06/09/2026
I love this article from Laurie fourleg.com. Back pain can and is often missed if we don’t know what we are palpating for.
Veterinary perception of the prevalence of back pain and dysfunction for 6 clinical scenarios
Dr. David Lane, DVM, DACVSMR, CVSMT, CCRT, CVA
This photo, of David's Dog Fig-Jam, hangs in on the bathroom wall in his clinic - Points East West Veterinary Services in Squamish, BC, Canada.
If you haven’t read last week’s blog - Factors affecting veterinary perception of the prevalence of back pain and dysfunction – you might want to consider doing so. In that blog, the term back pain and dysfunction (BPAD) was introduced. BPAD is not a diagnosis, but rather an umbrella term to describe any neurologic or musculoskeletal (MSK) condition affecting the back or trunk of veterinary patients. This term has been proposed as an alternative to “non-specific back pain”, a term used in human medicine, but also one that is criticized for being misleading.
A recent research paper (link) looked at 6 different clinical scenarios and asked veterinarians how frequently the primary lesion was axial (back) or appendicular (limb) in origin, or how often there were both axial and appendicular lesions present, such that it was difficult to tell which was the primary, and which was the secondary lesion. Here’s what we learned:
Scenario 1: Any patient with a prior diagnosis of MSK pain, lameness, or dysfunction
We asked this question to determine what percentage of MSK issues affect the axial region compared to the appendicular region. Opinions between veterinarians varied widely, something that proved true for all of the scenarios, so there was no clear consensus. However, approximately 75% (1st quartile) of veterinarians agreed that 50% of such patients had primary appendicular lesions, 20% had primary axial lesions, and 5% of patients had both axial and appendicular lesions concurrently (preventing the clinician from determining which was the primary and which was the secondary lesion).
This suggests that BPAD is a common problem. Yet, as discussed in last week’s blog, most veterinarians are not taught how to perform a physical examination of the back. We also learned last week that the way a back examination is performed significantly affects the perception of how prevalent BPAD is. This suggests a need for improved veterinary education, both within the DVM degree itself, and for those who have already graduated.
Scenario 2: Patient presents with a unilateral leg lameness
We asked this question to see whether veterinarians believe that BPAD can sometimes present as a unilateral limb lameness. The majority of veterinarians agree that at least 8% of the time, unilateral limb lameness is due to a primary axial lesion. In addition, 5% of unilateral limb lameness dogs have both axial and appendicular lesions that prevent the clinician from determining which was the primary and which was the secondary lesion.
This suggests that axial origin limb lameness is not an uncommon clinical presentation. However, a review of textbooks dedicated to the topic of canine rehabilitation therapy or canine lameness, do not discuss this phenomenon. The reason for this disconnect is unknown.
Scenario 3: Patient presents with altered spinal posture, pain when turning or bending, or reluctance to move
We chose this scenario to reflect a clinical presentation that strongly indicated BPAD. The majority of veterinarians agreed that 69% of such patients have a primary axial lesion. Frankly, I was surprised that number wasn’t higher. In retrospect though, I hadn’t considered that this presentation could reflect primary visceral origin pain, and there was no place on the survey to indicate that. So, in the end, this question was a bit of a bust.
Scenario 4: Patient presents with a non-specific reduction in athletic performance but no lameness
In horses, a non-specific reduction in athletic performance is a recognize sign of back pain. In dogs, no such research exists. Despite this, the majority of canine respondents reported that 30% of such patients have a primary axial issue, and that only 20% of such patients have a primary appendicular issue.
The fact that most veterinarians agree that decreased athletic performance is more likely to reflect a back origin issue than a limb one, despite there being no research on this topic is interesting. Clearly, more research needs to be done.
Scenario 5: Patient presents with no known signs of MSK pain, dysfunction, or reduced athletic performance
We asked this question to get a sense of how much subclinical BPAD, based on clinical history, exists. How often are practitioners detecting BPAD on examination in patients that the client perceives to be normal? The majority of veterinarians report finding BPAD in 10% of such patients.
Scenario 6: What percentage of patients with primary limb lameness also have secondary BPAD?
The majority of veterinarians report that at least 15% of patients with a primary limb lameness have secondary or coincidental BPAD. This finding, combined with the findings of scenarios 1 & 5, underscores the need to perform a comprehensive axial examination with every patient seen, whether or not they present with a clinical history suggestive of MSK pain or dysfunction.
Bottom line:
The actual prevalence of BPAD remains unknown, but veterinarians believe it is a common phenomenon. This contrasts sharply against the lack of education provided in veterinary school, or discussion in relevant textbooks. Opinions between veterinarians vary widely both within and between those with differing education backgrounds.
There are many potential explanations for the differences in veterinary opinion, but one of the factors identified was the lack of a standardized reporting system for BPAD. Being able to use a scale that semi-quantifies the severity of back pain and dysfunction, each as a separate category, might foster greater agreement on the prevalence of BPAD. The absence of such a scale will inherently hinder any future research on the prevalence or severity of BPAD. We hope to publish such a scale within the year.
Reference:
Lane D and Haussler KK (2026) Factors affecting veterinary perception of the prevalence of back pain and dysfunction in dogs and horses. Front. Vet. Sci. 13:1857696. doi: 10.3389/fvets.2026.1857696
** Want to hear more from David? He'll be lecturing at the BARC Behaviour and Rehabilitation Conference September 12th & 13th, 2026 in Richmond, BC - at the Sheraton Vancouver Airport Hotel. Check it out here -
https://www.canadianveterinarians.net/sbcv/continued-education-ce-and-events/2026-barc-behaviour-and-rehabilitation-conference/
