It is estimated that as many as 80% of all horses have some touching of the dorsal spinous processes at some point in their life. Kissing spine, otherwise known as the Overriding of the Dorsal Spinous Processes is defined in Diagnosis and Management of the Lameness in the Horse by Mike Ross and Sue J. Dyson as “Impingements of the summits of the spinous processes causing remodeling of the dorsal aspect or an avulsion fracture reflects an insertional lesion of the supraspinous ligaments.” Pressure points between adjacent overriding spines are shown by local inflammation of the bone covering, small bone cysts, and false joint formation. Severity is graded between a 1 & 4. Grade 1 being narrowing of the interspinous space . Grade 2 is loss of interspinous space with moderate sclerosis. Grade 3 is severe sclerosis and thickening. Grade 4 being severe sclerosis of the spinous processes, osteolysis and a change in shape of the spinous processes. Lesions may not be limited just to the summits. Lesions are most commonly seen at thoracic vertebra 10 through 18 but have also been seen in lumbar vertebra 1 through 6. Ultrasound is used to view the condition of the ligament whereas x-ray and nuclear scintigraphy (bone scan) are used for viewing the bone remodeling. However, “active bone remodeling is not synonymous with pain. Increased uptake in nuclear scan does not appear to be well correlated with the severity of the clinical signs or the radiographic abnormalities” (Ross & Dyson, Lameness in the Horse). Horses with obtrusive back pain may have only mild impingement and mild uptake on the nuclear scan. Regardless of the radiographs, confirmation and bio-mechanical limitations may contribute to back stiffness. Kissing spine is also seen in horses that exhibit no back pain. Extensive evaluation of all involved structures should be performed even after kissing spine has been found. Other contributing factors and lesions will play a part in diagnosis. For instance, injuries to the supraspinous ligament are best identified with ultrasound and can cause local thickening and pain.
Symptoms include back pain, tight back, being “cold backed”, girthy or agitated when saddling, bucking, bolting, exploding when mounted, refusing to jump or do certain movements, grouchiness, unwillingness to perform, hollowing of the back, unwillingness to go forward, or not accepting the bit. Obviously, these symptoms could describe numerous lamenesses or problems and a veterinary diagnosis is needed to be sure. In order to be diagnosed, anesthetics, radiographs, ultrasound, nuclear scintigraphy and/or thermography are used.
When the musculoskeletal system becomes strained either from poor confirmation, overuse, asymmetry, trauma, posture imbalances, pathology or negative emotional states, the body responds with a long list of reactions. These reactions include increased tonicity, edema, distortions in the tissue, joint distortions, inflammation, and changes in the nerves, blood and fibers. Pain occurs and eventually changes in the widespread function of the whole body occurs (Chaitow, Modern Neuromuscular Techniques). The ligaments and muscles surrounding a joint are responsible for joint stability. Without proper function of these structures, joints may subluxate, cause damage to the capsule, cartilage, tendons, nerves, blood vessels and discs and of course to themselves. It is this pattern that we see in kissing spine. Therefore, treatment of each individual must address all of the reactions in the body. Usually a multi-discipline approach is most successful in handling the dysfunctions that contribute to developing kissing spine.
Treatment involves relieving pain, correcting the dysfunction and rehabilitating the horse to develop strong core muscles to support the horses back and allow him to hold rider weight. The following treatments have been used to address kissing spine:
NSAIDS: can help alleviate pain. Some horses respond better than others
Injections: Corticosteroids injected in the back and between the vertebra can alleviate inflammation and reduce pain. B12 can be injected into acupuncture points and be part of a Chinese medical treatment.
Shockwave: (positive pressure acoustic waves) is shown to be good for healing bone, tendon and ligament problems. Success has been documented with kissing spine patients.
Mesotherapy: pharmaceuticals are injected in the mesoderm layer of the skin to facilitate healing, reduce pain and address the surrounding muscles, nerves and ligaments.
Acupuncture: based on Chinese medicine, acupuncture relieves pain, rebalances the energetic body to speed healing in both bone and soft tissues and also works along the meridians to release the muscles, tendons, ligaments and fascia.
Myofascial Release & Neuromuscular techniques: a manual therapy that works on correcting fascial imbalances and snares that pull on the musculoskeletal system creating lameness and pain.
Craniosacral Therapy: energetic manual therapy that concentrates on the bones of the pelvis, sacrum, lumbar/thoracic and cervical spine and cranium (head). Obviously any imbalance here could lay the foundation for developing kissing spine and be a causative factor. This is a very gentle modality.
Chiropractic: can be helpful in prevention and treatment but make sure your practitioner is aware of your horses condition.
Infrared Therapy/ Magnetic Therapy/ Ceramic blankets and others: all work on reducing pain and inflammation.
Surgery: surgically repairs the dorsal spinous processes and eliminates the touching between the processes. Employed when response to other treatments have failed and does not address the underlying cause.
Anecdotal evidence suggests various levels of success in horses returning to full work. Some horses were retired, some could return to a lower level of work and some were able to return to full work and be top competitive horses. Age, fitness, confirmation, severity, symptoms and amount of rehabilitation all play a role in prognosis. Each case is individual. The underlying causative factors must be addressed and usually frequent therapy and treatments are needed. Time is needed to not only correct the problem but teach the horse a different way of using itself.
Horses should be kept in work even if it’s light work. Time off, stall rest etc. does not help correct the problem and may only be palliative. Core strength, muscle development over the top line, and stretching and strengthening the back are all very important factors for having success in bringing a “kissing spine” horse back to solid work. However, the rider/trainer must always remember that from day to day the horse may change how he feels, sometimes for no apparent reason. Patience is a virtue when training these horses and listening to the horse is imperative. Never should work be demanded or forced on them. Just like other rehabilitation situations, pushing for just a little more without over-facing is a very precarious balance and it is easy to cross that very fine line into over expectation.
Alterations in the training or exercise techniques may be needed. For instance, long lining, long reining and lunging can be very good for building core muscles without the horse having to carry rider weight. Keep in mind, over-flexion in the work actually allows the horse to drop his back, inverting the spine and aggravating impingement of the dorsal spinous processes.
Poor saddle fit can be a major contributor to back pain. Call in an expert to check saddle fit.
BUILDING THE CORE
One of the best ways to build the core muscles of the equine body without the added weight of the rider is through long lining, Pessoa type systems and ground exercises. In long lining, the horse can be put through dressage exercises and encouraged to stretch the back. The Pessoa type systems are great for replacing basic lunging exercises, especially for tight back horses. Finally, core strengthening exercises on the ground can be found in “Activate Your Horse’s Core” by Narelle Stubbs and Hilary Clayton. These exercises will increase your horse’s mobility, strength and balance.
- Sternum, wither, thoracic and lumbar lifts. (Note: Edward Robinson in Current Therapy in Equine Medicine found these exercises to be greatly helpful for kissing spine.)
- Rounding, lateral bending and extension exercises
- Engaging the core through weight shifts
- Combining the above
- Leg extensions
Start with a long, easy warmup including lots of walking. Add exercises for suppleness: shoulder in, haunches in, turn on the forehand, turn on the haunches, flexion and counter flexion and frequent changes of direction. All the while, encourage a loose swinging back and no tension in the top line.
Another important aspect is very correct work in short duration. It is better to do very correct training for 5-10 minutes with walk breaks in between than to haphazardly ride around for 30 minutes. For instance, ride the horse correctly over the top line for 5 minutes (while he can actually hold his body correctly), then free walk for 3 minutes and repeat. When this becomes easy, time can always be increased. The same goes for ground exercises. Duration and frequency can always be increased as the horse gains strength and flexibility. For anyone who has trained for a marathon or picked up a new sport, you understand how starting slowly and building is a key component for success. Let me also stress frequency. Rehabilitation doesn’t work if you only do it once a week. Instead, think of riding 5-6 times per week for 15 minutes with sets of quality work for 3-5 minutes. Building on this until you reach a 45 minute ride with 10 minute sets.
Not only does cross training keep the horse mentally fresh but it also encourages building of good stability muscles and general conditioning. Navigating trails, logs, jumps and hills will greatly increase your horse’s athleticism all on its own. No amount of ring work can replace this type of conditioning. Starting at the walk, as the horse gains strength, trot and canter can be introduced. Hill work even at the walk is hard work and a great conditioning exercise. Eventually trot poles, jumping and a return to regular work can be introduced as the horse builds strength.
“The direct application of human nutraceutical or herbal preparations to horses is often difficult because absorption, bioavailability, dosages, mechanism of action and side effects vary.” (Current Therapy in Equine Medicine by Robinson) However, most side effects are seen when an herb is used for too long or in very high dosages. Using supplements and herbs to treat a horse is best when supervised by a practitioner well studied in this area.
White Willow Bark: analgesic, anti-inflammatory
Devils Claw: anti-inflammatory, analgesic, great for arthritis; alternative to bute
Meadowsweet: anti-inflammatory, effective against ulceration caused by drugs, herbal aspirin
Calendula: rich in sulfur, blood cleansing, anti-inflammatory
Nettle: high in Vitamin C, tonic and blood cleanser, stimulates circulation
Comfrey: source of B12, stimulates cell production and used to heal bone, cartilage and connective tissue, improves circulation. DO NOT USE for long periods.
Hawthorn: vasodilator, improves circulation, tonic for the heart and circulatory system
Chinese herbs are administered in formulas and the herbs act together synergistically to treat the ailment. All formulas are prescribed according to the individual’s chinese medical diagnosis and a well trained practitioner should be consulted. The following useful formulas are from “Clinical Handbook of Chinese Veterinary Herbal Medicine” by Beebe, Salewski, Monda and Scott.
Bone and Sinew Formula: promotes the rapid healing of bones, tendons and ligaments, improves circulation
Du Huo and Loranthus Formula: removes obstructions, supplements energy (qi)
Chase Wind, Penetrate Bone Formula: removes obstructions, reduces swelling, alleviates pain, strengthens muscles
Clematis and Stephania Formula: for stasis, unblocks and relaxes channels/meridians
Eleuthero Tablets: supplementing, strengthens ligaments, tendons and bones, invigorates blood circulation
Essential Yang Formula: warms and supplements
Corydalis Formula: moves energy (qi), removes obstructions in the channel, relieves pain, relaxes muscles, relieves spasms
Seven Treasure Formula: supplements yin and essence
Stasis-Transforming Formula: transforms stasis, disperses nodules, regulates energy (qi), clears toxins, alleviates pain
Nutritional excesses and deficiencies can play a role in developing disease and proper diet can effectively treat disease. Be careful of over supplementation and read labels! Concentrate on the basics first and only add supplementation where needed. Provide a well balanced whole food diet, free of processed foods and chemicals. Allow plenty of turnout and room to move around. Consulting a nutritionist who can taylor a diet to your individual horse’s needs is recommended.
How easily your horse progresses through rehab, the better you learn to ride, the more diligent you are in the rehabilitation schedule, the better the horse’s confirmation and the response to treatment all dictate the prognosis. I find the worst case scenario develops because the rider/trainer was inconsistent in their schedule and approach, not because the horse couldn’t succeed.