elbow replacement system. This system is inserted as a cartridge to replace the humeral and radioulnar joint surfaces simultaneously through an epicondyle osteotomy.

Modern total elbow replacement (TER) uses cementless, porous implants. Current designs couple a humeral component to a radial/ulnar construct with the radius and ulna fused; substantial pain relief is expected, though a residual gait asymmetry is typical due to altered strike mechanics. Many dogs weight-bear early; visible lameness usually improves over 4 to 6 months. Longevity data for current systems are still maturing (earlier generations have shown implant survival for up to 8 years). Key complications include infection (potentially requiring implant removal and arthrodesis), perioperative fissure/fracture, and luxation if collateral integrity is not maintained. Some surgeons employ a lateral approach with PSI to streamline exposure and recovery, recognizing this departs from the original design and requires precise preoperative planning.

OA consistently reduces canine quality of life through pain and compensatory gait changes.

When medical therapy plateaus, arthroplasty is the only modality that both removes bone-on-bone pain and restores joint mechanics; durability and expectations vary by joint.

THR is mature and predictably restores function; TKR is progressing with modern alignment philosophy and PSI; TER provides major pain relief with an anticipated, manageable gait difference and requires diligent follow-up.

Thoughtful case selection and timely intervention generally improve recovery trajectories and long-term outcomes.

Kokkinos P, Parsons K, Belch A, Barthelemy N. The influence of age at total hip replacement on perioperative complications associated with a press-fit cementless stem with lateral bolt in dogs. 

. 2025;54(3):581-593. doi: 10.1111/vsu.14203

Kwok JY, Wendelburg KL. Clinical outcomes of canine total hip replacement utilizing a BFX lateral bolt femoral stem: 195 consecutive cases (2013-2019). 

. 2023;52(1):51-61. doi: 10.1111/vsu.13871

Allaith S, Tucker LJ, Innes JF, et al. Outcomes and complications reported from a multiuser canine hip replacement registry over a 10-year period. 

. 2023;52(2):196-208. doi: 10.1111/vsu.13885

Liska WD, Doyle ND. Canine total knee replacement: surgical technique and one-year outcome. 

. 2009;38(5):568-582. doi:10.1111/j.1532-950X.2009.00531.x

Fink BR, Guiot LP, Muir P. Total knee replacement in a dog with an articular epiphyseal medial condylar fracture of the distal femur, a case report. 

. 2025;49(3):142. doi:10.1007/s11259-025-10712-0

Defining the role of joint replacement in modern orthopedic care.

Managing osteoarthritis in dogs and cats

A documentary highlighting the role of canine cancer drugs in human medicine is generating awareness for comparative oncology. The program, 

, was recently brought more prominently into the national spotlight with a pair of 2025 Daytime Emmys nominations.

premiered on PBS in December 2024 and is now available for viewing through the network’s streaming services. Created by Steven Latham Productions as part of the 

film series presented by Petco Love, it features veterinarians and other health experts as the curtain is peeled back to show the investigative work in comparative oncology at the National Institutes of Health, the National Cancer Institute, the University of Pennsylvania, the University of Illinois, the University of Wisconsin and Colorado State University with oncology research.

The film also shares “intimate, emotional, and hopeful” stories of dogs with cancer and undergoing advanced immunotherapy treatments in clinical trials, according to the production company. The experiences of these canines illustrate they and researchers are working to advance human cancer care through comparative oncology.

"This is one of the most uplifting and consequential stories we've ever shared," Steven Latham, creator and producer of the "Shelter Me" series, said in a news release.

"Through their courage and loyalty, these dogs are helping us unlock a better future for human cancer patients."

One of the therapies featured in the film is OST-HER2, a drug from OS Therapies used to treat canine cancer that is in development for treating osteosarcoma in humans. “We have a great opportunity to address a very deadly disease in canine veterinary medicine. The trials that we've done, both in humans and in canines, are very safe and seem to extend life and control the disease,” Paul Romness, MPH, chairman and CEO of OS Therapies, said in a 

interview. “The genetic makeup of osteosarcoma in canines and humans is like 99% exact.”

According to Romness, osteosarcoma is very rare in humans but much more prevalent—and deadly—in canines. “In dogs, it's approaching 100% fatality within 12 months. In humans, 10% of the kids [with osteosarcoma] pass away. Of the 90% [of children] that survive the 9 months of chemotherapy, half of them go on to live their life with the side effects of chemotherapy and the surgery” he said.

OST-HER2 works by using the immune-stimulatory effects of 

 to initiate a strong immune response targeting the HER2 protein, according to OS Therapies.

 The drug has the potential to not only extend lifespan but improve quality of life as well, Romness noted in the interview. “This is a great example of where we could really have the dogs lead humans. And if it's out on the market for canines, it's a great proof of concept for the FDA to understand that they really need to have this available for kids too,” he said of the drug.

OS Therapies recently announced the FDA has granted OST-HER2 a second Type C Meeting. This meeting—scheduled for December 11, 2025—would follow a successful Phase 2b clinical trial with the goal of aligning the clinical efficacy data endpoints in support of a Biologics Licensing Application under the Accelerated Approval Program for the drug.

The nearly 90-minute documentary addressing osteosarcoma with a One Health approach was nominated for Outstanding Daytime Special and Outstanding Writing Team for a Daytime Non-Fiction Program. Daytime Emmy Awards winners were announced Friday, October 17, 2025, by the National Academy of Television Arts & Sciences. In those categories, 

Disney Parks Magical Christmas Day Parade

 did not take home either trophy, the nominations have generated recognition for the human-animal bond in oncology research and development.

"We are incredibly honored by these nominations," Latham, said in a news release.

 "This film is about heroes, both humans and canine, working together to bring hope to millions of people. The Daytime Emmy Award recognition…bring attention to these inspiring stories."

 nominated for two Daytime Emmy Awards. Shelter Me. July 11, 2025. Accessed October 20, 2025. 

https://www.prnewswire.com/news-releases/shelter-me-the-cancer-pioneers-nominated-for-two-daytime-emmy-awards-302503073.html

 premieres on PBS streaming today. Shelter Me. May 15, 2025. Accessed October 20, 2025. 

https://www.prnewswire.com/news-releases/shelter-me-the-cancer-pioneers-premieres-on-pbs-streaming-today-302455856.html

COS Therapies granted final Type C Meeting by US FDA and pre-MAA meeting by UK MHRA for OST-HER2 in the prevention or delay of recurrent, fully resected, pulmonary metastatic osteosarcoma. OS Therapies. October 17, 2025. Accessed October 20, 2025. 

https://ir.ostherapies.com/news-events/press-releases/detail/86/os-therapies-granted-final-type-c-meeting-by-u-s-fda-and

52nd annual Daytime Emmy Awards winners. National Academy of Television Arts & Sciences. October 2025. Accessed October 20, 2025. 

https://theemmys.tv/wp-content/uploads/2025/10/2025-Daytime-Emmy-Winners-Release-FOR-WEB.pdf

Canine oncology drug featured in Emmy-nominated documentary

Happy Monday dvm360 readers! Although Veterinary Technician Week has officially come to a close, dvm360 has dedicated the entire month to veterinary technicians. You can check out all of our technician-specific content on dvm360’s dedicated 

Our final Fetch conference of the year is also now less than 2 months away. Join the dvm360 team, our amazing faculty, and your fellow veterinary professionals for 2 days packed with educational sessions, networking opportunities with attendees, faculty, and exhibitors, and have some fun to close out the year! This is not one to miss, so learn more and register for the show 

While we continue to celebrate veterinary technicians across the industry, here is what else you will be able to find this week on dvm360.com:

The Centers for Disease Control and Prevention is striving to educate the public about the health risk of rabies associated with feral cat colonies after an incident involving a rabid feral cat was thought to have exposed multiple people to the deadly virus.

When Morgan, a 5-year-old Alpine goat, was approaching her fourth kidding, there was a mastitis discovered under her udder. After months of getting better and then relapsing into a worsening condition, she was brought to UC Davis Livestock Medicine Surgery Service after an initial exam for a mastectomy.

On this week’s episode of The Vet Blast Podcast presented by dvm360, host Adam Christman, DVM, MBA, welcomed Dana Connell, DVM, MPH, DACVIM (Oncology), and Zachary L. Neumann, DVM, MS, DACVIM (Oncology) to the show to talk all about early detection in canine oncology patient, plus the latest advancements (

In an article submitted by dvm360 Strategic Alliance Partner Thrive Pet Healthcare, Laurent P. Guiot, DVM, DACVS-SA, DECVS, shares more on how veterinary teams can better manage osteoarthritis in both canine and feline patients.

A study conducted by Cornell University and The Farmer’s Dog that was recently published in 

 revealed that fresh, human-grade dog food can promote healthier aging in senior pets, demonstrating to researchers a clear metabolic boost and reduction in AGEs.

Here is a sneak peek of this week’s headlines.

Sneak peek: CDC cautions public about rabies exposure risk from feral cat colonies, and other news 

Back pain, or pain associated with the thoracolumbar spine and, to some extent, the sacroiliac region, is not uncommon in horses. It is widely accepted that back pain can be primary or secondary to other conditions, especially lameness or neck pathology.

In some instances, back pain may also result from behavioral changes. Therefore, one of the most challenging steps in treating back pain is obtaining an accurate and complete diagnosis that incorporates all the different pathologies involved in the clinical signs so they can be addressed to obtain the best outcome.

First, a thorough history should be obtained. Common complaints that may lead to investigation of back pain are usually nonspecific and may include reluctance to move forward, bucking under the saddle, refusing to jump, or becoming disunited. It is always important to ask about the signalment and current use of the horse, the onset and duration of the clinical signs, whether there was a specific trigger, what the management/routine for the patient is, and whether any treatment was implemented, and if so, the response. It is also important to ask whether a certified saddle fitter checked the tack; this should also include checking the bridle and bit used on the horse.

A thorough clinical examination should include visual assessment of the horse’s conformation and muscular distribution, as well as palpation of the neck, back, and limbs, looking for any signs of pain on palpation, decreased/ increased mobility, swelling, or heat. This should be followed by a full orthopedic and ridden assessment to rule out any concurrent lameness that may affect treatment and prognosis. In some cases, a neurological examination may also be needed. A pain scale of 0 to 10 has been established based on the degree of pain, muscle hypertonicity, joint stiffness, and overall functional ability.

Diagnostic anesthesia remains one of the most important tools for diagnosing the source of the pain, but, similar to the distal limb, careful interpretation should be made depending on the amount of local anesthetic used, the repeatability of the clinical signs, and confounding factors. There may be some false-positive and false-negative results.

Once the source of the pain has been localized, diagnostic imaging can be used to try to obtain a more refined diagnosis. This should include ultrasonography of the back to rule out articular or spinous process pathology and evaluate soft tissues, including the supraspinous ligament and the epaxial musculature.

Radiographs, including lateral views of T2 to L4 and, in some instances, obliques, should also be made to see evidence of fractures (

). Unfortunately, it has recently come to attention that the degree of changes seen on radiographs may not accurately reflect the clinical presentation. Nuclear scintigraphy, especially when associated with radiographs, may increase the sensitivity of back pain diagnosis.

 Finally, the increased availability of advanced diagnostic imaging, such as CT, shows great promise in increasing our diagnostic ability for the pathology of the thoracolumbar and sacroiliac region in the coming years.

Common osseous causes of thoracolumbar pain in horses include conformational/developmental abnormalities, impinging dorsal spinous processes, osteoarthritis, vertebral fractures, spondylosis, discospondylitis, and spinal neoplasia. Soft tissue causes may include epaxial muscle strain, supraspinous ligament/dorsal sacroiliac strain or desmitis, or exertional rhabdomyolysis. Primary back pain can also be idiopathic, associated with poor tack fitting, or caused by neurologic disorders such as equine protozoal myeloencephalopathy or equine herpesvirus type 1. Treatment will be surgical (

) or medical and guided by the primary problem.

Impingement of the dorsal spinous process can be treated surgically if the clinical signs are attributed to the radiographic changes (clinical signs, diagnostic anesthesia, trial treatment, additional imaging modalities).

 Surgical treatment for impinging dorsal processes was first described in 1968,

 and since then, the technique has evolved. Currently, surgical procedures commonly offered to clients are cranial or caudal resection of the affected spinous processes or interspinous ligament desmotomy.

 A minimally invasive technique for resecting the cranial aspect of the affected spinous process has also been described recently.

The main consideration when choosing a surgical technique is the extent and severity of the lesion. Unless they are minimally invasive, ostectomies involve a large incision of the midline and therefore are associated with a longer recovery time and rehabilitation period. Preference has recently been given to more minimally invasive techniques, such as interspinous ligament desmotomy, when possible, which may decrease the recovery time and improve long-term prognosis (

Medication of the joint facets, the interspinous region, or mesotherapy (Figure 4) of the thoracolumbar region can be performed to relax the epaxial musculature, both as a treatment and a trial diagnosis. Additionally, rehabilitation modalities such as shockwave therapy, laser therapy, kinesio tape, active mobilization, water treadmill, elastic resistance bands/training aids, dynamic mobilization exercises, or functional electrical stimulation have been incorporated in the treatment and rehabilitation of patients with back pain. They can be used as sole treatment modalities and rehabilitation tools following surgical treatment, as well as for maintaining back health, especially in sports horses. Back pain is usually best addressed and treated using a multimodal approach.

Back pain is a commonly recognized problem in equine patients that is often multifactorial and can be a serious cause of poor performance in horses. Successful management of horses with back pain starts with obtaining a complete and accurate diagnosis, and treatment relies on a multimodal approach that should include all parties involved, including the veterinarian, owner, trainers, rider, physiotherapist, and farrier.

Marshall-Gibson ME, Durham MG, Seabaugh KA, Moorman VJ, Ferris DJ. Survey of equine veterinarians regarding primary equine back pain in the United States. 

. 2023;10:1224605. doi:10.3389/fvets.2023.1224605

Shokry M, Ali LB, El-Sharkawy M. Relationship between back pain and poor performance in show jumping athletic horses. 

. 2025;15(3):1480-1487. doi:10.5455/OVJ.2025.v15.i3.37

Mayaki AM, Abdul Razak IS, Adzahan NM, Mazlan M, Rasedee A. Clinical assessment and grading of back pain in horses. 

. 2020;21(6):e82. doi:10.4142/jvs.2020.21.e82

Domańska-Kruppa N, Wierzbicka M, Stefanik E. Advances in the clinical diagnostics to equine back pain: a review of imaging and functional modalities. 

. 2024;14(5):698. doi:10.3390/ani14050698

Walmsley JP, Pettersson H, Winberg F, McEvoy F. Impingement of the dorsal spinous processes in two hundred and fifteen horses: case selection, surgical technique and results. 

. 2002;34(1):23-28. doi:10.2746/042516402776181259

Coomer RP, McKane SA, Smith N, Vandeweerd JM. A controlled study evaluating a novel surgical treatment for kissing spines in standing sedated horses. 

. 2012;41(7):890-897. doi:10.1111/j.1532-950X.2012.01013.x

Jeffcott LB, Hickman J. The treatment of horses with chronic back pain by resecting the summits of the impinging dorsal spinous processes.

. 1975;7(3):115-119. doi:10.1111/j.2042-3306.1975.tb03245.x

Jacklin BD, Minshall GJ, Wright IM. A new technique for subtotal (cranial wedge) ostectomy in the treatment of impinging/overriding spinous processes: description of technique and outcome of 25 cases. 

. 2014;46(3):339-344. doi:10.1111/evj.12215

de Souza TC, Crowe OM, Bowles D, Poore LA, Suthers JM. Minimally invasive cranial ostectomy for the treatment of impinging dorsal spinous processes in 102 standing horses. 

. 2022;51(suppl 1):O60-O68. doi:10.1111/vsu.13736

Connaughton MT, MacDonald EJ, Ireland JL, Rocchigiani G, Stack JD. Experimental comparison of caudal wedge ostectomy to cranial wedge ostectomy for surgical treatment of overriding/impinging spinous processes in horses. 

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Prisk AJ, García-López JM. Long-term prognosis for return to athletic function after interspinous ligament desmotomy for treatment of impinging and overriding dorsal spinous processes in horses: 71 cases (2012-2017). 

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Stubbs NC, Kaiser LJ, Hauptman J, Clayton HM. Dynamic mobilisation exercises increase cross sectional area of musculus multifidus. 

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Pfau T, Simons V, Rombach N, Stubbs N, Weller R. Effect of a 4-week elastic resistance band training regimen on back kinematics in horses trotting in-hand and on the lunge. 

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Zielińska P, Soroko-Dubrovina M, Dudek K, Ruzhanova-Gospodinova IS. A preliminary study of the influence of high intensity laser therapy (HILT) on skin surface temperature and longissimus dorsi muscle tone changes in thoroughbred racehorses with back pain. 

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Śniegucka K, Soroko-Dubrovina M, Zielińska P, Dudek K, Žuffová K. The effect of radial extracorporeal shock wave therapy (rESWT) on the skin surface temperature of the longissimus dorsi muscle in clinically healthy racing thoroughbreds: a preliminary study. 

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Caure S, Dendauw P, Thesee L, et al. Effects of different shoeing conditions on equine cervical and back kinematics during walking and trotting on a soft surface. 

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Brink P. Subtotal ostectomy of impinging dorsal spinous processes in 23 standing horses. 

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Ericson C, Stenfeldt P, Hardeman A, Jacobson I. The effect of kinesiotape on flexion-extension of the thoracolumbar back in horses at trot. 

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This common problem in equine patients is often multifactorial, requiring a complete and accurate diagnosis and a multimodal management approach for successful treatment.