I posted before, but it’s been about 2 years since we last did injections on mine, during which time he was still coming back into work from the scapula fracture. And for the most part I’ve been able to take him off Robaxin except for shows or other intense work. So I can tell you what I’ve done.
Monthly bodywork - chiro, massage, acupuncture. I also do Magnawave on him myself (a little less often now) and some stretches and mobilization exercises for the back and pelvis on a regular basis.
I’ve focused on dressage work this year, but some times when his back is just too tight, we add in poles or small jumps. Some jumping motion really helps him keep the lumbar loose so that I don’t have to fight with him inverting.
For the dressage, throughness in upward transitions is a priority (and hard for him). (It’s important on jump days too but he is usually more motivated and peppy when the jumps are out). We also do some forward and back like a lateral movement or volte into extension, with gently bringing back to working gaits. I’ve worked more on collection in the trot than canter. I’ve had to tune him more to the leg aids so that when we hit the gas, he has a feeling of lowering his booty rather than just reaching in front. We’d do a ton of those transitions but at first would not ask him to maintain the more extended gait for very long. Maybe even a few strides. Just check if the go button works all the time and in different parts of the ring and if you feel it behind the saddle. At the same time, prioritize lightness and a full swing with the whole front legs from the scapula. (Also important for him because of the injury). If they are free in the shoulder then they are using the thoracic sling which means that they can use the core in a way that also protects the lower back, now that you have also established forward from the hind legs.
After that, stay on top of all lower limb issues. Shoes, hocks, etc. I was afraid I’d have to inject his back again recently because his hocks had gotten sore (also 2 years since we treated those). We did hock injections and bodywork, and as he is starting back from that, so far his back is feeling pretty good! He can’t have steroids, so I only use biologics.
Probably, all of that does add up to more than routine steroid injections a couple times a year, but it works for us.
I will say that if your horse has any nerve type pain associated with the lumbar issues, then I’d tend to prioritize injections before things get bad, because when you add neuro stuff into the mix, it is a complicated issue and not all about strength and posture, although that can’t hurt of course.
