Myofascial pain in thoroughbreds is very common. The paraspinal muscles of the neck, thoracolumbar area, rump (sacroiliac, gluteal and hip area) and the triceps and hamstring muscles are most often affected. Many cases have two or more areas of pain. Few are clinically lame, but affected horses guard or protect the painful areas and are accident-prone. They may develop secondary or tertiary compensatory strain when attempting to take the pressure off the original painful areas. The net result is that the horses are more difficult to handle and ride. They “hold back” or have a shortened stride that reduces their training and racing performances. Horses free of muscle pain and spasms usually do not “defend” muscle areas that are gently yet firmly probed. Horses with muscle pain and spasm, however, protect those areas and resent muscle extension or pressure application. Pressure is applied to the muscles with a flexible plastic probe and boundaries of pain zones are determined by sliding the probe in several longitudinal and then dorsal to ventral sweeps. Once pain zones are identified, acupuncture at points relevant to affected areas can release the pain and spasms very quickly. The effect, however, is short-lived unless the horse receives daily in-house bodywork between weekly acupuncture sessions. Right rump pain, with compensatory pain in the left neck over vertebrae C5-C7, is the most common pattern seen in the author’s practice. Commonly treated paraspinal pain patterns and their treatment protocols are described.