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In this issue, readers will learn how to approach clinical cases from a whole-horse perspective and to apply a wide range of appropriate therapies in a staged manner. It is not the intent to review the basic application or mechanisms of action for each individual therapy, which has been reported in many prior publications and can be referenced elsewhere. Our goal is to provide an educated glimpse into the integrative medicine toolbox and to select whatever therapies are available to us that have been shown to be safe and have some level of clinical or scientific evidence of effectiveness for specific disease conditions. General clinical disorders will be approached in a staged or tiered diagnostic or therapeutic approach whereby readily available treatments will be prescribed first and more advanced procedures or treatments with higher costs or risk:benefit ratios will be recommended at later stages of disease development. It is hoped that most clinicians presented with a horse with back pain do not opt for interspinous ligament desmotomy as an initial treatment option, but instead provide a carefully guided progression through several stages of treatment prior to making the final decision to elect for a prescribed surgical procedure. And once surgery has been performed, then the patient is not put immediately back into ridden exercise but is provided an individually tailored rehabilitation program that incorporates a wide range of therapeutic options to restore function, maximize athletic performance, and limit recurrence or comorbidities. The role of proper tack fit and use and an introduction to select rider asymmetries and impairments is also discussed, as these topics are critical for managing the ridden horse but are unfortunately frequently relegated to paraprofessionals, as the human rider is not considered to be within the scope of veterinary medicine. The intent of this issue is to provide an objective foundation on which to base claims of effectiveness and to direct clinical practice efforts.