When Radiographic Abnormalities Are Common in Performance Horses

Radiography plays an important role in equine practice. It informs lameness investigations, prepurchase examinations, and discussions around performance, prognosis, and risk.

Imaging of the thoracolumbar spine has become increasingly routine, including in horses that are actively competing and apparently performing well.

What is less often acknowledged is how frequently radiographic abnormalities are identified in these horses, and how variable the relationship is between those findings and clinical performance.

In practice, this can create uncertainty, particularly when radiographs are reviewed in isolation or when there is an expectation that imaging should provide definitive answers.

A study published in the Journal of Equine Veterinary Science examined radiographic findings of the thoracolumbar spine in 100 Warmblood jumping horses actively competing at moderate to high levels.

All horses included in the study were in work, competing, and had no overt lameness or neurological abnormalities at the time of assessment.

Every horse in the study showed at least one radiographic abnormality of the thoracolumbar spine. Despite this, there was no significant association between radiographic findings and current level of performance, age, or number of years competing.

The overall severity of radiographic changes was mild, and many horses were competing successfully at higher levels.

These findings do not suggest that radiographic abnormalities are irrelevant. Rather, they highlight the high prevalence of mild radiographic abnormalities in actively competing horses and the need for caution when attributing clinical significance to imaging findings alone.

What the Study Helps Clarify

Radiographic assessment focused on narrowed interspinous spaces, sclerosis, lucency, and enthesopathy. Narrowed interspinous spaces and sclerosis were commonly observed, particularly between T15 and L1, while enthesopathy was most frequently identified at the withers.

Importantly, although some positive correlations were identified between certain radiographic findings and highest career level, these findings did not correlate with reduced current performance.

In other words, the presence of radiographic abnormalities did not equate to functional limitation in this study population.

The authors acknowledged several limitations. Clinical examinations were relatively cursory, which may have resulted in undetected back pain in some horses. In addition, horses with more severe radiographic abnormalities may have been excluded earlier through prepurchase screening.

The study population also consisted of horses actively competing, rather than horses presented specifically for investigation of poor performance or back pain.

This distinction is important and limits how broadly the findings should be extrapolated.

Common Does Not Mean Clinically Insignificant

High prevalence does not imply lack of clinical relevance.

Back pain remains a recognised cause of poor performance in horses, and radiographic abnormalities may be clinically significant in individual cases, particularly when findings align with clinical signs, ridden assessment, response to diagnostic analgesia, or changes in performance over time.

What this study reinforces is that mild radiographic abnormalities of the thoracolumbar spine are commonly identified in performance horses without overt clinical compromise. Their presence alone does not confirm pain, dysfunction, or future performance limitation.

This raises an important question for clinicians:

Are we interpreting the radiographic findings in isolation, or are we interpreting them within the context of the horse’s clinical presentation and performance history?

Imaging as Part of, Not a Substitute for, Clinical Assessment

Radiographs provide information about osseous structure. They do not, on their own, identify pain, functional impairment, or causality.

As with all diagnostic tools, their value lies in how they are integrated into the broader clinical assessment.

Over-interpretation of incidental findings risks labelling clinically normal horses as abnormal, altering management unnecessarily, or generating anxiety where none previously existed. Under-interpretation, conversely, risks missing clinically relevant pathology when signs are subtle.

The challenge lies in maintaining balance.

For equine veterinarians, this means remaining disciplined in interpretation. Imaging should support clinical reasoning rather than drive it.

Clinical examination, ridden assessment where appropriate, performance history, and response to intervention remain central to determining relevance.

Implications for Prepurchase Examinations

The prepurchase context is where these issues are often most challenging. Buyers increasingly expect extensive imaging, and radiographs may be scrutinised independently of the horse’s current performance or clinical findings.

Studies such as this highlight the importance of careful, measured reporting. Mild radiographic abnormalities should be described accurately, contextualised appropriately, and discussed in terms of uncertainty rather than prediction.

A useful question in these situations is:

What does this radiographic finding add to my clinical assessment, and what does it not tell me?

Clear communication around limitations supports defensible decision-making and helps manage expectations without overstating risk.

Confidence in Interpretation

This study is not an argument against imaging. It is an argument for thoughtful interpretation.

As access to diagnostic imaging continues to expand, the role of the equine veterinarian is not diminished. It becomes more clearly defined.

Our value lies not in identifying abnormalities, but in determining which findings are likely to be clinically relevant in a given horse, at a given time, for a given purpose.

Radiographic abnormalities of the thoracolumbar spine are common in actively competing performance horses. Rigorous clinical assessment, careful interpretation, and professional restraint remain essential.

Note: Radiographic findings should always be interpreted in conjunction with a thorough clinical examination and the horse’s current performance, rather than in isolation.