Exercise intolerance, unwillingness to perform and/or back pain in sports horses are frequently associated with bad saddle fit. Generally, saddles and saddle pads are fitted subjectively and exclusively on the standing horse and rely on the expertise of the saddler. However, for over 16 years, it is possible to objectively assess the pressure distribution underneath the saddle by using a pressure sensitive mat connected to a data logger system. The examination can be carried out in the standing horse as well as while the horse is ridden in different gaits. Saddle pressure measurements were not only performed in the context of saddle fitting, but also to study the interaction between rider and horse. Furthermore, mean and peak saddle pressures were correlated with clinical signs of saddle soreness and back pain in order to define the upper limit pressure values which are still tolerated by the horse. With the help of this device, the critical zones of the saddle area can be detected selectively and the results can be used to convince the rider or saddler of the necessary changes which have to be carried out on the saddle. The respectful co-operation between veterinarians, saddlers and riding instructors is an important prerequisite for an effective and sustainable resolution of the problems encountered in horses with back pain.