There is a regularly high proportion of x-ray findings indicating a pathological deterioration of the equine vertebral column which do not correlate with the clinical symptoms. Therefore, palpation remains one of the most important clinical examination methods to determine whether or not a horse is suffering from back pain. The aim of this study was to check the validity of palpation results of horses with an assumed back problem. The palpation results of 167 horses were evaluated in retrospect: If the palpation proceeds under following conditions, positive palpation results agree with an primary back problem in about 100% of cases: 1. Hind limb lameness, being the most likely reason for misleading positive palpation results, has to be ruled out. 2. Only reproducible painful behavior is allowed to be interpreted as positive. Under these conditions a negative palpation result is correct in about 72% of cases. For the examiner it is important to keep in mind that an apparent Kissing Spine-Syndrome can exist without being palpable. By means of clinical examination it is not always possible to distinguish between painful and normal reactions. In doubtful cases diagnosis can be made by a "diagnostic therapy", or better by scintigraphy.