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When forelimb and hind limb asymmetries coexist:If the hind limb component is worse, it is more likely to be primary.If the forelimb component is considerably worse (by more than one grade), it is more likely to be primary.If the severity of the two is comparable (within one grade of each other), the hind limb component is more likely to be primary.
In my opinion, back and neck issues are more likely to be secondary to limb lameness than vice versa. In fact, secondary sacroiliac (SI) and back pain are anticipated consequences of chronic and/or moderate hind limb lameness in the quadruped.
Common Forms of Secondary Lameness
flight path
Compensatory lameness might be observed in the following cases, as examples:
A horse that developed laminitis in one forelimb as a result of chronic severe lameness in the other (contralateral) forelimb.
A horse that developed proximal suspensory desmitis in a forelimb as a consequence of chronic overloading in an effort to underload the contralateral hind limb (of the same diagonal pair).