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You can tell if a horse has back pain the same way you'd see if any other animal with vertebrae does: poke them. Ok, maybe not poke them, but applying pressure along the spine will tell you if there is soreness.
Most horses have good enough structure to be able to carry weight without causing soreness, although things such as ill fitting saddles can cause problems. A properly rounded animal is also less likely to get back pain as the roundness through the spine helps support the rider's weight.
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