How long are you riding him for? Pssm is a disease and can continue to cause issues even if well managed. Remember, just because they can respond well to diet and exercise, doesn’t always mean that you will have an asymptomatic horse. My horse with pssm 2 has gotten worse over time and was retired due to severe exercise intolerance. As a younger horse, she was healthier and improved with consistent exercise.
5-10 minutes usually because he gets worse the longer I ride. The thing that makes me not think PSSM is the fact that he will move fine if following another horse and if I get off and lunge or long line him he is fine. No muscle pain/stiffness, nice fluid forward movement.
Have you tried longeing him with a rider up?
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Another vote for really being diligent about saddle fit.
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If he’s stopping and it’s not pain related or muscle have someone reinforce your aids with a lunge whip from the ground.
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Every time I’ve seen this behavior it is pain. Could be any kind of pain for ones where this is the go-to behavior. Saddle is a good place to start, but so would gastroscope, addressing the PSSM more (you need fats for PSSM1 right not just low NSC? And what’s the forage like out in his pasture?), lameness exam both in hand and ridden, etc.
Horses in pain/discomfort can be motivated to work through that pain/discomfort. It may be that he enjoys following another horse, it’s a distraction, or he fears being left behind.
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I bought an 8yo early last year and right from the start noticed he didn’t do more than mostly walk. Odd. If he broke into canter it was pretty quickly a buck. And another buck. He had only been started under saddle two years ago and no riding since.
I scoped for ulcers. None.
I ruled out PSSM1 but daggone it if a muscle biopsy didn’t give me the #&$^@ news it was PSSM2.
I’ve got a diet going including Immunbiome’s Lean Muscle, coconut meal, 8000/day vitamin E along with a bunch of other goodies. . I worked with a pro nutritionist to get my PSSM diet tight and helping him feel better. Also keeping warm muscles - blanketing. And yes, and MOST DAYS structured exercise program. And no stalling.
And it’s making a difference in his energy and how his body feels.
My guy is much happier out motoring around my woods and it’s noticeable the difference in his energy. But put him in an arena and to lunge - even the whole arena and I can just hear him saying and why are we in here?
Can you try bareback and riding out and seeing if you can tap into a more energetic mindset? And you want a nutritionist to put together your diet. The Michigan State program that diagnoses recommends a certain person. I can get that name for you if you are interested.
I’m very pleased with the changes and we’re just 10 days into the full program.
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So that’s exactly how PSSM works. You have multiple people commenting this is likely a pain response and it’s either PSSM or to check saddle fit. While I hate being the “super sleuth” 2 days ago you commented on another post " Even with just the saddle on my horse’s back my trainer wasn’t pleased with the way it fit on his shoulders." So maybe start there if your trainer is also telling you the saddle doesn’t fit?
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That is SO discouraging to hear. 
What was your journey with this disease?
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As a young horse, Harmony struggled with the canter. She never could canter well. It always felt a bit like she was bounding behind. More frequent/harder riding always resulted in an improvement. I had one vet tell me she was slightly lame and I should work her harder to see if it could make the lameness issue a bit clearer. She always improved the harder you worked her and the more consistently I rode her. At that point, I was thinking more along the lines of a stifle problem that improved as she became fitter.
She wasn’t really diagnosed until her teens, as she finally started tying up on trail rides. Before that her trot could get a bit fast, and I always felt like I had to hold her/help her balance. I’m assuming the tight muscles would somehow influence how easily she could hold a trot. She never really did develop a sitting trot. You could ask for it, and she would give you a half length down the arena, but she always preferred to move a bit faster.
She did remarkably well with her disability for most of her life. Things really progressed as she aged. I’ve switched her diet, tried all sorts of supplements, but really haven’t had a moment where I could say “this is definitely improving the issue.” She’s 19 this year so she’s had a riding career. Just not the career I had hoped for. She’s a super sweet horse and she will be with me until the end.
Over the last few years, she has been worse in the summer. The hotter the weather, the worse she did. She could barely crawl along at a slow walk. In the winter, she relished cooler weather and could really move out. Was definitely more comfortable with cooler weather, had less exercise intolerance, and just seemed to function so much better. This year I haven’t really seen the improvement during the winter, as I was seeing previously. I’ve increased her vitamin E and am going to try doubling or tripling her protein in her diet… Time will tell if this helps. I know as we head towards summer, she will do worse just because of the temperature change.
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Her bloodwork shows higher than normal CK levels, but AST tends to remain within normal limits.
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Having owned a PSSM positive horse your hoses elevated CK level coupled with reluctance to move forward are classic PSSM symptoms. It’s very common for this disease to start showing symptoms as a young horse is first put into work. Simple things in a PSSM horses management can make huge differences. Diet (hay/grain/supplements/grass), turnout , tack fit, hoof angles, blanketing to keep muscles warm . . .everything makes a huge difference in a PSSM horses comfort. It can be a difficult disease to manage. Some horses are able to continue a life of riding, some are not. Facebook has a couple great groups regarding PSSM management. I’d hop on and do a ton of reading. You’ll be surprised how your horses symptoms match what other people are dealing with as well.
My PSSM boy was a very well bred Dutch Warmblood dressage horse given to me for free. Why? Stopping and refusing to go forward. 
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Did you check for ulcers? Or try a Stubben saddle with flex tree sides that don’t impinge a wide shoulder? I had one like that and the saddle fixed it instantly
Well since I posted this my horse has now gone through 2 months of ulcer treatment with little to no improvement, had back x-rays, got a new saddle, had his blood work done for his PSSM (AST was very slightly elevated, CK was normal) but my vet said his diet is 100% appropriate. He did get a few extra days off prior to the visit though due to a blizzard preventing me from getting to him to exercise him, so that might explain the bloodwork.
No improvement under saddle. Still weird around his girth area, especially on the right. I am hoping now that I will soon be able to dig my trailer out of the massive amounts of snow that I can get him scoped and am seriously wondering if not that, if he injured a rib.
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Bloodwork cannot rule out PSSM. Many very symptomatic horses have normal bloodwork, and (sorry, Ghazzu) many vets have no idea at all about dietary management of performance horses, and certainly not PSSM horses. I think you need to investigate that possibility more thoroughly. The changes in the horse can be profound if you get the diet/exercise balance for PSSM right.
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Hindgut?
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Oh that’s right I forgot I did the stride 21 day hindgut program to no avail.
As for the PSSM nobody seems to be able to tell me what I should do. He is on a mineral balanced high fat low starch grain free diet, turned out 20 hours a day, exercised 5-6 days a week, and heavily blanketed to compensate for cold intolerance. WHAT ELSE CAN I DO??
He moves out completely fine until someone is on his back. Then he refuses to move/turn and bites at his right side.
No muscle soreness or tightness that I can find. No signs of tying up. Bloodwork only slightly suboptimal.
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Not much in the way of suggestions I’m afraid, but how incredibly frustrating for you! You are obviously doing everything in your power to fix it.
If you are hauling out to get him scoped, I’d get a good look at his feet (x-rays, blocks) at the same time. I have an upper-level dressage horse with navicular issues. He gets balky when his feet hurt.
Edited that I see OP says this horse long lines just fine….probably disregard my training suggestion, not related to pain troubleshooting.
I have a 5yo gelding WB that I’m starting myself, owned and cared for him on our farm him since he was 6mo. I’m an experienced amateur, and committed to starting him myself, but I’m not a professional by any means. So far this just means I make progress more slowly. 
My horse got a little stuck under saddle after a few rides and was a little reluctant to move forward. I went back to halter ground work, no problems there. Then I introduced ground driving, something I had not done previously. Ground driving was a great bridge to riding. The horse couldn’t use visual cues from me like in traditional ground work, so we got to work through the stickiness in a situation that more closely simulated riding.
In training a sticky horse I also just focus on releasing pressure after the initial response, I don’t get caught up in trying to keep them going. So if he walks forward when I ask but then peters out, I take a deep breath, raise my energy and ask again, but I don’t try to prevent him from stopping.
I’m not trying to say that your situation is or isn’t pain related, just offering another approach for experimentation. Good luck!
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